Safe Motherhood: an international perspective Prof Dr Valerie Fleming Director World Health Organisation Collaborating Centre

What is Safe Motherhood? Enter the term into google and almost 600,000 hits are returned. The vast majority of these focus on the programme supported by UN agencies supporting Millennium Development Goal Five: to improve maternal health by reducing the maternal mortality ratio by 75%, between 1990 and 2015.

UN programme goals Implementing an advocacy/media strategy to refocus global attention to improving the health of women and newborns in developing countries; Stimulating national-level commitment to make safe motherhood/newborn health a priority within national development plans and aid request s; Promoting effective interventions to improve the application of technical knowledge and research findings.

Safe Motherhood In 2008 almost 1 million women died in childbirth (960,216) (UNFPA); Latest WHO statistics show a global Maternal mortality rate of 400/100,000 live births (1/100,000 in Ireland and 2,100/100,000 in Sierra Leone).

Differences in different regions RegionMMR/ 100,000 live births (2005) Africa900 Americas99 Eastern Mediterranean420 Europe27 South – east Asia450 Western Pacific82

Differences in different regions RegionMMR/100,000 live births Developed regions9 Developing regions450 Commonwealth of Independent States 51

What is safe motherhood?

Becoming pregnant Carries with it real chance of dying; Basic public health issues lacking; Little or no antenatal care available; May be international organisations providing care which: –Conflict with local practices; –Conflict with each other.

Giving birth Women often in poor state of general health; Problems often not detected until labour established; Lack of skilled personnel; Lack of sanitation; Lack of any equipment.

The new family Lack of follow up care; Women suffering complications of prolonged labour; Usually supportive extended family; Many orphaned infants due to high maternal death rate.

Exceptions Increasing gap between rich and poor; Statistics of rich moving towards those of developed countries; Women caught up in conflict between relief organisations; Women abandoned when “donors” depart.

What is safe motherhood?

Becoming pregnant Chosen services are available: –May mean all medical facilities; –Health professional of choice; –Regular antenatal care; –Good referral system if required; –Expectation of healthy mother and baby but awareness that sometimes things go wrong.

Giving birth Most women give birth with skilled professionals in attendance; Many births in highly medicalised settings; Expectation of pain free labour or elective Caesarean section; Social support in labour.

The new family Early discharge from hospital; Expectation of normality; Follow up support may be available in community setting; Maternity pay with option to return to work.

How do expectations equate to safety? Choice dominates but increasing interventions carry increased morbidity; Professionals become deskilled leading to further intervention; Because of low mortality rates may become complacent and ignore minority groups such as those in poverty, poor health etc.

What is safe motherhood?

Becoming pregnant High incidence of abortion; Some community based ante natal care available; High incidence of bribery leading to split between those how can afford to pay and those who cannot; Lack of motivation of health professionals and few skilled midwives.

Giving birth Outdated equipment and practices; Lack of any attention to dignity; Some professional support; No social support; Often professional brutality.

The new family Little follow up care; Pilot projects are in place in Uzbekistan and Tajikistan; Midwives little in evidence; Midwives need better education!

Safe Motherhood? Money buys professional care; Long term problems likely such as fistulae and prolapses due to indiscriminately accelerated labours; Secondary infertility after repeated abortions.

Safe Motherhood What does this mean? No universal definition possible. –Sub Saharan Africa generally means prevention of death; –Eastern Europe means improving quality of life; –Northern America means maximising the experience; –What is it in your own experience?