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Programme Priorities |
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| Reducing Maternal Mortality | |
| Reproductive Health, including Family Planning and Sexual Health
Population and Development
Strategies
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Reducing maternal mortality Reducing maternal mortality continues to be a priority in UNFPA-supported reproductive health policies. This was particularly true in 1998, which was proclaimed the "Year of Safe Motherhood" by the Safe Motherhood Inter-agency Group. The group, of which UNFPA is a member, also includes the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the World Bank, the International Planned Parenthood Federation (IPPF), Family Care International and The Population Council. The group's proclamation focused attention on the fact that more than 600,000 women, most of them in developing countries, die each year from childbirth-related illnesses and injuries. Events included a World Health Day ceremony at World Bank headquarters in Washington, D.C., on 7 April. In preparing for the event, UNFPA collaborated in the production of "The Safe Motherhood Action Agenda: Priorities for the Next Decade". The 1998 events followed up on the completion of the first decade of the global Safe Motherhood Initiative. Launched in 1987, the initiative aimed to cut the number of maternal deaths in half by 2000. Though the initiative did not achieve the progress that had been hoped for, a number of important lessons were learned. Many of these lessons were discussed at an October 1997 technical consultation held in Colombo, Sri Lanka. Safe motherhood, it was agreed, requires a readily available network of community health care providers, clinics and hospitals. Among the integrated services that such a network should provide are: community education; antenatal care and counselling; skilled assistance during childbirth; care for obstetric complications; postpartum care; management of complications from abortions; and family planning counselling, information and services. The decade's experience shows that the single most effective way to reduce maternal deaths is to ensure that a health professional is present during childbirth. This professional must not only possess the skills to conduct a normal delivery but also be able to manage any complications that may arise. There is, however, a chronic shortage of such professionals in poor and rural communities in developing countries. Translating these lessons into practical advice for use in its country programmes, in 1998 UNFPA issued a programme advisory note on reducing maternal mortality and morbidity. The note, which draws on research from WHO and uses data from a joint WHO/UNICEF/UNFPA/World Bank statement, recommended actions aimed at reducing the number of women who die in pregnancy or childbirth as well as the number of those who survive, only to live with lifelong disabilities and ill-health. It identified specific actions that are required within families, in communities and in society at large; at the legal and 13 policy level; and in health systems. Reducing maternal mortality, according to the advisory note, requires a national strategy to bring about three essential changes: societal commitment to ensuring safe pregnancy and birth; improvements in access to, and the quality of, health care; and commitment to meeting the special needs of girls and women throughout their lives. The note also recommended actions for UNFPA to take to help build up health-sector capacity to reduce maternal mortality. The thematic evaluation of UNFPA-supported safe mother-hood projects found a number of constraints. For example, the activities often seemed to be based on national-level data and were monitored at the central level. However, assessments of need and monitoring of results at the local level were sometimes neglected. In addition, the activities promoted antenatal care as a strategy to reduce maternal deaths, but such care, in and of itself, cannot bring about significant reductions in maternal mortality, since all pregnancies pose risks for the mother. Likewise, training of traditional birth attendants (TBAs) has not had the impact that was hoped. If TBAs are to be involved in providing maternal care, they must be made an integral part of the formal health care system. Country-level initiatives. A UNFPA-supported pilot programme in Uganda, which embraces many of the key elements of the Safe Motherhood Initiative, has proven effective. Indeed, a survey commissioned by UNFPA has shown that Uganda's rural emergency relief programme has helped reduce maternal deaths significantly in the Iganga District, the area in which it was piloted. The programme developed an effective referral system for emergency obstetric cases. This was accomplished in part by establishing a communications link between TBAs and health units and between the health units and hospitals. In addition, transportation was provided from the TBAs to the health units and from the units to the district hospital. And finally, life-saving supplies and equipment were provided, and staff were trained in their use. As a result, supervised deliveries have increased significantly since 1995. At the same time, the number of babies delivered in hospitals and health units has increased, while the number delivered by TBAs has decreased. World Health Day provided Nepal with an ideal opportunity to draw national attention to safe motherhood efforts. The Prime Minister appealed to all politicians, journalists, social workers and health personnel to help make information and services available for safe deliveries. The country's Safe Motherhood Network, a consortium of women's NGOs with which UNFPA collaborates, organized a procession to raise awareness of issues related to safe deliveries and safe mother-hood. The procession observed a minute of silence to commemorate all those who had died in childbirth. In addition, the UNFPA country office released a cassette of songs on the theme of maternal mortality. Several other initiatives are worth noting. For example, UNFPA funded a year-long study intended to clarify the extent and nature of maternal mortality in Zambia, thereby enabling the country's health service to focus its efforts in the areas with the most pressing needs. UNFPA supported a similar study in Turkey, which was conducted with technical assistance from WHO. That study's results are being analysed. In Latin America and the Caribbean, the UNFPA regional programme supports activities designed to prevent maternal mortality, including the safe motherhood advocacy and coalition-building efforts of Family Care International in Bolivia and Colombia. |