GLOBAL ISSUES AND STRATEGY ON MATERNAL, NEWBORN AND CHILD HEALTH Launching of the “National Actions Plan for Accelerating Reduction of Maternal Mortality in Indonesia; “Scaling-Up PMTCT in Indonesia”; and “Maternal Health Pocket Book” Thursday, 26 September 2013 Dr Long Chhun

Key messages Maternal mortality trends and determinants in the Western World from 1880 to 1980 and Implications to Global efforts Global Initiatives to improving Maternal, Newborn and Child Health Discussion and recommendations on the current Global Maternal, Newborn and Child Health Issues and Strategy

Historical trend in maternal mortality rates in the Western World USA had the highest MMR Differences classification of deaths or methods of data collection

Why did maternal mortality rates remain on a high plateau from the 1850s to the mid-1930s in the Western World? Home deliveries Puerperal fever Unnecessary interference social class

What caused the abrupt change in the maternal mortality rate in the mid-1930s with the subsequent steep decline? Ergometrine Blood transfusions Penicillin Better Anesthesia & training Sulfonamides less interference in normal labour Better organization of obstetric services

Lessons from the past history of the Western World and the needs for data for Developing World Causes of high rates of maternal mortality in Developing Countries today are reasonably similar to those in Western World in the 1870s. Profound decline in maternal mortality rates in Western World dependent on accurate data and system of continuous audit During 1970s and 1980s, advances in statistical techniques and availability of data resulted in increasing availability and reliability of data on infant mortality, but no equivalent breakthroughs for measurement of maternal mortality During 1985, first community studies on levels of maternal mortality in developing countries provided an estimation

Safe Motherhood and Child Survival 1987: First international Safe Motherhood (SM) Conference Sound estimates based on new data for foundation of understanding and concern First international SM Conference in Nairobi 1989: World Summit for Children in New York Maternal mortality viewed within the context of ensuring the survival and health of children, largely by product of child survival efforts Reduction in maternal mortality as one of the goals to be monitored along with increases in antenatal care attendance 1997: 10th Anniversary SM Meeting in Sri Lanka Every pregnancy faces risks Ensure skilled attendants at delivery Improve quality and access of maternal care

Critical actions for increasing Child Survival Skilled care during pregnancy and birth Safe and clean delivery at birth Care of the newborn at birth Appropriate feeding in sickness and health Exclusive breastfeeding for the first six months of life Starting at six months of age, appropriate complementary feeding with continued breastfeeding up to 2 years of age and beyond Micronutrient supplementation (at least vitamin A) Prevention of illness Vaccination Insecticide-treated materials Water, sanitation and hygiene Prevention of mother-to-child transmission of HIV Antiretrovirals Safer infant feeding practices Treatment of illness Oral rehydration therapy to prevent and treat dehydration resulting from diarrhoea Zinc to reduce the duration and severity of diarrhoea Antibiotics for sepsis, pneumonia and dysentery Antimalarials

Millennium Development Goals in 2000 and Subsequent Global Efforts The Millennium Development Goals established in 2000, include MDGs 4 and 5: MDG 4: Reduce child mortality Target: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate Millennium Development Goal 5: Improve maternal health Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio Target 5.B: Achieve, by 2015, universal access to reproductive health Partnership for “Safe Motherhood and Newborn Health” merges with “Child Survival Partnership” and “Healthy Newborn Partnership” Women Deliver Conference held in London, th anniversary of Safe Motherhood Initiatives Countdown to Maternal, Newborn and Child Survival, 2008 UN Leaders’ Summit for MDGs, Global strategy for Women’s and Children’s Health

Global strategy for Women’s and Children’s Health from the UN Summit 2010

Status of MDG4 Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate Globally, significant progress has been made in reducing mortality in children under five years of age. In 2011, 6.9 million children under five died, compared with 12 million in % decline, from 87 deaths per 1000 live births to 51 estimated number of measles deaths decreased by 74%, accounting for about one fifth of the overall decline in child mortality Decline accelerated from 1.8% per year during 1990–2000 to 3.2% during 2000–2011 Despite improvement, the world is unlikely to achieve the MDG4 target In 2011, global measles immunization coverage was 84% among children aged 12–23 months

Status of MDG5 Target 5.A. Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio Target 5.B. Achieve, by 2015, universal access to reproductive health Significant reduction in the number of maternal deaths: from an estimated 543,000 in 1990 to 287,000 in 2010 the rate of decline is just over half that needed to achieve the MDG target In 2008, 63% of women aged years who were married or in a consensual union were using some forms of contraception 11% who wanted to stop or postpone childbearing were not using contraception Proportion of women receiving ANC at least once during pregnancy was about 81% for the period 2005–2011 for the recommended minimum of four visits or more the corresponding figure is around 55% Proportion of births attended by skilled personnel remains less than 50% in WHO African Region

Discussion on opportunity and weakness Need to reduce maternal and newborn deaths Progress towards the health MDGs is being made, but is unequal and fragile Reductions attributable to: technical requirements- data systems, professional expertise and access to technologies political enabling conditions- awareness of the problem and commitment to act Opportunities in place today in the developing world Technologies available and cost-effective Political will exists Health care professionals and women advocate for safe motherhood and MDGs Missing elements- health sector readiness: Combination of financial, human and organizational resources needed to provide required services Both recipient countries and donors need to invest Evidence of local operational constraints and best practices

Recommendations to improving the health of mothers and children and achieving MDGs 4 & 5 Effective interventions that are safe and evidence-based Operations research Health systems to deliver the interventions Community support systems to facilitate access to the interventions Monitoring and evaluation systems to assess, monitor and evaluate progress, impact and accountability Policies and strategies that set out how the resources needed to deliver results Increased investment in the health of mothers and children, to align financial and technical support to the national health policy and strategy

Thank you very much for your attention!