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Eradicating Preventable Maternal Deaths:Learning from Success Stories and Moving Forward

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Significant Progress

Global andregional maternal mortality in decline

Better measurement of maternal mortality

Consensus on safe and effective interventions for most

critical causes of MM

Higher proportion of deliveries by skilled attendants

Country level commitment to MDG5

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Progress at the Country Level:Maternal Mortality in Egypt & Iran

232.6

80.2

69.5

56.8

16.4

1990 2000 2011

Egypt

Iran, Islamic Republicof

Source: 2011 IHME

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Progress at the Country Level:Maternal Mortality in Malaysia & Sri Lanka

83.2

48.2

73.6

32.6

1990 2000 2011

Malaysia

Sri Lanka

Source: 2011 IHME

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Maternal Mortality in Bangladesh

Source: 2011 IHME

593.1

417.1

247.0

1990 2000 2011

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What We Know Works

1

2

3

4

Strong politicalcommitment to

maternalhealth

Improvedinfrastructure

Improved qualityof care

More skilledproviders

Better supplysystems

Evidence-

basedguidelines

Functional

referralsystems

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What We Know Works

5

6

7

8

Affordable &accessible

facility-basedservices

Comprehensivereproductivehealth careservices

Communityinvolvement

Strong data

for decision-making &targeting ofinterventions

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Big Challenges Remain

Ethiopia

India

Dominican Republic

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Ethiopia

Notable commitment to reduce maternal morbidity andmortality at the national level

Health Sector Development Program Improving the facility infrastructure Training health care providers Promoting referrals to health facilities for birth

Despite these efforts, MMR remains stubbornly highlow utilization of services (10%) poor quality of care

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India

Notable commitment to reduce maternal morbidity andmortality at the national level

Janani Suraksha Yojana(JSY) is the largest conditionalcash transfer program aimed at increasing institutionaldeliveries in the world.

Evidence of positive impact on perinatal & neonatalhealth

The verdict is still out in terms of impact on maternalhealth

India has seen a reduction in MMR, but maternalmortality remains a serious problem.

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Dominican Republic

The DR has a relatively high maternal mortalityratio despite nearly universal coverage ofinstitutionalized deliveries

Major referral hospitals are overcrowded &understaffed

Normal deliveries are over-medicalized

Complicated deliveries are often not handled in anappropriate or timely manner

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What might explain this limited progress?

1. Access and availability of services do notguarantee utilization or improved healthoutcomes

2. Critical challenges with quality of care persist

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The Way Forward:Improving the Quality of Maternal Health Care

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Maternal Health Task Force:Narrowing the Focus

Pre-conception

1st Trimester

Labor onset

Delivery

Immediate Postpartum (24 hours)

28 days

42 days

Time

2nd Trimester

3rd Trimester 7 days

Risk

ofMortality

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A focus on supporting promising innovative strategies for

improving quality of maternal health care

12

3

A focus on developing & improving tools to measure quality of care

4

A focus on supporting educational opportunities & technical capacitybuilding for maternal health professionals

A focus on improving the quality of interpersonal & technicalmaternal health care

The Approach of the

Maternal Health Task Force

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The question

should not be whydo women not

accept the servicethat we offer, but

why do we not offera service that

women will accept

- Mahmoud Fathalla, 1998

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Thank you!

Maternal Health Task Forcewww.maternalhealthtaskforce.org

Women andHealth Initiativewww.hsph.harvard.edu/women-and-health-initiative

http://www.facebook.com/pages/Maternal-Health-Task-Force/195664518984http://twitter.com/MHTFhttp://www.facebook.com/pages/Maternal-Health-Task-Force/195664518984http://twitter.com/MHTF