PRESENTATION 1.

Current Approach to Reduction of

Maternal and Neonatal Mortality

Federal Democratic Republic of Ethiopia

Ministry of Health

BEmONC – LRP
ETHIOPIA Best Practices in Maternal and Newborn Care
 Session Objectives

 By the end of this session participants will be able

to:
 Recognize the situation of maternal and neonatal
mortality & morbidity globally and in our country
specifically.
 Describe factors affecting maternal and perinatal
mortality and morbidity.
 Review interventions to reduce maternal and neonatal
mortality

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Best Practices in Maternal and Newborn Maternal and Neonatal Mortality
 What Is Safe Motherhood?

“ A woman’s ability to have a SAFE and

healthy pregnancy and childbirth. ”
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 Definitions

 Maternal Death = is defined as 'the death of a

woman while pregnant or within 42 days of
termination of pregnancy, irrespective of the duration
or site of pregnancy, from any cause related to or
aggravated by the pregnancy or its management but
not from accidental or incidental causes.

 Can be Direct or Indirect Maternal Deaths

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Best Practices in Maternal and Newborn Maternal and Neonatal Mortality
 Definitions; contd..

 Define:
 Maternal Mortality Ratio
 Perinatal Mortality
 Perinatal mortality Rate

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Best Practices in Maternal and Newborn Maternal and Neonatal Mortality
 Definitions; contd..

 Define:
 Maternal Mortality Ratio: the number of maternal deaths during
a given time period per 100,000 live births
 Perinatal mortality Rate ( stillbirths >28weeks and early
neonatal deaths (neonatal deaths within 7 days) in a given
population per thousand live births

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Best Practices in Maternal and Newborn Maternal and Neonatal Mortality
 Maternal Mortality: A Global Tragedy
 Annually, 303,000 women
die of pregnancy related
complications*
 99% in developing world

 ~ 1% in developed

countries
 Many millions more suffer

complications e.g. obstetric

fistulae, secondary
infertility
*WHO-2015 report

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Best Practices in Maternal and Newborn Maternal and Neonatal Mortality
 Maternal Mortality trends

 Globally, the total number of maternal deaths

decreased from 543 000 in 1990 to 303 000 in 2015.
 Likewise, the global maternal mortality ratio (MMR)
declined from 400 maternal deaths per 100 000 live
births in 1990 to 216 in 2015

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Best Practices in Maternal and Newborn Maternal and Neonatal Mortality
 Ask group: What are the major causes
of maternal mortality?

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Best Practices in Maternal and Newborn Maternal and Neonatal Mortality
 Causes of maternal deaths, global

*Nearly all (99%) abortion deaths are due to unsafe abortion.

Other direct causes include embolism, ectopic pregnancy, anesthesia-related. Indirect
causes include: malaria, heart disease.
Source: WHO 2014

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Best Practices in Maternal and Newborn Maternal and Neonatal Mortality
 Maternal Mortality in Ethiopia

 According to EDHS 2016 only 26% of pregnancies are

attended by a skilled health provider
 Maternal mortality ratio decreased from 871/100,000 live
births in 2000 to 412/100 000 live births in 2016 (DHS-2016)
 Ten countries including Ethiopia account for nearly 59% of
global maternal deaths (Trends in maternal mortality: 1990 to 2015, Estimates
by WHO, UNICEF, UNFPA…)

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Best Practices in Maternal and Newborn Maternal and Neonatal Mortality
Maternal Mortality in Ethiopia; contd…

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Best Practices in Maternal and Newborn Maternal and Neonatal Mortality
 Causes of maternal mortality in Ethiopia;
(Facility based study)
Causes of maternal mortality in Ethiopia; (Facility based study)
Women with Maternal
Complications (%) Deaths (%)
Total DIRECT complications/causes 90 43
• APH 4 2
• PPH/Retained placenta 7 10
• Ruptured uterus 1 2
• Obstructed/ Prolonged labor 18 4
• Postpartum sepsis 1 2
• Severe pre-eclampsia / eclampsia 6 10
• Severe complications of abortion 2 1
• Others:
Abortions with less severe complications 25 NA
Direct complications from other causes 26 12
Total INDIRECT complications/causes 10 5
• HIV/AIDS - related 7 0
• Anemia 1 2
• Other indirect causes 2 2
• Undefined cause NA 52
TOTAL 100% 100%

