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Maternal Mortality An overview

Maternal Mortality An overview. Dr Francisco F. Songane Roundtable on Maternal Mortality , Human Rights and Accountability Geneva, Sept 2, 2010. Why maternal mortality is an important issue? 1.

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Maternal Mortality An overview

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  1. Maternal MortalityAn overview Dr Francisco F. Songane Roundtable on MaternalMortality, HumanRights and Accountability Geneva, Sept 2, 2010

  2. Whymaternalmortalityis 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 society

  3. Whymaternalmortalityis an important issue? 2 It isNeglected • We know whereitoccurs • We know who are the mostaffected • We know the causes of death • We know how to tacklethem and preventdeath • Yet, women continue to die in the same large numbers as 20 yearsago

  4. 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)

  5. Where maternal deaths occur

  6. Inequities often go unchecked Argentina-21% of maternal deaths due to abortion complications. The % is double in districts with poor access to services, and the teenagers most affected Australia-overall MMR of 4, but among indigenous women is 21.5, 3 times higher than in the non indigenous

  7. Inequitiesoften go unchecked(cont) U K- Cases of severemorbidity, with a rate of 0.8/1000 deliveriesamong white women, and 1.26/1000 among non white USA-In the past 20 yearsdeathsduring pregnancy and childbirth have doubled; the current MMR is 16/100,000 live births, and African American women 3 times more likely to die than the white, MMR of 32.7 and 9.5 respectively

  8. Everywhere WHO IS LEFT OUT • The poor • Those belonging to ethnic minorities • The unemployed • Those who didn’t have a chance to go to school • The very young • The marginalized for political reasons

  9. What are the causes There are solutions, and could be made available anywhere. Simply, the health systems are not working to deliverthe services that are needed

  10. It canbedone, and it has been doneIt is not a matter of money only MMR, deaths/100,000 live births 1960 1970% decline Malaysia 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

  11. Little change in the last 20 yearsA neglected issue MMR, deaths/100,000 live births ( ) number of deaths 1990 2005 Africa 910 (205,000) 900 (261,000) South Asia 650 (238,000) 500 (187,000) World 430 (576,000) 400 (536,000) 83% of the World maternal deaths occur in Africa and South Asia

  12. MDG 5 targets could be missed Globally the annual % of decline of MMR between 1990 and 2005 was 0.4% To reach the MDG 5 target, the required annual rate of decline is 5.5%

  13. Lowcoverage of key interventions is one of the problems to beaddressed Blue line-ICPD target for 2010 Source: WHO skilled birth attendants 2008 update

  14. Some thoughts on what could be done to address the challenge

  15. Proposedways to accelerate the change of the situation 1 • Disseminate the information showing how critical the situation is (in many instances people are not aware of the gravity) • Have the figures in the regional and sub-regional contexts • Breakdown the national figures • Show that the situation can be changed-highlight the success stories, particularly how they did it • Disseminate the « political instruments » calling for action-e.g. UNHRC Resolution of June 2009, the Summit Resolutions, The Millennium Declaration…

  16. Proposedways to accelerate the change of the situation 2 • Makehumanrights an integral component of good governance • Maternalmortality figures as keyindicators of the level of response of governments and society to their people • Emphasize the centrality of women in the family • Care of womenduringpregnancy and childbirth in the context of the familywellbeing

  17. Proposedways to accelerate the change of the situation 3 • GovernmentStewardship • Parliaments and similar institutions shouldstepinto the process • The importance of functioninghealthsystems • Integratedapproach • Introduction of mandatoryregularanalysis of maternaldeaths • Active involvement of civil society • Local research to inform the people and local institutions/entities • Additionalresources and International Solidarity

  18. Long term sustained actionNo « quick fixes » Source: WHO-2005 world report

  19. For Change to Happen We need to follow it up Accountability at all levels

  20. Thank you

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