Ghana Statistical Service 3rd Global Forum and Inter-Agency Expert Group Meeting on Gender Statistics Manila, Philippines, 11-14 October 2010 Ghana’s Experience in Measuring Maternal Mortality and Maternal Health Ethel Koney Ghana Statistical Service ESA/STAT/AC.219/22 3/27/2017

Outline Introduction Maternal Health Maternal Mortality Sources of data GDHS GMHS Institutional data Interventions Challenges Planned surveys 3/27/2017

Introduction Every year more than half a million women die in pregnancy and childbirth related issues In the sub-Saharan Africa one in twenty-two women has the risk of dying during pregnancy or childbirth In Ghana, research and survey conducted reveal that there are about 451 deaths out of 100,000 live births. This is largely due to poor access to skilled birth attendance. The goal is to “reduce by three quarters, between 1990 and 2015, the maternal mortality ratio” and to “Achieve, by 2015, universal access to reproductive health” Government agencies, policy makers and NGOs have measures to increase maternal health care provided women during pregnancy and even after delivery. 3/27/2017

MDG Goal 5: Improve maternal health Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio 5.1 Maternal mortality ratio 5.2 Proportion of births attended by skilled health personnel Target 5.B: Achieve, by 2015, universal access to reproductive health 5.3 Contraceptive prevalence rate 5.4 Adolescent birth rate 5.5 Antenatal care coverage (at least one visit and at least four visits) 5.6 Unmet need for family planning 3/27/2017

Maternal Health Maternal health refers to the health of women during pregnancy, childbirth and the post-partum period. 3/27/2017

Maternal Mortality Health experts refer to maternal mortality as the death of a woman while pregnant or within 42 days of termination of pregnancy. CAUSES Hemorrhage Infection High blood pressure Unsafe abortion Obstructed labour. 3/27/2017

Sources of data on maternal mortality and maternal health The main surveys are: The Ghana Demographic and Health Survey (GDHS) Ghana Maternal Health Survey (GMHS) Administrative Institutional data from Centre for Health Information Management of the Ministry of Health 3/27/2017

Ghana Demographic and Health Survey Ghana has conducted 5 rounds of GDHS, in the following periods: 1988, 1993, 1998, 2003, and 2008. The surveys covered the whole country and analysis were done on national as well as regional basis 3/27/2017

Content of the GDHS The surveys obtained detailed information on fertility marriage sexual activity fertility preferences awareness and use of family planning methods breastfeeding practices nutritional status of women and young children childhood mortality maternal and child health awareness and behavior regarding HIV/AIDS, and other STIs. 3/27/2017

Some differences in the different rounds (GDHS) 1998-included testing of level of iodine in the salt consumed by the household 2003-included questions on domestic violence 2008-collection of information on domestic violence, malaria and use of mosquito net, and carried out anemia testing. 3/27/2017

Trends in Maternity care indicators Ghana 1988 -2008 There has been consistent improvement in the indicators over the 20-year period Note: Data for 1988, 1993, and 1998 are with reference to births, whereas data for antenatal care and tetanus toxoid for 2003 and 2008 are with reference to women who had a live birth 3/27/2017

Ghana Maternal Health Survey, 2007 This is the first national population-based survey to collect information on maternal health and mortality in Ghana through a combination of methods. It was conducted to serve as a baseline information for the Reducing Maternal Morbidity and Mortality (R3M) program initiated in 2006 in some three regions in Ghana to increase the contraceptive prevalence rate (CPR) Household questionnaires were administered in about 240,000 households to identify female deaths Individual questionnaires were administered to 10,370 women age 15-49 about maternity care particularly abortion and miscarriage, and siblings (sisterhood method), and Follow-on 4,203 verbal autopsies of women age 12-49 into the specific causes of female deaths, particularly maternal deaths 3/27/2017

Tracking Indicators (GMHS) Delivery care Place of delivery Assistance of delivery Complications of delivery Postnatal care Timing of postnatal check-up Service provided and service provider Barriers to accessing health care Access to skilled birth attendance Distance of health care facility from patient 3/27/2017

Institutional data In-between surveys, there is the need to monitor or track changes in maternal health and mortality levels. In Ghana, the main source of data is the Centre for Health Information Management of the Ministry of Health 3/27/2017

Trends in maternal mortality ratios, 2006-2009 Source: MOH/GHS Health Sector Program of Work 2009 Review Source: Ministry of Health 3/27/2017

Interventions Safe-Motherhood Initiative Ghana VAST Survival Programme Prevention of Maternal Mortality Programme (PMMP) Making Pregnancy Safer Initiative Prevention and Management of Safe Abortion Programme Intermittent Preventive Treatment Maternal and Neonatal Health Programme and Roll Back Malaria Programme Declaring maternal mortality a national emergency in 2008 Free health care for pregnant women including deliveries through the national health insurance scheme. 3/27/2017

Challenges Social, cultural, health systems and economic indicators. Unavailability of family planning services and lack of post natal care for new born babies and their mothers Unavailable data set on maternal health care for systematic investigation into maternal health, Barriers to access to critical health services by families and communities Absence of well-structured plans and procedures to check and assess where maternal health programmes are Poor access to health care providers Caused by long distance to the health facility Poor health-seeking behaviors among the poor 3/27/2017

Planned Surveys The Ghana Statistical Service will be having the next round of the Ghana Demographic and Health Survey in 2013. The 2010 Population and Housing Census currently underway, seeks information on maternal mortality. Data collected will better inform if interventions and indicators are on track, and if so, Ghana’s progress towards the 2015 MDG target. 3/27/2017

Maternal Mortality in the 2010 Census Has any member of this household died in the past 12 months.? Sex of deceased? Age at death Was death due to accident, violence, homicide, suicide? For death of FEMALES 12 - 54 YEARS OLD Did death occur whilst pregnant, during delivery or within 6 weeks after the end of a pregnancy or child birth? 3/27/2017

Thank You. 3/27/2017