Safe Motherhood: an international perspective

Prof Dr Valerie Fleming

Director World Health Organisation Collaborating Centre

What is Safe Motherhood?• Enter the term into google and almost

600,000 hits are returned.

• The vast majority of these focus on the programme supported by UN agencies supporting Millennium Development Goal Five: to improve maternal health by reducing the maternal mortality ratio by 75%, between 1990 and 2015.

UN programme goals• Implementing an advocacy/media strategy to

refocus global attention to improving the health of women and newborns in developing countries;

• Stimulating national-level commitment to make safe motherhood/newborn health a priority within national development plans and aid requests;

• Promoting effective interventions to improve the application of technical knowledge and research findings.

Safe Motherhood

• In 2008 almost 1 million women died in childbirth (960,216) (UNFPA);

• Latest WHO statistics show a global Maternal mortality rate of 400/100,000 live births (1/100,000 in Ireland and 2,100/100,000 in Sierra Leone).

Differences in different regions

Region MMR/ 100,000 live births (2005)

Africa 900

Americas 99

Eastern Mediterranean 420

Europe 27

South – east Asia 450

Western Pacific 82

Differences in different regions

Region MMR/100,000 live births

Developed regions 9

Developing regions 450

Commonwealth of Independent States

51

What is safe motherhood?

Becoming pregnant

• Carries with it real chance of dying;

• Basic public health issues lacking;

• Little or no antenatal care available;

• May be international organisations providing care which:– Conflict with local practices;– Conflict with each other.

Giving birth

• Women often in poor state of general health;

• Problems often not detected until labour established;

• Lack of skilled personnel;

• Lack of sanitation;

• Lack of any equipment.

The new family

• Lack of follow up care;

• Women suffering complications of prolonged labour;

• Usually supportive extended family;

• Many orphaned infants due to high maternal death rate.

Exceptions

• Increasing gap between rich and poor;

• Statistics of rich moving towards those of developed countries;

• Women caught up in conflict between relief organisations;

• Women abandoned when “donors” depart.

What is safe motherhood?

Becoming pregnant

• Chosen services are available:– May mean all medical facilities;– Health professional of choice;– Regular antenatal care;– Good referral system if required;– Expectation of healthy mother and baby

but awareness that sometimes things go wrong.

Giving birth

• Most women give birth with skilled professionals in attendance;

• Many births in highly medicalised settings;

• Expectation of pain free labour or elective Caesarean section;

• Social support in labour.

The new family

• Early discharge from hospital;

• Expectation of normality;

• Follow up support may be available in community setting;

• Maternity pay with option to return to work.

How do expectations equate to safety?

• Choice dominates but increasing interventions carry increased morbidity;

• Professionals become deskilled leading to further intervention;

• Because of low mortality rates may become complacent and ignore minority groups such as those in poverty, poor health etc.

Microsoft Office Word 2007.lnk

What is safe motherhood?

Becoming pregnant• High incidence of abortion;

• Some community based ante natal care available;

• High incidence of bribery leading to split between those how can afford to pay and those who cannot;

• Lack of motivation of health professionals and few skilled midwives.

Giving birth

• Outdated equipment and practices;

• Lack of any attention to dignity;

• Some professional support;

• No social support;

• Often professional brutality.

The new family

• Little follow up care;

• Pilot projects are in place in Uzbekistan and Tajikistan;

• Midwives little in evidence;

• Midwives need better education!

Safe Motherhood?

• Money buys professional care;

• Long term problems likely such as fistulae and prolapses due to indiscriminately accelerated labours;

• Secondary infertility after repeated abortions.

Safe Motherhood• What does this mean?

• No universal definition possible.– Sub Saharan Africa generally means

prevention of death;– Eastern Europe means improving quality of

life;– Northern America means maximising the

experience;– What is it in your own experience?