Frequently Asked Questions

Major Partners and Donors

Glossary of Selected Terms

Central to UNFPA’s effort to reduce maternal death and disability is a new emphasis on making emergency obstetric care available to all women who need it.

This does not mean that all births should take place in well-equipped health facilities. It does mean that all pregnant women should have access to functioning facilities that offer essential obstetric care if they develop complications.

This, in turn, has other implications for a country's health care system. Since complications can not be prevented or reliably predicted, it requires that facilities capable of delivering essential obstetric care are distributed throughout the country, that they are well-equipped and staffed 24 hours a day, seven days a week — and that the women who need them have a way of getting to them in time to prevent death or disability.

UNFPA-supported programmes work in all these areas – from advocating health reform policies and upgrading health facilities to mobilizing communities to prepare for and respond to obstetric emergencies. With funding from the Columbia University’s Averting Maternal Death and Disability programme, UNFPA is focusing on improvements in the availability of emergency obstetric care in India, Morocco, Mozambique and Nicaragua.

Setting Standards for Obstetric Care

Basic emergency obstetric care, provided in health centres and small maternity homes, includes the capabilities for:

• Administration of antibiotics, oxytocics, or anticonvulsants
• Manual removal of the placenta
• Removal of retained products following miscarriage or abortion
• Assisted vaginal delivery with forceps or vacuum extractor.

Comprehensive emergency obstetric care, typically delivered in district hospitals includes all basic functions above, plus Caesarean section and safe blood transfusion.

In guidelines jointly issued in 1997 by WHO, UNICEF, and UNFPA, it is recommended that for every 500,000 people there should be four facilities offering basic and one facility offering comprehensive essential obstetric care.

To manage obstetric complications — the life-saving component of maternity care — a facility must have trained staff and a functional operating theatre, and must be able to administer blood transfusions and anaesthesia.

Existing facilities (district hospitals and health centres) can often, with just a few changes, become capable of providing emergency obstetric care.

Reducing Life-Threatening Delays

Timing proves to be critical in preventing maternal death and disability: Although post-partum haemorrhage can kill a woman in under two hours, for most other complications, a woman has 12 hours or more to get life-saving emergency care. The “three delays” model (see below) has proved to be a useful tool to identify the points at which delays can occur in the management of obstetric complications, and to design programmes to address these delays.

The first two "delays" (delay in deciding to seek care and delay in reaching appropriate care) relate directly to the issue of access to care, encompassing factors in the family and the community, including transportation. The third "delay" (delay in receiving care at health facilities) relates to factors in the health facility. Unless the three delays are addressed, no safe motherhood programme can succeed.

Because they require that many sequential procedures all function — from ante-natal care and preparation to attended births with referral capabilities — maternal mortality reduction activities are an integral part of the health sector reform effort and of the sector-wide approaches. They also provide an indication of the success of such approaches.

Find out how UNFPA has helped strengthen essential obstetric care in selected countries.

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