UNFPAState of World Population 2004
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Maternal Health

New Approaches
Causes and Consequences
Maternal Morbidity
Obstetric Fistula
Reducing Maternal Mortality and Morbidity
Difficulties in Measurement
Holistic Responses
Antenatal Care
Skilled Attendance
Emergency Obstetric Care
Post-abortion Care
Quality of Maternal Health
Men and Maternal Health
UNFPA and Safe Motherhood

Emergency Obstetric Care

Any woman can experience complications during pregnancy. But virtually all obstetric complications can be treated. Low maternal mortality ratios are due, in large part, to the fact that complications are identified early and are treated.

COMBATING THE “THREE DELAYS”. The “three delays” model has proven useful in designing programmes to manage obstetric complications. Overcoming delays in deciding to seek care, in reaching appropriate care facilities and in receiving care at those facilities requires sequential procedures—from antenatal care and preparation to attended births with referral capabilities.

Health services related to emergency obstetric care are categorized as basic and comprehensive.(41) Basic emergency functions, performed in a health centre without an operating theatre, include: assisted vaginal delivery; manual removal of the placenta and retained products to prevent infection; and administering antibiotics to treat infection and drugs to prevent or treat bleeding, convulsions and high blood pressure.

Comprehensive services require an operating theatre and are usually provided in a district hospital. These include all the functions of a basic emergency facility, plus the ability to perform surgery (Caesarean section) to manage obstructed labour and to provide safe blood transfusion to respond to haemorrhages.

A number of countries are seeking to increase the number of basic and emergency obstetric care facilities as well as to bolster the capacity of staff and the quality of care provided. For example, with UNFPA support, Guinea-Bissau assessed needs for emergency obstetric care and has made plans to increase the number of facilities offering basic emergency care and those offering comprehensive care.(42)

QUALITY SERVICES. The quality of emergency obstetric care is key to success. Services must be available 24 hours seven days a week, and have well-trained and motivated staff, essential supplies and logistics in place, functioning transport and communication systems and ongoing monitoring.

A number of countries have put priority on improving access to emergency obstetric care, and raising its quality. Lebanon and Oman have strengthened their referral services. El Salvador has developed quality obstetrical model services in hospitals and health units. In Jamaica, access to emergency obstetric care, including special facilities for transportation and referral to higher levels of care, is provided in each district.(43)

Since the ICPD, various countries in sub-Saharan Africa have introduced training for health staff in essential obstetric care. These include: Angola, Benin, Burundi, Cameroon, Chad, Côte d’Ivoire, Guinea, Kenya, Lesotho, Liberia, Mozambique, Namibia, the Niger, Senegal, Swaziland and Zambia.

In Morocco, providers have been trained to use new protocols for treating obstetric emergencies. Comprehensive services have been established in five rural hospitals, and ten provincial hospitals have improved the quality of emergency obstetric care, resulting in a significant increase in the number of women receiving appropriate care.(44)

IMPROVING TRANSPORT AND REDUCING OTHER BARRIERS. Poor families are often unable and sometimes reluctant to find or pay for transport to a medical facility when a woman goes into labour. The Mother Friendly Movement in Indonesia has helped communities recognize the need for and establish emergency transport systems for women in labour.(45)

New efforts seek to understand obstacles to and promote the use of available care. A partnership of Canadian and Ugandan medical associations, undertaken as part of the Save the Mothers Initiative of the International Federation of Gynaecology and Obstetrics (FIGO), worked in the rural district of Kiboga in Uganda to improve emergency obstetric care and its use.

The number and capabilities of skilled attendants in the district hospital were increased, and local dispensaries made care available 24 hours a day; health facilities were upgraded and stocked; and workshops were held to improve health workers’ attitudes towards community members. UNFPA provided two ambulances.

As a result of the interventions, met need for treatment of women with obstetric complications rose from 4 per cent in 1998, when the project began, to 47 per cent in 2000. Maternal deaths dropped from 9.4 per cent of those receiving emergency obstetric care in 1998 to around 2 per cent in 1999 and 2000.(46)

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