Safe Motherhood 2018

It is a Medical Educational Presentation.

1. Dr. Poly Begum Associate Professor ( Obst & Gynae ), DAMC, Faridpur. SAFE MOTHERHOOD

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3. History In 1930 the League of Nations Health Section noted concerns about maternal mortality. The first international conference on Safe Motherhood was in 1987, Nairobi. It led to the formation of an Inter-Agency Group (IAG) for Safe Motherhood. To reduce maternal mortality in developing countries by 50% in 1 decade .

4. Incidence Underreported “Tip of the iceberg”

5. Maternal Mortality: A Global Tragedy Annually, 585,000 women die of pregnancy related complications 99% in developing world ~ 1% in developed countries Current Approach to Reduction of Maternal Mortality 5

6. Daily Death Toll: during pregnancy & in childbirth WORLDWIDE

7. Africa: % of all Maternal Death: 48% Lifetime risk: 1 in 20 MMR: 830 Developed Countries: % of all Maternal Death: 0.5% Lifetime risk: 1 in 2500 MMR: 20 (per 100,000 live births) WHO/UNICEF/UNFPA, 2000

8. Maternal Health: Scope of Problem 180–200 million pregnancies per year 75 million unwanted pregnancies 50 million induced abortions 20 million unsafe abortions (same as above) 600,000 maternal deaths (1 per minute) 1 maternal death = 30 maternal morbidities Current Approach to Reduction of Maternal Mortality

9. COUNTRY SITUATION : Eighty percent of the maternal deaths happen at home as because more than 90% of deliveries occur at home attended by traditional birth attendants (75.6 percent) and relatives (10.8 percent). Deliveries by a medical trained person are 11.6 percent , i.e. 6.5 percent doctors and 5.3 percent by nurse-midwives/Family Welfare Visitors/others. 47.5 percent of pregnant women avail one or more antenatal care check.

10. Only 41% of the current health workforce is available to women to provide necessary maternal and newborn health interventions. Bangladesh is currently training 500 midwives in the next 4 years through the Community-based Midwifery Diploma Program. I t is calculated that throughout their 30 year career span these midwives will drive down maternal mortality from 194 to 35/100,000; infant mortality from 52 to 12/1,000 and save 36,178 lives. Source : Sate of the World’s Midwifery 2014

11. Safe Motherhood Definition: Safe motherhood is one of the important components of Reproductive Health. It means ensuring that all women receive the care they need, to be safe and healthy throughout pregnancy and childbirth. It is the ability of a mother to have safe & healthy pregnancy & child birth.

12. SAFE MOT H ERHOOD GOAL T o imp r ove we l l being of mothe r s th r ough a comp r ehensive app r oach of p r oviding, p r eventing, p r omotive , curative and r ehabil i tative health ca r e

13. SAFE MOT H ERHOOD OBJECTIVE  Improve qua l i t y and incre a se acc e ss to fam i ly pl a nning and ma t ernal heal t h care services  Educa t e couples to en s ure they have the best chance for a wanted and safe pregna n cy

14. T o pr o mote impr o v e ment of syst e ms for mo n itori n g mater n al and ne w bo r n he a lth ser v ice s ; T o pr o mote the imple m e n tation of evi d e n c e - ba s ed integr a ted co s t -e f fective rep r od u ctive h e alth inter v e n tions with a focus on mat e rn a l a n d n e wb o rn h e alth within prim a ry h e alth c a re a p pr o a c h; T o c o n d u c t o p er a tions res e ar c h to ge n er a te b e st pr a ctic e s a n d e v ide n ce for a d dr e ssing pri o rity re p ro d u c t i ve h e alth pr o ble m s.

