Introduction to global crisis match course

MatCh Course

Understanding the maternal- child

global health crisis

Illuminate the darkness. Ignite the hope.

Around the world, each day of every year is indelibly marked by the deaths of mothers and children whose lives are lost

from causes that are entirely preventable.

These deaths don’t number in the hundreds or even thousands,

but in the millions.

Huffington Post- Global Motherhood January 2014

www.everymothercounts.orgWHO, Maternal Health Task Force, UNICEF, UNFPA, WorldBank, Amnesty International, USAID, the Guttmacher Institute, the Millennium Development Goals Report 2007

One death every 2 minutes =

almost 800 women every day and 287, 000 per year.

These women die from pregnancy and childbirth complications, making reproductive health problem the leading cause of death worldwide among women.

http://www.everymothercounts.org/

Experts estimate that 90% of these deaths are PREVENTABLE.

www.everymothercounts.orgWHO, Maternal Health Task Force, UNICEF, UNFPA, WorldBank, Amnesty International, USAID, the Guttmacher Institute, the Millennium Development Goals Report 2007


15 % of all pregnancies result in a potentially fatal complication during

labor and birth.

WHO, Maternal Health Task Force, UNICEF, UNFPA, WorldBank, Amnesty International, USAID, the Guttmacher Institute, the Millennium Development Goals Report 2007

Pregnancy is the biggest killer of women ages 15-19 in the developing world. Nearly 70,000 young women die every year because their

bodies are not ready for childbirth.


Sub-Saharan Africa faces the greatest crisis. 1 in 39 women are likely to die during childbirth. (1 in 3,800 in developed nations)

9 out of 10 women will lose a child in her lifetime.

Only 30% of women in sub -Saharan Africa will ever have contact

with a health

professional

during the

postpartum

period.


The United states ranks 50th globally in maternal

health even though we spend more per capita

than any other nation.

vs.


For every death there are 20 life changing injuries and

complications. That means 7 million women suffer from post-delivery infections,

disabilities and severe injuries.


A Walk to Beautiful a 2007 documentary depicting birth injuries in Ethiopia.

USAID estimates that $15 billion in productivity

is lost each year due to maternal and newborn

Mortality.

Women spend at least twice as much time as

men on domestic work, and when all work – paid

and unpaid – is considered, women work longer

hours than men do.


United Nations Statistics Division 2013

Estimates state over 200 million women

would like to choose when they get

pregnant, but do not have access to modern contraception.

Giving these women access would reduce the number of maternal deaths

due to unsafe abortions and

pregnancy complications.WHO, Maternal Health Task Force, UNICEF, UNFPA, WorldBank, Amnesty International, USAID, the Guttmacher Institute, the Millennium Development Goals Report 2007

Higher education levels = Less chance of maternal death

Educated women, choose to have a skilled birth attendant

with them during delivery 84% of the time.

Skilled Birth Attendant: A skilled attendant operating within an enabling environment or health system capable of providing care for normal deliveries as well as appropriate emergency obstetric care for all women who develop complications during childbirth. UNPF


“We know what works.” WHO

We know what it takes to prevent 90% of all

maternal deaths and they are often very

simple, common-sense, affordable solutions.


Index MUNDI

In 2000, 189 countries committed to ending extreme poverty worldwide through the achievement of the eight Millennium Development Goals (MDGs) by 2015.

MDG 5 Improve Maternal Health

Unfortunately, MDG 5 has made the least progress.

“With increased awareness, leadership, policy and funding, this can change.”

www.everymothercounts.orgMap- un.org


In the most resource-poor countries, maternal mortality has been attributed to what is called the three delays. These are:

The delay in deciding to seek care

The delay in reaching care in time

The delay in receiving adequate treatment

• The first delay is generally due in part to the mother; the family; an unskilled birth attendant; the community not recognizing a potentially life-threatening condition; not having the money to pay for care; social or cultural barriers including fear of going to a hospital; or males having the decision-making power.

• The second delay can be due to a lack of transportation, the remoteness of a mother’s location, or poor infrastructure, such as bad road conditions.

• The third delay occurs at the health care facility due to inefficient or inadequate care, such as the facility’s lack of supplies, appropriate staff, or the inability to provide critical care for hemorrhaging, infection or other emergency conditions.

www.everymothercounts.org

Up to 15% of all women who give birth suffer life-threatening complications that, in most cases, can be treated with emergency obstetric care.

Central to the efforts to reduce maternal mortality worldwide is making emergency obstetric care available to all women.

The five major causes of maternal mortality—

1. Hemorrhage2. Sepsis 3. Unsafe abortion4. Obstructed labor5. Hypertensive disorders including preeclampsia and eclampsia

Most all are treatable if the woman has Access to trained healthcare workers at a well-equipped health facility.


