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Safe Motherhood. Table of Contents. Essentials of Safe Motherhood Situational Analysis Brief History Concepts and operational definitions Goals Safe Motherhood Pillars Family Planning Antenatal Safe Delivery Obstetric care Elements of Safe Motherhood Foundations of Safe Motherhood
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Table of Contents • Essentials of Safe Motherhood • Situational Analysis • Brief History • Concepts and operational definitions • Goals • Safe Motherhood Pillars • Family Planning • Antenatal • Safe Delivery • Obstetric care • Elements of Safe Motherhood • Foundations of Safe Motherhood • Strategies for Management • Programs Safe Motherhood
National Safe Motherhood Day is observed on April 11 every year Safe Motherhood
Essentials of Safe motherhood • A mother will give birth to a healthy child without adverse events, if the mother herself is healthy. • Story of Rita from Nepal In session assignment (Note down the pitfalls of story) Safe Motherhood
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. Safe Motherhood
MMR in Pakistan 178 deaths/100,000 Live births Safe Motherhood
Brief history • UK MOH professional inquiry on MMR in 1928 • The League of Nations Health Section noted concerns about maternal mortality in 1930 • The UN Decade for Women (1976–1985) • Where is the M? in 1970s & 1980s • First community studies on levels of maternal mortality in developing countries in 1985 by WHO & UNFPA • The first international Safe Motherhood Conference, 1985 • Starting point of Safe Motherhood Initiative (SMI). • The World Summit for Children took place in New York in 1989 • During the mid-1990s, a series of international conferences. Safe Motherhood
Brief history • 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 5th goal was “Improve Maternal health” • An Expanded Global Partnership for Maternal Health (2005) • SDGs Goal 3: Good Health and Well-Being for People Safe Motherhood
Concept • 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) Safe Motherhood
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 Safe Motherhood
Goal Safe Motherhood
Pillars of Safe Motherhood Family Planning Antenatal Care Essential Obstetric care Clean/Safe Delivery Basic Maternity care Primary Health care Equity for Women Safe Motherhood
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. Safe Motherhood
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. Safe Motherhood
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. Safe Motherhood
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 Safe Motherhood
Post Natal Care Post-partum care • lactation assistance. • Provision of family planning services • One post-natal visit is necessary for home delivery with 24 hrsand 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. Safe Motherhood
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. Safe Motherhood
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. In session Assignment (Continuum of care?) Safe Motherhood
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 Safe Motherhood
Equity for Women • Providing women and girls with equal access to • Education, health care, decent work, and representation in political and economic decision-making processes • Implementation of new legal frameworks • Female equality in the workplace • Eradication of harmful practices • Ending the gender-based discrimination Safe Motherhood
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 Safe Motherhood
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 Safe Motherhood
IRMNCH & NP Initiatives • Scale up of 24/7 Basic EmONCservices. • 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. Safe Motherhood
“ We have just started on what would be a massive transformation in the coming years” Way Forward • The essential core of the Pakistan Safe Motherhood initiative should be an inter sectoral multilevel programmatic framework that links the common women and men in the community, the obstetricians, midwives, nurses and educators and, is supported by a strong political commitment at the national, provincial and district levels. Safe Motherhood
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 • Have a written breastfeeding policy that is routinely communicated to all health care staff • Train all health care staff in skills necessary to implement this policy • Inform all pregnant women about the benefits and management of breastfeeding • Help mothers initiate breastfeeding within half n hour of birth
Show mothers how to breastfeed and maitainlactation,even if they should be separated fromtheir infants • Give new born infants no food or drink other than breastfeed,unless medically indicated • Practice rooming-in- that is allow mothers and infants to remain together 24 hours a day • Encourage breastfeeding on demand
Give no artificial teats or pacifiers to breastfeed infants • 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 Safe Motherhood
