Towards Equity and Towards Equity and Rights:Rights:

South Asian Partnerships South Asian Partnerships for Reducing Maternal for Reducing Maternal

Mortality Mortality

Maternal mortality in south Maternal mortality in south AsiaAsia

South Asia has the highest South Asia has the highest concentration of maternal mortality concentration of maternal mortality after sub-Saharan Africaafter sub-Saharan Africa

It is said to be responsible for almost It is said to be responsible for almost half of the estimated half a million half of the estimated half a million maternal deaths worldwide (Bhutta maternal deaths worldwide (Bhutta et al BMJ 2004)et al BMJ 2004)

MMR ranges from 23 per 100,000 live MMR ranges from 23 per 100,000 live births in Sri Lanka to 539 in Nepalbirths in Sri Lanka to 539 in Nepal

India’s unique positionIndia’s unique positionConsidered a world-class health care Considered a world-class health care

provider, but women are unable to provider, but women are unable to access the basic health care needed to access the basic health care needed to avoid maternal deaths and illnessesavoid maternal deaths and illnesses

Has the highest number of maternal Has the highest number of maternal deaths globally (WHO estimates deaths globally (WHO estimates 140,000)140,000)

Strong political will required to ensure Strong political will required to ensure that the 25 odd million births (and that the 25 odd million births (and abortions wherever needed) that take abortions wherever needed) that take place each year are safeplace each year are safe

Political will for maternal Political will for maternal healthhealth

““Maternal and Child Health is matter of Maternal and Child Health is matter of highest priority for our government …we highest priority for our government …we need a comprehensive approach to deal need a comprehensive approach to deal with the painfully high levels of maternal with the painfully high levels of maternal and child mortality … We have the and child mortality … We have the knowledge, we have the resources; what knowledge, we have the resources; what is needed is a collective will …” – is needed is a collective will …” –

Speech by Sonia Gandhi, Chairperson UPA Speech by Sonia Gandhi, Chairperson UPA at the WHO meeting in Delhi 7 April 2005at the WHO meeting in Delhi 7 April 2005

Comparative dataComparative data (Bhutta et al, BMJ (Bhutta et al, BMJ 2004)2004)

Est. 1000 Est. 1000 birthsbirths

MMRMMR % Skilled % Skilled birth birth attendanceattendance

% TT % TT coveragcoveragee

IndiaIndia 2448924489 440440 3434 7373

BangladesBangladeshh

35043504 600600 1313 8585

PakistanPakistan 53495349 200200 1919 5151

NepalNepal 8282 830830 99 6565

Sri LankaSri Lanka 328328 6060 9494 9191

Health and related expenditureHealth and related expenditureHDIHDI Gross Gross

National National Inc/ Inc/ capitacapita

Per Per capita capita exp exp health health 20012001

% govt % govt exp exp health health ‘92-2001‘92-2001

% govt % govt exp on exp on defencedefence

ODA in ODA in mill.$mill.$

20012001

BanglaBangladeshdesh

139139 360$360$ 5$5$ 5%5% 10%10% 10241024

IndiaIndia 127127 480$480$ 4$4$ 2%2% 16%16% 17051705

NepalNepal 143143 230$230$ 3$3$ 5%5% 5%5% 388388

PakistPakistanan

144144 410$410$ 4$4$ 1%1% 18%18% 19381938

Sri Sri LankaLanka

9999 840$840$ 15$15$ 6%6% 18%18% 330330

What does the data indicate?What does the data indicate?

The fundamental obstacle remains the The fundamental obstacle remains the willingness of the governments and policy willingness of the governments and policy makers to give due importance to and makers to give due importance to and apportion resources for human development apportion resources for human development and public health and public health

Investment in maternal and child health as a Investment in maternal and child health as a central focus of public health policy is criticalcentral focus of public health policy is critical

Lessons may be learnt from better Lessons may be learnt from better performance in other countries such as Sri performance in other countries such as Sri LankaLanka

Strategies in Sri Lanka Strategies in Sri Lanka (Senanayake, (Senanayake, 2005)2005)

Maternity Care including surgery and Maternity Care including surgery and blood transfusion is available free of blood transfusion is available free of cost to every woman in Sri Lankacost to every woman in Sri Lanka