Note: Other causes of maternal death include ectopic pregnancy, embolism, other direct and indirect causes, and unclassified ed deaths. Percentages in the pie chart do not total 100% because of rounding.Source for figures on this page: World Health Organization, UNICEF, United Nations Population Fund and the World Bank, Maternal Mortality in 2005, 2007. Causes of maternal death: Khan, Khalid S., et al., ’WHO Analysis of Causes of Maternal Deaths: A Systematic Review’, The Lancet, vol. 367, no. 9516, 1 April 2006, pp. 1066-1074.

80% of all maternal mortality occurs within 24

nations. With the exception of Afghanistan,

has the highest rate of maternal

mortality world-wide.

Somalia followed by the Democratic Republic of the Congo is the worst place to give birth, where a woman

has more than a 1 in 20 chance of dying. Sierra Leone has the world's worst lifetime maternal risks of death.

The riskiest thing a woman can do in Sierra Leone is get pregnant.

Babies in sub-Saharan Africa are more than seven times as likely to die on the day they are born than babies in industrialized countries.

www.savethechildren.org


The world’s leading non-governmental organizations (NGOs) have determined a key set of care-related factors that continue to contribute to the large number of women dying during pregnancy and childbirth:

1. Lack of health workers.

Half of the world’s women give birth at home ALONE or with only a friend or relative to help

. Skilled attendance at all births is considered to be the single most critical intervention for

ensuring safe motherhood.Up to 15 percent of all births are complicated by a potentially fatal condition and yet almost all are treatable when there is a skilled attendant present to recognize problems early and to intervene and manage the complication.

2. Lack of equipment and supplies. Even when a woman does get to a health center, there may be no trained staff, no drugs, no blood bank, nor the necessary surgical equipment and skills to perform a caesarean section.

3. Transportation. Rural women are far less likely than their urban counterparts to receive skilled care during childbirth. In rural areas, health clinics and hospitals are often spread out over vast distances and transportation systems are often rudimentary. It can take all day or night for a woman to walk to a health center, and even more time for her to get to a referral hospital for emergency care. A woman can bleed to death in two hours, and such delays cost many women and newborns their lives. 4. Funds. A lack of money means that many women can’t buy the simple things needed for their care, let alone pay the fees often charged by clinics and health workers.


20 million of the estimated 210 million who become pregnant each year experience life-threatening complications, many of which occur during the postpartum period.

In fact, up to 50 percent of all maternal deaths take place during the first 48

hours after delivery.


Postpartum care is a key intervention necessary to reducing maternal

mortality worldwide.

It is ESSENTIAL women be educated on how to care for themselves and their babies.

This includes:

Knowing the warning signs of complications and where to go for emergency care

Having access to regular screening and treatment for health conditions, such as hypertension, that are aggravated by pregnancy and childbirth

Having access to family planning information and services.


Family Planning

The planning and spacing of births has a powerful impact on the survival of the mother and her child.

Children born less than 2 years after a previous birth are about two-and-a-half times more likely to die before the age of five than children born 3-5 years after the previous birth.

Complications of pregnancy and childbirth are the leading cause of death for young women aged 15 to 19 in developing countries. Compared to women in their twenties, girls aged 15 to 19 are twice as likely to die in childbirth.

Girls under the age of 15 are five times as likely to die in childbirth.

Mortality and morbidity rates are also higher among infants born to young mothers.


Many women do not use health services during pregnancy and childbirth because their families simply

cannot afford the costs.

Improving the health care system overall is

undoubtedly a critical component to reducing

maternal mortality and improving the

general health of a nation.

“We have identified the barriers and we know what it takes to prevent maternal mortality, but we

continue to need strong leadership, policies and political agendas that will commit to and deliver the

necessary resources for women to have safe pregnancies.


”

The use of birth attendants is

considered an essential, if sometimes

controversial, health service for women,

particularly those living in rural areas, who are

either too far from health centers or unable to

afford the cost of

getting there or using

The available services.

• Liz Ford in Kuala Lumpur theguardian.com,

800 women die per day

287,000 per year

99% in developing nations

Highest in rural areas

Higher still amongst teen mothers.

1 woman dies every 2 minutes

WHO

"Many things have gone wrong with the world that God made and...God insists, and insists

very loudly, on our putting them right again."

C. S. Lewis

This is not the job of the agencies...or the politicians...this is the mandate of the Church.

Christ in you the hope of glory.

Colossians 1:27

“Time is ripe for breakthrough in child mortality.”

Mark Tran theguardian.com, Tuesday 28 August 2012 07.27 EDT

2,000,000 Babies Die ...

...the Day They’re Born

www.savethechildren.org

Co

pyrights S

oph

ie G

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Every year nearly 41% of all

under-five child deaths are newborn infants, babies in their first 28 days of life .

WHO 2011

Three quarters of all newborn deaths occur in the first week of life.

