Eliminating Preventable Maternal and Neonatal Mortality &

Improving Mother and Child Health

Dr. sridhar.DAssistant Professor

Community MedicineKamineni Academy of Medical Sciences and Research Centre

Maternal mortality “Women are not dying because of diseases we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving ……………”

Prof. Mahmoud Fathalla Past President, FIGO

Every 5 Minute...

Maternal Death Clock

1 woman dies from a pregnancy-related complication

In India

UNICEF

Problem statement• Globally, 289,000 maternal deaths occurred in 2013, 47 % 1990.

• SubSaharan Africa (62 %) & Southern Asia (24 %)= 86 % (249,000 maternal deaths 2013.

• India at 17 % (50,000) and Nigeria at 14 %(40,000). • The global MMR in 2013 was 210 maternal deaths per lac live births.• The MMR in developing regions (240) was 15 times higher than in

developed regions .• Hieghest - Sub-Saharan Africa -510 per lac live births,• Lowest- Eastern Asia 33 per lac live births

• Under MDG 5, countries committed to reducing maternal mortality by 3 quarters between 1990 and 2015. Since 1990, the number of maternal deaths worldwide has dropped by 43%

Annual Rates of Reduction (1990–2013)

• 2013- 178 per lac live births• 2007-09 212 per lac live births• Kerala , Maharastra, Tamil nadu < 100/Lac live

births• EAG states – Bihar, Jharkhand, Madya Pradesh,

Chattisgarh, Uttar pradesh, Orissa, Rajasthan,Assam, Uttaranchal

Causes of maternal mortality

• Indirect Causes: Aneamia, Malaria, Heart disease• Other direct causes: ectopic pregnancy,

embolism, Anesthesia related

20%

8%

25%

15%

12%

8%

13%

Indirect causes

Other direct causes

Severe bleeding

Infections

Eclamspsia

Obstructed labour

Unsafe abortion

34%

8%5%5%11%

38%Other conditionsabortionObstructed LabourHypertensive disorderSepsisHaemorrhage

Maternal deaths timing

50-70% during post partum periodFirt 24 hrs- more than 2/3 rd With in week- 45%During child birth 11-17%

Neonatal mortality

Deaths at birth and ending 28 completed days after birth per 1000 live births.

• 2.8 million die before 4wks

• half die before 24Hrs• 98% daths in developing countries.• 44% contribute total under 5 daeths

• 31% in Sub Saharan Africa and South East Asia.• Lifetime risk for a woman to lose new born

baby 1 in 5 Africa 1 in 125 developed countries

Indian Scenario

• Early neonatal mortality 23/1000 live births

• 25/1000 in rural 12/1000 in urban

Distribution of under-five deaths by age-groups

Source:Calculated based on data from the UNICEF/WHO/The World Bank/UN Pop Div. Levels and Trends in Child Mortality Report 2014

Causes of neonatal deaths

24%

15%

5%35%

1%2%

8% 10%

Intra partum re-lated complica-tions

Sepsis

Pneumonia

Preterm birth complications

Diarrheoa

Tetanus

Other

Congenital abnormalitis

2% 9%3%

20%

35%

15%

16%

DiarrheoaMalformationsOtherBirth AsphyxiaPretermSepsisPneumonia

Causes of neonatal deaths 2013 Globally

causes of neonatal deaths 2013 in India

distribution of causes of neonatal and under-five deaths, 2013

Source: CHERG/WHO/UNICEF for distribution of causes of neonatal and under-five deaths (published in Liu et al, Lancet 2014).

Vision for Improved Maternal and Feotal Health and Survival