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2 REDUCING MATERNAL AND NEWBORN DEATHS Ethiopia: 11 Regions 62 Zones

3 Demographic Characteristics Total Population67.2mill Population Growth Rate2.7% Population doubling time23 years Population under 15 years 44 % Life Expectancy at birth54 years Infant Mortality Rate113/1,000 Under five mortality187.8/1,000 Maternal Mortality Ratio871/100,000

4 Demographic Characteristics Population below absolute poverty line44.2% Economic Growth Rate5.8% Per capita income (GDP) US $100 Access to potable water28.4% Access to sanitation16.9% Health service coverage 61.8% Adult literacy31.9%

5 United Nations Human Development Index,2002

6 Socio-Demographic characteristics of women Total Female Population33.6 million Population of Women (15-49) 16 million Median age at first marriage16.4 years Total Fertility Rate5.9 Female life expectancy at birth55 years Maternal Mortality Rate 871/100,000

7 High Risk Fertility Behavior

8 Total Fertility Rate by Region

9 Low Status of Women  Limited Access to education Female literacy30.9% Female primary School Enrollment51.2% Female secondary School enrollment13.7%  Limited representation in Governance 7.7%  Limited access to employment 45%  Gender Development Index of 142/162

10 Women Waiting at Health Facility

11 Population per health facility by region

12 Health Providers/Population Physician1: 58,913 Midwife per expected deliveries 1: 3,756 Nurse1: 5,236 Health Assistant1: 8,249 Environmental Health Workers1: 69,228

13 Maternal Health Service Statistics (2002) Family Planning17.23% Antenatal Care34.11% Attended Delivery9.63% Postnatal Care7.12% Expected number of deliveries2,682,445

14 Delivery Attendants

15 Causes of Maternal Death* *Facility based, Ethiopia

16 Contributing Factors to Maternal Deaths Adolescent pregnancy HIV among pregnant women Malaria Malnutrition Harmful traditional practices

17 Selected Maternal Mortality Ratios in Africa

18  Lack of information and inadequate knowledge about danger signals during pregnancy and labour  Cultural /traditional practices that restrict women from seeking health care  Lack of money The First Delay Male Involvement is Key Delay in deciding to seek care at the household level

19 The Second Delay Inability to access health facilities:  Out of reach health facilities  Poor roads and communication network  Poor community support mechanisms

20 Delay between arriving and receiving care at the health facility:  Inadequate skilled attendants  Poorly motivated staff  Inadequate equipment and supplies  Weak referral system The Third Delay

21 Perinatal, Neonatal & Infant Mortality Rates Perinatal Mortality Rate100/1000 Births Neonatal Mortality Rate58/1,000 LB Infant Mortality Rate113/1,000 LB

22 Neonatal Mortality Rate by Region

23 Causes of Newborn Death

24 REDUCE MODEL Impact on survival and productivity ( ) Data on Maternal & Newborn Health Estimating Consequences of Poor Maternal and Newborn Health

25 Key assumptions in “REDUCE” The model assumes two scenarios: Scenario 1: Maternal mortality ratio remains constant from Scenario 2: With appropriate interventions maternal mortality ratio will decline

26 Maternal Mortality No interventions 415, 000 maternal deaths 9 Million suffer disabilities

27 Infant Deaths resulting from Maternal Death and Disability No interventions 2,000,000 infants will die

28 Effects of Mothers’ Death The death of a woman and mother is a tragic loss to the family, community and nation as a whole.

29 Disability Consequences Chronic anemia Fistulae Chronic pelvic pain Emotional depression Maternal exhaustion $750 million US or 6.4 billion Birr

30 Economic Losses The loss of productivity due to maternal deaths will be US $650,000,000 or about 5.5 billion Birr Birr

31 Commitment to Reducing Maternal Deaths GOAL Reduce current MMR by 75 % by 2015

32 Reduction in Maternal Deaths

33 Economic Gains US $475 million or 4 billion Birr gain Birr

34 Intervention 1 Allocate at least 15% of total annual budget for health (Arusha Declaration, 2001) and at least 25 % of that health budget for reproductive health services. Strengthen the National RH programme to promote multi-sectoral involvement. Ensuring implementation of policies, guidelines and standards related to maternal and newborn health services. Develop appropriate strategies for effective community involvement and participation.

35 intravenous sedatives, oxytocic drugs and antibiotics manual removal of the placenta postabortion care assisted vaginal deliveries basic newborn life support Interventions 2 Designate and equip one Hospital per 500,000 population to provide comprehensive essential obstetric which includes basic obstetric care as well as surgical procedures particularly caesarian section and safe blood transfusions; Ensure that each Woreda has a minimum of one health center equipped to provide basic essential obstetric and newborn care for 24 Hours daily offering: Ensure that malaria, TB, TT, VCT & PMTCT are focused on during ANC

36 Interventions 3 For all newborns – born at home or in facility: Clean delivery and cord care Keep baby dry and warm Breastfeeding: immediate and exclusive Avoid harmful practices

37 Interventions 4 All obstetric emergencies must be treated free for the first 48 hours. Maintain two way referral system; Abrogate Taxation on Contraceptives All health facilities especially the Health Centers and Hospitals must have regular supply of water and electricity;

38 Interventions 5 Capacity building and improvement of skills: Train 1,148 midwives to meet Government’s stipulated midwife requirement based on HSDP-I target. Review the curriculum to upgrade the skills of junior midwives Train more obstetricians Strengthen the EOC component of pre-service training Delegate responsibility to GPs, HOs and midwives with adequate training and supervision to offer EOC. Upgrade the skills of existing health providers to offer newborn care and family planning. Offer incentives for these cadres to attract and retain them especially for the rural areas

39 If we act now, By 2015… $ 475 million US (4 billion Birr) in productivity gains 140,000 women’s lives saved 3,000,000 disabilities averted 700,000 children’s lives saved

40 Conditions Needed Strong commitment to maternal and newborn survival and health by political leaders and decision makers at national and local levels Community involvement, Resource mobilization and Partnership Realistic and appropriate investment in women’s education, health and economic empowerment

41 Conditions Needed cont. Male involvement and participation in Reproductive Health issues and services Implementation framework with clearly defined supervision, monitoring and evaluation mechanisms.

42 Conclusion To guarantee the RIGHT of Ethiopian women and newborns to health and life, they must have access to quality reproductive health services, including skilled attendance at birth.

43 THANK YOU FOR JOINING THE “REDUCE” TEAM MOH/WHO