Global Maternal and Newborn Health

8th International Medical Summer School 2016 www.doctorsacademy.
org
Global Maternal and Newborn Health
Professor Matthews Mathai

Liverpool School of Tropical Medicine
8th International Medical Summer School 2016 www.doctorsacademy.org
Outline
Current status of maternal and newborn
health
The story of Mrs X
How did we get here?
Where do we want to reach?
What should we do to get there?
A few definitions .
Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity.
Maternal health refers to the health of women during
pregnancy, childbirth and the postpartum period.
Neonatal period first 28 days of life
Perinatal period fetal period (22 weeks) to 7 days after
birth
Measuring health ..
Wellbeing quality of life, disability

Mortality
Maternal mortality ratio
Stillbirth rate
Neonatal mortality rate
Perinatal mortality rate
Maternal death
A maternal death is the death of a woman while
pregnant or within 42 days of termination of
pregnancy, irrespective of the duration and site
of the pregnancy, from any cause related to or
aggravated by the pregnancy or its
management but not from accidental or
incidental causes"
Tenth Revision of International Classification of Diseases (ICD-
10)
7
Maternal mortality
MMR 80% UI No of Life time
deaths risk
World 216 207-249 303 000 180
Developed 12 11-14 1700 4900
Region
Developing 239 229-275 302 000 150
Regions
10
5.945 million deaths globally

among children under 5
5.865 million of these deaths in
developing regions
Increasing proportion of newborn

deaths
Why mothers and newborns die

Haemorrhage Prematurity
Hypertension Birth asphyxia
Sepsis Sepsis
Unsafe abortion
Difficult labour
Indirect causes
Prevention and treatment available
Why did Mrs X die?

Died during labour
in a small district
hospital
Why did Mrs X die?

Straight forward clinical
diagnosis
A case of Antepartum
haemorrhage
Caused by Placenta
Praevia
Why did Mrs X die?

Although she was admitted
as a case of severe bleeding
in a condition of shock, she
received only 500 ml of
blood by transfusion
Caesarean section was
carried out 3 hours after her
admission
Mrs X died during the
operation
It took 4 h after
she started
bleeding for Mrs X
to reach the
hospital
This was not the first

time she had suffered
bleeding during
pregnancy
She had two previous
episodes which were
minor
Malnourished
even before
pregnancy
The Road to Death and the Roads

to Life
Distant Factors Intermediate Factors Outcomes
Health & Pregnancy

reproductive
behaviour
Health status
Socio-
economic Complications
Access to
status health services
Unknown Maternal
factors Mortality
Looking backwards, moving forwards
Maternal and infant deaths reported from Biblical times

Menopause a twentieth century phenomenon?
Primary health care - focus on improving child survival

Vaccinations, nutrition, etc
Antenatal care and high risk approach
Mother as a container for the baby
Ensuring the next generations wellbeing through improving care for mothers
Reproductive health - targeting mothers to control population

explosion
Would not reducing maternal mortality imply that the population
explosion will worsen?
Where is the M in MCH
It is difficult to understand why maternal mortality receives

so little serious attention from health professionals, policy
makers, and politicians. The worlds obstetricians are
particularly neglectful of their duty in this regard. Instead of
drawing attention to the problem and lobbying for major
programmes and changes in priorities, most obstetricians
concentrate on subspecialties that put emphasis on high
technology
*Rosenfield A, Maine D. Maternal Mortality A Neglected Tragedy. Where is the

M in MCH? Lancet 1985; 2: 83-85
Changing focus
Safe Motherhood Conference Nairobi, 1987

Jumbo jets crashing
International Conference for Population and
Development Cairo, 1994
10 years of Safe Motherhood Colombo, 1997
All pregnancies face risk
Greater focus on emergency obstetric care
Safe Motherhood World Health Day 1998
Millennium Development Goals 2000
Goal 4: Reduce child mortality
Reduce by two thirds, between 1990 and 2015, the under-five

mortality rate
Goal 5: Improve maternal health
Reduce by three quarters, between 1990 and 2015, the maternal

mortality ratio
Achieve, by 2015, universal access to reproductive health

Approaches to improving maternal and neonatal

health
Skilled Birth Attendant: WHO 2004
SAB as an indicator to monitor progress
World Health Report 2005 on MNCH
Partnership for Maternal, Newborn and Child Health
formed 2005
Differences between maternal and newborn health

experts on approaches to reduce preventable deaths
Skilled care, facility births
Home care, community approaches
Effective interventions are available

Intervention coverage
Wide range in
coverage levels
for virtually
all interventions
Coverage levels for selected Commission

indicators of intervention coverage,
median and range for priority countries
with data available, 2007-2012
Increasing coverage with skilled attendants
Proportion of births attended by skilled health personnel

is a proxy indicator for improvement in maternal health
Strategies used in countries
Training new midwives
Upgrading other health workers who are not fully
trained midwives
Promoting births in facilities
Increasing coverage but concerns about quality of care
Maternal health care in Bharwani, India (Subha Sri

et al 2012)
The policy of institutionalisation of childbirth alone does

not necessarily result in better maternity care or fewer
maternal deaths.
Giving cash to pregnant women to deliver in poor quality
facilities without first ensuring quality of care and
strengthening the facilities to cope with the increased
patient loads is an unfair and inequitable policy outcome.
Indicators for maternal health must move beyond the
number of cash incentives given and number of
institutional deliveries to include the WHO process and
quality of care indicators.
Holding ourselves to account
Global Strategy for Women's

and Children's Health 2010
Recommendations of the
Commission on Information
and Accountability 2011
Better information for
better result
Better tracking of
resources
for women's and
children's health
Better oversight of
results and resources:
nationally and globally
Every day.
Approximately 830 women
die.
Finding the black box !

