1. Ghana Statistical Service
3rd Global Forum and Inter-Agency Expert Group Meeting on Gender Statistics Manila, Philippines, October 2010
Ghana’s Experience in Measuring Maternal Mortality and Maternal Health
Ethel Koney
Ghana Statistical Service
ESA/STAT/AC.219/22
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2. Outline Introduction Maternal Health Maternal Mortality
Sources of data
GDHS
GMHS
Institutional data
Interventions
Challenges
Planned surveys
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3. 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.
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4. 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
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5. Maternal Health
Maternal health refers to the health of women during pregnancy, childbirth and the post-partum period.
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6. 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.
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7. 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
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8. 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
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9. 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.
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10. 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.
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11. 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
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12. 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 about maternity care particularly abortion and miscarriage, and siblings (sisterhood method), and
Follow-on 4,203 verbal autopsies of women age into the specific causes of female deaths, particularly maternal deaths
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13. 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
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14. 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
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15. Trends in maternal mortality ratios, 2006-2009
Source: MOH/GHS Health Sector Program of Work 2009 Review
Source: Ministry of Health
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16. 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.
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17. 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
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18. 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.
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19. 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 YEARS OLD
Did death occur whilst pregnant, during delivery or within 6 weeks after the end of a pregnancy or child birth?
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20. Thank You.
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