During their ‘high MMR’ stage, Sri During their ‘high MMR’ stage, Sri Lanka managed with a strategy of Lanka managed with a strategy of low level skilled attendancelow level skilled attendance

Established foundations forEstablished foundations forProfessionalized midwiferyProfessionalized midwiferyMonitoring systemsMonitoring systemsAdvocacyAdvocacy

Strategies in Sri LankaStrategies in Sri Lanka

Gave priority to improving Gave priority to improving access to rural & marginalized access to rural & marginalized groupsgroups

Improvement of utilization of Improvement of utilization of available services by improved available services by improved quality of carequality of care

Focus on Client Empowerment Focus on Client Empowerment (Demand side)(Demand side)

Maternal death Audit in Sri Maternal death Audit in Sri LankaLanka

Maternal mortality reviews from Maternal mortality reviews from 1970:1970:

Visits to home and hospital for Visits to home and hospital for each maternal deatheach maternal death

Detailed report and fact-finding Detailed report and fact-finding enquiry (not fault finding)enquiry (not fault finding)

Regional and national meetings to Regional and national meetings to plan remedial measuresplan remedial measures

Recommendations for 11Recommendations for 11thth PlanPlan

Empowerment of users through massive Empowerment of users through massive public education on entitlementspublic education on entitlements

Training of all community birth Training of all community birth attendants (low to medium skilled) for attendants (low to medium skilled) for ensuring that all deliveries are covered ensuring that all deliveries are covered

Offer completely free comprehensive Offer completely free comprehensive maternal care including post-partum and maternal care including post-partum and post-abortion care, to women, in post-abortion care, to women, in accessible institutions,accessible institutions,

User groups and Panchayats to monitor User groups and Panchayats to monitor the quality of care through Social Audit of the quality of care through Social Audit of facilities and services in both public and facilities and services in both public and private hospitals in rural areasprivate hospitals in rural areas

Recommendations for 11Recommendations for 11thth PlanPlan

Use of IT (all ‘dais’ with special mobile Use of IT (all ‘dais’ with special mobile phones) for monitoring all births and for phones) for monitoring all births and for improved referral to institutions during improved referral to institutions during complicationscomplications

Strengthen the system of auditing maternal Strengthen the system of auditing maternal deaths (based on Sri Lanka model)deaths (based on Sri Lanka model)

Examine evidence from different parts of Examine evidence from different parts of the country to understand what works best the country to understand what works best where – especially in rural, hilly, tribal, where – especially in rural, hilly, tribal, conflict-ridden /disturbed, remote, poor or conflict-ridden /disturbed, remote, poor or urban slum areasurban slum areas

Recommendations for 11Recommendations for 11thth PlanPlan

Provide for learning opportunities and Provide for learning opportunities and exchanges/study visits for policy makers, exchanges/study visits for policy makers, managers and providers to learn how to managers and providers to learn how to address Maternal Mortalityaddress Maternal Mortality

(Especially from states with greater need to (Especially from states with greater need to improve maternal health services - EAG improve maternal health services - EAG states and Assam) states and Assam)

Strengthen the Civil Society – Strengthen the Civil Society – Government interface on this crucial Government interface on this crucial issue by constituting a National issue by constituting a National Maternal Health Task ForceMaternal Health Task Force

WHRAP Policy DialoguesWHRAP Policy Dialogues

Recognizing that the region has many Recognizing that the region has many similarities in terms of problems as well as similarities in terms of problems as well as situation on the ground - situation on the ground -

Policy makers, technical experts and Policy makers, technical experts and officials from Pakistan, Nepal, Bangladesh officials from Pakistan, Nepal, Bangladesh and India have been meeting at Regional and India have been meeting at Regional Policy DialoguesPolicy Dialogues

These are organized by WHRAP, a civil These are organized by WHRAP, a civil society network in South Asiasociety network in South Asia

A Sub-regional Task Force is being formed A Sub-regional Task Force is being formed to take up the issue of maternal health to take up the issue of maternal health and young people’s access to SRH rights.and young people’s access to SRH rights.

Thank you!Thank you!

Jashodhara DasguptaJashodhara Dasgupta

SAHAYOGSAHAYOG

Lucknow, UPLucknow, UP