WHO Strategic Framework to End

Preventable Maternal Mortality and

MorbidityDr Pavel Ursu / WHO Representative

Dr Tufan Nayir / Consultant

WHO Country Office

Ankara, Turkey 6 November 2019

Sources: Trends in Maternal Mortality, 1990-2013; Levels and Trends in Child Mortality, Report 2014

Goal 3: Ensure healthy lives and promote well-being for all at all ages

Target 3.1:By 2030, reduce the global maternal mortality ratio to less than 70 per

100 000 live births

0

100

200

300

400

500

600

1990 2000 2010 2020 2030

Countries with baseline MMR < 420 in 2010

Country 2

Global

Country 3

Reduction > 2/3ARR – 5.5%

Country targets to increase equity in maternal mortality

Country 1

“In countries that provide everyone with safe, affordable, high-quality health services, women and babies survive and thrive."

Dr Tedros Adhanom Ghebreyesus,Director-General of WHO

Maternal deaths decline slowly with vast inequalities worldwide

Source: European Health Information Gateway https://gateway.euro.who.int/en/themes/reproductive-maternal-adolescent-child-health

WHO European Region

▪ Substantial progress in reducing maternal mortality

▪ Wide variation between the countries

- highest national MMR

is estimated to be 20

times the lowest

0

5

10

15

20

25

Maternal deaths Near-misses Other complications Long-term disability

Nu

mb

er (

mill

ion

s)

Extent of maternal mortality, morbidity, and disabilities

Source: (Filippi et al. 2006)

Strategies, policy documents and tools

ACCOUNTABILITY

INNOVATION

PARTNERSHIP

Global Strategy’s

targets

SURVIVEEnd preventable deaths

• Reduce global maternal mortality to less

than 70 per 100,000 live births

• Reduce newborn mortality to at least as

low as 12 per 1000 live births in every

country

• Reduce under-5 mortality to at least as

low

as 25 per 1000 live births in every

country

• End epidemics of HIV, tuberculosis,

malaria , neglected tropical diseases and

other communicable diseases

• Reduce by 1/3 premature mortality from

NCDs and promote mental health and

well-being

TRANSFORMExpand enabling environments

• Eradicate extreme poverty

• Ensure that all girls and boys complete

free, equitable and good quality

secondary education

• Eliminate all harmful practices and all

discrimination and violence against

women and girls

• Achieve universal and equitable

access to safe and affordable drinking

water and to adequate sanitation and

hygiene

• Enhance scientific research, upgrade

technological capabilities and

encourage innovation

• Provide legal identity for all, including

birth registration

• Enhance the global partnership for

sustainable development

THRIVEEnsure health and well-being

• End all forms of malnutrition,

and address the nutritional

needs of adolescent girls,

pregnant and lactating women

and children

• Ensure universal access to sexual

and reproductive health-care

services (including for family

planning) and rights

• Ensure that all girls and boys

have access to good quality early

childhood development

• Substantially reduce pollution-

related deaths and illnesses

• Achieve universal health

coverage, including financial risk

protection, and access to quality

essential services, medicines and

vaccines

• Address inequities in access to and quality of sexual, reproductive, maternal and newborn health care

• Ensure UHC for comprehensive sexual, reproductive, maternal and newborn health care

• Address all causes of maternal mortality, reproductive and maternal morbidities, and related disabilities

• Strengthen health systems to respond to the needs and priorities of women and girls

• Ensure accountability to improve quality of care and equity

Ending preventable maternal mortality 5 Strategic Objectives

People-centered care is one of theguiding principles of the Action plan for Sexual and Reproductive Health: Towards achieving the 2030 Agenda for Sustainable Development in Europe – leaving no one behind (2016)

Parental Health and Responsive Caregiving

Essential Package of Interventions for Integrated Care across the Life-Course

hypothyroidism childhood cancers

vertical transmission of HIV/STIs

underweight and stunting

type 2 diabetes and cardiovascular disease

child mortality maternal mortality

preterm birth macrosomia

neonatal hypoglycemia

birth defects low birth weight

diarrhoea

mental retardation

congenital andneonatal infections

Preconception care: Maximizing the gains for maternal and child health

Evidence-based interventions in pre-conception care: selected examples

Areas addressed by the

preconception care package

Evidence-based interventions

• Screening for anemia• Supplementing iron and folic acid• Information, education and counselling• Monitoring nutritional status• Screening for diabetes mellitus• Management of diabetes mellitus• Counselling people with diabetes mellitus• Monitoring blood glucose (also in pregnancy)• Promoting exercise• Salt iodization• Genetic counselling• Carrier screening and testing• Providing contraceptives• Engaging men and boys to critically assess norms and

practices regarding gender-based violence

Nutritional conditions

No data and/or very low

2014 Global Nutrition Report Dataset",http://dx.doi.org/10.7910/DVN/27857, Harvard Dataverse, V2

0

10

20

30

40

50

60

Uzb

eki

stan

Aze

rbai

jan

Kyr

gyzs

tan

Turk

men

ista

n

Kaz

akh

stan

Turk

ey

Cyp

rus

Geo

rgia

Re

pu

blic

of

Mo

ldo

va

Arm

enia

Serb

ia

Tajik

ista

n

Cro

atia

Bo

snia

an

d H

erze

govi

na

Ro

man

ia

Mo

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Esto

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Bu

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ia

Slo

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Hu

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Latv

ia

Po

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Lith

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WRA anaemia (%)

Anemia in Women of Reproductive Age (%) in the European Region

A key part of the solution of the puzzle is Midwives

• Recent evidence indicates that when midwives are educated to international standards, and midwifery includes the provision of family planning, it could avert more than 80% of all maternal deaths, stillbirths and neonatal deaths.

https://apps.who.int/iris/bitstream/handle/10665/324738/9789241515849-eng.pdf?ua=1

Beyond preventing maternal and newborn deaths, quality midwifery care improves over 50 other health-related outcomes, including in

• Sexual and reproductive health,

• Immunization,

• Breastfeeding,

• Tobacco cessation in pregnancy,

• Malaria,

• Tb,

• HIV

• Obesity in pregnancy,

• Early childhood development

• Postpartum depression.

Results published Reports available in countries

Confidential enquiry of maternal deaths in the WHO European Region

Near-miss case review at hospital level

Quality Improvement of Maternal Health Services

RESEARCH – Global maternal sepsis study

Core countries in EURO:- Kazakhstan- Kyrgyzstan- Lithuania- Republic of Moldova- Romania- Slovakia- Tajikistan

Available from:

https://tinyurl.com/evidencebaseddecisionmaking

Research to action:Collaborating with

Member States towards evidence-informed

policy- making

WE KNOW WHAT WORKS

TIME TO ACT

Photo: shutterstock.com