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Maternal Health
Any woman can experience complications during
pregnancy. But virtually all obstetric complications
can be treated. Low maternal mortality ratios are
due, in large part, to the fact that complications
are identified early and are treated.
COMBATING THE “THREE DELAYS”. The “three delays”
model has proven useful in designing programmes to
manage obstetric complications. Overcoming delays
in deciding to seek care, in reaching appropriate care
facilities and in receiving care at those facilities requires
sequential procedures—from antenatal care and preparation
to attended births with referral capabilities.
Health services related to emergency obstetric care
are categorized as basic and comprehensive.(41) Basic
emergency functions, performed in a health centre
without an operating theatre, include: assisted vaginal
delivery; manual removal of the placenta and
retained products to prevent infection; and administering
antibiotics to treat infection and drugs to
prevent or treat bleeding, convulsions and high
blood pressure.
Comprehensive services require an operating theatre
and are usually provided in a district hospital. These
include all the functions of a basic emergency facility,
plus the ability to perform surgery (Caesarean section) to manage obstructed labour and to provide safe blood
transfusion to respond to haemorrhages.
A number of countries are seeking to increase the
number of basic and emergency obstetric care facilities
as well as to bolster the capacity of staff and the
quality of care provided. For example, with UNFPA
support, Guinea-Bissau assessed needs for emergency
obstetric care and has made plans to increase the
number of facilities offering basic emergency care
and those offering comprehensive care.(42)
QUALITY SERVICES. The quality of emergency obstetric
care is key to success. Services must be available 24
hours seven days a week, and have well-trained and
motivated staff, essential supplies and logistics in
place, functioning transport and communication
systems and ongoing monitoring.
A number of countries have put priority on improving
access to emergency obstetric care, and raising its
quality. Lebanon and Oman have strengthened their
referral services. El Salvador has developed quality
obstetrical model services in hospitals and health units.
In Jamaica, access to emergency obstetric care, including
special facilities for transportation and referral to
higher levels of care, is provided in each district.(43)
Since the ICPD, various countries in sub-Saharan
Africa have introduced training for health staff in
essential obstetric care. These include: Angola, Benin,
Burundi, Cameroon, Chad, Côte d’Ivoire, Guinea,
Kenya, Lesotho, Liberia, Mozambique, Namibia, the
Niger, Senegal, Swaziland and Zambia.
In Morocco, providers have been trained to use
new protocols for treating obstetric emergencies.
Comprehensive services have been established in five
rural hospitals, and ten provincial hospitals have
improved the quality of emergency obstetric care,
resulting in a significant increase in the number
of women receiving appropriate care.(44)
IMPROVING TRANSPORT AND REDUCING OTHER BARRIERS.
Poor families are often unable and sometimes reluctant
to find or pay for transport to a medical facility
when a woman goes into labour. The Mother Friendly
Movement in Indonesia has helped communities recognize
the need for and establish emergency transport
systems for women in labour.(45)
New efforts seek to understand obstacles to and
promote the use of available care. A partnership of
Canadian and Ugandan medical associations, undertaken
as part of the Save the Mothers Initiative of
the International Federation of Gynaecology and
Obstetrics (FIGO), worked in the rural district of
Kiboga in Uganda to improve emergency obstetric
care and its use.
The number and capabilities of skilled attendants
in the district hospital were increased, and local dispensaries
made care available 24 hours a day; health
facilities were upgraded and stocked; and workshops
were held to improve health workers’ attitudes
towards community members. UNFPA provided two
ambulances.
As a result of the interventions, met need for
treatment of women with obstetric complications rose
from 4 per cent in 1998, when the project began, to
47 per cent in 2000. Maternal deaths dropped from
9.4 per cent of those receiving emergency obstetric
care in 1998 to around 2 per cent in 1999 and 2000.(46)
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