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Eradicating Preventable Maternal Deaths: Learning from Success Stories and Moving Forward

Significant Progress
Global and regional maternal mortality in decline
Better measurement of maternal mortality

Consensus on safe and effective interventions for most


critical causes of MM Higher proportion of deliveries by skilled attendants Country level commitment to MDG5

Progress at the Country Level: Maternal Mortality in Egypt & Iran


232.6 Egypt Iran, Islamic Republic of

80.2 56.8 69.5

16.4

1990

2000

2011
Source: 2011 IHME

Progress at the Country Level: Maternal Mortality in Malaysia & Sri Lanka
83.2 73.6

Malaysia Sri Lanka

48.2 32.6

1990

2000

2011
Source: 2011 IHME

Maternal Mortality in Bangladesh


593.1

417.1

247.0

1990

2000

2011
Source: 2011 IHME

What We Know Works

2
Improved infrastructure
Strong political commitment to maternal health

Improved quality of care


More skilled providers Better supply systems Evidencebased guidelines

Functional referral systems

What We Know Works

6
Affordable & accessible facility-based services

Comprehensive reproductive health care services


Community involvement

Strong data for decisionmaking & targeting of interventions

Big Challenges Remain


Ethiopia
India

Dominican Republic

Ethiopia
Notable commitment to reduce maternal morbidity and mortality at the national level Health Sector Development Program
Improving the facility infrastructure Training health care providers Promoting referrals to health facilities for birth

Despite these efforts, MMR remains stubbornly high low utilization of services (10%)
poor quality of care

India
Notable commitment to reduce maternal morbidity and mortality at the national level Janani Suraksha Yojana (JSY) is the largest conditional cash transfer program aimed at increasing institutional deliveries in the world.
Evidence of positive impact on perinatal & neonatal health The verdict is still out in terms of impact on maternal health

India has seen a reduction in MMR, but maternal mortality remains a serious problem.

Dominican Republic
The DR has a relatively high maternal mortality ratio despite nearly universal coverage of institutionalized deliveries
Major referral hospitals are overcrowded & understaffed Normal deliveries are over-medicalized Complicated deliveries are often not handled in an appropriate or timely manner

What might explain this limited progress?


1. Access and availability of services do not guarantee utilization or improved health outcomes

2. Critical challenges with quality of care persist

The Way Forward:


Improving the Quality of Maternal Health Care

Maternal Health Task Force: Narrowing the Focus


Delivery Labor onset Immediate Postpartum (24 hours) 7 days

Risk of Mortality

3rd Trimester

2nd Trimester

28 days
1st Trimester 42 days

Pre-conception

Time

The Approach of the Maternal Health Task Force

A focus on improving the quality of interpersonal & technical maternal health care

A focus on developing & improving tools to measure quality of care

A focus on supporting promising innovative strategies for improving quality of maternal health care

A focus on supporting educational opportunities & technical capacity building for maternal health professionals

The question should not be why do women not accept the service that we offer, but why do we not offer a service that women will accept
- Mahmoud Fathalla, 1998

Thank you!
Maternal Health Task Force
www.maternalhealthtaskforce.org

Women and Health Initiative


www.hsph.harvard.edu/women-and-health-initiative