Welcome

Global Issues and Strategy on Maternal, Newborn and child Health

Launching of the National Actions Plan for Accelerating Reduction of Maternal Mortality in Indonesia; Scaling-Up PMTCT in Indonesia; and Maternal Health Pocket Book

Thursday, 26 September 2013

Dr Long Chhun1Key messagesMaternal mortality trends and determinants in the Western World from 1880 to 1980 and Implications to Global efforts

Global Initiatives to improving Maternal, Newborn and Child Health

Discussion and recommendations on the current Global Maternal, Newborn and Child Health Issues and Strategy

Historical trend in maternal mortality rates in the Western World

USA had the highest MMRDifferences classification of deaths or methods of data collection3

Why did maternal mortality rates remain on a high plateau from the 1850s to the mid-1930s in the Western World?

Home deliveriesPuerperal fever Unnecessary interferencesocial class4What caused the abrupt change in the maternal mortality rate in the mid-1930s with the subsequent steep decline?

Ergometrine Blood transfusions Penicillin

Better Anesthesia & trainingSulfonamidesless interference in normal labourBetter organization of obstetric services5Lessons from the past history of the Western World and the needs for data for Developing WorldCauses of high rates of maternal mortality in Developing Countries today are reasonably similar to those in Western World in the 1870s .Profound decline in maternal mortality rates in Western World dependent on accurate data and system of continuous audit

During 1970s and 1980s, advances in statistical techniques and availability of data resulted in increasing availability and reliability of data on infant mortality, but no equivalent breakthroughs for measurement of maternal mortality

During 1985, first community studies on levels of maternal mortality in developing countries provided an estimation

Safe Motherhood and Child Survival1987: First international Safe Motherhood (SM) Conference Sound estimates based on new data for foundation of understanding and concernFirst international SM Conference in Nairobi 1989: World Summit for Children in New YorkMaternal mortality viewed within the context of ensuring the survival and health of children, largely by product of child survival effortsReduction in maternal mortality as one of the goals to be monitored along with increases in antenatal care attendance 1997: 10th Anniversary SM Meeting in Sri LankaEvery pregnancy faces risksEnsure skilled attendants at deliveryImprove quality and access of maternal care

7Critical actions for increasing Child SurvivalSkilled care during pregnancy and birthSafe and clean delivery at birthCare of the newborn at birthAppropriate feeding in sickness and healthExclusive breastfeeding for the first six months of lifeStarting at six months of age, appropriate complementary feeding with continued breastfeeding up to 2 years of age and beyondMicronutrient supplementation (at least vitamin A)Prevention of illnessVaccinationInsecticide-treated materialsWater, sanitation and hygienePrevention of mother-to-child transmission of HIVAntiretroviralsSafer infant feeding practicesTreatment of illnessOral rehydration therapy to prevent and treat dehydration resulting from diarrhoeaZinc to reduce the duration and severity of diarrhoeaAntibiotics for sepsis, pneumonia and dysenteryAntimalarials

Millennium Development Goals in 2000 and Subsequent Global Efforts

The Millennium Development Goals established in 2000, include MDGs 4 and 5: MDG 4: Reduce child mortalityTarget: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rateMillennium Development Goal 5: Improve maternal healthTarget 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratioTarget 5.B: Achieve, by 2015, universal access to reproductive healthPartnership for Safe Motherhood and Newborn Health merges with Child Survival Partnership and Healthy Newborn PartnershipWomen Deliver Conference held in London, 2007- 20th anniversary of Safe Motherhood InitiativesCountdown to 2015- Maternal, Newborn and Child Survival, 2008UN Leaders Summit for MDGs, 2010- Global strategy for Womens and Childrens Health

Global strategy for Womens and Childrens Health from the UN Summit 2010

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Status of MDG4 Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

Globally, significant progress has been made in reducing mortality in children under five years of age. In 2011, 6.9 million children under five died, compared with 12 million in 1990- 41% decline, from 87 deaths per 1000 live births to 51estimated number of measles deaths decreased by 74%, accounting for about one fifth of the overall decline in child mortalityDecline accelerated from 1.8% per year during 19902000 to 3.2% during 20002011 Despite improvement, the world is unlikely to achieve the MDG4 target In 2011, global measles immunization coverage was 84% among children aged 1223 monthsStatus of MDG5 Target 5.A. Reduce by three quarters, between 1990 and 2015, the maternal mortality ratioTarget 5.B. Achieve, by 2015, universal access to reproductive health

Significant reduction in the number of maternal deaths:from an estimated 543,000 in 1990 to 287,000 in 2010the rate of decline is just over half that needed to achieve the MDG targetIn 2008, 63% of women aged 15-49 years who were married or in a consensual union were using some forms of contraception11% who wanted to stop or postpone childbearing were not using contraceptionProportion of women receiving ANC at least once during pregnancy was about 81% for the period 20052011for the recommended minimum of four visits or more the corresponding figure is around 55%Proportion of births attended by skilled personnel remains less than 50% in WHO African Region

Discussion on opportunity and weaknessNeed to reduce maternal and newborn deaths Progress towards the health MDGs is being made, but is unequal and fragileReductions attributable to:technical requirements- data systems, professional expertise and access to technologies political enabling conditions- awareness of the problem and commitment to act Opportunities in place today in the developing world Technologies available and cost-effectivePolitical will existsHealth care professionals and women advocate for safe motherhood and MDGsMissing elements- health sector readiness:Combination of financial, human and organizational resources needed to provide required services Both recipient countries and donors need to investEvidence of local operational constraints and best practicesRecommendations to improving the health of mothers and children and achieving MDGs 4 & 5Effective interventions that are safe and evidence-basedOperations researchHealth systems to deliver the interventionsCommunity support systems to facilitate access to the interventionsMonitoring and evaluation systems to assess, monitor and evaluate progress, impact and accountabilityPolicies and strategies that set out how the resources needed to deliver resultsIncreased investment in the health of mothers and children, to align financial and technical support to the national health policy and strategyThank you very much for your attention!You can adapt this phrase to make a call to action16