15. Safe Motherhood “SIX PILLAR S ” OF SAFE M OTHERHOOD FP ANC Obs. Ca r e P N C Post A b orti on Ca r e S T D/ HIV Contr ol Communicat i on for behavior change Pri m ary heal t h ca r e E q uity & Ed u cation for w omen

16. 1. F amily Plann in g --- I n f orm a t i o n & se r vices t o p lan the ti m i n g , num b er & spac i n g of p r egnanc i es

17. 2 . A n t en a t al Ca r e - -- F o r early d e t ect io n & t r e a tme n t o f c omp l i ca t i on s o f p r egnancy

18. 3 . O b st e tr i c Ca r e - -- P r ov i d e p r ope r kn o wled g e & equ i p me n ts t o the b ir t h a t t enda n ts & ensu r e eme r g ency c a r e f o r h i gh ri s k p r egnancy

19. 4. P o s tn a t al Ca r e -- - F o r bot h mot he r & h e r ba b y . Incl u des l ac t a ti o n assi s t ance, F P se rvi c e s & mana g em e n t o f c omp l i c a ti on s o f de l i v ery

20. 5. P o s t aborti o n c a r e -- - Mana g eme n t of c omp l i ca t i on s & F P c onsu l t a t i on

21. 6. S TD/H I V Co n t r ol --- V o l u n t a r y Counse l i n g & T e s t i n g ( V CT) , P r e v e n t i o n o f Mo t he r t o Ch i ld T r ansm i ss i o n (PM T CT)

22. K e y i n d i c a t o r s o f t h e g oa l --- M a t erna l Mor t a l ity R a ti o - 170 death/100000 live births (2015). Neon a t al Mor t a l ity R a t e – 20.1 death/1000 live birth

23. Othe r i nd i ca t o r s o f s a f e mothe r hoo d --- I n f a n t Mor t ali t y R a t e – 28.2 (2016) T o t al F ert i l i ty R a t e - (2.17) Co n t r ace p t i v e P r e v alence R a t e - (62.3%) A N C c o v e r a g e r a t e – (67.7%) % de l i v ery as s i s t ed b y S B A – (42.1%) % o f w ome n who t oo k i r o n dur i n g p r egnancy % o f i n s t i tu t i on a l de l i v e r y - % o f c aesa r ean sec t i on - O b st e tr i c c ase f a t ali t y r a t e -

24. Worldwide Causes of Maternal Deaths Severe bleeding 31% Sepsis 1% Eclampsia 20% Obstructed labor 7 % Unsafe abortion 1% Indirect causes 35% Other direct causes 5 %

25. But WHY Do These Women Die? Three Delays Model Delay in decision to seek care Lack of understanding of complications Acceptance of maternal death Low status of women Socio-cultural barriers to seeking care Delay in reaching care Transport problem Delay in receiving care Supplies, personnel Poorly trained personnel with punitive attitude Finances Current Approach to Reduction of Maternal Mortality 25

26. The strategies to reduce maternal mortality are Reduce Maternal Mortality & Morbidity Strengthening of health facilities to provide EmOC service Emergency obstetrical care as important back up service in all the facilities (MCH, DH, MCWC and UHC) Community-based skilled Birth Attendant Programme Demand side Financing Maternal Health Voucher Scheme

27. White Ribbon Alliance for Safe Motherhood The White Ribbon Alliance for Safe Motherhood (WRA )   is a non-profit and non-governmental membership organization that aims to decrease maternal and newborn death globally . Every minute somewhere in the world a woman dies in pregnancy or childbirth. 99% of these deaths occur in developing countries. Almost all can be prevented . The WRA is raising awareness of this shameful injustice and demanding political priority to end the needless deaths of women and newborns around the world.

28. The White Ribbon Alliance For Safe Motherhood is a grassroots movement that builds alliances, strengthens capacity, influences policies and inspires action to save the lives of women and newborns around the world .

