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Maternal and Child Health



Maternal Health

• Maternal health refers to the health of women

during pregnancy, childbirth and the

postpartum period.

• While motherhood is often a positive and

fulfilling experience, for too many women it is

associated with suffering, ill-health and even

death.



Maternal Death

• According to the WHO maternal death is:

• “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 orincidental causes.”



Causes of maternal deaths

• The major complications that account for 80% ofall maternal deaths are: – severe bleeding (mostly bleeding after childbirth)

– infections (usually after childbirth)

– high blood pressure during pregnancy (pre-eclampsiaand eclampsia)

– unsafe abortion.

– obstructed labour

• The remainder are caused by or associated withdiseases such as malaria, and AIDS duringpregnancy.



Maternal Health Services

• Family Planning

• Antenatal Care

•

Intrapartum Care• Postnatal Care



Child Health

• 6.6 million children under the age of five diedin 2012.

• More than half of these early child deaths are

due to conditions that could be prevented ortreated with access to simple, affordableinterventions.

•

Children in sub-Saharan Africa are about over16 times more likely to die before the age offive than children in developed regions.



Child Health

• A child's risk of dying is highest in the neonatal

period, the first 28 days of life.

• 44% of child deaths under the age of five take

place during the neonatal period.

• Safe childbirth and effective neonatal care are

essential to prevent these deaths.



Child Health

• Causes of death during the neonatal period:

• Preterm birth

•

Intrapartum related complications (birthasphyxia or lack of breathing at birth

• Infections cause most neonatal deaths.



Child Health

• Leading causes of death in under-five childrenare: – Pneumonia

– Preterm birth complications

– Birth asphyxia,

– Diarrhoea

– Malaria

• About 45% of all child deaths are linked tomalnutrition.

• Making children more vulnerable to severediseases



Child Health

Child care services:

• Care of the newborn

•

Vaccination• Growth monitoring and nutrition

• Integrated Management of Childhood illnesses

(IMCI)



Maternal Health

Family Planning



Family Planning

• Family planning allows people to attain their

desired number of children and determine the

spacing of pregnancies.

• It is achieved through:

1. Use of contraceptive methods

2. The treatment of infertility



Modern Contraceptive MethodsMethod Description How it works

Combined oral

contraceptives (COCs)

or “the pill”

Contains two hormones

(estrogen and progestogen)

Prevents the release of

eggs from the ovaries

(ovulation)

Progestogen-only pills

(POPs)

Contains only progestogen

hormone,

Thickens cervical mucous

to block sperm and eggfrom meeting and

prevents ovulation

Implants Small, flexible rods or

capsules placed under theskin of the upper arm;

contains progestogen

Same mechanism as

POPs

Progestogen only

injectables

Injected into the muscle

every 2 or 3 months,

Same mechanism as

POPs



Modern Contraceptive Methods

Method Description How it works

Monthly injectables or

combined injectable

contraceptives (CIC)

Injected monthly into

the muscle, contains

estrogen and

progestogen

Same mechanism as

COCs

Intrauterine device

(IUD): copper containing

Small flexible plastic

device containing copper

sleeves or wire that is

inserted into the uterus

Copper component

damages sperm and

prevents it from meeting

the egg

Intrauterine device (IUD)levo-norgestrel A T-shaped plasticdevice inserted into the

uterus that steadily

releases small amounts

of levonorgestrel each

day

Suppresses the growthof the lining of uterus

(endometrium)



Modern Contraceptive Methods


Male condoms Sheaths or coverings Forms a barrier to

prevent sperm and egg

from meeting

Female condoms Sheaths, or linings, thatfit loosely inside a

woman's vagina, made

of thin, transparent, soft

plastic film

Forms a barrier toprevent sperm and egg

from meeting

Male sterilization

(vasectomy)

Permanent

contraception to block

or cut the vas deferens

tubes that carry sperm

from the testicles

Keeps sperm out of

ejaculated semen



Modern Contraceptive MethodsMethod Description How it works

Female sterilization

(tubal ligation)

