of 49
8/2/2019 Islam_Global progress in maternal mortality 19902011
1/49
Maternal Morality: 1990-2011Asia and Pacific
Stories of Tremendous Successes
Dr Monir Islam,DirectorHealth System DevelopmentWorld Health Organization
South East Asia Regional Office
8/2/2019 Islam_Global progress in maternal mortality 19902011
2/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
3/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
4/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
5/49
170
130110
56
180
340
1200
690
12011082
46
140
300
970
640
919360
120
290
39
790
470
66110
270
79
34
650
44
350
5694
250
6531
580
38
290
0
200
400
600
800
1000
1200
1400
Cambodia China Laos
Mala
ysia
Mon
golia PNG
Philli
pinesVi
etnam
Baseline 1990 1995 2000 2005 2008
Asia and Pacific: Comparison of MMR Estimates
Source: Trends in Maternal Mortality: 1990 to 2008: Estimates developed by WHO, UNICEF,UNFPA, and The World Bank.
8/2/2019 Islam_Global progress in maternal mortality 19902011
6/49
850
600
500
420
340
190
940
650
420
260
200
570
440390
280
230212
620
440
350
270
229
420
350
411
316
219
870
700
550
440
240
229
0100
200
300
400500
600
700
800900
1000
Bangladesh Bhutan India Indonesia Myanmar Nepal
1990 1995 2000 2005 2008 2010
South East Asia: Comparison of MMR Estimates
8/2/2019 Islam_Global progress in maternal mortality 19902011
7/49
Vulnerable population vs facilitychildbirth
05
101520
2530
35
404550
55606570
75
Nigeria 2003
(MMR 1100)
Pakistan
2006/07 2004(MMR 1500)
Bangladesh
2004 (MMR570)
Chad 2004
(MMR 1500)
Egypt 2005
(MMR 130)
Philippines
2003 (MMR230)
%o
fchildbirthathealthfacilities
Age group of 15-19 year Age group of 40 year and above
Birth interval of less than 24 months Mother with 5 or more children
8/2/2019 Islam_Global progress in maternal mortality 19902011
8/49
Lets talk about Bangladesh!
8/2/2019 Islam_Global progress in maternal mortality 19902011
9/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
10/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
11/49
Service Utilization: Bangladesh 1999-2007
8/2/2019 Islam_Global progress in maternal mortality 19902011
12/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
13/49
Childbirths in Bangladesh
8/2/2019 Islam_Global progress in maternal mortality 19902011
14/49
Childbirths by C-Section
8/2/2019 Islam_Global progress in maternal mortality 19902011
15/49
What About
Cambodia?
8/2/2019 Islam_Global progress in maternal mortality 19902011
16/49
Geographical inequities of Childbirths by SBA
8/2/2019 Islam_Global progress in maternal mortality 19902011
17/49
Geographical inequities of Childbirths by C-Sections
8/2/2019 Islam_Global progress in maternal mortality 19902011
18/49
When, Where and Why
women give their lives for bringing lives
8/2/2019 Islam_Global progress in maternal mortality 19902011
19/49
0
20
40
60
80
100
120
140
160
Durin
gpreg
nanc
yDa
y1
Day2
Day3-7
Day8-42
Day43
-90
Day91
-180
Day18
1-365
Year
2
Deaths
per10
00personyear
Timing of death is critical
Most deaths clusteraround labour or
within 24 hours after
delivery
Matlab, Bangladesh
Time since pregnancy
Source Ronsmans C& Graham W 2006; Lancet (9542):1189-200.
Pl f l d h
8/2/2019 Islam_Global progress in maternal mortality 19902011
20/49
Place of maternal deaths(74% in health facilities)
13%3%
6%
50%
13%
5%10%
Home TBA home Clinic Rural hospital
Provincial hospital Central hospital Traveling
Source: Fawcus S, Mbizvo MT, Lindmark G, Nystrom L. A community based investigation of causes of maternal mortality in rural and urbanZimbabwe. Maternal Mortality Study Group. Cent Afr J Med. 1995 Apr;41(4):105-13.
http://www.ncbi.nlm.nih.gov/pubmed?term=%22Fawcus%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstracthttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Mbizvo%20MT%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstracthttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Lindmark%20G%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstracthttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Nystrom%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstracthttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Nystrom%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstracthttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Lindmark%20G%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstracthttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Mbizvo%20MT%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstracthttp://www.ncbi.nlm.nih.gov/pubmed?term=%22Fawcus%20S%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract8/2/2019 Islam_Global progress in maternal mortality 19902011
21/49
Reason for not going to health facilityDHS data from 26 countries in Africa (N=250000 women)
8/2/2019 Islam_Global progress in maternal mortality 19902011
22/49
Demand or supplies or
its organization of services
or its all about Quality?
My photo
stories
8/2/2019 Islam_Global progress in maternal mortality 19902011
23/49
PNG
8/2/2019 Islam_Global progress in maternal mortality 19902011
24/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
25/49
Bangladesh: any other districts
8/2/2019 Islam_Global progress in maternal mortality 19902011
26/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
27/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
28/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
29/49
1. Home 3. Lamb Hospital
CommunityHospital
Integrated
2. Safe Delivery Unit
Obstetric First Aid Comprehensive EOC
Bangladesh: the LAMB facilitiess
8/2/2019 Islam_Global progress in maternal mortality 19902011
30/49
So it is not an impossible task
8/2/2019 Islam_Global progress in maternal mortality 19902011
31/49
Lamb Hospital Deliveries
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
deliveries 492 711 674 740 776 882 1288 1363 1526 1686 2251 2156 2352 2673 3181 3723 3719 3444 3039 3321 3821
0
500
1000
1500
2000
2500
3000
3500
4000
4500
numberofdeliveries
year
LH Deliveries by Year
8/2/2019 Islam_Global progress in maternal mortality 19902011
32/49
Bangladesh: Its Chowgacha - so its possible!!
8/2/2019 Islam_Global progress in maternal mortality 19902011
33/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
34/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
35/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
36/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
37/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
38/49
Stories of India: Demand side: What about supplies
8/2/2019 Islam_Global progress in maternal mortality 19902011
39/49
Stories of India: Demand side: What about supplies
and quality?
8/2/2019 Islam_Global progress in maternal mortality 19902011
40/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
41/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
42/49
Stories of India: So, its doable!!!
8/2/2019 Islam_Global progress in maternal mortality 19902011
43/49
Stories of India: So, its doable!!!
8/2/2019 Islam_Global progress in maternal mortality 19902011
44/49
Way Forward
Its about demand side along with
supply side financing
Its about organization of services Its about quality
Its about monitoring
Its all about Health System
8/2/2019 Islam_Global progress in maternal mortality 19902011
45/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
46/49
8/2/2019 Islam_Global progress in maternal mortality 19902011
47/49
Quality Facility Childbirths: Live saved, stillbirth prevented
0
50
100
150
200
250
0
200
400
600
800
1,000
1,200
2009 2010 2011 2012 2013 2014 2015
Numberofm
aternaldeathsaverted
Thousands
Number
ofnewborndeaths/stillbirthaverted
Thousands
YEAR
Stillbirth averted Newborns deaths averted Maternal deaths averted
Source: WHO Framework for accelerated reduction of maternal and newborn mortality, 2009.
R l hi ill b
8/2/2019 Islam_Global progress in maternal mortality 19902011
48/49
Real partnership will be necessaryto achieve our goals
N ti f l
8/2/2019 Islam_Global progress in maternal mortality 19902011
49/49
No more poor options for poor people
Developing countries are not rich enough
to invest on cheap ideas and strategies