This document summarizes a presentation on improving maternal mortality through policy perspectives. It discusses the high maternal mortality ratio in countries like Sierra Leone compared to low ratios in countries like Grenada. The root causes of maternal mortality are identified as inequality, low socioeconomic status, lack of healthcare access, and cultural practices. Effective policies to reduce mortality ratios include increasing access to skilled healthcare workers, emergency services, transportation, and community health programs.

1. Improving Maternal Mortality: Policy Perspectives Presented by: Rachel Koffman Crystal Lawrence Tseli Mohammed International health Policy Heller School for social policy Brandeis university

2. Presentation Outline Warm Up: What Do You Know About Maternal Mortality? Background, Root Causes and Measurement International Policies Case Study: Highest Maternal Mortality Case Study: Lowest Maternal Mortality Moving Forward: Recommendations Questions

3. Question #1 Which country below has the highest maternal mortality ratio (MMR)? Sudan Sierra Leone Bangladesh

4. Question #2 Which country below has the lowest maternal mortality ratio (MMR)? Mauritius Japan Grenada

5. Background Every day 1,500 women die due to pregnancy and/or childbirth. Annually more than 500,000 women die due to complications during pregnancy or childbirth, 99% of these are in developing countries. Women in poor nations are 300 times more likely to die. Of these, more than half are in Africa. In sub-Saharan Africa, a woman’s maternal mortality risk is 1 in 30, compared to 1 in 5,600 in developed regions. Rural and poor women who do not have equal access to quality skilled care are the most affected. The gap in accessing skilled care is widest between urban and rural areas, and between rich and poor women. Additionally, HIV/AIDS, malaria, and anemia before and during pregnancy increase pregnant women’s risk of dying. Retrieved from: http://ghequity.wordpress.com/tag/maternal-mortality/ Source: WHO/MPS/08.13

8. Root Causes Inequality and discrimination against women Low socioeconomic status of women, prohibits: access to education access to personal income (dependency) control of their fertility and reproductive rights Socio-cultural practices and traditions Poor healthcare and systems for women Lack of sanitation and hygienic practices (water) Lack of policies and standards for maintaining women’s rights, protection and empowerment

9. Measurement Maternal Mortality Ratio : the annual number of deaths of women from pregnancy-related causes per 100,000 live births. Indicator used most often to describe the level of maternal health and maternal mortality. Maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to, or aggravated by the pregnancy or its management but not from accidental or incidental causes. Source: WHO/MPS/08.13

10. International Policies MDGs # 5: Improve Maternal Health : Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. Achieve, by 2015, universal access to reproductive health. Also MDG #6 Combat AIDS, malaria, and other diseases and MDG #3 Promote Gender Equality and Empower Women are critical to improving maternal health WHO: Making Pregnancy Safer Care during pregnancy Care during and after delivery Post partum family planning Community Component

11. Maternal Mortality in Sierra Leone MMR in Sierra Leone: 970/100,000 (2008) Only 42% of deliveries are attended by a skilled attendant Less than 1/5 deliveries are carried out in health facilities 1/5 of women receive no antenatal care The fertility rate is estimated at 5.1-6.1 children per woman 6 of 13 districts have no emergency obstetric care at all, depriving women in these districts of access to life-saving caesarean sections and blood transfusions

12. Maternal Mortality in Sierra Leone

13. Unavailability and inequitable distribution of health services, including skilled health personnel and emergency obstetric services Insufficient drugs, medical equipment and supplies Poorly equipped and inadequate referral system Lack of adequate training and supervision of medical personnel Lack of skilled attendance at births Lack of transport to reach health facilities Prohibitive cost of health care Low/infrequent pay of health care personnel High MMR: Contributing Factors

14. Positive Steps In 2008 MOH of Sierra Leone developed a comprehensive Reproductive and Child Health Strategic Plan ($282 million from donors), aimed at addressing the many of the barriers to maternal health care Created a Reproductive and Child Health Unit within the Ministry of Health Undertook (with technical assistance from UN/WHO) Nationwide Needs Assessment for Emergency Obstetric and Newborn Care Services Worked closely with the Ministry of Health, with funding from donors including DFID, the World Bank and the African Development Bank, to provide comprehensive emergency services in seven districts This plan will be reevaluated and measured in 2012

15. Public Private Partnerships in Sierra Leone Cordaid, Sierra Leone Midwives Association (SLMA), Medical Research Centre (MRC), Principal National School of Midwifery in Freetown (NSMF), Research department of Ministry of Health (RDMoH), Kenema Diocesian Health Care Office (KDHCO), University of Sierra Leone Research Institute, Principal National School of Midwifery in Freetown (NSMF), Catholic Diocese of Kenema, Church Health Association in Sierra Leone, Panguma Hospital, Royal Tropical Institute (KIT), Maastricht University Centre for International Cooperation in Academic Development (MUNDO), TNO Quality of Life, Royal Dutch Organization of Midwives (KNOV), International Confederation of Midwifes (ICM), University of Midwifery Education and Studies Maastricht (AVMU), Midwifery Academy Rotterdam (VAR), Development and Relief Corporation B.V., Malaria No More!, National Committee for International Cooperation and Sustainable Development (NCDO)

16. Maternal Mortality in Grenada MMR in Grenada: 0/100,000 since 2007

17. Low MMR: Contributing Factors Improved access to health facilities and maternal care Delivery assistance from trained medical personnel Risk detection Management of complications Uptake of post-natal care

18. Multi-Sector Approach to Reducing MMR Sector/Agency Approach/Action Environmental Health Department Entrusted w/ monitoring and control of public health and general health issues Caribbean Environmental Health Institute Water quality monitoring The Health Education Department Promotes health sector’s links with other sectors USAID funded health care policy Facilitated dialogue among officials of the MoH and MoF, and social institutions of the Organization of the Eastern Caribbean States WHO National Strategic Plan for Health Geared towards improving and maintaining the health of Grenadian citizens

19. Emphasis on Maternity Care Provided by trained nurse midwives, maternity care emphasizes: Third trimester coverage Health education for women Clear protocols for managing serious complications Round the clock coverage Effective referral system Enhanced communication and record keeping

21. Grenada’s Health Policy Stewardship Ministry of Health : implements and formulates healthcare policies Community Health Services (CHS): ensures quality of primary healthcare Environmental Health Department : monitors and controls public health and general issues

22. Recommendations Access to quality skilled care during pregnancy, childbirth and postpartum/postnatal period Develop health education programs on women’s health maintenance and pre-natal care Disseminate critical information through the existing media channels Provide comprehensive family planning services Promote research in areas such as women’s health, cultural competency and maternal mortality Establish maternal mortality surveillance systems to enhance collaboration Place emphasis on preconceptional care and counseling versus dealing with labor/birth complications

24. "…there is no tool for development more effective than the empowermen t of women ." ~ Kofi Annan

25. Thank you!