Safe Motherhood & Child Survival

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Birth attendance with backup emergency obstetric care. Many of these countries have halved their maternal deaths in the space of a decade. Severe shortages of trained health providers with midwifery skills are holding back profess in many countries. The partnership for Maternal, Newborn and Child Health aims to mobile action to reduce deaths among mothers, newborns and children, promote universal coverage of essential interventions, and advocate for increased resources for scaling up these efforts.

The ultimate aim is to make motherhood as safe as possible during crisis situations that compound women’s vulnerability. Skilled attendance at all births is considered to be the single most critical intervention for ensuring safe motherhood, because it hastens the timely delivery of emergency obstetric and newborn care when life-threatening complications arise. Skilled attendance denotes not only the pressure of midwives and others with midwifery skills(MOMS) but also enabling environment they need in order TABLE to perform capably.

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It also implies access to a more comprehensive level of obstetric care in case of complications requiring surgery or blood transfusions Historical as well as contemporary evidence from many countries, most tabby China, Cuba, Egypt, Jordan, Malaysia, Sir Lankan, Thailand and Tunisia, indicate that skilled midwifes functioning in or very close to the community can have a drastic impact on reduction of maternal and neonatal mortality. This is why the proportion of births attended by a skilled health provider is one of the two indicators for measuring progress toward the fifth Millennium Development Goal, improving maternal health.

The term ‘Skilled attendance’ refers exclusively to people with midwifery skills (for example, doctors, midwives, and nurses) who have been trained to reflection in the skills necessary to manage normal deliveries and diagnose, manage or refer obstetric complications. They must be TABLE to recognize the onset of complications, perform essential interventions, start treatment, and supervise the referral of mother and baby for interventions that are beyond their competence or not possible in the particular setting.

Some women may clearly be at risk for complications, such as those with obvious physical malformations or very short stature, those that are too young and immature, or those having severe health conditions. It is indeed essential to refer them to an institution before the start of the labor, in order to anticipate and manage obstetric complications. But the great majority of complications arise with little or no warning among women who have no risk factors. Every minute, 110 women in the world experience a complication in their pregnancy, and one of them will die.

Since it is difficult to predict who will develop a life-threatening complication, all pregnant women should have access to a qualified health provider for prenatal and delivery care, operating in a health centre with adds Tate referral services to a higher level of facility if deed. Maternal mortality statistics are indicative of the overall state of maternal health for a particular population. But they are only the tip of the iceberg. For every woman who dies, some twenty others face serious or long- lasting consequences.

Women who survive severe, life-threatening complications often require lengthy recovery times and may face long-term physical, psychological, social and economic consequences. The chronic ill- health of a mother puts surviving children, who depend on their mothers for food, care and emotional support, at great risk. Obstetric fistula is one of the cost devastating complications of childbearing, but there are many others. These may include anemia, infertility, damaged pelvic structure, chronic infection, depression and impaired productivity.

These problems, in turn, may lead to others, including marital problems, household dissolution, social isolation, shortened life spans and suicide. Costs of medical care and lost productivity may drive women and their families into poverty. The dangers of childbearing can be greatly reduced if a woman is healthy and well nourished before becoming pregnant, if she has a health check-up by a trained health rocker at least four times during every pregnancy, and if the birth is assisted by a skilled birth attendant such as a doctor, nurse or midwife.

The woman should also be checked during the 12 hours after delivery and six weeks after giving birth It is very likely that that maternal underproduction during pregnancy and lactation is the the underlying cause of prenatal and postnatal growth retardation through its effects on fetal growth and breast milk output. The role of maternal nutrition in the chain of events leading up to impaired fetal growth has been assessed in prospective, community-based dietary intervention studies in Guatemala ( Habit et al. , 1 AAA-b; Leeching et al. , 19751-d; Leeching& Klein, 1980), Taiwan (Blackwell et al. , 1973; McDonald et al. 1981; Adair & Polite, 1985) , Bogota, Colombia (Moral et al. , 1973, Hearer et al. , 1980), the Gambia (Prentice et al. , AAA; 1987) as well as in industrialized countries (Rush et al. , 1980; Rush, 1981; 1983). The results were not consistent, and the degree of maternal underproduction may have contributed to the different impact of energy supplementation on infant and maternal outcomes (Mainmast, 1980; 1981; Beaten, 1983; Morgan, 1987). The link between maternal nutrition during lactation and breast milk output, and indirectly postnatal growth, is even less well understood ( Prentice et al. Bibb; NAS, 1991; Crossover et al. , AAA). Motherhood should be a time of expectation and joy for a woman, her family, and her community. For women in developing countries, however, the reality of motherhood is often grim. For these women, motherhood is often marred by unforeseen complications of pregnancy and childbirth. Some die in the prime period of their lives and in great distress: from hemorrhage, convulsions, obstructed labor, or severe infection after delivery or unsafe abortion. Worldwide, it is estimated that 529,000 women die yearly from complications of pregnancy and childbirth?about one woman every minute.

