Maternal & Reproductive Health

1. Maternal & Reproductive Health Odessa Hamidi Dr. Casanova

2. Objectives • Understand measures of maternal health and major causes of maternal mortality • With focus on Malaria, Obstetric Fistula, HIV/AIDS • Understand and describe the perception of women and gender inequalities • Understand areas that have an impact in decreasing maternal mortality 

3. What issues do you think of?

4. What issues do you think of? • Lack of access to health services • Cost, transportation, societal norms • Lack of facilities, education • Antenatal care & post-partum care • Contraception & Family Planning • Gender Inequality issues • Female Genital Mutilation/Cutting • Child Marriage

5. Current Picture • 350,000+ women die each year from complications due to pregnancy or childbirth • Higher lifetime risk of death for women in high-fertility settings • 1 in 76 in developing world • 1 in 8,000 in the developed world

6. Measures of Reproductive Health • Life expectancy • Fertility • Perinatal mortality • Low birth weight • Maternal mortality

7. Reproductive Health Disparities • 99% of maternal deaths occur in the developing world • 65% occur in 11 countries – Afghanistan, Bangladesh, Ethiopia, Democratic Republic of Congo, Kenya, India, Indonesia, Nigeria, Pakistan, Sudan, Tanzania • For every woman who dies in pregnancy/childbirth, 20 endure injury, infection, disease, and disabilities

8. Maternal Mortality Ratio

9. "That women in some regions of the world, primarily sub-Saharan Africa and South Asia, are still facing such high risks of dying during pregnancy and childbirth is an infringement of their rights."

10. Maternal Mortality

11. Anemia & Malaria • Risk of stillbirths, spontaneous abortions, low birth weight infants, neonatal death • Maternal death due to anemia • Intermittent preventative treatment in pregnancy (IPTp) and insecticide-treated bed nets (ITN)

12. Obstetric Fistula

13. Obstetric Fistula

14. Obstetric Fistula • Occurs to young women in rural areas without access to medical care • Most frequently during first birth • Uncomplicated fistula can be repaired by a simple surgery that has cure rates of 90% • Preventable with family planning to delay age of first pregnancy and timely access to obstetric care • "Every Mother Counts" Video

15. HIV/AIDS • Two-thirds of all people infected with HIV live in sub-Saharan Africa • Access to antiretroviral medication • 370,000 children were born with HIV in 2009 • Sub-Saharan Africa, India

16. Preventing Mother to Child Transmission (PMTCT)

17. Preventing Mother to Child Transmission (PMTCT) • HIV/AIDS transmission can occur during pregnancy, labour and delivery, or breastfeeding. • 15-30% during labour/delivery • 5-20% during breastfeeding • Mother to child transmission programs in 80 villages in 10 African countries • Even where PMTCT services are available, not all women receive the full benefit

18. “No child should be bornwith HIV; no child should be an orphan because of HIV; no child should die due to lack of access to treatment.” -EbubeSylvia Taylor, an 11-year-old Nigerian, born free of HIV, speaking to world leaders who gathered in New York in 2010 to share progress made towards achieving the Millennium Development Goals by 2015.

19. “My husband might see me with the medicines, and he will want to know what they are for. That way he will find out about my [HIV positive test] result. Even the location bothers me, because everyone who comes to the clinic knows what goes on [at the programme]. As soon as a pregnant woman is seen coming here, it's known right away that she is seropositive.” -Woman from Cote D’Ivoire

20. Prevention & Progress • Family planning services, contraceptives, and abortion services • Avoidance of unintended pregnancies • Skilled attendants • Emergency care for complications

21. “Better health and education, and freedom to plan their family's future, will widen women's economic choices; but it will also liberate their minds and spirits.” - NafisSadik, Secretary-General of the ICPD (International Conference on Population and Development)

