Global overview of Maternal Health:

1

• Global overview of Maternal Health
• Strategic response to prevent maternal mortality
  and morbidity
• Dr France Donnay, UNFPA
• Regional Workshop on Skilled Attendants in South
  and West Asia
• April 19-21, 2004
• Islamabad, Pakistan

2
Context

• 1994 ICPD sets mutually reinforcing population,
  RH and gender goals
• 1999 ICPD 5 and HIV UNGASS introduces new
  targets mostly with respect to HIV/AIDS
• 2000 Millennium Declaration provides integrated
  development framework, focusing on poverty
  reduction and goals as development objectives
• 2004 ICPD 10 reinforces linkages between Cairo
  Agenda and Poverty, and between RH and HIV

3
MDGs and ICPD Goals

• Reproductive Health central to the achievement of
  all MDGs
• Focus on goals and targets consistent with rights
  based approach to development can help mobilize
  resources for meeting obligations and
  entitlements
• Generally poor and excluded whose rights are
  ignored and who lack access to information and
  services

4
Source World Bank Development Group
5
Global Maternal Mortality (yr 2000)

• Each year 529,000 deaths
• And probably 40 times more disease disability
• Average MM Ratio 400 per 100,000 live births
• Higher in least developed areas up to 1200 per
  100,000 in some rural/isolated areas
• Lifetime risk 1 in 74 births (range 9 to 3500)
• Growing role of indirect causes HIV, Malaria, TB

6
Maternal Morbidity Obstetric Fistula

• Each minute, 1 woman dies from pregnancy-related
  complications
• For each death, there are approximately 15-30
  others who experience chronic disability, ie
  obstetric fistula
• Obstetric Fistula severe physical and social
  consequences
• Estimated 2 million women living with fistulas
  and an estimated 50,000 to 100,000 new cases each
  year
• Fistula are preventable and treatable!

7
2000 MM Estimates for Asia

• Total 530,000 MMR 400
• 253,000 maternal deaths
• 207,000 in South Asia
• Average MMR 330/100,000
• Skilled attendance
• South 35(30), West 65(8), SE 60(64)
• By doctors S 76, W 37, SE 52 - most of
  the increase - excl China
• C sections S from 2 to 8(444), W 14 (182),
  SE 7(181)
• Rural/urban differentials approx 1 to 3

8
Effective interventions existThey need to reach
more people
9
The new paradigm in reducing MM and PNM

• All pregnancies are at risk Most obstetrical
  complications are neither predictable, nor
  avoidable, but can be treated
• Shift of focus from pregnancy to delivery, and
  from home to facility
• Therefore, readiness is key, accompanied by
  quality of obstetric care

10
The UNFPA Vision and Strategy for Reduction of
Maternal Mortality Morbidity

• 3 pillars
• Family Planning
• Skilled Attendance at (all) births
• Emergency Obstetric Care

11
EmOC a marker of skilled care

• Now we have definition skilled attendant is
  capable of performing basic EmOC functions, in a
  (non-surgical) facility with infrastructure,
  equipment, and supplies
• Also capable of referring severe cases to
  comprehensive facilities, and managing them
  during transport
• Skilled care is the above PLUS the enabling
  environment (systems and support)

12
Human Resources strategies

• The most crucial constraint (or success!)
• The challenge is to post (and keep) skilled and
  committed providers in district level facilities
• Formulate/review national HR policies and
  strategies (addressing brain drain)
• To be included in the reform of the health system
• Need multi-partner coordination, not only health

13
Rich and poor differentials in access to health
services
Contraceptive prevalence rates richest and
poorest quintiles
The promotion of reproductive health as a poverty
reduction strategy, to be effective, must target
the poor.
14
Comparative Disparities in Skilled Care at Birth
15
The Way Forward Invoking Human Rights

• High MMR indicates failure of public health and
  development systems to provide adequate health
  care
• Also indicates neglect and discrimination against
  women
• All branches of government should be engaged in
  making motherhood safer
• Importance of monitoring and evaluation to hold
  governments accountable

16
Meeting the Challenge

• The world must save women so that women can save
  the world.
• -UNFPA Executive Director Thoraya Obaid