2 REDUCING MATERNAL AND NEWBORN DEATHS Ethiopia: 11 Regions 62 Zones
3 Demographic Characteristics Total Population67.2mill Population Growth Rate2.7% Population doubling time23 years Population under 15 years 44 % Life Expectancy at birth54 years Infant Mortality Rate113/1,000 Under five mortality187.8/1,000 Maternal Mortality Ratio871/100,000
4 Demographic Characteristics Population below absolute poverty line44.2% Economic Growth Rate5.8% Per capita income (GDP) US $100 Access to potable water28.4% Access to sanitation16.9% Health service coverage 61.8% Adult literacy31.9%
6 Socio-Demographic characteristics of women Total Female Population33.6 million Population of Women (15-49) 16 million Median age at first marriage16.4 years Total Fertility Rate5.9 Female life expectancy at birth55 years Maternal Mortality Rate 871/100,000
9 Low Status of Women Limited Access to education Female literacy30.9% Female primary School Enrollment51.2% Female secondary School enrollment13.7% Limited representation in Governance 7.7% Limited access to employment 45% Gender Development Index of 142/162
15 Causes of Maternal Death* *Facility based, Ethiopia
16 Contributing Factors to Maternal Deaths Adolescent pregnancy HIV among pregnant women Malaria Malnutrition Harmful traditional practices
17 Selected Maternal Mortality Ratios in Africa
18 Lack of information and inadequate knowledge about danger signals during pregnancy and labour Cultural /traditional practices that restrict women from seeking health care Lack of money The First Delay Male Involvement is Key Delay in deciding to seek care at the household level
19 The Second Delay Inability to access health facilities: Out of reach health facilities Poor roads and communication network Poor community support mechanisms
20 Delay between arriving and receiving care at the health facility: Inadequate skilled attendants Poorly motivated staff Inadequate equipment and supplies Weak referral system The Third Delay
24 REDUCE MODEL Impact on survival and productivity (2001 - 2015) Data on Maternal & Newborn Health Estimating Consequences of Poor Maternal and Newborn Health
25 Key assumptions in “REDUCE” The model assumes two scenarios: Scenario 1: Maternal mortality ratio remains constant from 2001-2015. Scenario 2: With appropriate interventions maternal mortality ratio will decline
26 Maternal Mortality 2001-2015 No interventions 415, 000 maternal deaths 9 Million suffer disabilities
27 Infant Deaths resulting from Maternal Death and Disability 2001-2015 No interventions 2,000,000 infants will die
28 Effects of Mothers’ Death The death of a woman and mother is a tragic loss to the family, community and nation as a whole.
29 Disability Consequences 2001-2015 Chronic anemia Fistulae Chronic pelvic pain Emotional depression Maternal exhaustion $750 million US or 6.4 billion Birr
30 Economic Losses 2001-2015 The loss of productivity due to maternal deaths will be US $650,000,000 or about 5.5 billion Birr Birr
31 Commitment to Reducing Maternal Deaths GOAL Reduce current MMR by 75 % by 2015
33 Economic Gains2001-2015 US $475 million or 4 billion Birr gain Birr
34 Intervention 1 Allocate at least 15% of total annual budget for health (Arusha Declaration, 2001) and at least 25 % of that health budget for reproductive health services. Strengthen the National RH programme to promote multi-sectoral involvement. Ensuring implementation of policies, guidelines and standards related to maternal and newborn health services. Develop appropriate strategies for effective community involvement and participation.
35 intravenous sedatives, oxytocic drugs and antibiotics manual removal of the placenta postabortion care assisted vaginal deliveries basic newborn life support Interventions 2 Designate and equip one Hospital per 500,000 population to provide comprehensive essential obstetric which includes basic obstetric care as well as surgical procedures particularly caesarian section and safe blood transfusions; Ensure that each Woreda has a minimum of one health center equipped to provide basic essential obstetric and newborn care for 24 Hours daily offering: Ensure that malaria, TB, TT, VCT & PMTCT are focused on during ANC
36 Interventions 3 For all newborns – born at home or in facility: Clean delivery and cord care Keep baby dry and warm Breastfeeding: immediate and exclusive Avoid harmful practices
37 Interventions 4 All obstetric emergencies must be treated free for the first 48 hours. Maintain two way referral system; Abrogate Taxation on Contraceptives All health facilities especially the Health Centers and Hospitals must have regular supply of water and electricity;
38 Interventions 5 Capacity building and improvement of skills: Train 1,148 midwives to meet Government’s stipulated midwife requirement based on HSDP-I target. Review the curriculum to upgrade the skills of junior midwives Train more obstetricians Strengthen the EOC component of pre-service training Delegate responsibility to GPs, HOs and midwives with adequate training and supervision to offer EOC. Upgrade the skills of existing health providers to offer newborn care and family planning. Offer incentives for these cadres to attract and retain them especially for the rural areas
39 If we act now, By 2015… $ 475 million US (4 billion Birr) in productivity gains 140,000 women’s lives saved 3,000,000 disabilities averted 700,000 children’s lives saved
40 Conditions Needed Strong commitment to maternal and newborn survival and health by political leaders and decision makers at national and local levels Community involvement, Resource mobilization and Partnership Realistic and appropriate investment in women’s education, health and economic empowerment
41 Conditions Needed cont. Male involvement and participation in Reproductive Health issues and services Implementation framework with clearly defined supervision, monitoring and evaluation mechanisms.
42 Conclusion To guarantee the RIGHT of Ethiopian women and newborns to health and life, they must have access to quality reproductive health services, including skilled attendance at birth.
43 THANK YOU FOR JOINING THE “REDUCE” TEAM MOH/WHO