Safe Motherhood Initiative: Definitions and Pillars

Dr. Olive Sentumbwe-MugisaFamily Health and Population Officer,World Health Organisation

Components of Reproductive Health Safe motherhood Family Planning Unsafe abortion STIs including HIV/AIDS Adolescent Health Infertility Menopause and Andropause Cancers of the RH Organs( Cervix and breast) Gender Issues (Gender Based Violence, Obstetric

Fistula, Female Genital Mutilation, Male Involvement)

Definition of Safe MotherhoodSafe Motherhood means that no woman, fetus

or baby should die or be harmed by pregnancy or birth. Safe Motherhood begins with the assurance of basic safe living as a girl and a woman in society.

Safe Motherhood is founded on freedom to choose when and whether to have children, and encourages active participation during health care. Safe Motherhood is founded on freedom from discrimination of any form.

Safe Motherhood values the girl child, respects the freedom to choose when and whether to have children, and encourages active participation during health care.

Definition of Safe MotherhoodSafe Motherhood implies the availability,

acceptability, and easy access to health care for a woman’s prenatal, birth, postpartum, family planning and gynaecological needs

Safe Motherhood requires involvement and commitment from each community and the nation to fairly allocate resources that promote the health of all women and infants.

Safe Motherhood means: social equity for women, maternal health care in Primary Health Care, Essential Obstetrics for all and Family Planning for all couples.

Why is maternal mortality an important issue? 1

Pregnancy is not a disease, it is one of the most important moments in the life of a woman,perhaps one of the noblest achievements

The birth of a baby is a moment of great joy for the mother, the father, the rest of the family, the village, the whole community

Reproduction is key to society5

Introduction

Making motherhood safe for the world’s women calls for national governments, multi-lateral and bi-lateral agencies , non-governmental organisations (NGOs)and civil society to make maternal health a top priority

There is a need to ensure that the necessary political and financial resources are dedicated to this effort.

Safe motherhood is a vital, compelling and cost-effective economic and social investment. Promoting women’s health improves not only individual health, but also the health and survival of women’s families, labour force and the well-being of communities and countries.

Source: WHO estimates 2000

The Health of the mother and newborn are entwined

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Africa Asia Latin America &the Caribbean

More developedregions

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Neonatal deaths per 1000 live births

Stillbirths per 1000 births

Maternal deaths per 10'000* live births

The burden

For women of reproductive age, pregnancy and childbirth are the leading causes of death, disease and disability, accounting for at least 18% of the global burden of disease in this age group.

Yet pregnancy is perceived to be a normal event

African countries with greatest numbers of neonatal deaths

country Range in neonatal deathsNumber of

deaths

Range in

maternal deaths Nigeria 1 255,500 1

RD Congo 2 130,900 2

Ethiopia 3 119,500 3

Tanzania 4 44,900 8

Uganda 5 44,500 6

Kenya 6 43,600 4

Côte d'Ivoire 7 42,800 16

Angola 8 40,100 5

Mali 9 36,900 9

Niger 10 31,700 7

Ghana 11 29,200 24

Mozambique 12 28,500 10

South Africa 13 23,000 27

Madagascar 14 22,500 21

Burkina Faso 15 18,600 11

50%

90%

WhenWhen are the world 4 million newborn deaths occurring? are the world 4 million newborn deaths occurring?

Daily numbers of death in 37 countries during the first month of life - based on 38 DHS datasets (2000 to 2004) with 5,763 neonatal deaths

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Days of life

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About 30% of neonatal

deaths are on the day of birth

More than 70% of neonatal deaths are

in the first week ~ 3 million deaths Birth

and first week is key:

• when most babies die

• when coverage

of care is lowest for

mothers and babies

Almost all are due to preventable conditions

4 million newborn deaths Why?

Definition of maternal death

The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

WHO-International Statistical classification of Diseases and related Health Problems,tenth Revision,1992 (ICD-10)

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Where maternal deaths occur

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It can be done, and it has been doneIt is not a matter of money only

MMR, deaths/100,000 live births 1960 1970 %

declineMalaysia 250 150 66%Sri Lanka 260 150 73%Thailand 420 260 62%Kerala state (India), figures of 2006, MMR of 95

when for the whole of India is 254

Currently,Malaysia-28, Sri Lanka-47, Thailand-44

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Causes of maternal deaths: percent distribution

Sepsis22%Eclampsia

6%

Obstructed labour

13%

Other direct2%

Other causes23%

Haemorrhage

26%

Abortion8%

Four Pillars of Safe Motherhood

SAFE SAFE MOTHERHOODMOTHERHOOD

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BASIC MATERNITY CARE

PRIMARY HEALTH CARE

EQUITY FOR WOMEN

Family Planning Family Planning is the practice of spacing

children that are born using both natural (traditional) and modern (artificial) birth control methods. Birth spacing promotes the health of the mother, children and the father. There are two types of birth control methods: natural and modern (artificial). The modern methods are further sub-divided into short-term, long-term and emergency contraception methods.

Antenatal Care

Ante-natal care is defined as a planned programme of medical management of pregnant women directed towards making pregnancy and labour a safe and satisfying experience with an outcome of a healthy baby and mother.

Safe Delivery

Refers to ensuring that the mother experiences a clean and safe delivery This area refers to both normal vaginal birth and other modes such as C/S and vacuum extraction

A Skilled attendant is recommended Provision of emergency Obstetric and

newborn care when needed.

Postnatal Care

Postnatal care: This is health care given to a mother and baby after childbirth up to 6-8 weeks.

Emergency Obstetric Care This is urgent medical care given to a

woman for complications related to pregnancy, labour, delivery and puerperium. Basic EmOC includes parental (administered by

IV) antibiotics; parental oxytocic drugs; parental sedatives for eclampsia; manual removal of placenta; manual removal of retained products; assisted vaginal delivery.

