FinalRH Assignment For Presentation

MPH program
Seminar presentation on
Maternal Health Services
By Group One
Adola ,Oromia
Feb-2022
02/17/2023 Maternal Health Serices 1
Group Members
1. ASNAKE TADESSE…………WP0540/14
2. ASHENAFI LEMESA..............WP0536/14
3. YOSEF TEKLE……………...WM0011/14
4. KASAHUN TESFAYE……….WM0010/14
5. MUSTAFA AMAN…….………WP0534/14
Contents of presentation
 Introduction
 Maternal health services
 Different approaches to ANC
 Current strategic focuses related to delivery services
 What are components and importance of post-natal care
 Family planning
 Safe abortion & comprehensive PAC

Learning objectives
At the end of this session, students able to:

 Describe the maternal health services
 Discuss the different approaches to ANC
 Describe the current strategic focuses related to delivery
services
 State components and importance of post-natal care
 Discus Family planning
 Discus Safe abortion & comprehensive PAC

Introduction
Maternal health refers to a woman's health and well-being before,

during, and after pregnancy and encompasses aspects of physical,
mental, emotional, and social health.
For most women in the developing world the luck of regular

access to modern health services greatly contributes to the
increased morbidity and mortality.

Intro…
 Most mothers receive insufficient family planning advice and

ante natal care or none at all and deliver without access to
skilled obstetrical care when complications develop.
 Even in countries with relatively well-developed health

systems, preventable maternal illness and death persist
because of inadequate management of the complications of
pregnancy.

Intro…
 Based on the above issues the important and major purposes of

provision of Maternal Health Services are:
• Prevention of maternal morbidity and mortality
• Recognition and treatment of complications as they arise,
and
• The promotion of the health of the mother and the
newborn.

General Consideration
• Globally, an estimated 810 women died each day due to
complications of pregnancy and childbirth with the majority of
deaths in low- and middle-income countries in 2017
• The SDGs prioritize maternal mortality reduction, with a

global average maternal mortality target of less than 70 per
100,000 live births and a supplementary national target that no
country should have an MMR greater than 140 per 100,000
live births by 2030

General Cons …
 Ethiopia made a striding change in maternal death over the last decades,
the MMR decreased from 871 per 100,000 in 2000 to 401 per 100,000 in
2017
 This is death of about 12,000 mothers every year.

 Direct obstetric complications account for 85% of the deaths.
 High maternal mortality rates are also directly related to high

neonatal mortality rate of 29/1,000 live births.

Major maternal health services
 Antenatal Care
 Delivery services
 Postnatal care
 Family planning
 Safe abortion & comprehensive PAC

Antenatal Care
 ANC: Care given to pregnant Women so that they have safe

pregnancy and healthy baby.

Cont…
• ANC is still a big pillar of Safe Motherhood.

• It needs to be linked with quality emergency obstetric services
• A good safe motherhood services must be part of a continuum
of services in which FP, PAC, intra-partum & postpartum care
are all provided & support one another.

.
SAFE
MOTHERHOOD
Essential Obstetric C.
Post abortion Care
Antenatal Care
Family Planning
Postpartum Care
Safe Delivery
BASIC HEALTH SERVICES
EQUITY
EMOTIONAL & PSYCHOLOGICAL SUPPORT
Essential Health Sector Interventions for Safe

Motherhood
Aims of ANC
 Promote & maintain the physical, mental & social health of
mother & baby.
 To detect & treat complications during pregnancy.
 To advise the mother on ways of carrying for herself during

pregnancy & her baby.
 Develop birth preparedness & complication readiness plan.

Aims…
 To give TT immunization for mothers.
 To help women limit harmful behavior such as smoking &

alcohol consumption (smoking is associated with fetal growth
restriction, preterm labor, abruption & fetal uterine death).
 Help prepare mother to breastfeed successfully, experience
normal puerperium, & take good care of the child physically,
psychologically & socially.

Effective ANC
 Care from a skilled attendant & continuity of care
 Preparation for birth & potential complications
 TT Immunization & education on nutrition, tobacco
& alcohol use & other behaviors

Effective ANC…
 Promoting health & preventing disease
 Detection of existing diseases & Rx
 HIV, syphilis, TB, other co-existing medical diseases
 Early detection & management of complications

Approach to ANC
There are two approaches to ANC
1. Risk approach (standard western model)
2. Goal-directed approach (New WHO Model)

1. Risk Approach
Risk approach is a managerial tool for health services to
identify people at risk as early as possible & intervene in
order to reduce the risk.
 The basic concept behind this approach is that it assumes all
women in reproductive age group are vulnerable to disease,
death & disability.
However, all women are not equally vulnerable & this risk
approach helps to identify mothers who are at a higher risk
than others with a lesser risk.

Purposes of risk approach
 Optimal use of existing resources for the benefit of the
majority.
 Minimum of care for all & diversion of limited resources to
those who most need them (high risks)

Criteria to identify high risk women
1. Relation ships b/n the risk factors & adverse outcomes
 Causative or triggering: E.g. maternal malnutrition, low BW, placenta
previa, congenital malformation…

 Contributory factors: E.g. grand multiparty can lead to transverse
lie, cord prolapse

 Predictive or associative: e.g. previous fetal loss

Conti…
2. Biological, medical & social conditions

• Biological: age, birth interval, weight gain
• Medical: diabetes, obstetric complications
• Social: work load, economic status

Limitations of risk approach
More than 10 years of experience has shown:

 “Risk factors” cannot predict complications
 Risk factors” do not appear to be good indicators of
complications.
 The majority of women who experience complication were
considered “low risk;” while the vast majority of women
considered to be “high risk” give birth without complications.

