Maternal health challenges & successes: an overview focussing on low-income settings

Transcription

1 Maternal health challenges & successes: an overview focussing on low-income settings Oona Campbell 9 March 2012 Improving health worldwide

2 High maternal mortality historically, for UK & rich Pictures of Monument to Princess Charlotte died 1817 St. George s Chapel, Windsor Castle and portrait of a wealthy pregnant woman painted to leave a memento in case she died Year MMR Population European nobility ~ E&W Social Class I&II 444 E&W Social Class IV Afghanistan 1400 Swaziland 420 UK 12

3 Dramatic declines in high-income populations Maternal mortality ratios, England & Wales, Declines coincide with: Antibiotics Blood transfusions Management of hypertensive diseases of pregnancy 400 Maternal deaths in rich countries eliminated Deaths by cause & sex England & Wales 2009: 63 maternal deaths 66 breast cancer deaths in men

4 Background A woman dying each minute: day in, day out Photo of pregnant women with lifetime risk of death painted on their bodies MDG 5 improve maternal health; an important global health challenge Ensuring women give birth with a skilled birth attendant, and can access emergency obstetric care, is crucial

5 Global Commitment 700 Maternal mortality ratios, England & Wales, and Global Targets UK Global

6 Epidemiology of Maternal Death Maternal deaths per 100,000 live births, 2008 <

7 Maternal mortality ratio Direct causes What are the causes of death? 1000 Haemorrhage Hypertensive diseases of pregnancy Sepsis Obstructed labour Unsafe abortion As well as other underlying conditions (indirect causes) Sub-Saharan Africa Haemorrhage Hypertensive diseases Sepsis/Infection Obstructed labour Other direct Abortion Indirect causes Unclassified

8 Epidemiology of Maternal Death Complications difficult to predict or prevent Treatment needs some skill

9 What needs to be done? 1. Renewed focus on delivery & emergency obstetric care, & family planning and abortion Combined with: 2. More health professionals 3. Greater financial resources 4. Robust tracking of progress & accountability 5. Greater political commitment

10 Global Strategy for Women s and Children s Health (United Nations, 2010) Every Woman Every Child: 3 strategic areas Reducing financial barriers Creating stronger policy environment towards women s and children s health Strengthening and improving delivery of health services Photo of Ban Ki Moon at world economic summit

11 Challenges & successes

12 Services availability: Emergency Obstetric Capability, Zambia health facilities (n=1370) Gabrysch 2010 Categorisation of all Zambian health facilities according to their EmOC functions (n=1370) No delivery service Substandard delivery service BEmOC-4 BEmOC-2 BEmOC-1 BEmOC CEmOC-1 CEmOC Number of facilities

13 Distance from services: Access to obstetric care in Zambia (Gabrysch et al 2011) Urban population: 3,460,000 Urban Rural population: 7,057,000 Rural 14/ % of Population within 15km of BEmOC % of Population within 15km of any delivery service

14 Staffing: doctor density in Zambia compared to Sri Lank a (Gabrysch et al 2011) Northern North North-Central Luapula Southern Eastern Uva Western East Sabaragamuwa Southern Zambia Sri Lanka - Doctors - Doctors per per births births by by province Northwestern North-Western SRI ZAMBIA LANKA Copperbelt Central Lusaka Western

15 Poor Quality of Care in Facilities: time to treatment (Ivory Coast): near misses Uterine Rupture Uterine Rupture Uterine Rupture Uterine Rupture Uterine Rupture Uterine Rupture call doctor obtain kit kit complete kit other 16 Gohou et al 2004

16 Economic costs: catastrophic consequences of unaffordable emergency care (Borghi et al 2006) Country/year % GDP/capita for normal delivery in hospital % GDP/capita for caesarean section Ghana, Burkina Faso National policies to remove user fees for delivery care Dzakpasu (2010)

17 Percent of deliveries Ghana: skilled attendance increasing; inequality decreasing , Ghana Demographic and Health Survey 2008; Dzakpasu et al 2012

18 Quality of care: can be poor: (Khayat & Campbell 2000) Evidence based practices in Lebanese hospitals: 1997 Perineal shaving for all 92% All women tied during delivery 59% Adopts any position likes during labour 38% All mothers helped breastfeed 23% Can be improved Gabrysch et al 2009) Increase in facility use following adoption of culturally sensitive practices in Ayacucho, Peru: 6% (1999) to 83% (2007)

19 Global financial resources have not been adequate but are improving (Pitt et al 2011) Percent of DALYs Maternal & newborn health not given financial priority despite a burden of disease larger than for HIV, TB, or Malaria Global development assistance to maternal & neonatal health was $563million (2003) & $1227million (2008) 2 1 0

20 Unmet need for Contraception, & : appalling but improving Sedgh et al 2007 & UNFPA % in least developed vs. 9% in developing countries 137 million women worldwide

21 Abortion Policies/Provision improving in some places

22 Conclusions

23 Achievable Target? 75% in 25 years 700 Maternal mortality ratios, England & Wales, and Global Targets (and transposed to )

24 Progress 700 Maternal mortality ratios, England & Wales, and Global MMR ; Target

25 Maternal deaths per live births 700 Progress in LMICs Sri Lanka Thailand Malaysia Honduras Egypt Matlab, Bangladesh Bangladesh MM Survey 2001 China India

26 Photo of woman burdened by carrying a child A topic for women s day?? Bhavna Bahri Gregory John Smith Child birth and maternal mortality pose many challenges: Women in need of care. Women in their traditional role burdened, and weak Photo of woman uplifted by child But also Women as skilled birth attendants providing care that prevents death Women as survivors strong, resilient and creators of the future

27 8th of March is the day of the rebellion of the working women against the kitchen slavery March 8 th is the day we ensure other women don t lose their lives giving life

28 Too many women are still dying in their prime years Maternal mortality is an MDG that 189 countries have signed up to We need to get on with what works Copyright ICDDR,B/ /Bitu/Map

29 Thank you