Comprehensive EmOC: includes surgery (caesarean section); anaesthesia; and blood transfusion in addition to all of the basic EmOC

Newborn Care

Ensure normal breathing Thermal care-keeping baby warm Cord care Immunisation as per schedule Appropriate infant feeding/breast

feeding

Evidence from the Lancet

Cause-specific effect of intervention packages delivered at different periods

Nature of intevention (main elements of intervention packages)Reduction: all-cause

neonatal mortality

Antenatal/ intrapartum/ postnatal

Family care: clean home delivery, hygienic cord care, thermal care, breastfeeding promotion

10-50%

Preconception Folic acid supplementationIncidence of neural tube

defects: 40-85%

Extra care for low birthweight infants: extra warmth, hygiene, feeding 20-40%Case management for pneumonia 10-35%

Emergency neonatal care: management of serious ilness 15-50%Postnatal

Antenatal care: physical exam, tetanus toxoid, detection and treatment of syphilis and pre- eclampsia

10-20%

Malaria ( intermittent presumptive treatment) 10-30%Detection and treatment of asymptomatic bacteriuria Incidence of

prematurity or low birthweight20-55%

Antenatal

Skilled maternal and immediate neonatal careSkilled birth care:20-30%;

Resuscitation: 5-20%;

Emergency obstetric care: management of complications- obstructed labour, haemorrhage, hypertension, infection

10-15%

Intrapartum

Family and Community Practices for promotion of New Born and Maternal heath

Early initiation of and exclusive breastfeedingKeeping the neonate warmHygienic cord and skin care Routine postnatal care through home visits at critical momentsHome care for LBW infant -Skin to skinEarly recognition of danger signs by caregivers and prompt care seeking Antenatal visits, TT vaccination, IPTITN use by pregnant women, mothers and infantsFamily Planning Delivery by a skilled workerMaternal NutritionMale involvement

The components Family Planning expansion of service delivery points; improvement of communication through community based

and social marketing approaches; training of service providers to enhance technical skills and

improve attitudes; guaranteeing the availability of family planning

commodities and supplies at all levels; improvement of family planning logistics management

(LMIS/HMIS); enhancement of political and community support and

participation in family planning activities; improvement of record keeping; strengthening of the follow-up, supervision and referral

systems.

Antenatal Care Information, education and communication on risk factors

and warning signs and symptoms during pregnancy. prevention and management of anemia; provision of iron and folic acid supplement; screening for pre-eclampsia and diabetes; Examination of the mother to evaluate the pregnancy; early detection and referral or management of mothers with

high risk pregnancies; immunization against tetanus; syphilis screening and treatment; HIV information, testing, treatment and referral; prevention and management of malaria; ARVs for prevention of mother-to-child transmission of HIV Infant feeding counselling

Delivery Care Information on signs of labor, what to

expect and what to do Monitoring labour and documenting Referral if it becomes necessary Clean supplies / Warm clothing Drugs required for pain relief and delivery Communication with the family members

especially the spouse HIV testing and counseling Infant feeding options

Post Natal care and newborn care Information on danger signs , what to

expect and what to do Immunization for both mother and baby Infant feeding options Maternal wellbeing Responsible fatherhood Family planning options Resumption of sex Post Natal Clinic

Current status

Only 48% of Women attend the recommended 4 times during ANC

Only 52% of women deliver in health units

Only 14% of HFs offer EmOC Only 23% of women get post partum

care during the first 2 days following child birth

Challenges

Insufficient awareness on danger signs, safe motherhood in general

Low status of women- decision making

Inadequate male support Poor Education level Poor health seeking behavior High/ uncontrolled fertility

Why we must take action and The costs involved While the needless suffering and death of a woman when

giving life to the next generation is sufficient cause for action in itself, there are also other significant social and economic considerations. Families lose her contribution to household management

and provision of care for children and other family members;

Children suffer most: when a mother dies, surviving children are 3 to 10 times more likely to die within two years than children who live with both parents; motherless children are likely to get less health care and education as they grow up.

Communities lose a vital member whose unpaid labour is often central to community life;

The economy loses her productive contribution to the work force

What Can Be Done

Even in low resource settings, improving maternal health is possible. What is needed is a strong political commitment. Governments, international agencies, NGOs and other development partners need to make concerted efforts to safeguard maternal health by; Reallocating investment in health care to

support the most cost-effective interventions Investing in maternal health care services and

making them available, especially in poor and rural areas

Framework for Promotion and Implementation of Community-based interventions

Information and Education Materials: danger signs, birth preparedness and emergency plan

Mobilisation of key stakeholders and community leaders

Support to existing community organizations and structures: associations, NGOs, etc.

Proposed ways to accelerate the change of the situation • Government Stewardship• Parliaments and similar institutions should step

into the process• The importance of functioning health systems• Integrated approach• Introduction of mandatory regular analysis of

maternal deaths • Active involvement of civil society• Local research to inform the people and local

institutions/entities• Additional resources and International Solidarity

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Framework for Promotion and Implementation of Community-based interventions

Community component in referral system Organisation of transport (common transport

mechanisms) Communication systems (telephone, radio

communication)

Community-based financing schemes Community-based surveillance system for the

health of the mother and newborn (birth and death registrations, audits)

Strengthening the referral system

Emergency transportation

Communication

The Safe motherhood day and commemoration week

Annual events have been held in Soroti, Kamwenge ,Kayunga Mayuge etc.27th October

Patron is the first lady A national report is usually produced We are in preparation for this year Districts are encouraged to conduct

district specific activities

For Change to Happen

We need to follow it up

Accountability at all levels

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Thank you!