Maternal and Child health
Presented by Rtr. Rana Zulfiqar
Director Health Services
Deputy Head Nimra Batool
Objectives
To appreciate the importance of Maternal and Child health
To appreciate the link between the health issues of mothers
and children and understand the consequences of ill health
To be able to enlist the global strategies in place for MCH care
Specific Objectives of MCH
Reduction of maternal, perinatal, infant and childhood
mortality and morbidity
Promotion of Reproductive health
Promotion of the physical and psychological development of
the child and adolescent within the family
Components of MCH
Maternal health
Family planning
Child health
School health
Handicapped children
Care of children in special setting such as Day care
Maternal Health
Maternal Health
• Maternal health refers to the health of
women during pregnancy, childbirth and the
postpartum period. While motherhood is
often a positive and fulfilling experience, for
too many women it is associated with
suffering, ill-health and even death.
Issues in Mental Health
Fact 1
Nearly 830 women die every day due to
complications during pregnancy and childbirth
About 303 000 women will die worldwide in 2015 due to complications during pregnancy
and childbirth. In developing countries, conditions related to pregnancy and childbirth
constitute the second leading causes (after HIV/AIDS) of death among women of
reproductive age.
Fact 2:
Women die in pregnancy and childbirth for
5 main reasons
These are severe bleeding, infections, unsafe abortion,
hypertensive disorders (pre-eclampsia and eclampsia), and
medical complications like cardiac disease, diabetes, or
HIV/AIDS complicating or complicated by pregnancy.
Fact 3:
More than 135 million women give birth per year
About 20 million of them are estimated to experience pregnancy-related
illness after childbirth. The list of morbidities is long and diverse, and
includes fever, anaemia, fistula, incontinence, infertility and depression.
Women who suffer from fistula are often stigmatized and ostracized by
their husbands, families and communities .
Fact 4:
About 16 million girls aged between 15 and
19 give birth each year
They account for more than 10% of all births. In the developing
world, about 90% of the births to adolescents occur in marriage.
In low- and middle-income countries, complications from
pregnancy and childbirth are the leading cause of death among
girls 15-19.
Fact 5
Maternal health mirrors the gap between the
rich and the poor
Less than 1% of maternal deaths occur in high-income countries.
The maternal mortality ratio in developing countries is 239 per
100 000 births versus 12 per 100 000 in developed countries. Also,
maternal mortality is higher in rural areas and among poorer and less
educated communities.
Other issues:
Smoking
Depression
Violence
Discrimination (nutrition, education, social
rights, culturally)
Fast Facts about Maternal Health…WHO Fact sheet
2015
Every day, approximately 830 women die from preventable causes related
to pregnancy and childbirth.
99% of all maternal deaths occur in developing countries.
Maternal mortality is higher in women living in rural areas and among poorer
communities.
Young adolescents face a higher risk of complications and death as a result
of pregnancy than other women.
Skilled care before, during and after childbirth can save the lives of women
and newborn babies.
Between 1990 and 2015, maternal mortality worldwide dropped by about
44%.
Between 2016 and 2030, as part of the Sustainable Development Agenda,
the target is to reduce the global maternal mortality ratio to less than 70 per
100 000 live births.
Why are women dying?
The major complications that account for nearly 75% of all
maternal deaths are:
severe bleeding (mostly bleeding after childbirth)
infections (usually after childbirth)
high blood pressure during pregnancy (pre-eclampsia and
eclampsia)
complications from delivery
unsafe abortion
The remainder are caused by or associated with diseases
such as malaria, and AIDS during pregnancy.
Global Causes of Maternal Mortality
Source: WHO, Systematic Review of Causes of Maternal Death (preliminary
data), 2010.
Why do women not get the care they need?
Why do these women die?
Three Delays Model
Delay in decision to seek care
Lack of understanding of complications
Acceptance of maternal death
Low status of women
Socio-cultural barriers to seeking care
Delay in reaching care
Mountains, islands, rivers — poor organization
Delay in receiving care
Supplies, personnel
Poorly trained personnel with punitive attitude
Finances
Where do Maternal Mortality data come
from?
Vital registration data - MM Rate and MM Ratio
Health service data – maternity registers - MM Ratio
Special studies
Hospital studies – tracing deaths, interviews
Research, longitudinal studies, verbal autopsy
Surveys & censuses
Direct estimation - Rate and Ratio
Sisterhood method (indirect) – Rate and Ratio
Why has the mortality declined?
Interventions for Maternal Care
SAFE MOTHERHOOD
ANC SD EOC
F
P
BASIC MATERNITY CARE
PRIMARY HEALTH CARE
EQUITY FOR WOMEN
FP: Family planning, ANC: Antenatal care, SD : Clean safe delivery,
EOC:Emergency obstetrics care
Other Interventions for Maternal Care
Antenatal care
Nutrition support (anemia)
Personal hygiene, dental care, rest and sleep
Immunization (mother and the new born)
Education on delivery and care of the new born
Identifying high risk pregnancies
Emphasizing on ANC visits and maintenance of AN card
Importance and management of lactation
Advise on birth spacing
Maternal Mortality Indicators
Maternal mortality ratio
Maternal mortality rate
Life-time risk of maternal morality
Proportion maternal
Other Maternal Mortality Indicators
Lifetime risk of maternal mortality = (N of maternal deaths
over the reproductive life span) / (women entering the
reproductive period)
Proportion maternal = proportion of all female deaths due to
maternal causes = (N of maternal deaths in a period/Number
of all female deaths in same period) * 100
Child Health
Facts about child health
5.9 million children under the age of 5 died in 2015.
More than half of these early child deaths are due to conditions
that could be prevented or treated with access to simple,
affordable interventions.
Leading causes of death in under-5 children are preterm birth
complications, pneumonia, birth asphyxia, diarrhoea and
malaria. About 45% of all child deaths are linked to malnutrition.
Children in sub-Saharan Africa are more than 14 times more
likely to die before the age of 5 than children in developed
regions.
Emerging Issues in child health
Congenital anomalies
Injuries
Non-communicable diseases (chronic
respiratory diseases, acquired heart
diseases, childhood cancers, diabetes,
and obesity)
Global response ???
Global response
Sustainable Development Goal 3
The Sustainable Development Goals (SDGs) adopted by the United
Nations in 2015 aim to ensure healthy lives and promote well-being for
all children. The SDG goal 3 target 3.2 is to end preventable deaths of
newborns and under-5 children by 2030.
Indicators of Child Health
Mortality in infancy and childhood
Prenatal mortality rate
Neonatal mortality rate
Infant mortality rate
Under 5 mortality rate
Mortality in and around infancy
Infant Mortality
Post-neonatal death
Neonatal death
Early Late
neo- neonatal
natal death
death
Preinatal death
Still birth
28 weeks Birth 7 Days 28 Days 1 Year
of gestation
“There can be no
keener revelation
of a society’s soul
than the way it
treats its children”
Nelson Mandela,
1988
