Maternal newborn health in the pacific
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Maternal & Newborn Health in the Pacific. Pasifika Medical Association, Tonga September 2013. “ Children have a right to special care and assistance”. No mother should die giving life. PICT commonalities. Relative isolation Resource poor Collectivism Service & obligation

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Maternal & Newborn Health in the Pacific

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Maternal & Newborn Health in the Pacific

Pasifika Medical Association, Tonga September 2013


“ Children have a right to

special care and assistance”


No mother should die giving life


PICT commonalities

  • Relative isolation

  • Resource poor

  • Collectivism

  • Service & obligation

  • Traditional social structures

  • Scattered populations

  • Geographical isolation

  • Resource poor

  • Cultural diversity

  • Traditional social structure

  • Gender inequity

  • Globalisation

  • Urbanisation

  • Erosion of traditional social structures


Available Medical Rx & technology


Pregnancy and better outcomes

Pre-pregnancy health

Antenatal care

Health promoting behaviors

Labour & delivery

Postnatal care

Supportive environment

Mortality & Morbidity for mothers

Mortality & morbidity for babies


MCH Policy & Strategy

  • “Regional Child Survival Strategy” 2005

  • “Pacific Policy Framework for Universal access to Reproductive Health” 2008

  • “Achieving MDG 4 & 5 : Scaling up programmes for Women and Childrens Health”. 9th Meeting Pacific MOH’s, 2011.

  • “Global Strategy for Women and Children’s Health” United Nations, 2010

  • “Monitoring maternal newborn and child health: understanding key progress indicators”. UN Health Metrics, 2011


United Nations Commission on Information and Accountability, 2011


11 Global MCH indicator Pacific data

Data source: World Bank data Bank 2012, Cook Is Census 2011, World Health Statistics 2012, Division of Statistics FSM 2009, Marshall Is 2007, Nauru DHS 2007, Samoa DHS 2009, Global Aids Progress Reporting 2012


Health information & Vital statistics


DHS data complementing MOH dataTUVALU under 5 yr mortality


Maternal & Newborn healthChallenges & opportunities

  • Access to essential interventions

  • New technologies and medication

  • Lack of Investment in Maternal & infant health

  • Unclear policy and strategic direction

  • Not tracking results

  • ?? Accountability


Maternal & Newborn healthChallenges & opportunities

  • Maternal obesity

  • Maternal smoking

  • Non-communicable diseases

  • Maternal mental health

  • Family Planning access

  • Adolescent Mothers


Adapted from Black et al.2008.Cook I, FSM ,Fiji, Marshal Is, Nauru, Nuie, Palau, PNG, Samoa, Solomon Is, Tonga, Tuvalu, Vanuatu


Children’s lives saved if MDG target trajectory increased

Adapted from : Asia Pacific MDG Report 2011/12 UNFPA, UNICEF, WHO


Oceania

31%

30%

23%


Country Neonatal Mortality, 2010per 1000 livebirths


Newborn survival

  • Maternal health & perinatal care

  • Neonatal resuscitation

  • Neonatal care – warmth, antibiotics, breastfed

  • Postnatal review <3 days


“Best Bets” Saving Newborn lives


“Neonatal Resuscitation in Low resource settings. What , who and How to overcome challenges to scale up” Wall et al. 2009


Change in Maternal Mortality Ratio by region 1990 – 2010Not all on track to Achieve MDG 5

WHO 2012 “MM Trends”


MDG 5 – Reduce Maternal mortality by 75%MMR (maternal deaths/100,000 births)

MMR

Source: ESCAP database


Maternal Deaths saved if “Off track” countries achieved MDG target

Adapted from : Asia Pacific MDG Report 2011/12 UNFPA, UNICEF, WHO


Preventing Maternal Mortality

  • Maternal / women’s health

  • Prevent unintended pregnancies

  • Antenatal care

  • Skilled birth attendant

  • Access to emergency obstetric care

  • Postnatal care


Why women die

Ronsmans et al. Maternal Survival. The Lancet, 2006


Giving Birth in the Pacific

  • Ideal = Delivery in a health facility with skilled birth attendant

  • Most continue to deliver at home with Skilled birth attendant access improving

  • Intervention needs to be “at the right time”

    >50% maternal & newborn deaths during the birth period (labour/delivery/postpartum)


Obstetric complications


Maternal & Newborn survivalStrategies for limited health facility setting

Community based care

  • Education, access to Family Planning

  • Community Antenatal visits (nutrition, malaria, STI, birth preparedness)

  • Traditional Birth attendants / Village health workers

  • Delivery kits/hygiene/neonatal resuscitation/oral misoprostol

  • Postnatal care – temperature/hygiene/exclusive breast


Giving Birth in the Pacific - The “three delays”

  • Delay in decision to seek care

  • Delay in reaching care

  • Delay in receiving adequate care


The 1st delay – barriers & strategies

  • Female Education

  • Antenatal education

  • Antenatal care

  • Community promotion of Maternal & newborn care

  • Low status of women

  • Lack of understanding of pregnancy /labour complications

  • Lack of knowledge of interventions

  • Acceptance of maternal death


The “2nd delay”

  • Geography

  • Isolation & distance

  • Transport, roads

  • Seasonal barriers

  • Climate disasters

  • Cost

  • Transport infrastructure

  • Emergency transport

  • Anticipatory transfer

  • “waiting houses”

  • Patient subsidies


“third delay” - strategies

  • Infrastructure

  • Workforce

  • Skilled birth attendants

  • Emergency Obstetric care

  • Technology

  • Equipment & meds

  • Communication


MDG 5 - % of Births with Skilled birth attendant

%


HIV +ve antenatal women receiving antiretroviral treatmentSource: Global Aids Progress Reporting 2012 for individual countries

Pacific MCH Indicators


Essential equipment


“Stillbirth” weights TTM Hospital, Samoa, 2006-2009

Source: Pacific CHIP project PATIS & Delivery unit record data, Percival & Stowers 2012


Family Planning in the Pacific

  • 1 in 5 Adolescent girls (15-19yrs) already mothers

  • Increased health risk to mother & baby


Contraception Prevalence by region


Improving Maternal & newborn Health

  • Leadership (Country & Region)

  • Prioritize mothers and children

  • Prioritize Health

  • Infrastructure & workforce

  • Health Information, Vital statistics

  • Evidence based policy

  • Upscale “best bets”


Levels of Maternal & Newborn care

Essential tools & skills

  • Village level (non-clinical workforce)

  • Core intervention/Rx

  • Expanded care & Rx

  • Comprehensive care & Rx


Maternal and newborn health included in other Policy


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