Accelerating Progress: The Maternal Health Thematic Fund
In 2008, UNFPA launched the Maternal Health Thematic Fund to accelerate progress towards making safe motherhood a reality in some of the poorest countries in the world. It is one response to the fact that improving maternal health is the Millennium Development Goal target lagging farthest behind. Since 2009, the UNFPA-ICM Midwifery Programme and the Campaign to End Fistula have come under the MHTF umbrella.
Still, every day almost 800 women die of pregnancy-related complications and thousands more suffer from debilitating conditions. Though the global number has changed little over the last two decades, some countries have made dramatic progress in improving maternal health. Experience from countries such as Egypt, Guatemala and Sri Lanka shows that maternal mortality in developing countries can be reduced rapidly if adequate political and financial support is in place and effective approaches employed. The thematic fund aims to jump-start progress in countries where far too many women continue to die from preventable complications of pregnancy.
For example, in 2010, the Maternal Health Thematic Fund supported:
- An assessment of Haiti’s emergency obstetric care needs following the January 2010 earthquake, which will contribute to reconstruction;
- Work with the Government of Ethiopia to place maternal health as a central pillar of the country’s new health sector development plan; and
- Major efforts to support several countries’ commitments to the Global Strategy for Women’s and Children’s Health.
Reducing maternal mortality is a multidimensional problem. This series of feature stories looks at several countries' efforts to improve the health of women, their families and communities. UNFPA provides support to these programmes through the H4+ and the Maternal Health Thematic Fund. Read more
The Maternal Health Thematic Fund focuses on high-priority countries that have maternal mortality ratios of over 300 deaths per 100,000 live births. The approach revolves around strengthening national health systems, rather than creating parallel structures, and in helping governments overcome obstacles that prevent their own maternal health plans from succeeding.
Support from the Maternal Health Thematic Fund is provided to national governments in close coordination with UNFPA’s Global Programme on Reproductive Health Commodity Security and the Campaign to End Fistula. This fosters a strengthened and streamlined approach towards accelerating progress towards MDG5 and ensuring that every pregnancy is wanted and every birth safe.
Technical and financial support provided through the Maternal Health Thematic Fund aims to:
- Build political and social commitment to maternal health.
- Assist country health systems to scale up provision of a full spectrum of maternal health care.
- Improve access to maternal health services such as having a skilled health professional present at delivery.
- Increase access to emergency obstetric care, especially for those most impoverished.
- Empower individuals to exercise their rights to quality maternal health care.
Key components of the Maternal Health Thematic Fund's work include supporting programmes that build up human resources for maternal health and needs assessments that provide countries with up-to-date data in the area of obstetric care.
Data show that fewer than two thirds of women in developing countries receive assistance from a skilled health worker when giving birth. The State of the World’s Midwifery Report found that at least 112,000 health workers with midwifery skills are missing from 38 countries with the highest burden of maternal death. As long as women continue to give birth without skilled care, the number of women dying in childbirth will remain stagnant. UNFPA has partnered with the International Confederation of Midwives to address this critical gap. The Midwifery Program is now operational in some 30 Maternal Health Thematic Fund supported countries, with a focus on improving and expanding midwifery training and strengthening national midwifery associations.
Without up-to-date data, countries are not able accurately identify the best strategies for improving maternal health. In strong collaboration with UNICEF, WHO and Columbia University, the Maternal Health Thematic Fund is supporting priority countries to conduct emergency obstetric care field surveys, which are providing critical information on where gaps in services exist. Surveys have already been conducted in fourteen countries – Afghanistan, Benin, Burkina Faso, Burundi, Cambodia, Côte d’Ivoire, Ethiopia, Ghana, Guyana, Haiti, Liberia, Madagascar, Malawi and Niger - and another 6 are planned for 2011.
Progress of the Maternal Health Thematic Fund
As of December 2010, $60 million in donations had been received from: Austria, Finland, Ireland, Luxembourg, Netherlands, Norway, Spain and Sweden.
30 countries have been given assistance:
- Africa: Benin, Burkina Faso, Burundi, Chad, Côte d’Ivoire, Democratic Republic of Congo, Ethiopia, Ghana, Liberia, Madagascar, Malawi, Mali, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sierra Leone, Uganda, Zambia
- Arab States: Djibouti, Sudan, Yemen
- Asia: Afghanistan, Bangladesh, Cambodia, Lao People’s Democratic Republic, Nepal
- Latin America and the Caribbean: Guyana, Haiti
An additional twelve countries receive support for obstetric fistula programmes only:
- Africa: Cameroon, Central African Republic, Republic of Congo, Eritrea, Guinea, Guinea Bissau, Kenya, Mauritania, Senegal, Somalia
- Asia: Pakistan, Timor-Leste
Guyana is one of the poorest countries in the Americas, with a gross national income of $1300 per capita and one of the highest levels of maternal death in the region. Though the country is known for the quality of its midwives, Guyana has a problem of out-migration. Many of its trained health professionals end up leaving the country for positions elsewhere, where they can find better living and working conditions. As a result, maternity wards and reproductive health programmes are poorly staffed, especially in rural areas. One strategy to help curb this trend is to enhance the support and status midwives are accorded within the overall health system.
In Malawi 16 women die every day in pregnancy or childbirth. This African country has one of the highest maternal mortality ratios in the world at 1,100 deaths per 100,000 live births. Though the Government has shown strong commitment to the issue and has launched a roadmap for maternal health, a number of obstacles hinder progress. There is a serious shortage of doctors and nurses, with vacancy rates of over 60 per cent. Access to delivery kits, critical drugs and other supplies is limited. The fertility rate remains high - about six pregnancies per woman. Young women in Malawi tend to marry early, risking teenage pregnancy, obstetric fistula and HIV. The Maternal Health Thematic Fund will focus on strengthening Malawi's health system both at the national and district levels. It will also support family planning activities, youth-friendly health services, training for birth attendants and education about maternal health services.
In Ethiopia, reducing the high maternal mortality ratio - 420 deaths per 100,000 live births - is one of the greatest public health challenges facing the country. Every year 14,000 women and girls die as a result of complications during pregnancy or childbirth, and several hunder thousand suffer from pregnancy-related disabilities. The population is growing at a rate of two million people a year and the health system is under increasing strain. In view of these enormous challenges, a nationwide assessment of hospitals and health centres was conducted in 2009 to clearly identify gaps in the health system. The survey found 25 facilities – in contrast to the national minimum recommended number of 591 – available to provide basic emergency obstetric and newborn care, or the ability to:
- Administer, by injection or intravenous infusion, parenteral antibiotics
- Administer uterotonic drugs (i.e., parenteral oxytocin, to treat post-partum haemorrhage)
- Administer parenteral anticonvulsants for pre- eclampsia and eclampsia (i.e., magnesium sulfate)
- Manually remove the placenta
- Remove retained products (e.g. manual vacuum extraction, dilation and curettage)
- Perform assisted vaginal delivery (e.g. vacuum extraction, forceps delivery)
- Perform basic neonatal resuscitation (e.g., with bag and mask)
Comprehensive emergency obstetric care, which comprises the above functions, plus Caesarian section and blood transfusion, was found to be available in another 58 facilities (out of a national recommended minimum of 148). Together, these facilities are able to meet just 3 per cent of the estimated need for care. Based on this assessment, the Maternal Health Thematic Fund is helping address the bottlenecks to proper maternal health care. This includes support to voluntary, long-term family planning programmes and $1 million in funding for the country’s health extension worker programme to scale up access to community-level midwifery.