Maternal Health

Maternal and Child health
Presented by Rtr. Rana Zulfiqar

Director Health Services
Deputy Head Nimra Batool
Objectives
To appreciate the importance of Maternal and Child health

To appreciate the link between the health issues of mothers
and children and understand the consequences of ill health
To be able to enlist the global strategies in place for MCH care
Specific Objectives of MCH
Reduction of maternal, perinatal, infant and childhood

mortality and morbidity
Promotion of Reproductive health
Promotion of the physical and psychological development of

the child and adolescent within the family
Components of MCH
Maternal health
Family planning
Child health
School health
Handicapped children
Care of children in special setting such as Day care
Maternal Health
Maternal Health
• Maternal health refers to the health of

women during pregnancy, childbirth and the
postpartum period. While motherhood is
often a positive and fulfilling experience, for
too many women it is associated with
suffering, ill-health and even death.
Issues in Mental Health
Fact 1
Nearly 830 women die every day due to

complications during pregnancy and childbirth
About 303 000 women will die worldwide in 2015 due to complications during pregnancy
and childbirth. In developing countries, conditions related to pregnancy and childbirth
constitute the second leading causes (after HIV/AIDS) of death among women of
reproductive age.
Fact 2:
Women die in pregnancy and childbirth for

5 main reasons
These are severe bleeding, infections, unsafe abortion,

hypertensive disorders (pre-eclampsia and eclampsia), and
medical complications like cardiac disease, diabetes, or
HIV/AIDS complicating or complicated by pregnancy.
Fact 3:
More than 135 million women give birth per year
About 20 million of them are estimated to experience pregnancy-related

illness after childbirth. The list of morbidities is long and diverse, and
includes fever, anaemia, fistula, incontinence, infertility and depression.
Women who suffer from fistula are often stigmatized and ostracized by
their husbands, families and communities .
Fact 4:
About 16 million girls aged between 15 and

19 give birth each year
They account for more than 10% of all births. In the developing
world, about 90% of the births to adolescents occur in marriage.
In low- and middle-income countries, complications from
pregnancy and childbirth are the leading cause of death among
girls 15-19.
Fact 5
Maternal health mirrors the gap between the

rich and the poor
Less than 1% of maternal deaths occur in high-income countries.

The maternal mortality ratio in developing countries is 239 per
100 000 births versus 12 per 100 000 in developed countries. Also,
maternal mortality is higher in rural areas and among poorer and less
educated communities.
Other issues:
Smoking
Depression
Violence
Discrimination (nutrition, education, social
rights, culturally)
Fast Facts about Maternal Health…WHO Fact sheet
2015
Every day, approximately 830 women die from preventable causes related
to pregnancy and childbirth.
99% of all maternal deaths occur in developing countries.
Maternal mortality is higher in women living in rural areas and among poorer
communities.
Young adolescents face a higher risk of complications and death as a result
of pregnancy than other women.
Skilled care before, during and after childbirth can save the lives of women
and newborn babies.
Between 1990 and 2015, maternal mortality worldwide dropped by about
44%.
Between 2016 and 2030, as part of the Sustainable Development Agenda,
the target is to reduce the global maternal mortality ratio to less than 70 per
100 000 live births.
Why are women dying?
The major complications that account for nearly 75% of all
maternal deaths are:
 severe bleeding (mostly bleeding after childbirth)
 infections (usually after childbirth)
 high blood pressure during pregnancy (pre-eclampsia and
eclampsia)
 complications from delivery
 unsafe abortion
 The remainder are caused by or associated with diseases

such as malaria, and AIDS during pregnancy.
Global Causes of Maternal Mortality
Source: WHO, Systematic Review of Causes of Maternal Death (preliminary

data), 2010.
Why do women not get the care they need?
Why do these women die?
Three Delays Model
Delay in decision to seek care
 Lack of understanding of complications
 Acceptance of maternal death
 Low status of women
 Socio-cultural barriers to seeking care
Delay in reaching care

 Mountains, islands, rivers — poor organization
Delay in receiving care

 Supplies, personnel
 Poorly trained personnel with punitive attitude
 Finances
Where do Maternal Mortality data come
from?
Vital registration data - MM Rate and MM Ratio
Health service data – maternity registers - MM Ratio
Special studies
 Hospital studies – tracing deaths, interviews
 Research, longitudinal studies, verbal autopsy
Surveys & censuses

