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Women and Children's Reproductive Health

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Elizabeth Costello

on 12 February 2014

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Transcript of Women and Children's Reproductive Health

respiratory infections
Major Causes of Death for Children in Haiti
Women and Children's Reproductive Health
Around the World

The Americas
5 Most Common Causes of Maternal Death in the US
Embolism (20%) - Arterial embolism is a sudden interruption of blood flow to an organ or body part due to a clot
Hemorrage (17%) - bleeding, usually internal
Pre-eclampsia and eclampsia (16%) - characterized by high blood pressure and protein in urine, causes seizures.
Infection (13%)
Cardiomyopathy (8%) - weakening of heart muscle, which can lead to failure

Five most common causes ofMaternal Death Rate in Haiti
hypertension/eclampsia (26%)
postpartum haemorrhage (23%)
indirect causes such as malaria, HIV/AIDS and cardiac diseases (20%)
other direct causes such as infection and obstructed labor (11%)
unsafe abortion (10%)
Looking Forward: US
Better access to clinics in under-served populations
improved insurance laws for maternal health
Widely available Prenatal care
More information on possible conditions upon leaving the hospital
UK's 10 component guidelines

Looking Forward: Haiti
Midwives for Haiti and other organizations are working hard to provide skilled health professionals to be available all over the country.
These clinics should look into providing safe family planning methods, including safe abortions.
More women should be educated on why modern methods of birthing can be safe and healthy.
Maternal health overview for Afghanistan.
Looking forward: Haiti
Western Pacific
5 Main Causes of Neo-natal Deaths in the United States
The AMS 2010 found a maternal mortality rate of 327 deaths per 100,000 live births in the survey area.
Three-quarters of Afghan women have no education.
Very poor Acess to healthcare services
Haemorrhage (25%)
Infection (15%) hospitals are dirty, no clean water and the staff does not practise proper hygiene procedures
Unsafe abortion (13%)
Eclampsia (very high blood pressure leading to seizures – 12%)
Obstructed labor (8%). No one takes responsibility for a patient's health. Unsafe environment.

Congenital malformations, deformations and chromo­somal abnormalities
Disorders related to short gestation and low birth weight, not elsewhere classified
Sudden infant death syndrome
Newborn affected by maternal complications of preg­nancy
Accidents (unintentional injuries)

Looking foward on Afghanistan

There needs to be more robust construction of more healthcare facilities
Training more mid-midwifery to increase staff to patient ratio, women are getting educated on childcare and childbearing issues.
increase their tolerance to allow women to be independent decision makers of their own health.
USAID has helped provide health care services for over 11 million patients annually, and trained over 21,000 healthcare providers, including midwives and community health workers.
Looking Forward: US
Women's Health in India

Support groups
Car seat workshops at hospitals
free child-proofing consultation
Support Groups
Comprehensive education for new mothers
Clinics with better resources
Total population (000s) 3632
Total health expenditure (% of GDP) 2.7
Maternal mortality ratio (per 100 000 live births) 11
Primary health care units and centres (per 10 000 population) 0.2
Total life expectancy at birth (years) 77.7

improved nutrition easy access to maternal hospital throughout the country
free healthcare for citizens
free education for citizens
more advocacy groups that support women maternal health

increasing the number of trained delivery stuff
boost construction of maternal hospitals
increase their budget on overall healthcare spending in GDP/capita

In 2000, the Cambodia DHS found the rate of maternal mortality to be 437 per 100 000 live births.
In 2005, the rate had risen to 472 per 100 000

barriers to better maternal health in Cambodia
financial barriers; Lack of Educated maternal personnel and delivery equipment
physical barriers; poor transport infrastructure
organizational barriers; lack of poor laws and healthcare delivery services
psychological and socio-cultural barriers

There has been a substantial reduction in the under five mortality rate from 127 deaths per 1000 live births in 2000 to 83 deaths per 1000 live births in 2005.
improvement in the place of delivery, assistance by trained health professionals has also increased.
Obstetric care by a trained provider during delivery has moved from 32% in 2000 to 44% in 2005.
However, more than half (55%) of births are still assisted by traditional birth attendants.
There is vital need to educate more skilled personnel in-order to help in the delivery process
There is also need to improve access to maternal health facilities by constructing hospitals and improving transportation infrastructure, especially in the rural areas

looking forward
Overall maternal mortality is 9.5 per 100,000 births.
Hemorrhage is the most common cause of death, occurring in 86 (39%) of 219 women.
Japan ranks #10 around the world in terms of education