WHO 2011

In developing countries nearly half of all mothers and newborns do not receive skilled care

during and immediately after birth. WHO 2011

Several aspects go hand-in hand with the maternal-child health crisis and we cannot look at one without looking at the others.

Poverty

Malnutrition

Under Five Death

Lower Levels of Education

Injustice particularly Gender-based Injustice

Records show more than 1,200 newborns killed and dumped in Pakistan last year.

Many of those killed are girls because of cultural attitudes and poverty.

In some countries, infanticide of girls is enough to skew population figures, U.N. Says.

-Video-

"The real power lies in … invoking the response in people to demand more from their health service. Often there is a feeling if someone dies it's God's will. There is a cultural fatalism," says Yilla (a local midwife).

Up to two thirds of newborn deaths can be prevented if known, effective health measures are provided at birth and during the first week of

life. WHO 2011

Of the 8.2 million under-five child deaths per year, about 3.3 million occur during the neonatal period

—in the first four weeks of life. WHO 2011

The majority - almost 3 million of these - die within one week and almost 2 million on their

first day of life. WHO 2011

A child’s risk of death in the first four weeks of life is nearly 15 times greater than any other time

before his or her first birthday. WHO 2011

Virtually all (99%) newborn deaths occur in low- and middle-income countries. It is especially in Africa and South Asia that the least progress in

reducing neonatal deaths has been made. WHO 2011

Almost 3 million of all the babies who die each year can be saved with low-tech, low-cost care.

WHO 2011

Most of their deaths are unrecorded and remain

invisible. WHO 2011

Because many of these deaths are related to care at the time of birth, newborn health goes hand in

hand with the health of mothers.WHO 2011

The first week of life is the riskiest week for newborns, and yet countries are only just starting

postnatal care programs to reach mothers and babies at this critical time.

WHO 2011

Perinatal mortality rate: The annual number of deaths from 28wks gestation to 7 days after birth per 1000 live births

Neonatal mortality rate: The annual number of deaths at 0 to 28 days of age per 1000 live births

Infant mortality rate: The annual number of children less than 1 year old who die per 1000 live births

U5 mortality rate: The annual number of children less than 5 year old who die per 1000 live births

© 2011 Finnish Medical Society Duodecim http://www.duodecim.fi/verkkokurssit/

Why has care for newborns gone unnoticed?

Lack of continuum of care from maternal to child:

a lack of continuity of care between maternal and child health programs has meant that care of the newborn has fallen through the cracks. More than half the neonatal deaths occur after a home birth and without any health care.

In many countries there is no record of neonatal deaths: until recently, there has been little effort to tackle the specific health problems of newborn babies.

Most of their deaths are unrecorded. Neonatal mortality and gender: reduced care-seeking for girl babies

compared with boy babies has been reported, especially in South Asia. WHO 2011

What can be done?Effective care can reduce almost THREE of the 4 million deaths

of babies under-one month:

Essential care includes:

Antenatal care for the motherObstetric care and birth attendant's ability to resuscitate newborns at birth. Treating maternal infections during pregnancy Ensuring a clean birth, Care of the umbilical cordImmediate, exclusive breast-feeding. Low birth weight babies maintain body temperature through skin-to-skin contact with the mother.

Empowering families and communities to close the gap of postnatal care: healthy home practices and empowering families to recognize problems and access care will quickly save many lives. In high mortality settings with low access to care, some interventions may need to be provided closer to home.

The gap for care of mothers and babies in the first few days of life is important even where women do deliver in facilities. New approaches are required to reach a large majority of these families.

Adapted from WHO 2011

The three major causes of neonatal deaths worldwide are:

Infections 36%

Pre-term 28%

Birth asphyxia 23%

WHO 2011

What are BASIC measures that can be taken to teach others about prevention:

-Delayed cord cutting approximately 3-4 hrs.

-Do NOT bath vernix is natural protection

-Keep the baby with the mother do NOT touch

-Breastfeed increases immune and antibodies

EducationPreventionCrisis ResponseReclamation

Whose faces are behind the numbers ?

What were their stories?

What were their

dreams?

Saving Mothers’ Lives 2006-2008, National launch-March 2011

Can Man Solve the Crises Facing the

Next Generation?

"The prayer power has never been tried to its full capacity. If we want to see mighty wonders of divine power and grace wrought in the place of weakness, failure and disappointment, let us answer God's standing challenge, "Call unto me, and I will answer thee, and show thee great and mighty things which thou know not!'" J. Hudson Taylor

"No learning can make up for the failure to pray. No earnestness, no diligence, no study, no gifts will supply its lack." E.M. Bounds

"We must begin to believe that God, in the mystery of prayer, has entrusted us with a force that can move the Heavenly world, and can bring its power down to earth." Andrew Murray

'Not by might nor by power, but by my Spirit,' says the LORD Almighty.

Zechariah 4:6