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REDUCING MATERNAL AND NEWBORN DEATHS
Ethiopia:
11 Regions
62 Zones
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Demographic Characteristics
Total Population67.2mill
Population Growth Rate2.7%
Population doubling time23 years
Population under 15 years 44 %
Life Expectancy at birth54 years
Infant Mortality Rate113/1,000Under five mortality187.8/1,000
Maternal Mortality Ratio871/100,000
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Demographic Characteristics
Population below absolute poverty line44.2%
Economic Growth Rate5.8%
Per capita income (GDP) US $100
Access to potable water28.4%
Access to sanitation16.9%
Health service coverage 61.8%
Adult literacy31.9%
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United Nations Human Development Index,2002
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Socio-Demographic characteristics of women
Total Female Population33.6 million
Population of Women (15-49) 16 million
Median age at first marriage16.4 years
Total Fertility Rate5.9
Female life expectancy at birth55 years
Maternal Mortality Rate 871/100,000
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High Risk Fertility Behavior
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Total Fertility Rate by Region
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Low Status of Women
Limited Access to education
Female literacy30.9%
Female primary School Enrollment51.2%
Female secondary School enrollment13.7%
Limited representation in Governance 7.7%
Limited access to employment 45%
Gender Development Index of 142/162
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Women Waiting at Health Facility
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Population per health facility by region
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Health Providers/Population
Physician1: 58,913
Midwife per expected deliveries 1: 3,756
Nurse1: 5,236
Health Assistant1: 8,249
Environmental Health Workers1: 69,228
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Maternal Health Service Statistics (2002)
Family Planning17.23%
Antenatal Care34.11%
Attended Delivery9.63%
Postnatal Care7.12%
Expected number of deliveries2,682,445
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Delivery Attendants
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Causes of Maternal Death*
*Facility based, Ethiopia
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Contributing Factors to Maternal Deaths
Adolescentpregnancy
HIV amongpregnant women
Malaria
Malnutrition
Harmful traditionalpractices
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Selected Maternal Mortality Ratios in Africa
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Lack of informationand inadequateknowledge aboutdanger signalsduring pregnancyand labour
Cultural /traditionalpractices thatrestrict women fromseeking health care
Lack of money
The First Delay
Male Involvement is Key
Delay in deciding to seek care at the household level
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The Second Delay
Inability to access healthfacilities:
Out of reach healthfacilities
Poor roads andcommunication network
Poor community supportmechanisms
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Delay between arriving andreceiving care at thehealth facility:
Inadequate skilledattendants
Poorly motivated staff
Inadequate equipmentand supplies
Weak referral system
The Third Delay
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Perinatal, Neonatal & Infant Mortality Rates
Perinatal Mortality Rate100/1000 Births
Neonatal Mortality Rate58/1,000 LB
Infant Mortality Rate113/1,000 LB
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Neonatal Mortality Rate by Region
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Causes of Newborn Death
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REDUCE MODEL
Impact on survival and productivity (2001 - 2015)
Data on Maternal & Newborn Health
Estimating Consequences of Poor Maternal andNewborn Health
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Key assumptions in “REDUCE”
The model assumes two scenarios:
Scenario 1:
Maternal mortality ratio remainsconstant from 2001-2015.
Scenario 2:
With appropriate interventionsmaternal mortality ratio will decline
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Maternal Mortality 2001-2015
No interventions
415, 000 maternal deaths
9 Million suffer disabilities
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Infant Deaths resulting from MaternalDeath and Disability 2001-2015
No interventions
2,000,000 infantswill die
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Effects of Mothers’ Death
The death of awoman andmother is a tragicloss to the family,community andnation as a whole.
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Disability Consequences2001-2015
Chronic anemia
Fistulae
Chronic pelvic pain
Emotional depression
Maternal exhaustion
$750 million US or
6.4 billion Birr
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Economic Losses2001-2015
The loss of productivity due tomaternal deaths will be
US $650,000,000 or
about 5.5 billion Birr
Birr
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Commitment to ReducingMaternal Deaths
GOAL
Reduce current MMR by75 % by 2015
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Reduction in Maternal Deaths 2001-2015
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Economic Gains2001-2015
US $475 million or4 billion Birr gain
Birr
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Intervention 1
Allocate at least 15% of total annual budgetfor health (Arusha Declaration, 2001) and atleast 25 % of that health budget forreproductive health services.
Strengthen the National RH programme topromote multi-sectoral involvement.
Ensuring implementation of policies,guidelines and standards related tomaternal and newborn health services.
Develop appropriate strategies for effective
community involvement and participation.
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intravenous sedatives,oxytocic drugs andantibiotics
manual removal of theplacenta
postabortion care
assisted vaginaldeliveries
basic newborn lifesupport
Interventions 2
Designate and equip one Hospital per 500,000population to provide comprehensive essentialobstetric which includes basic obstetric care as wellas surgical procedures particularly caesarian sectionand safe blood transfusions;
Ensure that each Woreda has a minimum of one healthcenter equipped to provide basic essential obstetric andnewborn care for 24 Hours daily offering:
Ensure that malaria, TB, TT, VCT & PMTCT are focusedon during ANC
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Interventions 3
For all newborns – born at home or in facility:
Clean delivery and cord care
Keep baby dry and warm
Breastfeeding: immediate and exclusive
Avoid harmful practices
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Interventions 4
All obstetric emergencies must be treated freefor the first 48 hours.
Maintain two way referral system;
Abrogate Taxation on Contraceptives
All health facilities especially the HealthCenters and Hospitals must have regularsupply of water and electricity;
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Interventions 5
Capacity building and improvement of skills:
Train 1,148 midwives to meet Government’sstipulated midwife requirement based on HSDP-I target.
Review the curriculum to upgrade the skills of juniormidwives
Train more obstetricians
Strengthen the EOC component of pre-service training
Delegate responsibility to GPs, HOs and midwiveswith adequate training and supervision to offer EOC.
Upgrade the skills of existing health providers to offernewborn care and family planning.
Offer incentives for these cadres to attract and retainthem especially for the rural areas
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If we act now,By 2015…
$ 475 million US (4 billion Birr)in productivity gains
140,000 women’s lives saved
3,000,000 disabilities averted
700,000 children’s lives saved
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Conditions Needed
Strong commitment to maternal and newbornsurvival and health by political leaders anddecision makers at national and local levels
Community involvement, Resource mobilizationand Partnership
Realistic and appropriate investment in women’seducation, health and economic empowerment
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Conditions Needed cont.
Male involvement and participation inReproductive Health issues and services
Implementation framework with clearlydefined supervision, monitoring and evaluationmechanisms.
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Conclusion
To guarantee the RIGHT of Ethiopianwomen and newborns to health and life,they must have access to qualityreproductive health services, includingskilled attendance at birth.
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THANK YOU FOR JOINING THE“REDUCE” TEAM
MOH/WHO
