Maternal Morality: 1990-2011 Asia and Pacific Stories of Tremendous Successes

Dr Monir Islam, Director Health System Development World Health Organization South East Asia Regional Office

Asia and Pacific: Comparison of MMR Estimates

1400
1200

1200

1000

970

800
690 640

790 650 580 470

600

400

350 290 130 110 93 79 31

340

200
110 82 60 44 38 56 46 39 34

300 290 270 250 180 140 120 110

170 94 120 91 66 56

65

P N G

es

ia

bo d

C hi

La

on g

lli p

al a

C am

Baseline 1990

1995

2000

hi

2005

ie

Source: Trends in Maternal Mortality: 1990 to 2008: Estimates developed by WHO, UNICEF, UNFPA, and The World Bank.

tn am

na

ia

os

ys i

ol

in

2008

South East Asia: Comparison of MMR Estimates

1000 900 800 700 600 500 400 300 200 100 0

940 850 870

700 600 500 420 340 260 190 200 280 230 212 420 440 390 440 350 350 270 229 219 420 411 316 240 229 440 650 570 620 550

Bangladesh

Bhutan

India

Indonesia

Myanmar

Nepal

1990

1995

2000

2005

2008

2010

Vulnerable population vs facility childbirth

75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 0 Nigeria 2003 (MMR 1100) Pakistan 2006/07 2004 (MMR 1500) Bangladesh 2004 (MMR 570) Chad 2004 (MMR 1500) Egypt 2005 (MMR 130) Philippines 2003 (MMR 230)

% of childbirth at health facilities

Age group of 15-19 year Birth interval of less than 24 months

Age group of 40 year and above Mother with 5 or more children

Lets talk about Bangladesh!

Service Utilization: Bangladesh 1999-2007

Childbirths in Bangladesh

Childbirths by C-Section

What About Cambodia?

Geographical inequities of Childbirths by SBA

Geographical inequities of Childbirths by C-Sections

When, Where and Why women give their lives for bringing lives

Timing of death is critical

160 140
Deaths per 1000 person year

120 100 80 60 40 20 0
1 2

Most deaths cluster around labour or within 24 hours after delivery

18 0

an c

43 -

-3 65

84

ay

ay

91 -

pr e

ay

ay

ur in

Time since pregnancy

ay

18 1

gn

ay

Source Ronsmans C& Graham W 2006; Lancet (9542):1189-200.

Matlab, Bangladesh

Ye

ay

ar 2

37

90

Place of maternal deaths (74% in health facilities)

10% 5% 13% 13% 3% 6%

50%

Home Provincial hospital

TBA home Central hospital

Clinic Traveling

Rural hospital

Source: Fawcus S, Mbizvo MT, Lindmark G, Nystrom L. A community based investigation of causes of maternal mortality in rural and urban Zimbabwe. Maternal Mortality Study Group. Cent Afr J Med. 1995 Apr;41(4):105-13.

Reason for not going to health facility

DHS data from 26 countries in Africa (N=250000 women)

Demand or supplies or its organization of services or its all about Quality?

My photo stories

PNG

Bangladesh: any other districts

Bangladesh: the LAMB facilitiess

Integrated

Community

Hospital

1. Home

2. Safe Delivery Unit Obstetric First Aid

3. Lamb Hospital Comprehensive EOC

So it is not an impossible task

Lamb Hospital Deliveries

LH Deliveries by Year
4500 4000 3500 3000 2500 2000 1500 1000 500 0

number of deliveries

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 deliveries 492 711 674 740 776 882 1288 1363 1526 1686 2251 2156 2352 2673 3181 3723 3719 3444 3039 3321 3821 year

Bangladesh: Its Chowgacha - so its possible!!

Stories of India: Demand side: What about supplies and quality?

Stories of India: So, its doable!!!

Way Forward

Its about demand side along with supply side financing

Its about organization of services

Its about quality Its about monitoring

Its all about Health System

Quality Facility Childbirths: Live saved, stillbirth prevented

Thousands 1,200
Number of newborn deaths/ stillbirth averted
1,000

Thousands 250
Number of maternal deaths averted

200

800 150 600

100

400 200 0 2009 2010 2011 2012 YEAR

Stillbirth averted Newborns deaths averted Maternal deaths averted

50

0 2013 2014 2015

Source: WHO Framework for accelerated reduction of maternal and newborn mortality, 2009.

Real partnership will be necessary to achieve our goals

No more poor options for poor people Developing countries are not rich enough to invest on cheap ideas and strategies

Because Women Deserve the Best