Permanent contraception

to block or cut the

fallopian tubes

Eggs are blocked from

meeting sperm

Lactational amenorrhea

method (LAM

Temporary contraception

for new mothers whoseMP has not returned;

requires exclusive

breastfeeding day and

night of an infant less

than 6 months old

Prevents the release of

eggs from the ovaries(ovulation)

Emergency contraception

(levonorgestrel 1.5 mg)

Progestogen-only pills

taken to prevent

pregnancy up to 5 days

after unprotected sex

Prevents ovulation



Traditional Contraceptive Methods


Withdrawal (coitus

interruptus)

Man ejaculates outside

the vagina, keeping

semen away from

external genitalia

Tries to keep sperm out

of the woman's body,

preventing fertilization

Fertility awareness

methods (natural family

planning or periodic

abstinence

Calendar-based

methods: monitoring

fertile days in menstrual

cycle; symptom-based

methods: monitoringcervical mucus and body

temperature

The couple prevents

pregnancy by avoiding

unprotected vaginal sex

during most fertile days,

usually by abstaining orby using condoms



Eligibility Criteria for Contraceptive

Use

• PERSONAL CHARACTERISTICS ANDREPRODUCTIVE HISTORY( age, parity,breastfeeding, past ectopic pregnancy, obesity)

• CARDIOVASCULAR DISEASE(DVT, HBP, stroke,valvular disease)

• RHEUMATIC DISEASES (SLE)

• NEUROLOGIC CONDITIONS( headache, epilepsy,depressive D)

• REPRODUCTIVE TRACT INFECTIONS ANDDISORDERS ( vaginal bleeding, tumours, breastdiseases, STIs,



Eligibility Criteria for Contraceptive

Use

• OTHER INFECTIONS (TB, Schistosomasis, Malaria)

• ENDOCRINE CONDITIONS (diabetes M, thyroid

problems)• ENDOCRINE CONDITIONS

• GASTROINTESTINAL CONDITIONS( liverconditions)

• ANAEMIAS

• DRUG INTERACTIONS



Benefits of family planning

• Preventing pregnancy-related health risks inwomen

• Allows spacing of pregnancies and can delay

pregnancies in young women at increased risk ofhealth problems and death from earlychildbearing,

• Can prevent pregnancies among older women

who also face increased risks.• By reducing rates of unintended pregnancies, it

reduces the need for unsafe abortion.




• Reducing infant mortality

• Family planning can prevent closely spaced

and ill-timed pregnancies and births

• Infants of mothers who die as a result of

giving birth also have a greater risk of death

and poor health




• Helping to prevent HIV/AIDS

• Family planning reduces the risk of

unintended pregnancies among women living

with HIV

• Male and female condoms provide dual

protection against against STIs including HIV.




• Empowering people and enhancing education

• Family planning enables people to make informed

choices about their sexual and reproductive

health.

• Family planning represents an opportunity for

women for enhanced education and participation

in public life• Children with fewer siblings tend to stay in school

longer than those with many siblings.




• Slowing population growth

• Family planning is key to slowing

unsustainable population growth and the

resulting negative impacts on the economy,

environment, and national and regional

development efforts.



Who provides family planning?

• It is important that family planning is widelyavailable and easily accessible through midwivesand other trained health workers

•

Midwives are trained to provide locally availableand culturally acceptable contraceptive methods.

• Other trained health workers, for examplecommunity health workers, also provide

counseling and some family planning methods,• For methods such as sterilization, women and

men need to be referred to a clinician.



Contraceptive use

• Contraceptive use has increased in many parts ofthe world, especially in Asia and Latin America,but continues to be low in sub-Saharan Africa.

• Globally, use of modern contraception has risen

slightly, from 54% in 1990 to 57% in 2012.• Use of contraception by men makes up a

relatively small subset of the above prevalencerates.

• The modern contraceptive methods for men arelimited to male condoms and sterilization(vasectomy).



Global unmet need for contraception

• An estimated 222 million women in developingcountries would like to delay or stop childbearingbut are not using any method of contraception.

•

Reasons for this include: – limited choice of methods;

– limited access to contraception

– Fear or experience of side-effects;

– cultural or religious opposition;

– poor quality of available services;

– gender-based barriers.

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