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Non-medical factors related to maternal mortality

Non-medical factors related to maternal mortality. Birgitta Essén, MD, associate professor Senior Lecturer in International Maternal Health Care Department of Women’s and Children’s Health IMCH, Uppsala University. outline. RH history (SRHR) MM: medical factors, classification

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Non-medical factors related to maternal mortality

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  1. Non-medical factors related to maternal mortality Birgitta Essén, MD, associate professorSenior Lecturer in International Maternal Health Care Department of Women’s and Children’s HealthIMCH, Uppsala University

  2. outline • RH history (SRHR) • MM: medical factors, classification • MM: non medical factors • UN, WHO policy

  3. How did it start?

  4. Biafra 1967-1970

  5. Main PH focus: Maternal health • Population ! • => FP • ”Maternal and child health” ”Reproductive Health” FP

  6. Reproductive health -International focus/attention • Bucharest 1974 – UN Population Conf. • Mexico City 1984 – same focus: population • Cairo 1994 – International Conference on Population and Development (=>”RH”) • Beijing – UN Conference on Women • WHO strategy approved 2004 Safe Mootherhood • UN MDG 5 • WHO Continum of Care 2010

  7. Abortion STD Maternal health Adolescent SRHR HIV/AIDS Sexual & reproductive health & rights ”Reproductive Health” Cx cancer Maternal newborn health Child- lessness FP FP Violence against women

  8. MGD 5 1990 to 2015 Reduce maternal mortality with 3/4

  9. Maternal mortality • MDG 5 • Hill K, et al. Estimates of maternal mortality worldwide between 1990 and 2005: an assessment of available data. Lancet. 2007;370. • Disparities poor-rich • Graham WJ, et al. The familial technique for linking maternal death with poverty. Lancet. 2004;363 • Lifetime risk (WHO 2007) • Ethiopa:1 in 10 • Norway: 1 in 15,000

  10. Trends in strategies to reduce maternal mortality • Safe MotherhoodInitiative, Nairobi 1987 • AbouZahr C. Safe motherhood: a brief history of the global movement 1947–2002. Br Med Bull. 2003. • OtherMDGs: • eradicatingpowerty • primaryeducation 3 gender equity • …however, most strategies have been vertical programs focusing on single interventions ! • Starrs AM. Safe motherhood initiative: 20 years and counting. Lancet. 2006.

  11. Maternal mortality ratio per 100 000 livebirths, 2008 Norge: 8/100 000 Afghanistan: 1575/100 000 Pakistan India Nigeria Etiopia: 590/100 000 Dem rep Kongo Hogan et al., Lancet 2010

  12. Yearly reduction MM (%), 1990-2008 Hogan et al., Lancet 2010

  13. Haemorrhage Sepsis Preeclampsia/eclampsia Obstructed labour Unsafe abortions “Big five”

  14. Why?

  15. Socioeconomic factors contributing • No power to decide • Inequality • Low education/illiteracy • Poverty • Early marriages • Harmful practices • No access to delivery care • No access to family planning and antenatal care • Infrastructure

  16. Halving MMR Sri Lanka Malaysia www.worldbank.org ”Investing effectively in maternal health”

  17. History: Sri Lanka & Malaysia How did they do it ? • Expanding access to effective maternity care by midwives and doctors • Improving utilization and quality of care with emphasis on making life-saving care free. The World Bank, 2003

  18. Maternal mortality, time trend(100 000/deliveries) Death women År

  19. Maternal mortality where?

  20. Shifting from Unskilled Care

  21. To Skilled Care

  22. 4 models of delivery careKoblinsky, Bull WHO • Traditional birth attendants (TBA) • Skilled birth attendants –at home • Skilled birth attendants –at health center • Hospital

  23. Trends in strategies to reduce maternal mortality – health care seeking behaviour “Consequently, increased attention with regard to the utilization of obstetric care has been directed toward understanding the motivations and behaviours of pregnant women and their social network” Rööst et al 2009.

  24. Contiuum of care Interventions at home/community level Interventions at first level health facilities Interventions at referral facilities WHO 4. august 2010

  25. WHO Policy, 2010 • Family planning (Safe abortion, STI prevention) ”Reduce MM with 30%” • ANC ”Reduce MM with 50 % and NM 15%” • Emergency Obsteric Care, Skilled BA ”Reduce MM 95%”

  26. Countdown report to 2015 Afghanistan Etiopia India

  27. Interventions in 68“Countdown Countries” Bhutta ZA et al., Lancet 2010

  28. Conclusions Maternal newborn health • Maternal & newborn survival extra dependent on functioning health care (less on general living conditions) • Public awareness through reporting is fundamental • Infrastructure and Education • Skilled birth attendance is key – midwives! • As well as backup for obstetric emergencies

  29. Thanks for listening! Any questions? Give me a break…

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