safe motherhood: an international perspective prof dr valerie fleming director world health...
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Safe Motherhood: an international perspective
Prof Dr Valerie Fleming
Director World Health Organisation Collaborating Centre
What is Safe Motherhood?• Enter the term into google and almost
600,000 hits are returned.
• The vast majority of these focus on the programme supported by UN agencies supporting Millennium Development Goal Five: to improve maternal health by reducing the maternal mortality ratio by 75%, between 1990 and 2015.
UN programme goals• Implementing an advocacy/media strategy to
refocus global attention to improving the health of women and newborns in developing countries;
• Stimulating national-level commitment to make safe motherhood/newborn health a priority within national development plans and aid requests;
• Promoting effective interventions to improve the application of technical knowledge and research findings.
Safe Motherhood
• In 2008 almost 1 million women died in childbirth (960,216) (UNFPA);
• Latest WHO statistics show a global Maternal mortality rate of 400/100,000 live births (1/100,000 in Ireland and 2,100/100,000 in Sierra Leone).
Differences in different regions
Region MMR/ 100,000 live births (2005)
Africa 900
Americas 99
Eastern Mediterranean 420
Europe 27
South – east Asia 450
Western Pacific 82
Differences in different regions
Region MMR/100,000 live births
Developed regions 9
Developing regions 450
Commonwealth of Independent States
51
Becoming pregnant
• Carries with it real chance of dying;
• Basic public health issues lacking;
• Little or no antenatal care available;
• May be international organisations providing care which:– Conflict with local practices;– Conflict with each other.
Giving birth
• Women often in poor state of general health;
• Problems often not detected until labour established;
• Lack of skilled personnel;
• Lack of sanitation;
• Lack of any equipment.
The new family
• Lack of follow up care;
• Women suffering complications of prolonged labour;
• Usually supportive extended family;
• Many orphaned infants due to high maternal death rate.
Exceptions
• Increasing gap between rich and poor;
• Statistics of rich moving towards those of developed countries;
• Women caught up in conflict between relief organisations;
• Women abandoned when “donors” depart.
Becoming pregnant
• Chosen services are available:– May mean all medical facilities;– Health professional of choice;– Regular antenatal care;– Good referral system if required;– Expectation of healthy mother and baby
but awareness that sometimes things go wrong.
Giving birth
• Most women give birth with skilled professionals in attendance;
• Many births in highly medicalised settings;
• Expectation of pain free labour or elective Caesarean section;
• Social support in labour.
The new family
• Early discharge from hospital;
• Expectation of normality;
• Follow up support may be available in community setting;
• Maternity pay with option to return to work.
How do expectations equate to safety?
• Choice dominates but increasing interventions carry increased morbidity;
• Professionals become deskilled leading to further intervention;
• Because of low mortality rates may become complacent and ignore minority groups such as those in poverty, poor health etc.
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Becoming pregnant• High incidence of abortion;
• Some community based ante natal care available;
• High incidence of bribery leading to split between those how can afford to pay and those who cannot;
• Lack of motivation of health professionals and few skilled midwives.
Giving birth
• Outdated equipment and practices;
• Lack of any attention to dignity;
• Some professional support;
• No social support;
• Often professional brutality.
The new family
• Little follow up care;
• Pilot projects are in place in Uzbekistan and Tajikistan;
• Midwives little in evidence;
• Midwives need better education!
Safe Motherhood?
• Money buys professional care;
• Long term problems likely such as fistulae and prolapses due to indiscriminately accelerated labours;
• Secondary infertility after repeated abortions.
Safe Motherhood• What does this mean?
• No universal definition possible.– Sub Saharan Africa generally means
prevention of death;– Eastern Europe means improving quality of
life;– Northern America means maximising the
experience;– What is it in your own experience?