1. Ending Preventable Maternal Mortality (EPMM) Dr. Richard Ayah School of Public Health, University of Nairobi Safari Park Hotel 13 th November 2014 ADVOCACY MEETING FOR SENATORS AND MEMBERS OF NATIONAL ASSEMBLY ON ACCELERATING THE ATTAINMENT OF MDG 5 & ADVANCE BEYOND ZERO CAMPAIGN IN KENYA

2. Population 45 million Births 1.5 million Maternal Deaths ~7,000 Background Number of women who die in China during child birth is roughly the same as Kenya despite Kenya having a population 30 times less.

3. Maternal Mortality Ratio Kenya vs. Global 1990 – 2008/9

5. Why Mothers die giving birth Quantity and quality of actual resources for maternal health Potential resources for maternal health: Environment, technology, Political, economic, cultural, religious and social systems, including women’s status limit the utilization of potential resources Inadequate and/or inappropriate knowledge, discriminating attitudes limit household access to actual resources Lack of education, health information and life skills Insufficient access to maternity services including EMOC Inadequate maternal health practices and care seeking Insufficient access to nutritious food and essential micronutrients Poor water & sanitation and inadequate basic health care services Obstetric risks including complications of abortions Diseases and infections Inadequate dietary intake Congenital factors Direct Causes Underlying causes at the household/ sub- county level Basic cause at societal level

6. Global The EPMM Working Group proposes a global MMR target of 50/100,000 live births by 2035 Annual Rate of Reduction 5.75% between 2010 and 2035; > MDGs (5.5%). By 2035, no country should have a MMR >100. Ending Preventable Maternal Mortality (EPMM) Target

7. KENYA’S EPMM TARGET 132 PER 100,000 BY 2030

8. How can we achieve the EPMM target ? By managing six factors. 1.Our Population 2.The Economy 3.An Equitable approach 4.Access to Reproductive Health Services 5.Socio-Cultural issues 6.Political leadership

9. Population Age/Sex structure. Median age 18.7 years 19% of the economy 23% of the economy 58 % of the economy

10. Equitable Approach Focus on the 10-15 counties that contribute the highest maternal mortality burden Turkana Lamu Migori Siaya Isiolo Marsabit Nairobi Samburu Wajir Taita-Taveta Garissa Homa Bay Kisumu West Pokot Kakamega Mandera

12. Addressing Maternal deaths beyond the health system

13. Conclusion Provide and budget resources Hold health system accountable Save 5,268 mother’s lives a year. EPMM 132 per 100,000 per 2030

14. THANK YOU FOR LISTENING Dr. Richard Ayah Lecturer, School of Public Health, University of Nairobi and Adjunct Associate Professor, School of Public Health, Tropical Medicine & Rehabilitation Science, James Cook University, Australia