22. Millennium Development Goals • 8 international development goals to reduce poverty and improve lives by 2015 decided upon by the members of the United Nations and international organizations • Goal 3 – Promote gender equality and empower women • Goal 4 – Reduce child mortality by 66% by 2015 • Goal 5 – Improve maternal health • Goal 6 – Combat HIV/AIDS, malaria and other diseases

23. Millennium Development Goals • MDG 5: Reduce maternal mortality by ¾ between 1990-2015 • 1990: 850 maternal deaths/100,000 live births • 2000: 400 maternal deaths/100,000 live births • 2015 goal: 213 maternal deaths/100,000 live births • Maternal deaths have dropped by almost 50 percent worldwide

24. Access to family planning, contraceptives, abortive services “122 million women around the world want contraception and can’t get it” –Half the Sky

25. Family Planning • Benefits • Reduction in maternal and newborn mortality • Reduction in transmission of HIV/AIDS • Reduction in # of abortions • Reduction in unplanned pregnancies in young women leading to improvements in education and employment opportunities

26. Contraceptive Use • Contraceptive use continues to increase although there is still an unmet need for contraception and family planning services • Female sterilization and IUDs are the main methods of contraception in developing countries

27. Abortions • Significant decline in the number of women dying from unsafe abortions worldwide (56,000 in 2003 to 47,000 in 2008) • Unintended pregnancies are the root of unsafe abortions • ~13% of maternal deaths

28. Skilled Attendance at Birth • Midwives, nurses, physicians and others who have been trained in proficiency in midwifery skills. • Provides safe, cost-effective, and timely emergency obstetric care

29. Giving Midwives More Responsibility • Increasing responsibility and protection to midwives makes emergency obstetric care more widely available in rural areas • Reduces costs • Increases access to care. • http://bcove.me/1g6f3s4k

30. Proportion of Births Attended by Health Personnel

31. Edna Adan Hospital: Hargeisa, Somaliland • First licensed nurse-midwife in her country • Treats women and trains the next generation of midwives • Trained > 700 students • Rate of maternal mortality in Somaliland has decreased from 16 deaths per 1,000 live births (1997) to 10 per 1,000 (2006) • http://youtu.be/b3ZHRj3bvws

32. Hamlin Fistula Hospital – Addis Abbaba, Ethiopia • Established in 1974 • Provides free fistula repair surgery and healthcare for women • Interview with Dr Hamlin

33. Gender Inequality “Globally, women between the age 15 and 44 are more likely to be injured or die as a result of violence against women than through cancer, traffic accidents, malaria and war combined.” – UN, Office for the Coordinator of Humanitarian Affairs. 9 December 2005.

34. Discrimination Throughout a Lifetime • Infancy– infanticide, sex-selective abortion • Childhood– educational disadvantages, decreased change of completing primary and secondary education • Adolescence– abuse, exploitation, violence, child marriage, trafficking, lack of knowledge of reproductive health • Motherhood– pregnancy complications, maternalmortality, lack of power to control reproduction • Old age– discrimination from inheritance, property laws

35. Female Genital Mutilation • Female genital mutilation (FGM) – procedures that intentionally alter or injure female genital organs for non-medical reasons • Reasons vary by region and include: • To reduce female sexuality (premarital sex, libido, etc) • Rite of passage to womanhood • Enhance fertility and child survival • Religious beliefs • In all cases female genital mutilation/cutting is a violation of humans rights as it offers no health benefits and leads to permanent damage or death

36. “There is no tool for development more effective than the empowerment of women.” • Kofi Annan (U.N. Secretary-General '97-'07) “If you think education is expensive, try ignorance.” -Derek Bok

37. Empowerment & Education • “For each additional year of education achieved by 1,000 women, two maternal deaths will be prevented” • Better knowledge about health care practices • Expanded use of health services • Improved nutrition • Increased spacing between births

38. http://www.youtube.com/watch?v=N4ok_5D27BY&feature=relmfu • “UNICEF: Girls around the world talk about their lives and their rights”‬http://www.youtube.com/watch?v=lfMmvr2yw2I