factors affecting maternal mortality (mm) in turkey and in the world dr. yeşim yasİn spring-2014
TRANSCRIPT
Definitions-1
• “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”.
Definitions-2
• Direct maternal mortality is the result of a complication of the pregnancy, delivery, or management of the two. • Indirect maternal mortality is a pregnancy-
related death in a patient with a preexisting or newly developed health problem unrelated to pregnancy. • Fatalities during but unrelated to a pregnancy
are termed accidental, incidental, or nonobstetrical maternal mortalities.
Key Facts-1
• Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth.• 99% of all maternal deaths occur in
developing countries.•Maternal mortality is higher in women
living in rural areas and among poorer communities.
Key Facts-2
• Young adolescents face a higher risk of complications and death as a result of pregnancy than older women.• Skilled care before, during and after
childbirth can save the lives of women and newborn babies.
MDGs
• Improving maternal health is one of the eight Millennium Development Goals (MDGs) adopted by the international community in 2000.
• Under MDG5, countries committed to reducing maternal mortality by three quarters between 1990 and 2015. Between 1990-2010, maternal deaths worldwide have dropped by almost 50%.
Strategies
• All women have access to contraception to avoid unintended pregnancies• All pregnant women have access to
skilled care at the time of birth• All those with complications have timely
access to quality emergency obstetric care
Actually…• In sub-Saharan Africa, a number of countries
have halved their levels of maternal mortality since 1990. • In other regions, including Asia
and North Africa, even greater headway has been made. • However, between 1990 and 2010, the global
maternal mortality ratio (i.e. the number of maternal deaths per 100 K live births) declined by only 3.1% per year.
• During the UN MDG summit in September 2010, UN Secretary-General Ban Ki-moon launched a Global strategy for women's and children's health, aimed at saving the lives of more than 16 million women and children over the next four years. •WHO is working with partners towards this
goal.
Measures of MM-1
• Maternal mortality ratio (MMR): the ratio of the number of maternal deaths during a given time period per 100,000 live births during the same time-period.
• Maternal mortality rate (MMRate): the number of maternal deaths in a population divided by the number of women of reproductive age, usually expressed per 1,000 women.
• Life time risk of maternal death: the risk of maternal death of a woman due to direct or indirect causes in a given population until her reproductive age.
Measures of MM-2• Pregnancy related mortality ratio: all deaths due to
pregnancy, delivery or post-partum/100 K live births
• Pregnancy related mortality rate: (all deaths related to pregnancy/no. of women in reproductive age)*100,000
• Lifetime risk of pregnancy related mortality: the risk of pregnancy-related death of a woman until the end of her reproductive age in a given population.
Some facts…
• The maternal mortality ratio in developing countries is 240 per 100 000 births versus 16 per 100 000 in developed countries. • There are large disparities between countries, with
few countries having extremely high maternal mortality ratios of 1000 or more per 100 000 live births. • There are also large disparities within countries,
between people with high and low income and between people living in rural and urban areas.
Major complications
• The major complications that account for 80% of all maternal deaths are:• severe bleeding (mostly bleeding after
childbirth)• infections (usually after childbirth)• high blood pressure during pregnancy (pre-
eclampsia and eclampsia)• unsafe abortion.
Don’t forget…
• Most maternal deaths are avoidable. • All women need access to antenatal care in
pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. • To avoid maternal deaths, it is also vital to
prevent unwanted and too-early pregnancies. All women, including adolescents, need access to family planning, safe abortion services to the full extent of the law, and quality post-abortion care.
Main barriers:
• poverty• distance• lack of skilled health workers• lack of information• inadequate services• cultural practices.
Three delays framework
• Phase 1: Delay in deciding to seek care by the woman and/or her family• Phase 2: Delay in reaching adequate
health care facility• Phase 3: Delay in receiving adequate care
at that facility
Follow-up of women in ages btw. 15-49
• Marital and preconception counseling program• Prevent deaths due to preventable causes• Maternal mortality risk increases by the age.• 1 in 5 marriages in Turkey is consanguineous
(endogamous).
Reproductive health programs in Turkey• Prenatal care (DÖB)• Iron supplement program for pregnant women• Vitamin D supplement program for pregnant women• Mum-friendly hospital • Birth/c section program• Post-partum care program• Emergency obstetric care• Maternal mortality follow-up program• Provision of Men’s participation in reproductive
services• In-service training on reproductive health• Reproductive health program for elderly
Gender equality
SAFE MOTHERHOOD
Antenatal care
Family planning
Healthy labor
Primary Heath Services
Basic Maternal Health Services
Post-partum care
Emergency obstetric care