Some 99 percent of these deaths occur in developing countries, where a woman’s lifetime risk of dying from pregnancy-related complications is 45 times higher than that of her counterparts in developed countries. The risk of dying from pregnancy- related complications is highest in sub-Sahara Africa and in South-Central Asia, where in some countries the maternal mortality ratios are more than 1 ,OHO deaths per 1 00,000 live births. Sixty to eighty percent of maternal deaths are due to obstetric hemorrhage, obstructed labor, obstetric sepsis, hypertensive disorders of pregnancy, and complications of unsafe abortion.

These direct complications are unpredicTABLE and most occur within hours or days after delivery. Maternal death and disability are the leading cause of healthy life years lost for developing county women of reproductive age, accounting for more than 28 million disability-adjusted life years (Dally) lost and at least 18 percent of the burden of disease in these women. For each woman who dies, an estimated 1 00 women survive childbearing but suffer room serious disease, disability, or physical damage caused by pregnancy- related complications.

Long-term consequences of pregnancy-related complications include uterine prolapsed, pelvic inflammatory disease, fistula, incontinence, infertility, and pain during sexual intercourse. A mother’s death carries profound consequences not only for her family, especially her surviving children, but also for her community and country. In some developing countries, if the mother dies, the risk of death for her children under age 5 is doubled or tripled. In addition, because a woman dies during err most productive years, her death has a strong social and economic impact?her family and community lose a productive worker and a primary care giver.

The Safe Motherhood Initiative In 1 987 the World Bank, in collaboration with WHO and UNAPT, sponsored a conference on safe motherhood in Nairobi, Kenya to help raise global awareness about the impact of maternal mortality and morbidity. The conference launched the Safe Motherhood Initiative (SIMI), which issued an international call to action to reduce maternal mortality and morbidity by one half by the year 2000. It also led to the formation of an Inter-Agency Group GAG) for Safe Motherhood, which has since been joined by EUNICE, UNDO, IPPP, and the Population Council.

The Semi’s target has subsequently been adopted by most developing countries. Under the Safe Motherhood Initiative, countries have developed programs to reduce maternal mortality and morbidity. The strategies adopted to make motherhood safe vary among countries and include: Providing family planning services. Providing postposition care. Promoting antenatal care. Ensuring skilled assistance during childbirth Improving essential obstetric care. Addressing the reproductive health needs of adolescents. Essential Obstetric Care Ensuring access to essential obstetric care is especially important in reducing maternal deaths.

Basic essential obstetric care (also called basic emergency obstetric care) at the health center level should include at least: Parental antibiotics Parental quixotic drugs Parental sedatives for clamps Manual removal of placenta Manual removal of retained products Assisted vaginal delivery Comprehensive essential obstetric care services at the district hospital level (first referral level) should include the entire above, plus: Surgery Anesthesia Blood transfusion Ten years after: Key lessons learned Ten years after the launch of the Initiative, the GAG held a Safe Motherhood technical consultation in Colombo, Sir Lankan in October 1997. The goal of the technical consultation was to review key lessons learned from the Initiative’s first ten years and articulate a clear consensus on the most effective strategies and ways to implement these strategies at the country level (Stars 1998). In addition, commitment to the Safe Motherhood Initiative was further strengthened when safe motherhood was named the theme of WHO’s World Health Day, April 7 1998 .

As part of World Health Day an International Symposium on Safe Motherhood was held in Washington, DC and attended by key representatives of governments, international aid agencies, and Nags. The message of the symposium was clear: motherhood can and should be made safe. Global experience from the Initiative’s first ten years showed that maternal death and morbidity due to obstetric complications can be prevented (with existing knowledge and technology) by: Recognizing that every pregnancy faces risks. Increasing access to family planning services. Improving the quality of antenatal and postpartum care. Ensuring access to essential obstetric care (including postposition care). Expanding access to midwifery care in the community. Training and deploying appropriate skilled health personnel (such as midwives). Ensuring a continuum of care connected by effective referral links, and supported by adequate supplies, equipment, drugs, and transportation. Reforming laws to expand women’s access to health services and to promote women’s health interests. Key lessons learned from the global experience of efforts to make motherhood safe include: Strong political commitment at the national ND/or local level can help facilitate the implementation of safe motherhood interventions and ensure their integration into the health care system.

Involving national and local leaders and other key parties (including donors and both public and private health sectors) in the planning and implementation of safe motherhood activities helps facilitate the delivery of maternal health services and ensure sustainability. Longing community members (particularly women and their families, health care providers, and local leaders) in efforts to improve maternal health helps ensure program Training and deploying a range of health care providers at success. Appropriate service delivery levels help increase access to maternal health services, especially life-saving services. Effective communication between health care providers at both the community level and the district (first- referral) level is essential for management of obstetric emergencies and for ensuring continuity of care. Community education about obstetric complications and when and where to seek medical care is important to ensure early recognition of complications and prompt care-taking behavior. International commitment to reducing maternal mortality was reaffirmed in December 2000 when 149 government leaders from 191 United Nations member states committed themselves to achieving a set of Millennium Development Goals by 2015. Reducing maternal mortality by three-quarters from its 1990 level is one of these key goals. The maternal mortality ratio and the proportion of deliveries with a skilled attendant will be used to monitor progress towards this goal.