 Direct estimation - Rate and Ratio
 Sisterhood method (indirect) – Rate and Ratio

Why has the mortality declined?
Interventions for Maternal Care
SAFE MOTHERHOOD
ANC SD EOC
F
P
BASIC MATERNITY CARE
PRIMARY HEALTH CARE
EQUITY FOR WOMEN
FP: Family planning, ANC: Antenatal care, SD : Clean safe delivery,

EOC:Emergency obstetrics care
Other Interventions for Maternal Care
Antenatal care
 Nutrition support (anemia)
 Personal hygiene, dental care, rest and sleep
 Immunization (mother and the new born)
 Education on delivery and care of the new born
 Identifying high risk pregnancies
 Emphasizing on ANC visits and maintenance of AN card
 Importance and management of lactation
 Advise on birth spacing
Maternal Mortality Indicators
Maternal mortality ratio

Maternal mortality rate
Life-time risk of maternal morality
Proportion maternal
Other Maternal Mortality Indicators
Lifetime risk of maternal mortality = (N of maternal deaths

over the reproductive life span) / (women entering the
reproductive period)
Proportion maternal = proportion of all female deaths due to

maternal causes = (N of maternal deaths in a period/Number
of all female deaths in same period) * 100
Child Health
Facts about child health
5.9 million children under the age of 5 died in 2015.

More than half of these early child deaths are due to conditions
that could be prevented or treated with access to simple,
affordable interventions.
Leading causes of death in under-5 children are preterm birth
complications, pneumonia, birth asphyxia, diarrhoea and
malaria. About 45% of all child deaths are linked to malnutrition.
Children in sub-Saharan Africa are more than 14 times more
likely to die before the age of 5 than children in developed
regions.
Emerging Issues in child health
Congenital anomalies
Injuries
Non-communicable diseases (chronic
respiratory diseases, acquired heart
diseases, childhood cancers, diabetes,
and obesity)
Global response ???
Global response
Sustainable Development Goal 3
 The Sustainable Development Goals (SDGs) adopted by the United
Nations in 2015 aim to ensure healthy lives and promote well-being for
all children. The SDG goal 3 target 3.2 is to end preventable deaths of
newborns and under-5 children by 2030.
Indicators of Child Health
Mortality in infancy and childhood

 Prenatal mortality rate
 Neonatal mortality rate
 Infant mortality rate
 Under 5 mortality rate

Mortality in and around infancy
Infant Mortality
Post-neonatal death
Neonatal death
Early Late
neo- neonatal
natal death
death
Preinatal death
Still birth
28 weeks Birth 7 Days 28 Days 1 Year
of gestation
“There can be no
keener revelation
of a society’s soul
than the way it
treats its children”
Nelson Mandela,
1988

Maternal Health

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Maternal and Child health

Presented by Rtr. Rana Zulfiqar

To appreciate the importance of Maternal and Child health

Reduction of maternal, perinatal, infant and childhood

Promotion of Reproductive health

Promotion of the physical and psychological development of

• Maternal health refers to the health of

Nearly 830 women die every day due to

Women die in pregnancy and childbirth for

These are severe bleeding, infections, unsafe abortion,

More than 135 million women give birth per year

About 20 million of them are estimated to experience pregnancy-related

About 16 million girls aged between 15 and

Maternal health mirrors the gap between the

Less than 1% of maternal deaths occur in high-income countries.

 The remainder are caused by or associated with diseases

Source: WHO, Systematic Review of Causes of Maternal Death (preliminary

 Acceptance of maternal death

 Low status of women

 Socio-cultural barriers to seeking care

Delay in reaching care

Delay in receiving care

 Poorly trained personnel with punitive attitude

 Research, longitudinal studies, verbal autopsy

Surveys & censuses

 Sisterhood method (indirect) – Rate and Ratio

BASIC MATERNITY CARE

PRIMARY HEALTH CARE

EQUITY FOR WOMEN

FP: Family planning, ANC: Antenatal care, SD : Clean safe delivery,

Maternal mortality ratio

Lifetime risk of maternal mortality = (N of maternal deaths

Proportion maternal = proportion of all female deaths due to

5.9 million children under the age of 5 died in 2015.

Mortality in infancy and childhood

 Neonatal mortality rate

 Infant mortality rate

 Under 5 mortality rate

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