strategies maternal

7/26/2019 Strategies Maternal

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Strategies to Improve

Maternal Health in the NextDecade

Annette BongiovanniUSAID LAC SOTA March 2001


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Safe MotherhoodInter-Agency Group

Action MessagesAdvance safe motherhood

through human rights

m!o"er #omen$ nsureChoices

Safe motherhood as a %ita&

Socia& and conomicInvestment

De&a' Marriage and (irst Birth

ver' )regnanc' (aces *is+s


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SafeMotherhood

Inter-Agency Group

Action Messages nsure S+i&&ed Attendance at

De&iver'

Im!rove Access to ,ua&it'Materna& -ea&th Services

)revent Un"anted )regnanc'and Address Unsafe A.ortion

Measure )rogress

)o"er of )artnershi!


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Source: World Bank, 1998 (unpublished)

Advance safe motherhoodthrough human rights:

ationale

% Deliveries Attended by Trained

Professionals

0

20

40

60

80

100

Poorest

20%

2nd 3rd 4th Richest

20%% people in the contry

Per

!olivia

1"#1

$2#4

13#3

81#6


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Advance safe motherhoodthrough human rights:

Strategies Increase a"areness among (irst Ladies

Uti&i/e the Legis&ative (rame"or+ toeducate on com!&iance "ith eisting &a"s

that !rotect "omen Deve&o! &oca& materna& hea&th committees

to investigate mitigate materna& deaths

O!timi/e eisting conventions ie$

Convention on the &imination of a&& (orms ofDiscrimination Against #omen$ Convention on the*ights of the Chi&d$ the )rogram of Action of the IC)D$

and the Bei3ing Conference


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Social and !conomicInvestment: ationale

Materna& causes of mor.idit'and morta&it' com!rise the

.iggest contri.ution to DAL4s&ost among "omen 15675 'ears

Mother&ess chi&dren$ es!ecia&&'gir&s$ have higher infant

morta&it' and are &ess educated


7/24Source: Burkhalter B, REDUE !odel, Uni"ersit# Research o

Social and !conomicInvestment: ationale

Tota& !roduction &osses in LAC for20008

materna& disa.i&ities for direct causes

9 :5;2 mi&&ion materna& deaths for direct causes 9

:10< mi&&ion

!ost6!artum hemorrhage :2=m

unsafe a.ortion :2>m

h'!ertensive disorders :1=m

se!sis :1;m

o.structed &a.or :11m


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Social and !conomicInvestment: Strategy

)rovide ministries of hea&th$!&anning$ economics$ and ?nance"ith costing data and information

to im!rove resource a&&ocationand the e@cienc' andeectiveness of materna& hea&thservices

Introduce ?nancing schemes suchas nationa& hea&th insurance torecover costs


9/24' Source: Bu"inic, osts o *dolescent hildbearin+, 1998,

Delay "irst #irth: ationale

ar&' chi&d.earing in 7 LAC countries isassociated "ith harmfu& economic eects

ferti&it'

fe"er traditiona& nuc&ear fami&ies and a.sent fathers

.egets teen mothers

Among the !oor$ ado&escent chi&d.earing8 mothers month&' "ages E0F&o"er than adu&ts inBar.adosG

chi&d nutritiona& status$but

mothers contri.ution to househo&d income "hich isassociated "ith im!rovements in chi&d "e&&6.eing

Hir&s 1561E are t"ice as &i+e&' to die fromchi&d.irth as "omen in their t"enties

;2F of 20627 'r in E LAC countries have given .irth


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Delay "irst #irth:Strategies

)romote socia& !o&icies thate!and the schoo&ing andincome earning o!!ortunities of

!oor "omen IC messages that !romote

de&a'ed chi&d.irth (teen mothers=vulnerable mothers) andcontinuing education of mothersafter chi&d.earing (educatedmothers = educated children)


11/24'Source: -anneste, et al$, .renatal screenin+ in rural Ban+lade

!very $regnancy "acesis%s: ationale *is+ assessment cannot determine

"hich "omen can safe&' de&iver' athome "ithout a s+i&&ed attendant a&&"omen need to have a trained hea&th

!rofessiona& assist their de&iveries )renata& screening .' trained mid"ives

fai&ed to identif' "omen "ho "ou&dneed s!ecia& care during de&iver'

-emorrhage is the ma3or cause of

materna& morta&it' in LAC and often isnot identi?ed during !renata& visits


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!very $regnancy "acesis%s: Strategies

*is+ assessment "or+s .est on anindividua& case6.'6case .asisCom!&ications identi?ed during!regnanc' shou&d indicate thea!!ro!riate &eve& of care a "omenmight need during de&iver' eg$ home"ith a s+i&&ed attendant$ in a hea&thcenter$ or in a hos!ita&G

*is+ a!!roach is not usefu& fordemogra!hic targeting !ur!oses

Train TBAs to identif' danger signs of!regnanc' and refer "omen "ith

com!&ications to OC faci&ities


13/24Source: /i 0, ortne# 2*, 1993$

!nsure S%illed Attendanceat #irth: ationale

)revious interventions aimed at!renata& care and traditiona& .irthattendant training have had &itt&e

im!act on materna& morta&it' Ma3orit' of materna& deaths occur

around the time of &a.or andde&iver' and immediate !ost6!artum

=0F of a&& !ost6!artum deaths occurduring the ?rst "ee+ !ost6!artum


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!nsure S%illed Attendanceat #irth: Strategies

