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Ghana’s Experience in Measuring Maternal Mortality and Maternal Health

3rd Global Forum and Inter-Agency Expert Group Meeting on Gender Statistics Manila, Philippines, 11-14 October 2010. Ghana’s Experience in Measuring Maternal Mortality and Maternal Health. Ethel Koney Ghana Statistical Service ESA/STAT/AC.219/22. Outline. Introduction

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Ghana’s Experience in Measuring Maternal Mortality and Maternal Health

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  1. 3rd Global Forum and Inter-Agency Expert Group Meeting on Gender Statistics Manila, Philippines, 11-14 October 2010 Ghana’s Experience in Measuring Maternal Mortality and Maternal Health Ethel Koney Ghana Statistical Service ESA/STAT/AC.219/22

  2. Outline • Introduction • Maternal Health • Maternal Mortality • Sources of data • GDHS • GMHS • Institutional data • Interventions • Challenges • Planned surveys

  3. Introduction • Every year more than half a million women die in pregnancy and childbirth related issues • In the sub-Saharan Africa one in twenty-two women has the risk of dying during pregnancy or childbirth • In Ghana, research and survey conducted reveal that there are about 451 deaths out of 100,000 live births. This is largely due to poor access to skilled birth attendance. • The goal is to “reduce by three quarters, between 1990 and 2015, the maternal mortality ratio” and to “Achieve, by 2015, universal access to reproductive health” • Government agencies, policy makers and NGOs have measures to increase maternal health care provided women during pregnancy and even after delivery.

  4. MDG Goal 5: Improve maternal health Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio • 5.1 Maternal mortality ratio • 5.2 Proportion of births attended by skilled health personnel Target 5.B: Achieve, by 2015, universal access to reproductive health • 5.3 Contraceptive prevalence rate • 5.4 Adolescent birth rate • 5.5 Antenatal care coverage (at least one visit and at least four visits) • 5.6 Unmet need for family planning

  5. Maternal Health • Maternal health refers to the health of women during pregnancy, childbirth and the post-partum period.

  6. Maternal Mortality • Health experts refer to maternal mortality as the death of a woman while pregnant or within 42 days of termination of pregnancy. CAUSES • Hemorrhage • Infection • High blood pressure • Unsafe abortion • Obstructed labour.

  7. Sources of data on maternal mortality and maternal health The main surveys are: • The Ghana Demographic and Health Survey (GDHS) • Ghana Maternal Health Survey (GMHS) Administrative • Institutional data from Centre for Health Information Management of the Ministry of Health

  8. Ghana Demographic and Health Survey • Ghana has conducted 5 rounds of GDHS, in the following periods: 1988, 1993, 1998, 2003, and 2008. • The surveys covered the whole country and analysis were done on national as well as regional basis

  9. Content of the GDHS The surveys obtained detailed information on • fertility • marriage • sexual activity • fertility preferences • awareness and use of family planning methods • breastfeeding practices • nutritional status of women and young children • childhood mortality • maternal and child health • awareness and behavior regarding HIV/AIDS, and other STIs.

  10. Some differences in the different rounds (GDHS) • 1998-included testing of level of iodine in the salt consumed by the household • 2003-included questions on domestic violence • 2008-collection of information on domestic violence, malaria and use of mosquito net, and carried out anemia testing.

  11. Trends in Maternity care indicatorsGhana 1988 -2008 There has been consistent improvement in the indicators over the 20-year period Note: Data for 1988, 1993, and 1998 are with reference to births, whereas data for antenatal care and tetanus toxoid for 2003 and 2008 are with reference to women who had a live birth

  12. Ghana Maternal Health Survey, 2007 • This is the first national population-based survey to collect information on maternal health and mortality in Ghana through a combination of methods. • It was conducted to serve as a baseline information for the Reducing Maternal Morbidity and Mortality (R3M) program initiated in 2006 in some three regions in Ghana to increase the contraceptive prevalence rate (CPR) • Household questionnaires were administered in about 240,000 households to identify female deaths • Individual questionnaires were administered to 10,370 women age 15-49 about maternity care particularly abortion and miscarriage, and siblings (sisterhood method), and • Follow-on 4,203 verbal autopsies of women age 12-49 into the specific causes of female deaths, particularly maternal deaths

  13. Tracking Indicators (GMHS) • Delivery care • Place of delivery • Assistance of delivery • Complications of delivery • Postnatal care • Timing of postnatal check-up • Service provided and service provider • Barriers to accessing health care • Access to skilled birth attendance • Distance of health care facility from patient

  14. Institutional data • In-between surveys, there is the need to monitor or track changes in maternal health and mortality levels. • In Ghana, the main source of data is the Centre for Health Information Management of the Ministry of Health

  15. Trends in maternal mortality ratios, 2006-2009 Source: Ministry of Health

  16. Interventions • Safe-Motherhood Initiative • Ghana VAST Survival Programme • Prevention of Maternal Mortality Programme (PMMP) Making Pregnancy Safer Initiative • Prevention and Management of Safe Abortion Programme • Intermittent Preventive Treatment • Maternal and Neonatal Health Programme and Roll Back Malaria Programme • Declaring maternal mortality a national emergency in 2008 • Free health care for pregnant women including deliveries through the national health insurance scheme.

  17. Challenges • Social, cultural, health systems and economic indicators. • Unavailability of family planning services and lack of post natal care for new born babies and their mothers • Unavailable data set on maternal health care for systematic investigation into maternal health, • Barriers to access to critical health services by families and communities • Absence of well-structured plans and procedures to check and assess where maternal health programmes are • Poor access to health care providers • Caused by long distance to the health facility • Poor health-seeking behaviors among the poor

  18. Planned Surveys • The Ghana Statistical Service will be having the next round of the Ghana Demographic and Health Survey in 2013. • The 2010 Population and Housing Census currently underway, seeks information on maternal mortality. • Data collected will better inform if interventions and indicators are on track, and if so, Ghana’s progress towards the 2015 MDG target.

  19. Maternal Mortality in the 2010 Census • Has any member of this household died in the past 12 months.? • Sex of deceased? • Age at death • Was death due to accident, violence, homicide, suicide? • For death of FEMALES 12 - 54 YEARS OLD • Did death occur whilst pregnant, during delivery or within 6 weeks after the end of a pregnancy or child birth?

  20. Thank You.

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