Safe Motherhood Dr Muhammad Shoaib MBBS MPH Senior

Safe Motherhood Dr. Muhammad Shoaib MBBS, MPH Senior Lecturer Department of community Medicine MBBS MC

Table of Contents 1. Essentials of Safe Motherhood 2. Situational Analysis 3. Brief History 4. Concepts and operational definitions 5. Goals 6. Safe Motherhood Pillars 1. Family Planning 2. Antenatal 3. Safe Delivery 4. Obstetric care 7. Elements of Safe Motherhood 8. Foundations of Safe Motherhood 9. Strategies for Management 10. Programs

National Safe Motherhood Day is observed on April 11 every year

Moment Concern Every minute of every day, somewhere in the world and most often in a developing countries, a woman dies from complications related to pregnancy or childbirth. That is 515, 000 women, at a minimum, dying every year. Nearly all maternal deaths (99 percent) occur in the developing world--making maternal mortality the health statistic with the largest disparity between developed and developing countries. As per current estimates, Pakistan loses >14, 000 women die in childbirth every year; translating into one death every 37 minutes.

Brief history Safe Motherhood became the subject of a conference held 24 th -28 th March, 1990 in Lahore, a Challenge for South Asia National and International representatives unrevealed why it is that, MMR in the region are 100 times higher than, in technically advanced countries while IMR are less than 20 times as high. The conference was hosted by Family Planning Association of Pakistan, The International Planned Parenthood Federation and Govt. of Pakistan. Cosponsor of the meeting include WHO, UNDP, UNFPA, UNICEF, World Bank and Population Council.

Brief history (Cont. ) International Conference on Population and Development (ICPD) in Cairo in 1994 The Fourth World Conference for Women (FWCW) in Beijing in 1995 The Social Summit in Copenhagen in 1995 WHO determined that World Health Day 1998 would be devoted to safe motherhood, with the slogan ‘Pregnancy is special: let’s make it safe’ In 2000, MDGs the 5 th goal was “Improve Maternal health” An Expanded Global Partnership for Maternal Health (2005) SDGs Goal 3: Good Health and Well-Being for People

Concept and conditions for ensuring that women receive the appropriate services in connection with pregnancy, childbirth and the post-natal period, including family planning and emergency obstetric care. (General Recommendation No 24 – Women and Health; World Health Organization)

Definition Safe motherhood encompasses: Series of initiatives, Practices, Protocols, Service delivery guidelines designed to ensure that women receive high-quality Gynecological Family planning Prenatal Delivery Postpartum care in order to achieve optimal health for the mother, fetus and infant during pregnancy, childbirth and postpartum

Goal Improvement in well being of mothers Reduction in Maternal & Child mortality

Pillars of Safe Motherhood Family Planni ng Antenatal Care Clean/Safe Delivery Basic Maternity care Primary Health care Equity for Women Essential Obstetric care

Family Planning Information and services to plan the timing, number and spacing of pregnancies Timing and spacing of pregnancy depend on age, family desires and family supports. Economic and social circumstances and access to health care may all play a vital role. Delay pregnancy until physically and emotionally mature. Recommended birth spacing is at least 2 years after a live birth or at least 6 months after a miscarriage or induced abortion.

Ante Natal Care Prevention & early detection of complications for appropriate Treatment Ante-natal care Focused assistance and individualized care. To detect and track Health promotion and education Counselling Tetanus immunization Iron-folic acid Prevention, detection and treatment of anemia According to WHO, at least 5 ante-natal visits should be done of pregnant women who don’t have complicated labor.

Clean/Safe Delivery All birth attendants have the knowledge, skills and equipment to perform a clean and safe delivery and provide postpartum care to mother and baby Emergency care for the high-risk pregnancies and complications should be made available to all women who need it. The presence of skilled birth attendants at delivery is a leading predictor of clean and safe delivery.

Essential Obstetric Care Essential care for high-risk pregnancies and complications Prevention and control of hemorrhage Vacuum extractor Repair of perineal lacerations Control of convulsions with parenteral medication Treatment of sepsis with antibiotics Evacuation of retained products for incomplete abortion. Essential newborn care Functional referral system and advocating for emergency transport system should be there for high risk pregnancies

Post Natal Care Post-partum care lactation assistance. Provision of family planning services One post-natal visit is necessary for home delivery with 24 hrs and next visit should be during the first week. Early detection and treatment of complications of mother and newborn, advise on breastfeeding, thermal control. Immunization, nutrition and hygiene should be explained. Prevent complications where possible, complications of abortion are detected early and treated appropriately.

STD & HIV/AIDS Control HIV screening Prevent & manage transmission Assess risk for future infection. Counselling should be done to encourage the people for testing and prevention. Inspire and motivate boys and men to be sexually responsible partners and value daughters equally as sons.

Basic maternity Care Objective: To ensure that all women have access to basic maternity care, including antenatal care, health promotion and information about signs and symptoms of complications.

Strategy Access to basic maternity care Awareness of the special needs of pregnant and lactating women Information about complications & awareness Knowledge and skills & detect, manage and/or refer high-risk cases and complications. All pregnant women should have a minimum of five antenatal visits Antenatal care sessions should be used as an opportunity to provide information to women and their All women and birth attendants should be aware of the requirements for a clean delivery Protocols of referral

Equity for Women Providing women and girls with equal access to Education, health care, decent work, and representation in political and economic decisionmaking processes Implementation of new legal frameworks Female equality in the workplace Eradication of harmful practices Ending the gender-based discrimination

Strategies For Management Promoting inter sectoral coordination with a focus on poor and excluded groups Strengthening and expanding deliveries by SBAs Strengthening HR Encourage community based awareness activities Establish functional referral system

Programs and Polices Pakistan Safe Motherhood initiative The National Program for Family Planning and Primary Health Care The Asia Foundation. MCHIP (Maternal & Child health Integrated Program), February 2013 The White Ribbon Alliance; 2006 Punjab Health Reforms Road Map The IRMNCH&N Program

IRMNCH & NP Initiatives Scale up of 24/7 Basic Em. ONC services. Launch of special initiative of BHU Plus model for provision of 24/7 on-call service for obstetric care. Scale up of nutrition OTP sites from 440 to 804 BHUs. Scale up of nutrition Stabilization Centers from 20 to 42 hospitals. Launch of rural ambulance service dedicated for obstetric cases. Improving the quality of services through introduction of functionality index for BHUs and RHCs (obstetric and nutrition services). Provision of funds to health councils to improve the service quality for obstetric and newborn care.

“ We have just started on what would be a massive transformation in the coming years ”

Transformation of Maternity Facilities To transform hospitals and maternity facilities through implementation of the ten steps To end the practice of distribution of free and low cost supplies of breast milk substitutes to maternity wards and hospitals

Ten steps to successful breastfeeding 1) Have a written breastfeeding policy that is routinely communicated to all health care staff 2) Train all health care staff in skills necessary to implement this policy 3) Inform all pregnant women about the benefits and management of breastfeeding 4) Help mothers initiate breastfeeding within half n hour of birth

Cont. 5) Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants 6) Give new born infants no food or drink other than breastfeed, unless medically indicated 7) Practice rooming-in- that is allow mothers and infants to remain together 24 hours a day 8) Encourage breastfeeding on demand

Cont. 9) Give no artificial teats or pacifiers to breastfeed infants 10) Foster the establishment of breastfeeding support groups and refer mothers on discharge from the hospital or clinic

Pregnancy is special: let’s make it safe THANK YOU