“TOWARDS THE MILLENNIUM DEVELOPMENT GOALS: ADVOCACY FOR IMPROVED MATERNAL AND NEWBORN CARE"

Presented by

Dr Doyin Oluwole

Director, Family & Reproductive Health,

WHO/AFRO

Introduction

• Reducing maternal deaths is the challenge of the new millennium in the African region.
  
  
• In its Health for All Policy for the 21^st Century in the African region: Agenda 2020, the WHO Regional Office for Africa calls for a 50% reduction of maternal mortality by 2020. 
  
  
• At the global level, the importance of maternal mortality reduction is reflected by its inclusion among the Millennium Development Goals, calling for a three-quarters reduction of maternal mortality by the year 2015.

The Magnitude of the problem

• Worldwide, approximately 600,000 women die annually from pregnancy and childbirth related conditions. Nearly half of these deaths occur in the African Region. MMR is estimated at 1000 per 100,000 live births, a Region that constitutes only 12% of the world’s population and only 17% of the births. 

• The high MMR, combined with the low contraceptive prevalence rate of 13% and the high fertility rate—estimated at 5.6 children per woman—increase the lifetime risk of maternal death – estimated at 1:14. Adolescent childbearing contributes significantly to this risk.
  
  
•   Consequent upon poor maternal health, the neonatal mortality in sub-Saharan Africa is the highest in the world, estimated at 45 deaths/1000 live births.

Causes of Maternal Deaths

• Severe bleeding during pregnancy, delivery, and after delivery causes 25% of the deaths; sepsis causes 15%; pregnancy-induced hypertension accounts for 12%; unsafe abortion, for 13%; and obstructed labor, for 8%. Indirect causes include malaria, anemia, and HIV/AIDS.  The re-emergence of tuberculosis in Africa also poses a threat to mother and child.

Obstacles to Safe Motherhood

•   Most women die in pregnancy and during labour because of three major delays. The first is the delay in deciding to seek care. The second is the delay in reaching the facility. And the third is the delay in receiving appropriate care after arrival at the facility. 
  
  
• In most countries of the region the health system remains weak and cannot adequately respond to the health needs of mother and newborn. The health system is characterized by inadequate number of skilled attendants; lack of needed equipment, drugs and supplies; and a poor referral system.  Available statistics show that overall, skilled attendants are present for only 42% of the deliveries in the African Region.

• This delay at the health facility, even when the other two delays have been resolved, may be the most critical for the survival of the pregnant woman and the newborn.

Why should we mobilize to address this longstanding problem?

• The right to life and health is a basic human right. All women should be guaranteed the right to quality reproductive health services for safe motherhood.

• Poor maternal health and care constrain human and economic development.

• Those women who die due to obstetric complications, during or after delivery, often leave behind orphaned children whose chances of survival are also reduced. Studies show that children who lose their mothers in childbirth have a two-thirds higher risk of dying than children whose mothers survive.
  
  
• Newborn survival is so intricately linked to maternal health and care and survival.

• If there are no changes in health services resulting in improved maternal health, over the ten-year period, nearly 7.5 million children will die.

• For each woman who dies as a result of maternal mortality, approximately 20 more will suffer short and long term disabilities. These disabilities include: chronic anemia, infertility, stress incontinence, fistulae, chronic pelvic pain, emotional depression and maternal exhaustion, or physical weakness.

• Over the next ten-years, there will be almost 49 million maternal disabilities in the WHO African Region. All of these disabling conditions reduce productivity. 

The Economic Consequences Of Maternal Mortality And Disabilities

• At current estimates, if no changes are made to avert maternal deaths, the loss in productivity, over the next ten-years, will be almost $22 billion dollars, and the loss for disabilities will total $23 billion dollars.  The total losses from poor maternal health and care from 2001 to 2010 will be 2.5 million maternal deaths, 7.5 million child deaths, 49 million maternal disabilities, and $45 billion dollars in lost productivity.

Interventions

• The WHO Making Pregnancy Safer Initiative focuses on strengthening the health system to ensure that pregnant women and their babies receive the care they need and deserve. To realize our target, immediate action is needed.
  
  
• Countries need support to strengthen their health systems to ensure the availability of 1) skilled attendance at birth (Studies show that the higher the proportion of deliveries with skilled attendants in a country, the lower the country’s maternal mortality ratio).2) emergency obstetric care 3) post abortion care, and 4) a functional referral system. Community participation is critical to increasing timely and appropriate utilization of health services.   
  
  
• For every 500,000 people, there should be at least four Basic Emergency Obstetric Care facilities and one Comprehensive Emergency Obstetric care facility.
  
  
• The basic essential obstetric care facilities offer, at the health center level, services for:

-         Normal delivery,

-         Manual removal of the placenta and retained products, and

-         Intravenous sedatives, antibiotics, and oxytocin. 

• The comprehensive emergency obstetric care facility, which represents the first referral level, offers:

-         All the basic obstetric care as well as surgical procedures, including caesarian section under anesthesia and safe blood transfusions.  

• For women to fully benefit from all of these interventions, there needs to be a functional referral system, including radio communication and transport. For effective referrals of critical obstetric cases, the government has an obligation to improve social and infrastructural amenities in the rural areas. The referral system should effectively link the different levels of health care, including the community level, to ensure a continuum of maternal health care.
  
  
• Community-based health providers, community health extension workers, and TBAs present an entry point into the community. They can educate and encourage women, their partners, and families to:

-         Recognize signs of life-threatening complications;

-         Know when and where to seek appropriate care if complications arise; and

-         Develop birth preparedness plans, including emergency transport.

Conclusion

• If we act now, we estimate that approximately 500,000 lives of women will be saved, 10 million disabilities averted, and 1.5 million lives of children saved over the next ten years. In addition, a net productivity gain of 10 billion dollars will be realised from prevention of these maternal deaths and disabilities.
  
  
• To contribute to the MDGs, the following actions are essential: i) maternal and newborn health should be placed high on the agenda of governments and development partners with commensurate resource allocation. ii) Member States to review the existing policies, guidelines, and programmes to ensure and sustain the availability of emergency obstetric care. iii) Member States should adhere to the Abuja Declaration by allocating and releasing at least 15 percent of the total annual national budget to health. Of this health budget, at least 10 percent should be designated for reproductive health services. iv) governments should work in partnership with the private sector, civil society, religious and other community-based organizations to implement proven interventions v) An appropriate health care financing mechanism that is pro-poor should be implemented in countries.