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2

Regions and Zones

REDUCING MATERNAL AND NEWBORN DEATHS

Ethiopia:11 Regions62 Zones

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Demographic Characteristics

Total Population 67.2millPopulation Growth Rate 2.7%Population doubling time 23 yearsPopulation under 15 years 44 % Life Expectancy at birth 54 years

Infant Mortality Rate 113/1,000 Under five mortality187.8/1,000

Maternal Mortality Ratio871/100,000

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Demographic Characteristics

Population below absolute poverty line44.2%Economic Growth Rate5.8%Per capita income (GDP) US $100

Access to potable water

28.4% Access to sanitation16.9%

Health service coverage

61.8%

Adult literacy

31.9%

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United Nations Human Development Index,2002

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Socio-Demographic characteristics of women

Total Female Population 33.6 millionPopulation of Women (15-49) 16

millionMedian age at first marriage16.4 yearsTotal Fertility Rate 5.9 Female life expectancy at birth 55 years

Maternal Mortality Rate 871/100,000

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High Risk Fertility Behavior

0

5

10

15

20

25

30

35

40

%

Birth Order 4+ Birth interval<24 mth Mothers aged<18

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Total Fertility Rate by Region

0

1

2

3

4

5

6

7

No. of ch

ildre

n p

er

wom

an

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Low Status of Women

Limited Access to educationFemale literacy 30.9%

Female primary School Enrollment 51.2%Female secondary School enrollment13.7%

Limited representation in Governance 7.7%

Limited access to employment 45%Gender Development Index of 142/162

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Women Waiting at Health Facility

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Population per health facility by region

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

Popula

tion p

er

faci

lity

Population/hospital Population/health center

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Health Providers/Population

Physician 1: 58,913

Midwife per expected deliveries 1: 3,756

Nurse 1: 5,236

Health Assistant 1: 8,249

Environmental Health Workers 1: 69,228

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Maternal Health Service Statistics (2002)

Family Planning 17.23%

Antenatal Care34.11%

Attended Delivery 9.63%

Postnatal Care 7.12%

Expected number of deliveries2,682,445

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Delivery Attendants

6% 4%

26%

58%

6%

H. Prof. TTBA NTTBA Relative Self

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Causes of Maternal Death*

Haemorrhage10%

Sepsis12%

Hypertention9%

Obstructed labor22%

Abortion32%

Others15%

*Facility based, Ethiopia

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Contributing Factors to Maternal Deaths

Adolescent pregnancyHIV among pregnant womenMalariaMalnutrition Harmful traditional practices

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Selected Maternal Mortality Ratios in Africa

0

200

400

600

800

1000

Mate

rnal death

s per

100,0

00 liv

e b

irth

s

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Lack of information and inadequate knowledge about danger signals during pregnancy and labour

Cultural /traditional practices that restrict women from seeking health care

Lack of money

The First Delay

Male Involvement is Key

Delay in deciding to seek care at the household level

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The Second Delay

Inability to access health facilities:

Out of reach health facilities

Poor roads and communication network

Poor community support mechanisms

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Delay between arriving and receiving care at the health facility:

Inadequate skilled attendants

Poorly motivated staff Inadequate equipment

and suppliesWeak referral system

The Third Delay

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Perinatal, Neonatal & Infant Mortality Rates

Perinatal Mortality Rate 100/1000 Births

Neonatal Mortality Rate 58/1,000 LB

Infant Mortality Rate 113/1,000 LB

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Neonatal Mortality Rate by Region

0

20

40

60

80

Num

ber

of neo

nat

al d

eath

s/1000 liv

e bir

ths

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Causes of Newborn Death

Infections32%

Birth asphyxia

29%

Prematurity24%

Others15%

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REDUCE MODEL

Impact on survival and productivity (2001 - 2015)

Data on Maternal & Newborn Health

Estimating Consequences of Poor Maternal and Newborn Health

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Key assumptions in “REDUCE”

The model assumes two scenarios:Scenario 1:

Maternal mortality ratio remains constant from 2001-2015.