Deve&o! a strong cadre of !rofessiona&!ractitioners to assist de&iveries and !rovidethem "ith the necessar' resources

Incor!orate !ost6!artum visits into materna&

hea&th !rograms investigate the feasi.i&it' ofTBA home visits during the ?rst "ee+ !ost6!artum to identif' com!&ications for referra&

ncourage TBA invo&vement in hea&th faci&it'.irths

!&ore feasi.i&it' and eectiveness ofmaternit' "aiting homes and .irthing centers


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!nsure S%illed Attendanceat #irth: Strategies &con't(

,ua&it' Im!rovement Teams atthe &oca& &eve& to identif'!ro.&ems and so&utions to

increase demand for materna&hea&th services$ eg$communit'6.ased ?nancing

schemes

emergenc' trans!ort s'stems

.irth !re!aredness !&ans

see the ,A) !resentation


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Access to )uality Services:Strategies

7 Basic ssentia& O.stetric Care OCGfaci&ities !er 500$000 inha.itants or20$000 .irthsG

1 Com!rehensive OC faci&it' !er

500$000 inha.itants or 20$000 .irthsG OC c&inica& standards shou&d .e

incor!orated into nationa& re!roductivehea&th guide&ines managers shou&d usec&inica& standards as a su!ervisor' too&

Deve&o! a!!ro!riate referra& s'stemsto adeJuate&' manage norma& versuscom!&icated de&iveries


17/24Source: World 4ealth 5r+ani6ation, 1991

Access to )uality Services:!ssential *+stetric ,are

management of !ro.&em!regnancies anemia$ dia.etes$ etcG medica& treatment of com!&ications

hemorrhage$ se!sis$ ec&am!sia$ etcG manua& !rocedures remova& of

!&acenta$ re!air of e!isiotomies$ etcG monitoring &a.or inc&udes )artogra!hG neonata& s!ecia& care

,om

prehe ns

i ve

#as

ic

surgica& interventionsanesthesia.&ood re!&acement


18/24Source: !aine D, et al$ 1987

Access to )uality Services:

Indicators Distance to the nearest referra&faci&it' estimated interva& from the.eginning of the s'm!tom unti& the recei!t

medica& assistance to !revent deathG

Complication Hours Days

Post-partum hemorrhagePre-natal Hemorrhage

212

Ruptured uterus 1Eclampsia 2Obstructed delivery 3n!ection "


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'B# con"ention, estiated coplication rate is 1 o all li"e bi

Access to )uality Services:

Indicators F de&iveries attended .' trainedhea&th !rofessiona& !h'sician$ nurse$ ornurse mid"ife "ho has at &east 1= months ofo.stetrica& training and attends an average of 56

10 de&iveries !er monthG F de&iveries .' cesarean6section

met need for o.stetric careK "omen " com!&ications "ho are treated

during a de?ned time !eriod in a s!eci?cgeogra!hic areaG

estimated K "omen "ith com!&ications duringthe same de?ned time !eriod in the sameareaG


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Source: Billin+s D$, .op ouncil, %&&1$

Address nsafe A+ortions:ationale &data from #olivia(

;5F of Bo&ivias materna&morta&it' is attri.uta.&e toa.ortion com!&ications

7>650F of hos!ita& g'neco&ogica&.eds are a.ortion com!&ications


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Address nsafe A+ortions:Strategies ationa& insurance cou&d cover cost of

care for Ntreatment of com!&ications ofhemorrhage during the ?rst ha&f of!regnanc'

)ost A.ortion Carereorgani/e services to am.u&ator' care

!rovide counse&ing and information

training in M%A for treatment of incom!&etea.ortion

!rovide fami&' !&anning counse&ing .eforedischarge

ma&e !artner invo&vement


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Source: W45, 199;

Maternal Deaths due toA+ortion

#$

2$

%$

"$

&$

1#$

12$

1%$

1"$

1&$


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Measure $rogress:

ationale

*are&' necessar' to measurematerna& morta&it' ratiosMM*G more often than ever' 56

10 'ears due to e!ense and"ide con?dence interva&s

)rocess and Outcome Indicatorsare more a!!ro!riate tomeasure the !rogress ofmaterna& hea&th !rograms


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Measure $rogress:

Strategies

As a !ro' for MM*$ S+i&&ed Attendance atBirth is a more accessi.&e annua& indicator

Materna& Death *evie" #-O too&G66

com.ination of a ver.a& auto!s' and c&inica&audit

Measure !rocess and outcome indicators$ eg contrace!tive !reve&ance rate

average num.er of !re6nata& visits !er "oman

F !regnant "omen "ith !renata& visits in the ?rsttrimester

F .irths in institutions

K faci&ities that have MC- norms avai&a.&e tota& K offaci&ities

K "omen "ith com!&ications treated in faci&ities tota& Kof "omen "ith com!&ications

strategies maternal

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