Japan before and now
In 1950, Japan had a maternal mortality ratio (MMR) of around 180 deaths for every
100,000 live births – similar to that found in some developing countries today, like
Jamaica and Tajikistan.
By 2004/5, this level had been reduced dramatically to just 6 maternal deaths for
every 100,000 live births – making it one of the lowest levels of maternal mortality in
the world. This compares favorably with other countries in the G8, particularly the
United Kingdom (MMR= 8,), Russia (MMR=28), and the USA (MMR=11).
Japan achieved a particularly dramatic fall in maternal mortality over just a ten-year
period from 1960 to 1970, with the MMR declining from around 130 to 50 – almost a
two-thirds reduction. This provides encouragement to many developing countries
trying to achieve significant falls in maternal mortality in the period remaining up to
2015 – the target year for the Millennium Declaration.
Japan’s achievements in relation to MDG5 – reducing maternal mortality, are
mirrored in their very low levels of prenatal mortality. In 2002, for every 1000
deliveries, just 5.5 babies were born dead or died in the first week of life. This gives
some optimism to the world in terms of achieving MDG4 which focuses on child
mortality – most of which is made-up of deaths babies. Japan’s level of baby
deaths is one of the lowest among the G8 nations.

European Region
But Why?
Access to family planning to prevent unwanted and miss-timed pregnancies
Universal access to skilled care at delivery ( no cost in training anyone who will work in the maternal health field)
Timely access to Emergency Obstetric Care for all women with

looking forward / recommendations

Japan has to boost its training of maternal health staff
The country has to boost awareness of maternal health problems
The government has to increase its spending on healthcare
Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood
Main Causes of Maternal Death
Eastern Mediterranean Region
1: Pre-pregnancy counselling
2: Professional interpretation services
3: Communications and referrals
4: Women with potentially serious medical conditions require immediate and appropriate multidisciplinary specialist care
5: Clinical skills and training
6: Specialist clinical care
7: Systolic hypertension requires treatment
8: Genital tract infection/sepsis
9: Serious Incident Reporting and Maternal Deaths
10: Pathology
Pulmonary embolism
Amniotic fluid embolism
Uterine rupture
Multi-organ failure
Cardiovascular disease
Looking Forward
General public health
disease prevention
traffic accident prevention

Causes of Death
In 2012, 3.5/1,000 babies died Causes:
Congenital malformation/deformation
chromosal abnormalities
Respiratory Disorders

Looking Forward
Genetic Counseling
General public health practices
Causes of Deaths
Looking Forward
Main Causes of Death
Hemorrhage (32%)
Eclampsia (19.8%)
Indirect causes (23.4%)
Looking Forward
Access to clean water
Health initiatives
More government funding

-- Low rates of education & literacy lead to
poor health literacy

-- Aprox
225 women and 1,200 newborns die each day
from complication in childbirth in West Africa
-- For every death, aprox. 30 women suffer from
pregnancy related disabilities such as anemia, obstetric fistulae, and infertility

Diarrhoeal diseases
Acute Respiratory Infections
Improve current Programs
Improve hygiene
more post natal exams
Exclusive breast feeding
Why does Kuwait have the best maternal care in this region?
Looking forward
Kuwait stats
The Major Issues
Female Genital Cutting
(also called Female Genital Mutilation or Female Circumcision)
is the practice of cutting female genitalia. It is a deeply entrenched cultural norm practiced across
central Africa
and parts of the Middle East and some Southern Asian countries.
Girls who do not undergo this process may face isolation and prejudice.
It is a very dangerous procedure that is harmful to health and can lead to death, It is a major cause of maternal morbidity and mortality.
FGC has affected
140 million
females world wide.
Obstetric Fistula
It is estimated that more than 2 million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa.
Obstetric Fistula is a hole in the birth canal that results from damage to tissues in an obstructed labor. It causes incontinence and debilitating pain.
WHO recommends 3 things to
reduce incidence of

delaying the age of first pregnancy
the end of harmful traditional practices; (
female genital cutting
to obstetric care

So what can be done?
grassroots community program
works to empower people through a human rights based education program

> has led to the
of Female Genital Cutting through community based decisions in 7,000 communities in Africa and reduced the
rate of child marriage
which in turn improves maternal health and reduce incidence of fistula.
> improvement of the
environment, education, and governance
of thousands of communities in 8 countries.
West Africa
Maternal Health
Children's and Infant's Health
Major Causes
of Infant and Child Death Worldwide
The Millenium Development Goals
The U.N. has set 8 development goals for 2015-- goal number 4 is to reduce child mortality globally by 2/3.

pneumonia (19%)
diarrhoea (18%)
malaria (8%)
neonatal pneumonia or sepsis (10%)
preterm delivery (10%)
asphyxia at birth (8%).