Scenario 2:With appropriate interventions maternal mortality ratio will decline

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Maternal Mortality 2001-2015

No interventions

415, 000 maternal deaths

9 Million suffer disabilities

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Infant Deaths resulting from Maternal Death and Disability 2001-

2015

No interventions

2,000,000 infants will die

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Effects of Mothers’ Death

The death of a woman and mother is a tragic loss to the family, community and nation as a whole.

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Disability Consequences2001-2015

Chronic anemia Fistulae Chronic pelvic painEmotional

depressionMaternal exhaustion

$750 million US or

6.4 billion Birr

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Economic Losses2001-2015

The loss of productivity due to maternal deaths will be

US $650,000,000 or

about 5.5 billion Birr

Birr

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Commitment to Reducing Maternal Deaths

GOAL

Reduce current MMR by 75 % by 2015

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Reduction in Maternal Deaths 2001-2015

0

250

500

750

1000

Year

Mat

erna

l dea

ths

per

100,

000

live

birt

hs

No change in maternal careImproved maternal care

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Economic Gains2001-2015

US $475 million or 4 billion Birr gain Birr

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Intervention 1

Allocate at least 15% of total annual budget for health (Arusha Declaration, 2001) and at least 25 % of that health budget for reproductive health services.

Strengthen the National RH programme to promote multi-sectoral involvement.

Ensuring implementation of policies, guidelines and standards related to maternal and newborn health services.

Develop appropriate strategies for effective community involvement and participation.

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intravenous sedatives, oxytocic drugs and antibiotics

manual removal of the placenta

postabortion careassisted vaginal deliveriesbasic newborn life support

Interventions 2Designate and equip one Hospital per 500,000 population to provide comprehensive essential obstetric which includes basic obstetric care as well as surgical procedures particularly caesarian section and safe blood transfusions;

Ensure that each Woreda has a minimum of one health center equipped to provide basic essential obstetric and newborn care for 24 Hours daily offering:

Ensure that malaria, TB, TT, VCT & PMTCT are focused on during ANC

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Interventions 3

For all newborns – born at home or in facility:

Clean delivery and cord care

Keep baby dry and warm

Breastfeeding: immediate and exclusive

Avoid harmful practices

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Interventions 4

All obstetric emergencies must be treated free for the first 48 hours.

Maintain two way referral system;

Abrogate Taxation on Contraceptives

All health facilities especially the Health Centers and Hospitals must have regular supply of water and electricity;

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Interventions 5Capacity building and improvement of skills:

Train 1,148 midwives to meet Government’s stipulated midwife requirement based on HSDP-I target.

Review the curriculum to upgrade the skills of junior midwives

Train more obstetricians

Strengthen the EOC component of pre-service training

Delegate responsibility to GPs, HOs and midwives with adequate training and supervision to offer EOC.

Upgrade the skills of existing health providers to offer newborn care and family planning.Offer incentives for these cadres to attract and retain them especially for the rural areas

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If we act now, By 2015…

$ 475 million US (4 billion Birr) in productivity gains

140,000 women’s lives saved

3,000,000 disabilities averted

700,000 children’s lives saved

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Conditions Needed

Strong commitment to maternal and newborn survival and health by political leaders and decision makers at national and local levels

Community involvement, Resource mobilization and Partnership

Realistic and appropriate investment in women’s education, health and economic empowerment

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Conditions Needed cont.

Male involvement and participation in Reproductive Health issues and services

Implementation framework with clearly defined supervision, monitoring and evaluation mechanisms.

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Conclusion

To guarantee the RIGHT of Ethiopian women and newborns to health and life, they must have access to quality reproductive health services, including skilled attendance at birth.

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THANK YOU FOR JOINING THE “REDUCE” TEAM

MOH/WHO