Overview of Overview of CommunityCommunity--Managed Managed

Maternal and Maternal and Newborn CareNewborn Care

PPT 1

“Nasa hukay ang isang paang isang manganganak”

photo courtesy of: BEMOC: A Trainers’ Guide (DOH) 2004.Photo Courtesy of BEmOC: A Trainer’s Guide (2004)

Maternal Mortality

1/10 Filipino mothers die everyday from complications related to pregnancy and childbirth

14 % of deaths among women aged 15-49 are due to maternal deaths

172 Filipino mothers die for every 100,000 live births

Health Care During Pregnancy, Childbirth and After Delivery

88% of women receive prenatal care from health professionals

Percentage of Antenatal Care Provider

Nurse/Midwife , 49.5

Doctor , 38.1

No one , 5.6

TBA, 6.5

3/10 women do not get at least 4 visits for prenatal care

Source: www.iccdrb.org

50% of women from among those who received prenatal care were informed of danger signs of pregnancy

57% of women were not informed to go to a specific facility in case of complications

28% of women didn’t receive any tetanus toxoidinjections during pregnancy

37% of mothers reported to have TT2 coverage

Percent distribution of women by number of TT injections during pregnancy

One injection, 33.4

None , 27.9Two or more injections, 37.3

61% of births are delivered at home

Percent distribution of live births by place of delivery

private sector , 13.7

govt health center, 1.4

govt hospital , 22.8

home , 61.4

60% of deliveries are attended by health professionals

Percent distribution of live births by person providing assistance during delivery

midwife, 25.1

nurse, 1.1

doctor , 33.6

relative/friend, 2.4

TBA, 37.1

6 /10 deliveries are attended by a traditional birth attendant at home

3/10 deliveries are attended by a midwife at home

1/3 women who delivered outside a health facility receive post natal check up within 2 days after delivery

17/ 1,000 babies die within their first 28 days of life

Child Survival

40/ 1,000 children die under the age of five

29/ 1,000 babies die under 12 months

49 % of married women use a contraceptive method (either traditional or modern)

Source: www.scienceclarified.com

Family Planning

33 % use modern methods

16% use traditional methods

Sources: NDHS (1998 and 2003); FHSIS (2000); MCHS-PNSO Philippines (2002)

• Intrauterine life as the foundation for child survival

Source: www.scienceclarified.com

Why integrate maternal and newborn care?

Reasons why children die due to maternal factors

24663240-49High at old ages

15281530-39

9261620-29Low mortality at middle ages

154228< 20High mortality at young ages

Child mortality

Infant mortality

Neonatal mortality

Biodemographic differentialsMother’s age at birth

Early childhood mortality rates by birth order

2956317+

1629144-6

823142-3

729191

Child mortalityInfant mortalityNeonatal mortalityBirth Order

Note:Clear positive association between birth order and probability of dying between ages one and five. Higher birth order have higher mortality ratio.

Early childhood mortality rates by previous birth interval

Note: Childhood mortality rates decline as the birth interval increases. Children born 3 years after a preceding birth have the best chance of surviving infancy, with IMR of 19 deaths/1,000 live birth.

625154 + years

1119103 years

1326102 years

203923<2

Child mortalityInfant mortalityNeonatal mortality

Previous birth interval

Early childhood mortality rates by birth size

na2011Average or larger

na5229Small/ very small

Child mortality

Infant mortality

Neonatal mortality

Birth weight

* No available data

Perinatal Mortality Rate by mother’s age at birth

68111340-49

23272430-39

18393020-29

38159<20

Perinatal mortality rate

No. of early neonatal deaths

No. of Still births

Age

* The sum of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months’ duration, multiplied by 1000

Perinatal Mortality Rate by Previous pregnancy interval in months

24221939 +28131827-3818151515-2635169<152326161st pregnancy

Perinatalmortality*

No. of early neonatal

No. of still births

Interval in months

* The sum of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months’ duration, multiplied by 1000

•Not just biological reasons, but also because of economic, socio-cultural, political and environmental factors.

Why are mothers and children dying?

Sources: NDHS (1998 and 2003); FHSIS (2000); MCHS-PNSO Philippines (2002)

•Disparities existGeographic – rural vs. urban, etcEconomic – rich vs. poor Socio-cultural – women vs. men,

indigenous peoples,level of education

Socio-economic differentials in Perinatal Mortality

Note: Perinatal mortality is slightly higher in rural than in urban areas; highest among pregnancies with preceding birth interval or less than 15 months. Wealthiest groups have the least perinatal mortality rate.

1174Highest292014Fourth 261322Middle 252317Second 252818Lowest

Wealth index quintile 171517College or higher 233832High School293525Elementary 4542No education

Education 275343Rural 213933Urban

Residence Perinatal mortality Early neonatal Still births Socio-demographic factor

Socio-economic differentials in childhood mortality

Notes: - mortality rates in urban areas are much lower than in rural areas; inversely related to mortality education level and wealth status

- regional differences should be used with caution due to large sampling errors

11913Highest42215Fourth 62615Middle 153219Second 254221Lowest

Wealth index quintile 3159College or higher 92618High School204322Elementary 426533No education

Education 173621Rural

72414UrbanResidence

Child mortalityInfant mortalityNeonatal MortalityFactor

1. Delay in deciding to seek medical care

The Three Delays

2. Delay in identifying and reaching the appropriate health facility; and

3. Delay in receiving appropriate and adequate care at the health facility.

• Save the lives of mothers and newborns

What is our role?

• Combat the Three Delays through provision of Emergency Obstetric Care (EmOC)

• Assurance of a skilled birth attendant

Emergency Obstetric Care• Part of Emergency Obstetric Care which includes pre- and

postnatal care, clean and safe delivery, neonatal care andfamily planning (4 pillars of safe motherhood)

How can we help save?

• Be equipped with essential skills both clinical and non-clinical to deliver maternal and newborn health services effectively

• Health is the responsibility of everyone

The Right to Health

• Every woman has a right to a safe pregnancy and childbirth

MCH in the Principle of Primary Health Care • Address MCH problems by

providing promotive, preventive, curative and rehabilitative services in communities

• Participation of people individually and collectively in the planning, implementation and evaluation of their health care

• “Health in the hands of the people”

What are the current efforts to ensure that women and newborns enjoy their rights?

• Health Sector Reform Program( Fourmula One)

• Women’s Health and Development Programs• Safe Motherhood Policy• Family Planning Policy

At the National Level

International Covenants• Beijing Platform of Action

• Convention on the Elimination of All- Forms of Violence Against Women

• Convention on the Rights of the Child

• Millennium Development Goals, meet the following goals by 2015 • Goal number 4: Reduce the

mortality rate among children under five by two thirds.

• Goal number 5: Reduce by three quarters the maternal mortalityratio.

• Alma Ata Declaration