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, 2007- 20th anniversary
of Safe Motherhood Initiatives
Countdown to 2015- Maternal, Newborn and Child Survival, 2008
UN Leaders Summit for MDGs, 2010- Global strategy for Womens
and Childrens Health


Global strategy for Womens and Childrens
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 1990- 41% 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 19902000 to 3.2%
during 20002011
Despite improvement, the world is unlikely to achieve the MDG4
target
In 2011, global measles immunization coverage was 84%
among children aged 1223 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 15-49 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 20052011
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!