SAFE MOTHERHOOD

Samson Udho
MSc, BSc
udhson10@gmail.com
 Outline
 Introduction
 Definition
 Origin
 Pillars
 Priorities
 International commitments
 Enabling factors
 Preventing factors
 Introduction
 Every minute of every day, somewhere in the world and most often in a
developing country, a woman dies from complications related to
pregnancy or childbirth.

 That is 515,000 women, at a minimum, dying every year.

 Nearly all maternal deaths (99 percent) occur in the developing world-
making maternal mortality the health statistic with the largest disparity
between developed and developing countries.

 New Born babies are also under going this terrible fate
 For every woman who dies, 30 to 50 women suffer injury, infection,
or disease.

 Pregnancy-related complications are among the leading causes of

death and disability for women age 15-49 in developing countries.

 When a mother dies, children lose their primary caregiver,

communities are denied her paid and unpaid labour, and countries
forego her contributions to economic and social development.

 A woman's death is more than a personal tragedy--it represents an

enormous cost to her nation, her community, and her family.  from
 Definition
 Safe motherhood means ensuring that all women receive the care
they need to be safe and healthy throughout pregnancy, childbirth
and postpartum period.  M

 Safe motherhood encompasses a series of initiatives, practices,

protocols and service delivery guidelines designed to ensure that
women receive high-quality gynecological, family planning,
prenatal, delivery and postpartum care, in order to achieve optimal
health for the mother, fetus and infant during pregnancy, childbirth
and postpartum.one in this.
 Origin of Safe motherhood
 The Safe Motherhood Initiative started in 1987 in a
conference held in Nairobi.

 The Conference was the beginning of a safe motherhood

initiative to reduce maternal mortality by 50% by the year
2000.
Maternal mortality 1990-2005
Pillars of Safe motherhood
1. Antenatal Care: Effective antenatal care is essential to detect
preexisting conditions, prevent complications where possible, and
ensure that complications of pregnancy are detected early and treated
appropriately.

2. Essential Obstetric Care: Pregnancy is a period of potential risk, and

any pregnant woman can develop complications. Therefore,
interventions are needed at a community level and also within health
services to ensure that essential care for high-risk pregnancies and
complications is made available to all women who need it.

3. Family Planning: Individuals and couples must have the information

and services to plan the timing, number, and spacing of pregnancies,
and to prevent unwanted
4. Postnatal care: The postpartum period refers to the first six weeks after
childbirth. The postnatal period is a critical phase in the lives of mothers
and newborn babies. Most maternal and infant deaths occur during this
time. Yet, this is the most neglected period for the provision of quality
care.

5. Abortion Care: Uganda currently only permits post abortion care. A

comprehensive abortion care would include; abortion, postabortion care
and family planning.

6. Equity for women: Women equity means fairness of treatment for

women according to their respective needs. This may include equal
treatment or treatment that is different but which is considered
equivalent in terms of rights, benefits, obligations and opportunities.
8. Primary health care: Primary healthcare refers to "essential health
care" that is based on "scientifically sound and socially acceptable
methods and technology, which make universal health care accessible
to all individuals and families in a community.

9. Communication for behavior change: Social and behavior change

communication (SBCC), often also only "BCC" or "Communication for
Development (C4D)" is an interactive process of any intervention with
individuals, communities to develop communication strategies to
promote positive behaviors which are appropriate to their settings and
there by solve worlds most pressing health problems.
Priorities for safe motherhood
 During the tenth anniversary of the Safe Motherhood Initiative, a
series of "action messages" were articulated that summarized key
programmatic priorities from the Initiative's first decade.

 The messages highlight the most critical interventions for reducing

maternal mortality and morbidity, and the range of barriers
(economic, legal, social, and cultural) that women face in accessing
high-quality maternal health care.ghl morbidity, and the range of barriers
(economic, legal, social, and cultural) that women face in accessing high-
quality maternal health care.
1. Advance Safe Motherhood Through Human Rights
 Preventing maternal death and illness is an issue of social justice and
women's human rights.

 Making motherhood safer requires women's human rights to be

guaranteed and respected.

 These include their rights to good quality services and information

during and after pregnancy and childbirth; their right to make their
own decisions about their health freely, without coercion or
violence, and with full information; and the removal of barriers legal,
political, and health that contribute to maternal mortality.
 Human Rights Implicated
oRight to life
oRight to health including sexual and reproductive health
oRight relating to privacy, liberty and security.
oRight to be free from inhuman or degrading treatment.
oRights relating to equality: 
o Right to be free from discrimination on the basis of race and gender
o Right to the equal protection of the laws
oRight to education and information
oRight to reproductive freedom
oRights relating to pregnancy and childbirth
2. Empower Women, Ensure Choices
 Maternal deaths are rooted in women's powerlessness and their
unequal access to employment, finances, education, basic health
care, and other resources.

