1. Factors Affecting Maternal Mortality (MM) in Turkey and in the World Dr. Yeşim YASİN Spring-2014

3. Definitions-1 “The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes”.

4. Definitions-2 Direct maternal mortality is the result of a complication of the pregnancy, delivery, or management of the two. Indirect maternal mortality is a pregnancy- related death in a patient with a preexisting or newly developed health problem unrelated to pregnancy. Fatalities during but unrelated to a pregnancy are termed accidental, incidental, or nonobstetrical maternal mortalities.

5. Key Facts-1 Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. 99% of all maternal deaths occur in developing countries. Maternal mortality is higher in women living in rural areas and among poorer communities.

6. Key Facts-2 Young adolescents face a higher risk of complications and death as a result of pregnancy than older women. Skilled care before, during and after childbirth can save the lives of women and newborn babies.

7. MDGs Improving maternal health is one of the eight Millennium Development Goals (MDGs) adopted by the international community in 2000. Under MDG5, countries committed to reducing maternal mortality by three quarters between 1990 and 2015. Between 1990-2010, maternal deaths worldwide have dropped by almost 50%.

8. Strategies All women have access to contraception to avoid unintended pregnancies All pregnant women have access to skilled care at the time of birth All those with complications have timely access to quality emergency obstetric care

9. Actually… In sub-Saharan Africa, a number of countries have halved their levels of maternal mortality since 1990. In other regions, including Asia and North Africa, even greater headway has been made. However, between 1990 and 2010, the global maternal mortality ratio (i.e. the number of maternal deaths per 100 K live births) declined by only 3.1% per year.

10. During the UN MDG summit in September 2010, UN Secretary-General Ban Ki-moon launched a Global strategy for women's and children's health, aimed at saving the lives of more than 16 million women and children over the next four years. WHO is working with partners towards this goal.

11. Global epidemiology

12. Measures of MM-1 Maternal mortality ratio (MMR): the ratio of the number of maternal deaths during a given time period per 100,000 live births during the same time- period. Maternal mortality rate (MMRate): the number of maternal deaths in a population divided by the number of women of reproductive age, usually expressed per 1,000 women. Life time risk of maternal death: the risk of maternal death of a woman due to direct or indirect causes in a given population until her reproductive age.

13. Measures of MM-2 Pregnancy related mortality ratio: all deaths due to pregnancy, delivery or post-partum/100 K live births Pregnancy related mortality rate: (all deaths related to pregnancy/no. of women in reproductive age)*100,000 Lifetime risk of pregnancy related mortality: the risk of pregnancy-related death of a woman until the end of her reproductive age in a given population.

15. Lifetime risk of MM

16. Some facts… The maternal mortality ratio in developing countries is 240 per 100 000 births versus 16 per 100 000 in developed countries. There are large disparities between countries, with few countries having extremely high maternal mortality ratios of 1000 or more per 100 000 live births. There are also large disparities within countries, between people with high and low income and between people living in rural and urban areas.

17. Major complications The major complications that account for 80% of all maternal deaths are: severe bleeding (mostly bleeding after childbirth) infections (usually after childbirth) high blood pressure during pregnancy (pre- eclampsia and eclampsia) unsafe abortion.

18. Direct causes

19. Don’t forget… Most maternal deaths are avoidable. All women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. To avoid maternal deaths, it is also vital to prevent unwanted and too-early pregnancies. All women, including adolescents, need access to family planning, safe abortion services to the full extent of the law, and quality post-abortion care.

20. Main barriers: poverty distance lack of skilled health workers lack of information inadequate services cultural practices.

21. Three delays framework Phase 1: Delay in deciding to seek care by the woman and/or her family Phase 2: Delay in reaching adequate health care facility Phase 3: Delay in receiving adequate care at that facility

22. Turkey and MM

25. Follow-up of women in ages btw. 15-49 Marital and preconception counseling program Prevent deaths due to preventable causes Maternal mortality risk increases by the age. 1 in 5 marriages in Turkey is consanguineous (endogamous).

26. Reproductive health programs in Turkey Prenatal care (DÖB) Iron supplement program for pregnant women Vitamin D supplement program for pregnant women Mum-friendly hospital Birth/c section program Post-partum care program Emergency obstetric care Maternal mortality follow-up program Provision of Men’s participation in reproductive services In-service training on reproductive health Reproductive health program for elderly

27. Gender equality SAFE MOTHERHOOD Antenatal care Family planning Healthy labor Primary Heath Services Basic Maternal Health Services Post-partum care Emergency obstetric care

28. No woman should die giving life!

29. THANK YOU!