Making Pregnancy Safer

04_DirectorReport_PCC/1

9/2004 Rita Kabra_/1

Access to essential Access to essential medicines for medicines for Maternal and Maternal and

Newborn Health Newborn Health

Dr Rita KabraDr Rita KabraMaking Pregnancy SaferMaking Pregnancy Safer

WHO/EDM Technical Briefing WHO/EDM Technical Briefing SeminarSeminar

Salle G, WHO/HQSalle G, WHO/HQ27 September – 1 October 20027 September – 1 October 20044



Outline of the presentationOutline of the presentation

• current situation: maternal and current situation: maternal and newborn health newborn health

• Making pregnancy safer, Integrated Making pregnancy safer, Integrated management of pregnancy and management of pregnancy and childbirth childbirth

• Examples of two medicinesExamples of two medicines• The way aheadThe way ahead



Current scenarioCurrent scenario

• Every minute a woman dies from Every minute a woman dies from complications of pregnancy or childbirthcomplications of pregnancy or childbirth

• All but 1% of these deaths occur in All but 1% of these deaths occur in developing countriesdeveloping countries

• Most deaths occur due to poor service Most deaths occur due to poor service provision, lack of access to and use of provision, lack of access to and use of these servicethese servicess

• Most of these deaths could be avoided Most of these deaths could be avoided onlyonly if appropriate care was available if appropriate care was available throughout pregnancy, childbirth and throughout pregnancy, childbirth and the post-natal period. the post-natal period.



Causes of maternal deathCauses of maternal death529,000 :529,000 : 99 % in developing countries99 % in developing countries

Severe bleeding24%

Infection15%

Eclampsia12%

Obstructed Labour

8%

Unsafe abortion13%

Other direct causes

8%

Indirect causes20%


9/2004 Rita Kabra_/5World Health Organization

Making Pregnancy Making Pregnancy SaferSaferWHO’s contribution to the Safe Motherhood initiative

Health sector strategy aimed to assist countries to identify and implement affordable strategies to address maternal and newborn health.



To ensure safe pregnancy and childbirth through the availability, access and use of quality skilled care for all women and their newborns

The central objective of the The central objective of the Making Pregnancy SaferMaking Pregnancy Safer



Essential component of skilled Essential component of skilled carecare

• A A skilled attendant/skilled attendant/skilled skilled professionals supported by an professionals supported by an appropriate environment with appropriate environment with access to basic supplies, access to basic supplies, essential essential medicinesmedicines and relevant emergency and relevant emergency services services

• Skilled care should be provided Skilled care should be provided within a within a continuum of carecontinuum of care at all at all levels of the health systemlevels of the health system



What is the continuum of care?What is the continuum of care?

FAMILY and FAMILY and COMMUNITYCOMMUNITY

FIRST LEVEL CAREFIRST LEVEL CARE

REFERRAL LEVEL CAREREFERRAL LEVEL CARE



(Arabic)(Arabic)(Portuguese)(Portuguese)

EnglishEnglishFrenchFrench

SpanishSpanishRussianRussianLaotianLaotian

VietnameseVietnameseIndonesianIndonesian

ChineseChineseFarsiFarsi

Evidence-based practice guidelines for maternal Evidence-based practice guidelines for maternal and newborn health care: according to level of and newborn health care: according to level of

carecare



Essential medicines are selected on Essential medicines are selected on basis basis

of evidence on efficacy and safetyof evidence on efficacy and safetyIntegrated Management of Pregnancy and

Childbirth (IMPAC)

Pregnancy, Childbirth, Postpartum and Newborn Care:

A guide for essential practice (PCPNC)

ADAPTATION GUIDEA guide to identify necessary adaptations of

clinical policies and guidelines

A. The Adaptation Process

December 2003Working Draft: for Limited Distribution Only

World Health OrganizationDepartment of Reproductive Health and Research



The midwifery modules

Using Human Rights to improve Maternal and Neonatal Health

Beyond the numbers Reviewing maternal deathsand complications to make pregnancy safer

MakingPregnancy Safer Planning Guide

2004

Integrated management of

Pregnancy and Childbirth

IMPAC



Essential medicines for maternal and Essential medicines for maternal and newborn healthnewborn health

Postpartum haemorrhagePostpartum haemorrhage Oxytocin injectable/ Oxytocin injectable/ unijectuniject

IV fluidsIV fluids

Eclampsia/Pre-eclampsiaEclampsia/Pre-eclampsia Magnesium sulphateMagnesium sulphateCalcium gluconateCalcium gluconateHydralazineHydralazine

Sepsis/InfectionSepsis/Infection AmpicillinAmpicillinGentamicinGentamicinMetronidazoleMetronidazoleTetanus toxid vaccineTetanus toxid vaccine

