Maternal Health in Arab States
Improving Maternal Health Improving maternal health is MDG number 5 and it has two targets Target A that measures reduction in maternal mortality ratio (MMR) and attended births with skilled personnel Target B that measures universal access to reproductive health services and particularly the strength of family planning programs (CPR, unmet need, adolescent fertility, ANC)
Every year it is estimated that 350,000 women die of causes related to pregnancy and delivery mostly in the African continent It is estimated that 11 countries world wide have MMR above 1000. Almost all of them are in Africa (Somalia, Sudan, Sierra Leone, CAR, Chad, Niger--)
Why are we still talking about maternal mortality Many countries around the world are struggling with the achievement of MDG5. The progress to date is slow. Among the middle and low income countries in the Arab region it is not expected that any country will succeed to achieve MDG5 although some are progressing better than others We know how to reduce maternal mortality. The interventions are costeffective and go beyond saving the life of the mother
Global Trends in MMR Number of Births per 100,000 1000 900 800 700 600 500 400 300 200 100 0 1990 2005
Average MMR by Arab Country Groups Number of births per 1000,000 900 800 700 600 500 400 300 200 100 0 2000 2007/8 LDC Maghreb Mashreq GCC
Maternal Mortality Ratio, Arab States 2008 MMR 15-100 100-200 200-550 Above 550 Source UNFPA Progress on MDG 5 has been generally slow for Arab countries. Collectively, the Arab States region will not achieve reduction of maternal mortality by 75% by the year 2015.
Trends in MMR in the Arab Region Current trends and Expectations for 2015 350 320 300 280 250 200 200 240 current trend expected goal 150 Gap 100 80 50 0 1990 2005 2015
Percentage of Births Attended by Skilled Personnel Among Arab Countries Yemen Somalia Sudan Mauritania Comoros Morocco Lebanon Egypt Iraq Djibouti Syria Tunisia Algeria Saudi Arabia OPT Oman Bahrain UAE Qatar Libya Kuwait Jordan 27,3 33 56,9 56,9 62 63 70,5 78,9 89 92 93 94,5 95,2 96 99 99 99 100 100 100 100 100 0 20 40 60 80 100 120 Births Attended by Skilled Health Staff % (Latest figures available)
Adolescent Fertility Rate (estimates are from 2005-2010) Early marriage and pregnancy are some of the main factors contributing to the high maternal mortality in the Arab countries. The high adolescent fertility rate is linked the traditional preference for early marriage. 57 61 68 70 79 86 90 42 39 46 3 7 7 10 13 16 16 16 17 19 23 25 26
Competing Priorities The health system, at all levels and particularly at the primary care level is facing many challenges including emerging diseases that contribute to mortality and to lowering life expectancy of the population Those include reproductive and non-reproductive health diseases 12
Mortality and Incidence from Cervix Cancer among Women in Selected Arab Countries 25 Mortality Incidence 23,6 Annual rate per 100,000 persons at risk 20 15 10 5 2,7 1,4 1,5 2,4 2 3,6 6,3 7,8 4,8 5,9 18,9 0 Saudi Arabia Qatar Oman Egypt Tunisia Somalia
Breast Cancer Mortality and Incidence among Women in Selected Arab Countries 30 Annual Rate per 100,000 persons at risk 25 20 15 10 Mortality Incidence 5 0 Saudi Arabia Qatar Oman Egypt Tunisia Somalia
Reducing Maternal Mortality and Improving Health 15
Maternal Mortality Direct Causes Bleeding Infection Unsafe abortion Eclampsia Prolonged obstructed labor Indirect Causes Nutrition status Causes of 1 st delay Repeated unspaced pregnancy Unsupervised home birth Age, access to care Age at 1 st pregnancy/ marriage HIS RHCS & FP Health Policies Referral system and EMOC Health systems issues Resources (human, financial) 3 rd delay Root Causes Gender discrimination Population growth Poverty Tradition and cultural barriers General laws and policies Conflict and Wars Causes of 2 nd delay
Factors affecting maternal health 17
Home Births by Education: Illiterate and Literate Yemen Tunisia Sudan Syria Morocco Libya Lebanon Literate Illiterate Djibouti Algeria 0 10 20 30 40 50 60 70 80 90 % of women who gave birth in the house
Percentage of Prenatal Coverage (4+ visits) in Arab Countries (1995-2006) 120. 100 % of prenatal care coverage 80 60 40 20 0
Prenatal Care by Socio-Economic Determinants Prenatal Care % by Income Level % of Prenatal care 60 40 20 0 41,7 26 21,4 23,3 15,3 17,2 12,6 8,5 3,2 2,8 Algeria Morocco Syria Tunisia Yemen LOW HIGH Prenatal Care % by Location % of women receiving prenatal care 90 80 70 60 50 40 30 20 10 0 89 85,1 75,3 69,7 49,3 39,3 Algeria Morocco Yemen URBAN (RUAL) 20
Prenatal Care by Socio-Economic Determinants Prenatal Care % Based on Education of Mother 100 90 93 98 98 89,6 81,4 below elementary 80 75,3 71,6 70 61,5 % prenatal care 60 50 40 41,2 elementary or Jr. High 30 high school or higher 20 10 0 Algeria Morocco Yemen
Prenatal Care By Birth Order 100 birth order of child 1 90 80 birth order of child 2-3 % of prenatal care 70 60 50 40 30 birth order of child 4+ 20 10 0 Algeria Morocco Yemen
Postnatal Care by Income Level: Low and High 60 57,1 LOW 50 HIGH % of postnatal care 40 30 20 23,8 36 23,3 18,9 25,7 38,8 17 11,3 10 7,4 0 Algeria Morocco Syria Tunisia Yemen
Can it be Done? Yes. How long should it take? It depends on the commitment that we put there 24
Maternal Mortality Can be Reduced by Half in less than 10 years
350 Progress towards achieving MDG5 Morocco 300 250 200 150 100 50 0 MMR 1997 MMR2004 MMR2008 MMR2010 MMR2015
The world reached the alarming figure of 7 Billion inhabitants The resources are declining The technology is improving, we know that saving women s lives during pregnancy and delivery is doable and affordable Collaborate and learn from each other, we all have experiences Strengthen the health system and at every health system block ensure that MDG 5 is fully integrated Address the other determinants of maternal health We just simply need to continue our efforts to advocate for mothers, to make sure that maternal health is a priority in our national health plans and ensure that we are making the best of our resources 27
Thank You 28