Undernutrition is also a factor in 53% of deaths
Major Causes of Death in Subsaharan Africa
Diarrhoea is most often caused by unsafe drinking water.
In Subsaharan Africa, only 58 percent of 684 million people have access to clean water.
Strategies for Improving Child and Infant Health
Each country is responsible for coming up with plans to meet the MDG targets.
These strategies vary.

Strategies include increasing access to insurance and care

improving quality of water and installing plumbing

increasing awareness of Malaria, HIV, and TB, and improving access to medicine
Child marriage
leads to higher rates of maternal morbidity/mortality (highest risk of MMR is for girls under
15 years
44% of women in West Africa are married before 18.
In Niger, the rate of child marriage is 75%, the highest in the world
Maternal Health
Maternal Health in India

Every 5 minutes, a woman in India dies from childbirth.
15 per cent of all pregnant women in India develop life-threatening complications.
60 per cent of all maternal deaths occur after delivery but only 1 in 6 women receives postnatal care.

Despite India’s huge leaps in economic growth, it has one of the highest rates of maternal mortality in the world.

The Challenges
Poor, rural women suffer the most from maternal morbidity and mortality.

Most maternal deaths can be averted by eliminating the “three delays”:
delay in the decision to
seek professional care
delay in
reaching the appropriate health care
delay in
receiving care
after arriving (a problem in understaffed, underfunded, overcrowded hospitals and clinics)

Maternal and Perinatal Death Inquiry & Response (MAPEDIR) is a Unicef organization working to address
maternal mortality
in India by
understanding the causes
of maternal death.

Major components include gathering data to better understand the causes of death, and matching
people in rural settings with healthcare

It seeks to address
personal, familial, socio-cultural, economic and environmental
factors contributing to MMR

Addressing Maternal Mortality
A major challenge to finding dsolutions is not having sufficient data on why mothers die.
The Barefoot college seeks to work with “marginalized, exploited and impoverished rural poor, living on less than $1 a day, and lift them over the poverty line with dignity and self respect.”

the Barefoot College in India
It provides training for impoverished people in India. The
program has trained impoverished women to serve their communities and improved access to skilled birth attendants in rural areas.
India alone accounts for 23% of global maternal deaths
India has over 1.3 billion people -- 24,000 cases of rape last year, figure has
by 25 percent in the past six years.

- A violent crime against a woman is reported once every five minutes
--Several high profile cases of gang rape
- aftermath: politicians and leaders victim blame
-international outrage
- huge protests and national debate
- stricter penalties for rapists

(And 900% over the last 40 years)
Rape and Reproductive Health
Infant and Child Health
Major Causes
of Infant & Child Mortality
Infant mortality remains as high as 63 deaths per 1,000 live births.
Highest rate of malnutrition: 46%
Diarrhea is 2nd leading cause of death
74% children under 3 have anemia
Highest number of child laborers in the world

Issues of 'social distance' and inequality are worsened by
caste, gender
, and
Gender and Children's Health
: culture strongly favors males, parents who can afford ultrasound will abort females children
Hospital ran an
infamous ad
in the 80s: "Pay 5,000 rupees today [to have an abortion] and save 50,000 rupees [in dowry payments] tomorrow."

Indian girl child aged 1-5 years is
75% more likely to die
than an Indian boy
worst gender discrepancy in child mortality for any country in the world
improving social, economic, and political standing of women is essential for protecting female children.
improving standing of mothers directly improves health and well being of children.

Moving Forward
No Longer "Unwanted"
Indian girls given Hindu name meaning "unwanted" went through renaming program

Able to choose new names for themselves
Draw international attention to need for change
Kuwait children's health
- children receive oral health education
-all children are required to bring a health card certified by a doctor from a government hospital
- all children must meet all vaccination requirements before they get into school
- mothers have the responsibility to make sure that their children receive adequate healthcare services the government provides for free.
- every school or pre-school has a nurse who is in charge of children's health


childre in cambodia need acess to education , health services and proper nutrition
Globally, the rates of maternal mortality remain needlessly high.

Half a million women die every year from largely avoidable causes.

99% of these deaths occur in developing countries.

Maternal Mortality:
is measured as the number of deaths per 100,000 live births.
In Sum
We've come a long way-- but we still have a long ways to go
> Millenium Development Goals 4 and 5 have galvanized leaders to recognize problems and act
> In developing regions, antenatal care increased from 63 % in 1990 to 81% in 2011.
> Eastern Asia, Northern Africa and Southern Asia, maternal mortality has declined by aprox 2/3
> Nearly 50 million babies worldwide are still delivered without skilled care.
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