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Best Practices in Maternal and Newborn Maternal and Neonatal Mortality
 Neonatal Health: Scope of Problem

 Newborn health and survival are closely linked to

care the mother receives before and during
pregnancy, childbirth, and the postnatal period.
 Every year:
 4 million neonatal deaths (first month of life)
 4 million stillbirths
 Eight neonatal deaths every minute
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 Two-thirds Rule
Global Infant Mortality Rates
More than 7 million infants die annually between birth and
12 months of age
 Of those who die in the first year
 Nearly 2/3 die in the first month

 Of those who die in the first month

 2/3 die in the first week

 Of those who die in the first week

 2/3 die in the first 24 hours

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 Ask group: What are major causes of
neonatal mortality?

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 Causes of Newborn Death

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 Ethiopia’s Neonatal Health status

 Neonatal mortality is 29 per1,000 live births (DHS 2016).

 50 percent of infant deaths in Ethiopia occur during the first
month of life.
 One in every 17 Ethiopian children dies before reaching age
one

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 Child Mortality Rate trends in Ethiopia:
NMR, IMR and U5MR

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Best Practices in Maternal and Newborn Maternal and Neonatal Mortality
 But WHY Do These Women and Newborns
Die?
Three Delays Model
 Delay in decision to seek care
 Lack of understanding of complications
 Acceptance of maternal and newborn death
 Low status of women
 Socio-cultural barriers to seeking care
 Delay in reaching care
 Mountains, islands, rivers - poor organization
 Lack of transport
 Delay in receiving care
 Lack of triage system
 Lack of supplies, personnel
 Poorly trained personnel; poor attitudes
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Ask group: What are the key interventions to reduce
maternal and neonatal mortality?

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 What are the key interventions to reduce
maternal and neonatal mortality?

 Access to family planning

 Skilled attendants during pregnancy and childbirth
 Access to emergency obstetric and newborn care
(EmONC),
 Effective referral system
 Fully functioning health services 24/7

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 Most important intervention:
Skilled Attendant at Childbirth
A skilled health provider is:
 an accredited health professional – midwife, doctor or nurse – who
has been educated and trained to proficiency in the skills needed to
manage normal (uncomplicated) pregnancies, childbirth and the
immediate postpartum period and in the identification, management
and referral of complications in women and newborns
(WHO, ICM & FIGO 2004)

WHO 1999. BEmONC – LRP: Ethiopia Current Approach to Reduction of

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 EmONC Signal Functions

Basic EmONC Comprehensive EmONC

1) Administer parenteral antibiotics Perform EmOC Signal functions 1-7, plus:

2) Administer uterotonic drugs (e.g. 8) Perform surgery (e.g. cesarean delivery)

parenteral oxytocin, misoprostol)
3) Administer parenteral anticonvulsants 9) Perform blood transfusion
(e.g. magnesium sulfate)

4) Perform manual removal of placenta 10) Provision of emergency obstetric

anaesthesia
5) Perform removal of retained products
(e.g. MVA)
6) Perform assisted vaginal delivery (e.g.
vacuum extraction)
7) Perform neonatal resuscitation (e.g. with
bag and mask)
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 Evidence based care
 For years, much of BEmONC was provided according to
“tradition” and “routine” practice rather than according to
evidence.
 To be effective, care should be evidence-based.
 We have better understanding of emergency obstetric care
(EmOC) and ‘best practices’ in labour and delivery and
 Enhanced appreciation of the role that community
mobilization, birth preparedness, and a continuum of care
make

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Best Practices in Maternal and Newborn Maternal and Neonatal Mortality
Proven Interventions for Maternal Survival

 Magnesium Sulfate  Nutrition Counseling

 Calcium  Iron Folate
 Partogram  IPTp, Malaria
 Cesarean Section Control

 Clean Delivery
 Antibiotics
 Tetanus Toxoid

 Active Management
of the Third Stage
 Family Planning
of Labor
 Postabortion Care  Misoprostol
Source: WHO Analysis of causes of maternal deaths: A systematic review.” The Lancet, Vol 367, April 1, 2006.

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Best Practices in Maternal and Newborn Maternal and Neonatal Mortality
 What do women want?
 Clean facilities
 Women friendly care – kindness,
respect, information
 Availability of drugs and medical
equipment
 Culturally appropriate services

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 Summary

Skilled attendant at all childbirth is one

of the most effective interventions to
prevent maternal and perinatal mortality
and morbidity

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