 These realities set the stage for poor maternal health even before a
woman becomes pregnant, and can worsen her health when
pregnancy and childbearing begin.

 Legal reform and community mobilization are essential for

empowering women to understand and articulate their health
needs, and seek services with confidence and without delay.
3. Safe Motherhood is a Vital Economic and Social Investment
 All national development plans and policies should include safe
motherhood programmes, in recognition of the enormous cost of a
woman's death and disability to health systems, the labor force,
communities and families.

 Additional resources should be allocated for safe motherhood, and

should be invested in the most cost-effective interventions (in
developing countries, basic maternal and newborn care can cost as
little as US$3 per person, per year).
4. Delay Marriage and First Birth
 Pregnancy and childbearing during adolescence can carry
considerable risks.

 To delay first births, reproductive health information and services

for married and unmarried adolescents need to be legally available,
widely accessible, and based on a true understanding of young
people's lives.

 Community education must encourage families and individuals to

delay marriage and first births until women are physically,
emotionally, and economically prepared to become mothers.
5. Every Pregnancy Faces Risks
 During pregnancy, any woman can develop serious, life-threatening
complications that require medical care.

 Because there is no reliable way to predict which women will

develop these complications, it is essential that all pregnant women
have access to high quality obstetric care throughout their
pregnancies, but especially during and immediately after childbirth
when most emergency complications arise.

 Antenatal care programs should not spend scarce resources on

screening mechanisms that attempt to predict a woman's risk of
developing complications.
6. Ensure Skilled Attendance at Delivery
 The single most critical intervention for safe motherhood is to ensure
that a health worker with midwifery skills is present at every birth,
and transportation to a health facility is available in case of an
emergency.

 A sufficient number of health workers must be trained and provided

with essential supplies and equipment, especially in poor and rural
communities.
7. Improve Access to Quality Reproductive Health Services
 A large number of women in developing countries do not have access
to maternal health services. Many of them cannot get to, or afford,
high-quality care.

 Cultural customs and beliefs can also prevent women from

understanding the importance of health services, and from seeking
them.

 In addition to legal reform and efforts to build support within

communities, health systems must work to address a range of clinical,
interpersonal, and logistical problems that affect the quality,
sensitivity, and accessibility of the services they provide.
8. Prevent Unwanted Pregnancy and Address Unsafe Abortion
 Each year, an estimated 75 million unwanted pregnancies occur around the
world.

 Many women without access to safe services for termination of pregnancy

resort to unsafe abortion which often results in death or disability.

 Unsafe abortion is the most neglected and most easily preventable cause
of maternal death.

 These deaths can be significantly reduced by ensuring that safe

motherhood programmes include client-centered family planning services
to prevent unwanted pregnancy, contraceptive counseling.
9. Measure Progress
 Governments around the world have pledged to reduce maternal
mortality by 50%.

 However, maternal mortality is difficult to measure, due to problems

with identification, classification and reporting.

 Therefore, safe motherhood partners have developed alternative means

for measuring the impact and effectiveness of programs; for example, by
recording the proportion of births attended by a skilled health provider.

 These indicators can identify weaknesses and suggest programmatic

priorities so that maternal deaths can be better prevented in the future.
10. The Power of Partnership
 Reducing maternal mortality requires sustained, long-term commitment and the
inputs of a range of partners.

 Governments, non-governmental organizations international assistance agencies,

donors, and others should share their diverse strengths and work together to
promote safe motherhood within countries and communities and across national
borders.

 Programs should be developed, evaluated and improved with the involvement of

clients, health providers, and community leaders.

 National plans and policies should put maternal health into its broad social and
economic context, and incorporate all groups and sectors that can support safe
motherhood.
International commitments to safe motherhood

 At the 1994 International Conference on Population and

Development (ICPD) in Cairo, governments agreed to cut the
number of maternal deaths by half by the year 2000, and in half
again by 2015.

 In 1995, the Fourth World Conference on Women (FWCW) in Beijing

gave substantial attention to maternal mortality and reiterated the
commitments made at the ICPD.
Specifically, governments around the world have agreed to:
 Develop a comprehensive national strategy to ensure universal
access to all individuals and couples of appropriate ages throughout
the life cycle to a full range of high quality, affordable sexual and
reproductive health services.

 
 Establish or strengthen integrated safe motherhood programs,
within the context of primary health care, with goals and target
dates to reduce maternal mortality and morbidity by one half
of 1990 levels by the year 2000, and by a further one half by 2015. 
 Enablers of safe motherhood
 Antenatal care in the village
 Good system of referral for women at risk
 Safe motherhood committee operating in village
 Maternity waiting home available to women
 Others?
 Preventing factors
 No trained midwives available to the community
 TBAs untrained
 No working relationship established with community leaders
 No transport available for emergencies
 Others?
QUESTIONS?
Thank you