M aternal S urvival and H ealth A P athway to D evelopment in U ganda

2. Maternal Survival and HealthA Pathway to Development in Uganda Application of the REDUCE Model in Uganda

3. Uganda: Sustained Economic Growth US$ 186 Annual per Capita Income

4. $ $ Uganda: Sustained Economic Growth US$ 330 186 Annual per Capita Income

5. Uganda: An Inspirational African Success Story

6. Uganda: An Inspirational African Success Story? • Total fertility rate (TFR) 6.9 • Infant mortality rate (IMR) 97 • Child mortality rate (CMR) 147 • Child stunting at 2 years of age 45% • Full vaccination at 2 years of age 44% • Access to safe water in rural areas 47% • Primary education completion 34% HDI: 158/174

7. Maternal Death (WHO, 1980) “The death of a woman during pregnancy, delivery, or the six weeks following the birth of her baby.” UNICEF/C-55-10/Watson

8. Maternal Mortality Ratios in Africa Maternal Deaths/100,000 Live Births Source: UNFPA, 1999

9. Maternal Mortality Ratios in Africa Maternal Deaths/100,000 Live Births Source: UNFPA, 1999

10. Mothers’ Index The Mothers’ Index ranks Uganda 76 out of 106 countries UNICEF/Pirozzi Source: Save the Children, 1999

11. Maternal Mortality: a Small Part of a Larger Problem Maternal Mortality UNICEF/C-79-53/Goodsmith Poor Health and Disability

12. Women’s Participation in the Labor Force Women’s economic contribution is crucial to reduce poverty UNICEF/C-79-53/Goodsmith 53% (Ugandan Labor Survey, 1998)

13. Population Living in Absolute Poverty Poor maternal health reduces dramatically the capacity of Ugandan women to grow out of poverty 44% (Source: UNICEF, 1999)

14. Investing in Safe Motherhood in Uganda • Increases Survival • Improves Health • Reduces Poverty

15. Major Causes of MaternalMortality in Uganda HIV/AIDS Malaria Anaemia

16. Women’s Low Status • Lack of access to and control of resources • Limited access to education • Lack of decision-making power Jorge Moreiro

17. Inadequate Attention to Adolescent Reproductive Health Percentage of Ugandan women who experience their first pregnancy by the age of 19 70%

18. REDUCE… a Model on Maternal Health and Survival

19. Estimating the Consequences of Poor Maternal Health Data on Maternal Health Reduce Model Impact on Survival and Productivity (2001-2010)

20. REDUCE: Data Used • Uganda 1995 Demographic and Health Survey • WHO Global Burden of Disease • Uganda Safe Motherhood Costing Study • 1991 Demographic Projections • Sexual and Reproductive Health Minimum Package • Other local literature and surveys

21. Survival

22. Maternal Deaths(2001-2010) 61,000 Maternal Deaths! Jorge Moreiro

23. Infant Deaths per 1000 Life Births(Bangladesh) Infant Deaths/1000 Life Births

24. Infant Deaths Resulting from Maternal Deaths 40,000 Infant Deaths 65% Jorge Moreiro

25. Infant Deaths Resulting from Maternal Poor Health During Pregnancy • Neonatal Tetanus: 38,000 Infant Deaths • Maternal Iodine Deficiency: 31,000 Infant Deaths • Maternal Malaria and Anemia: 220,000 Infant Deaths 65%

26. Maternal Deaths(2001-2010) 61,000 Maternal Deaths! Jorge Moreiro

27. Older Children

28. Orphaned Children More vulnerable to rights violations

29. Disabilities

30. Maternal Mortality: a Small Part of a Larger Problem 1 Woman Dies 20-30 Women Suffer Short and Long Term Disabilities

31. Maternal Mortality: a Small Part of a Larger Problem • 110,000 women will become infertile • 1,200,000 women will suffer: • Inability to breastfeed • Anaemia • Incontinence due to fistulae • Chronic pelvic pain • Emotional depression • Physical weakness • Reduced productivity (2001-2010)

32. Economic Consequences

33. Present Value of Productivity Losses (2001-2010) 47 353 400 million US $

34. Iodine Deficiency during Pregnancy Iodine is necessary for the normal development of the baby’s brain during pregnancy UNICEF/C-79-39

35. Iodine Deficiency during Pregnancy Translates into reduced • Learning ability • School performance • Retention rates in School-Age Children Permanent! UNICEF/C-56-19/Murray-Lee

36. Present Value of Productivity Losses (2001-2010) 47 353 400 408 million US $ 808

37. Recommendations

38. Three Delays • Delay in deciding to seek appropriate care • Delay in reaching a treatment facility • Delay in receiving adequate treatment at the facility UNICEF/C-55-10/Watson

39. Maternal Mortality Ratios in Africa Maternal Deaths/100,000 Life Births Source: UNFPA, 1999

40. Maternal Mortality Ratios in Africa Maternal Deaths/100,000 Life Births Source: UNFPA, 1999

41. The Six Pillars of Safe Motherhood in Uganda Safe Motherhood Family Planning Obstetric Care Ante-Natal Care Post-Natal Care STD-HIV Control Post-Abortion Care

42. 1. Family Planning • Increase number service delivery points • Encourage adolescents to delay first pregnancy • Encourage couples to space births • Update service providers’ skills: • Contraceptive technology • Counseling

43. 2. Ante-Natal Care • Provide iron+folic acid supplements • Conduct immunization against tetanus • Conduct routine deworming • Provide presumptive treatment for malaria • Screen for risk factors

44. 3. Skilled Obstetric Care at Birth • Increase the number of midwives • Update providers’ life saving skills • Monitor labor using a partograph • Provide essential obstetric care • Improve referral system • Mobilize ambulance/transportation services • Provide vitamin A supplement after delivery

45. 4. Post-Natal Care • Identify and manage danger signs • Counsel and provide family planning services • Counsel on maternal nutrition during lactation • Promote good traditional social support • Conduct maternal mortality audits and review meetings

46. 5. Post-Abortion Care • Train and equip personnel to offer MVA • Counsel and provide family planning services • Start prompt treatment for sepsis

47. 6. STD/HIV Control • Offer voluntary testing and counseling • Screen pregnant women for syphilis • Manage cases and their complications • Continue and expand ongoing successful prevention activities

48. The Six Pillars of Safe Motherhood in Uganda Safe Motherhood Family Planning Obstetric Care Ante-Natal Care Post-Natal Care STD-HIV Control Post-Abortion Care

49. The Six Pillars of Safe Motherhood in Uganda Safe Motherhood Family Planning Obstetric Care Ante-Natal Care Post-Natal Care STD-HIV Control Post-Abortion Care Communication for Behavior Change

50. The Six Pillars of Safe Motherhood in Uganda Safe Motherhood Family Planning Obstetric Care Ante-Natal Care Post-Natal Care STD-HIV Control Post-Abortion Care Communication for Behavior Change P r i m a r y H e a l t h C a r e