In January 2004, the Partnership for Safe Motherhood and Newborn Health was established to promote the health of women and newborns, especially those who are most vulnerTABLE. This group is expanding the scope of the global Safe Motherhood Initiative and aims to strengthen global, regional, and national maternal and newborn health efforts, in the context of equity, poverty reduction, and human rights. The new partnership will: Highlight the vital linkages between maternal and newborn health. Encourage partnerships among a range of stakeholders, by involving a broader range of organizations. Strengthen and expand efforts in maternal and newborn health. Respond more effectively to the challenge posed by the Millennium Development Goals, which define concrete global argues for reducing maternal and child mortality. Partnership for Safe Motherhood and Newborn Health In January 2004, an expanded Partnership for Safe Motherhood and Newborn Health Was established with the aim of promoting the health of women I land newborns, especially the most vulnerTABLE. Expanding the scope of the global Safe Motherhood Initiative and building on the work of the Safely I Motherhood Inter-Agency Group, the Partnership aims to strengthen maternal and newborn health efforts at the global, regional, and national I levels, in the context of equity, poverty reduction, and human rights.

I I The Partnership sis result of a consultative process, initiated in 2002, among a diverse group of international development agencies and laryngitis’s to promote greater attention to, and resources for, safe motherhood and newborn health. I Focusing on the areas of advocacy/ information-sharing technical advancement, and country-level support and partnership, the Partnership I I undertakes the following activities: I Implementing an advocacy/media strategy to refocus global attention to improving the health of women and newborns in developing countries; Stimulating national-level commitment to make safe motherhood/newborn lath a priority within national development plans and aid requests; I Promoting effective interventions to improve the application of technical knowledge and research findings.

I Safe Motherhood I Every minute of every day, somewhere in the world and most often in a developing country, a woman dies from complications related to pregnancy I or childbirth. That is 51 5,000 women, at a minimum, dying every year. Nearly all maternal deaths (99 percent) occur in the developing I world– making maternal mortality the health statistic with the largest disparity between developed and developing countries. I For every woman ho dies, 30 to 50 women suffer injury, infection, or disease. Pregnancy- related complications are among the leading causes of I Ideate and disability for women age 15-49 in developing countries. I When a mother dies, children lose their primary caregiver, communities are denied her paid and unpaid labor, and countries forego her contributions to economic and social development.

A woman’s death is more than a personal tragedy–it represents an enormous cost to her nation, her community, and her family. Any social and economic investment that has been made in her life is lost. Her family loses her love, I I her returning, and her productivity inside and outside the home. I More than a decade of research has shown that small and affordTABLE measures can significantly reduce the health risks that women face when they’ll I become pregnant. Most maternal deaths could be prevented if women had access to appropriate health care during pregnancy, childbirth, and I I immediately afterwards. I Safe motherhood means ensuring that all women receive the care they need to be safe and healthy throughout pregnancy and childbirth.

I Newborn Health and Survival I Each year, approximately 4 million newborn infants die during the first onto of life, and an additional 4 million are stillborn- most of theses Ideates are due to infection, asphyxia and birth injuries, and complications of premature birth. Low birth weight contributes to newborn death I in about 40-80% of cases. Nearly all of these newborn deaths occur in developing countries, and most of these deaths can be prevented if I Good-quality is availTABLE. Newborn health and survival are closely linked to the health of the mother before and during pregnancy, as well as during labor, childbirth, I land the postpartum period. Key interventions for improving newborn health include: insuring a skilled attendant at every birth; tetanus toxic limitation; and immediate and exclusive breastfeeding.

The principles and polices of each agency are governed by the relevant decisions of each agency’s governing body. Each agency implements the interventions described in this document in accordance with these principles and policies and within the scope of its mandate. The objectives of making pregnancy safer The objective of Making Pregnancy Safer (MSP) is to ensure that governments and partner agencies receive guidance and technical support. MSP interventions help strengthen health systems, including improving access to and quality of health services, and enhance individuals’, families’, and communities’ capacities to respond better to needs, to ensure that women and their newborn babies have access to and use the care they need when they need it.

Interruptions to a Healthy Pregnancy Tracking Weight And Condition Of Mothers During Pregnancy The nutritional adequacy of pregnant mothers during the first 90 days of conception can be assessed by tracking changes in body weight and body condition. During the first month after conception, mothers should, if possible, maintain their weight and body condition. Short periods of either severe underfeeding or excessively high levels of intake at this time can adversely affect embryo survival. In many cases, it is not possible to prevent some loss of weight and condition following conception, but it is important that any losses are gradual and don’t exceed 3 to 4 percent of the body weight at pregnancy.

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