Prevention of Maternal Mortality_Stanton

1. USAID’s Maternal Health Vision for Action:
How Can It Inform Programs?

2. Ending Preventable Maternal Mortality:
USAID Maternal HealthVision for Action
June 2014
Ending Preventable Maternal Mortality:
USAID Maternal HealthVision for Action
Evidence for Strategic Approaches
January 2015

3. Ending Preventable Maternal Mortality: USAIDVision
A world where no woman dies from preventable
maternal causes and maternal and fetal health are
improved

5. Reaching average global MMR < 70/100,00 by 2030
WHO: StrategiesToward Ending Preventable Maternal Mortality, 2015

8. 1.Improve Individual,
household and
community behaviors
and norms —including
community mobilization
to hold health systems
accountable
2. Improve equity of
access to and use of
services by the most
vulnerable

9. Despite
progress in
coverage of
maternal
health
services,
economic
disparities
are
significant

10. Address the knowledge/ information barrier
• Health education that imparts knowledge through dialogue
and problem solving
• Provided through community participation or empowerment
approaches in which communities are actively involved in
shaping their health

11. Financial incentives can improve coverage of MH services
Incentives Effects
Performance based
Incentives (PBI)
• Most show association with ↑ quality
Insurance • Most show positive correlation with SBAs and facility
delivery
• 6 studies show positive correlation with C/S
User fee
exemptions
• ↑ facility delivery rates
• ↑ C/S rates, in some cases
Conditional
cash transfers
• 6 studies show positive effect on birth with SBAs
• 3 studies show positive effect on birth in a hospital
Vouchers • Most show ↑ SBA or facility delivery
Source: JHPN on Financial Incentives for Maternal Health Services, Feb 2014

12. 3. Strengthening integration of maternal
services with family planning
4. Scale up quality maternal and fetal
health care
5. Prevent diagnose and treat indirect
causes of maternal mortality and poor
birth outcomes
6. Increase focus on averting and
addressing maternal morbidity and
disability
7. Advance choice and respectful
maternity care – and improve working
conditions for providers

13. Family planning is
essential to:
reduce # number of
times woman is exposed
to pregnancy and
associated complications
and
the number of high risk
pregnancies, including
advanced age and birth
order

14. Reducing
maternal and
fetal mortality
& morbidity
requires
quality care
for
prevention,
complication
identification,
and prompt
treatment

15. Indirect causes
of maternal
death:
- HIV/AIDS
- Malaria
-TB
- STIs
- undernutrition
- obesity
Anemia in pregnant women, an indirect cause of maternal mortality,
and of fetal growth restriction contributing to low birth weight, is very
high countries

16. Elements of disrespect and abuse…
• Lack of informed consent
• Lack of confidentiality
• Discrimination
• Physical Abuse
• Undignified Care → Humiliation
• Abandonment of Care
• Demand for payments → Detention in Facilities
Disrespect and abuse of
women in childbirth has
been reported in every
region of the world – it is a
human rights and a quality
of care issue

17. 8. Strengthen and support
health systems
9. Promote data for decision-
making and accountability
10. Promote innovation and
research for policy and
programs

18. Use of private sector care for childbirth,
Asia, Decade 2000-2012
Beyond the health
system “pillars”,
we need to
understand and
work within
evolving contexts
including:
-- urbanization
-- privatization
-- decentralization

19. Proportion facilities and delivery rooms
that are WASH safe, Tanzania
Strong health
system are
fundamental to
MM reduction.
USAID will focus
particularly on
• Human
resources
• Commodities
• Referral systems
• Water ,
sanitation and
hygiene (WASH)
• Information
systems

20. Barrier to care: Lack of data for
decisions and accountability

21. Ghana substantial regional variation, with Upper East
and Volta regions with highest mortality ratios
Innovation
New technology to
report, analyze and
display subnational
data to propel
problem solving and
decisions

22. Baselin
e 2013
Target
2020
ANC x 1 80% 90%
ANC x 4 44% 65%
SBA 51% 60%
Facility delivery 34% 60%
Facility delivery, rural 25% 45%
Facility deliver, 2 lowest
wealth quintiles
7% 20%
Cesarean section, rural 3.7% 5%
Cesarean section, 2 lowest
wealth quintiles
0.87% 3.5%
PNC within 2 days of birth,
regardless of location
38.7% 55%

23. Annual
Burden of
Maternal
and
Newborn
Mortality
and
Morbidity
Beyond maternal mortality… to maternal and fetal health

24. … Mahmoud Fathalla