29. Bangladesh expands training of midwives to improve maternal and neonatal health June 2014 Training strategy Bangladesh has made great progress in reducing the infant mortality rate and on improving maternal health as part of the Millennium Development Goals. For example, the maternal mortality ratio was halved between 2000 and 2013. But for every 100 000 live births 170 women still die, and 24 of every 1000 newborn babies don’t survive their first month. To improve this situation and fill gaps in maternal and neonatal health provision, the Government of Bangladesh, supported by WHO and the UN Population Fund (UNFPA), is aiming to train 3000 midwives by 2015.

30. Cooperation in all corners requires to improve MMR in Bangladesh

31. Bangladesh is on track to Achieve MDG 5 32 TARGET FOR thousand years (LIFE BIRTH PER LAC) 194, BMMS-2010 Bangladesh is on track to Achieve MDG 5

32. TARGET Maternal mortality ratio is 1.94 per 1,000 live births to 1.43 Neonatal mortality rate of 37 per 1,000 live births to 22 The infant mortality is 52 per 1,000 live births to 31 in 2015 Under 5 mortality rate 65 per 1, 000 live births to 50 in 2015

33. Making pregnancy safer in Bangladesh In Bangladesh, 12,000 women die needlessly every year as a result of the complications of pregnancy and childbirth. The government of Bangladesh is investing around $3 billion ( Tk 20 crore ) over seven years in the Health, Nutrition and Population Sector Program to make safe motherhood a fact of life. The UK is glad to be supporting this effort, along with many other donors and development partners.

34. Doubling the percentage of births attended by a skilled health worker by 2015 (from the current level of 24.4%) through : training an additional 3000 midwives staffing all 427 UHC (sub-district health centers) to provide round-the-clock midwifery services Upgrading all 59 district hospitals and 70 Mother and Child Welfare Centers as centers of excellence for emergency obstetric care services.

35. This three strategy is key to the achievement of the goal All women have access to contraception to avoid unintended pregnancies All pregnant women have access to skilled care at the time of birth All those with complications have timely access to quality emergency obstetric care

36. Is ANC important ? YES!! Early detection of problems and birth preparation.

37. Preventing Maternal Mortality through Emergency Obstetric Care ( EmOC ). EmOC have been used in more than 50 countries to plan programmes and to monitor and evaluate progress in reducing maternal mortality.

38. COMPONENTS EmOC 1. FIRST AID 2. BASIC EmOC 3. COMPRENSIVE EmOC

39. Obstetrics first Aid Administer parenteral Oxytocin drugs to control haemorrhage. Administer parenteral antibiotics to control infection. Administer parenteral MASO4 to control eclamptic fits.

40. Basic EmOC All functions included in Obstetric first Aid. Manual removal of placenta. Remove retained product (MVA, D&C) Perform assisted vaginal delivery (vacuum extract ion , forceps delivery). Perform basic neonatal resuscitation (face & mask)

41. Comprehensive EmOC Obstetric first aid + basic EmOC + Perform LSCS Perform blood transfusion

42. Most recently, UNFPA has joined with three key partners, UNICEF , the World Bank and the World Health Organization,   to  accelerate progress  in saving the lives of women and newborns.

43. What is a skilled birth attendant? A skilled birth attendant is a midwife, nurse, or doctor who has been trained to expert in the skills necessary to: manage normal deliveries diagnose, manage, and/or refer obstetric complications.

44. Midwifery in Bangladesh: The Facts Each year there are 50,90,000 pregnancies and this is expected to increase by 20% by 2030. 72% of child-bearing women live in rural areas where healthcare access is limited or non-existent. To achieve universal access to sexual, reproductive, maternal and newborn care, 4.3 million pregnancies per year need attending to by a trained health professional. Source : Sate of the World’s Midwifery 2014

45. “These new midwives are going to play a crucial role in improving the advice and care given to women during pregnancy, birth and postpartum. Global evidence shows that midwives who are educated and regulated to international standards can provide 87% of essential care needed for women and newborn.

46. National leadership, increased financial and human resources, and system strengthening including monitoring & evaluation.

47. SAFE MOT H ERHOOD