Safe Motherhood: an international perspective

2. Safe Motherhood: an international perspective Prof Dr Valerie Fleming Director World Health Organisation Collaborating Centre

3. 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.

4. 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.

5. 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).

6. Differences in different regions

7. Differences in different regions

8. What is safe motherhood?

9. 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.

10. 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.

11. 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.

12. 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.

13. What is safe motherhood?

14. 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.

15. 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.

16. 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.

17. 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.

18. What is safe motherhood?

19. 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.

20. Giving birth • Outdated equipment and practices; • Lack of any attention to dignity; • Some professional support; • No social support; • Often professional brutality.

21. The new family • Little follow up care; • Pilot projects are in place in Uzbekistan and Tajikistan; • Midwives little in evidence; • Midwives need better education!

22. 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.

23. 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?