Maternal Death Surveillance and
Response (MDSR)
QoC Vital
Surveillance
improvement registration
Response Identify
action deaths
Review Report
deaths deaths
Response
QoC MMR
measurement tracking
Each maternal death is a tragedy.

What is also a tragedy is failing to
learn lessons from why she died.
The silent numbers

Every misclassified or unrecorded maternal death is a lost opportunity
to take corrective action to ensure that other women do not die in the
same way.
Time to respond, 2016 global report on the status of Global MDSR implementation (Unpublished)
www.sida.se
Ending preventable maternal mortality
Global MMR of less than 70 per

100.000 live births by 2030
Ending preventable newborn mortality and stillbirths is within reach!
Every Newborn Action Plan

goal:
National NMR of less than 10 in 2035
National NMR of less than 12 in 2030
Global average NMR of 9 by 2030
Ending Preventable Maternal Mortality
Address all causes of maternal mortality,

reproductive and maternal morbidities, and related
disabilities
Address inequities in access to and quality of
reproductive, maternal, and newborn healthcare services
Ensure universal health coverage for comprehensive
reproductive, maternal and newborn healthcare
Strengthen health systems to respond to the needs and
priorities of women and girls
Ensure accountability to improve quality of care and
equity
Every Newborn Action Plan Strategic Objectives

Strengthen and invest in care during labour, birth and the first day
and week of life
Improve the quality of maternal and newborn care
Reach every woman and every newborn; reduce inequities
Harness the power of parents, families and communities
Count every newborn measurement, tracking and accountability

Care around the time of birth: a triple return on investment
Source: Special analysis detailed in The Lancet Every Newborn Series, launched 19 May 2014
More than 3 million babies and women could be saved each year through
investing in quality care around the time of birth.
Global Strategy for Womens, Childrens

and Adolescent Health, 2015
Survive, Thrive and Transform
Sustainable Development Goals 2015
Ten countries with substantive progress
Note: In 2012, these countries were on-track for both MDGs 4 and 5 based on annual rates of change and/or
absolute reductions in mortality rates
What were determinants of success? p

These ten countries significantly outperformed the other low- and middle-
income countries in three areas:
Factors: Improvements in an integrated set of factors within and outside

the health sector
Catalysts: Leadership of key stakeholders and use of innovative strategies
to drive progress
Context-specific: Adapting a variety of potential solutions to countries
unique contexts
In conclusion: Accelerated progress is possible!

People-centred agenda that integrates efforts across:
Inclusive economic development
Environmental sustainability
Inclusive social development
Peace and security
Smart investments in the health sector that include:

Effective interventions across the life course for women and children
Access and quality at all levels of the health system
Mobilizing the power of communities
Accountability
All of us have roles to play
Govt /
Policy
makers Parliamenta
UN agencies
rians
Women
Health care Business
workers
and community
children
Academic
/research Donors
institutions Civil society
Thank you

Global Maternal and Newborn Health

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Global Maternal and Newborn Health

Uploaded by

Copyright:

Available Formats

8th International Medical Summer School 2016 www.doctorsacademy.

Global Maternal and Newborn Health

Professor Matthews Mathai

Wellbeing quality of life, disability

5.945 million deaths globally

Increasing proportion of newborn

Why mothers and newborns die

Why did Mrs X die?

Why did Mrs X die?

Why did Mrs X die?

This was not the first

The Road to Death and the Roads

Distant Factors Intermediate Factors Outcomes

Health & Pregnancy

Looking backwards, moving forwards

Maternal and infant deaths reported from Biblical times

Primary health care - focus on improving child survival

Reproductive health - targeting mothers to control population

Where is the M in MCH

It is difficult to understand why maternal mortality receives

*Rosenfield A, Maine D. Maternal Mortality A Neglected Tragedy. Where is the

Safe Motherhood Conference Nairobi, 1987

Goal 4: Reduce child mortality

Reduce by two thirds, between 1990 and 2015, the under-five

Goal 5: Improve maternal health

Reduce by three quarters, between 1990 and 2015, the maternal

Achieve, by 2015, universal access to reproductive health

Approaches to improving maternal and neonatal

Differences between maternal and newborn health

Effective interventions are available

Coverage levels for selected Commission

Increasing coverage with skilled attendants

Proportion of births attended by skilled health personnel

Maternal health care in Bharwani, India (Subha Sri

The policy of institutionalisation of childbirth alone does

Holding ourselves to account

Global Strategy for Women's

Finding the black box !

Each maternal death is a tragedy.

The silent numbers

Ending preventable maternal mortality

Global MMR of less than 70 per

Ending preventable newborn mortality and stillbirths is within reach!

Every Newborn Action Plan

Ending Preventable Maternal Mortality

Address all causes of maternal mortality,

Every Newborn Action Plan Strategic Objectives

Improve the quality of maternal and newborn care

Reach every woman and every newborn; reduce inequities

Harness the power of parents, families and communities

Count every newborn measurement, tracking and accountability

Care around the time of birth: a triple return on investment

Global Strategy for Womens, Childrens

What were determinants of success? p

Factors: Improvements in an integrated set of factors within and outside

In conclusion: Accelerated progress is possible!

Smart investments in the health sector that include:

All of us have roles to play

You might also like