HIVHIV Nevirapine or Nevirapine or ZidovudineZidovudine

AnaemiaAnaemia Iron/folic acidIron/folic acidBloodBlood



Access to essential medicines is a pre Access to essential medicines is a pre requisite to improved maternal and requisite to improved maternal and

newborn healthnewborn health• Essential medicines are those that Essential medicines are those that

satisfy the priority health care needs satisfy the priority health care needs of the population. of the population. (report to WHO (report to WHO Executive Board, January 2002) Executive Board, January 2002)

• Selection criteria:Selection criteria: Essential medicinesEssential medicines are selected with due regard to are selected with due regard to disease prevalence, evidence on disease prevalence, evidence on efficacy and safety, and comparative efficacy and safety, and comparative cost effectivenesscost effectiveness



Oxytocin for preventing and treating Oxytocin for preventing and treating postpartum postpartum hemorrhagehemorrhage (PPH) (PPH)• 150,000 maternal deaths per year 150,000 maternal deaths per year • Active management of third stage of Active management of third stage of

labourlabour reduces the risk of PPH by about reduces the risk of PPH by about 60% reduces the need for extra 60% reduces the need for extra oxytocic by 70%, reduces the risk of oxytocic by 70%, reduces the risk of postpartum anaemiapostpartum anaemia

• Management of PPH: Management of PPH: oxytocinoxytocin prostaglandins : misoprostolprostaglandins : misoprostol

ErgometrineErgometrineblood transfusionblood transfusionsurgerysurgery



Table 3 Cost estimates for using oxytocin for Table 3 Cost estimates for using oxytocin for prevention of post-partum hemorrhage in prevention of post-partum hemorrhage in

Uganda Uganda PopulationPregnanciesIncidence of PPHPotential casesIntervention’s effectiveness

Unit cost of treatment for PPHCost of treatment for cases of PPHSavingsTotal programme costPotential savings

1,094,00064,86310%648650% (3243 fewer cases)

Scenario 1: no preventive intervention

$56$364,011

Scenario 2: with preventive intervention

$56$182,006$182,006$1,800,00010%

Rounded to nearest whole numbers. Figures taken from two Districts Iganga and Mbarara.*Actual savings depend on factoring, such as additional costs, savings from all types of complications averted, etc.



Magnesium sulphate for preventingMagnesium sulphate for preventingand treating eclampsiaand treating eclampsia

• 50,000 maternal deaths women per 50,000 maternal deaths women per yearyear

• The Collaborative Eclampsia trialThe Collaborative Eclampsia trial: : llowers risk of owers risk of recurrent convulsions recurrent convulsions by 67%by 67%, lower risk for ventilation, , lower risk for ventilation, pneumonia, and need for intensive pneumonia, and need for intensive care care

• The Magpie trial :The Magpie trial : Lowers risk of Lowers risk of eclampsia by 58% for women with eclampsia by 58% for women with pre eclampsia. pre eclampsia.



Inclusion of magnesium sulphate in 45 of 112 national lists

0

2

4

6

8

10

Added to the WHO EML

Access to magnesium Access to magnesium sulphate: a long way to gosulphate: a long way to go



ChallengesChallenges• Availability: Every pregnancy faces risk, Availability: Every pregnancy faces risk,

essential medicines should always be available at essential medicines should always be available at every health centreevery health centre

• Accessibility: geographical distribution of Accessibility: geographical distribution of

medicines, and at loer level facilities medicines, and at loer level facilities

• Quality and safety : Storage, stability, avoid Quality and safety : Storage, stability, avoid overuse and misuseoveruse and misuse

• Policy: Regulations on who can prescribe, Policy: Regulations on who can prescribe, training of health workers, rational selection, training of health workers, rational selection, evidence based guideline evidence based guideline

• Political willPolitical will



Key points for policy makersKey points for policy makers

• Most maternal deaths are avoidableMost maternal deaths are avoidable

• Most maternal health problems can be Most maternal health problems can be treated with a few essential medicines treated with a few essential medicines

• Access to essential medicine is a Access to essential medicine is a prerequisite to improve maternal and prerequisite to improve maternal and newborn healthnewborn health

• Procurement, reimbursement, training Procurement, reimbursement, training and donations of drugs should be based and donations of drugs should be based on proper use of these few medicineson proper use of these few medicines


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The future is promisingThe future is promising• International commitment :The Millennium

Development Goals reduce maternal mortality by three quarters reduce under-five mortality by two thirds

• WHO s commitment :Making Pregnancy Safer Department for country implementation

• MPS commitment: strengthening of integrated health systems. A co-ordinated response to essential maternal and perinatal health care. malaria, HIV programme.

• Close collaboration with EDM on reproductive health/ maternal health medicines.



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

Dr. M. FathallaDr. M. Fathalla



Web site: Web site: www.who.int/reproductivehealth www.who.int/reproductivehealth

Documentation centre:Documentation centre:[email protected]@who.int

Making Pregnancy Safer

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