2. Goal-directed/focused approach
Because of the above, limitations many literatures strongly

suggested that:
 All pregnancies should be regarded as “at risk” of developing a
complication & be managed with the greatest care.
 The focus of obstetric care should be shifted from predicting
complications through identification of “risk factors” to –
‘detecting signs & symptoms of actual problems & Educating women,
men & family members about danger signals & complication readiness’

Conti…

Basic components of the new Approach
 As per the 2016 WHO recommendation, Ethiopia is

replacing the previous four-visit FANC model with the new
ANC eight-contact model.
 In order to reduce perinatal mortality and improve the
pregnancy experience of women, a minimum of eight
contacts is required.

CONT…
Accordingly,
In the first trimester the first contact is to be a single
contact (up to 12 weeks),
In the second trimester two contacts (at 20 and 26
weeks of gestation), and
In the third trimester five contacts (at 30, 34, 36, 38,
and 40 weeks)

Contacts Gestational age of contacts in week schedule of next
appointment
Basic components
Firstof the new Approach
trimester
1st visit Up to 12 After 8weeks
Second trimester
2nd 20 After 8weeks
3rd 26 After 6weeks
Third trimester
4th 30 After 4weeks
5th 34 After 4weeks
6th 36 After 2weeks
7th 38 After 2weeks
8th 40
02/17/20237 Maternal Health Serices

CONT…
The reason for increasing the number of contacts in the third
trimester is considering the increased risk of complications to
the mother and the fetus during this period of gestation.
In the current model, the word “visit” is replaced with

“contact” as the connotation of the latter indicates an active
connection between a pregnant woman and a health care
provider

Trends in antenatal care coverage in Ethiopia

Delivery services
Most of the times labor & birth have natural & good outcome.
However, there are conditions during labor & child birth that
contributes to maternal morbidity & mortality.

Most of these conditions can be avoided by providing good
quality delivery services.

Aims of delivery care
 To provide clean & safe delivery.
 Recognition, early detection & management of complications
at health center or hospital.

Strategies
All women & their birth attendants should be aware of the
requirements for a clean delivery.

 The 5 cleans of delivery
 Clean hands
 Clean delivery surface
 Clean perineum
 Clean cord cutting
 Clean environment

Strategies…
Health workers training to practice clean & safe delivery &
avoid unnecessary procedures.

All women & their birth attendants should be aware of the need
to refer cases of prolonged or obstructed labor to a higher level

of care.
All institutional deliveries should be monitored using an
appropriately adapted version of a partograph in order to

prevent prolonged labor.
Current Strategic focus
1. Skilled attendant at every birth
2. Access to obstetric care

3. Emergency referral
4. Progress monitoring using process indicators
5. Commitment from the government

1. Current Strategic- Skilled attendant
Skilled care: refers to the care provided to a woman & her
newborn during pregnancy, childbirth & immediately after

birth by an accredited & competent health care provider.
Skilled attendant: refers to an accredited health professional
such as a midwife, doctor, health officer or nurse.

Trends in Delivery care

2. Current Strategic- Obstetric Cares
 Obstetric care categories
 Essential obstetric care (EOC)
 Emergency obstetric care (EmOC)
 Obstetric First Aid (OFA)

Essential Obstetric care (EOC)
EOC is the elements of obstetric care for the mother &
newborn needed for the management of normal & complicated

pregnancy, delivery & the postpartum period.
Includes elective procedures

EOC….
Two types of EOC
 Basic Essential Obstetric Care (BEOC) - includes the EOC
needed for detecting complications early, but it does not

include surgery, anesthesia, and blood replacement .
 Comprehensive Essential Obstetric Care (CEOC)

BEOC Vs CEOC
Type of care CEOC BEOC
Surgical obstetrics X
Anesthesia X
Blood replacement X
Mgt of problems of pregnancy X X
Medical treatment X X
Manual procedures X X
Monitoring of normal labor X X
Neonatal special care X X
Family planning X X

Emergency obstetric care (EmOC)
Life saving functions which can prevent the death of women
experiencing the start of complications during pregnancy,

delivery or the postpartum period.
Is a medical response to a life treating conditions.
Responds to unexpected complications, such as hemorrhage &
obstructed labor, with blood transfusion, anesthesia & surgery.

EmOC….
Unlike EOC, it does not include management of problem
during pregnancies ( e.g. preeclampsia), monitoring of labor, or

neonatal special care.
Midwives with life saving skills & obstetricians are needed.
 Two types:
 BEmOC: at a health center by nurse, midwife or MD
 CEmOC: at district hospital with OR & professional with
surgical skill.

BEmOC Vs CEmOC
Type of care BEmOC CEmOC
Administer parenteral oxytocic drugs X X
Administer parenteral Antibiotics X X
Administer parenteral anticonvulsants for X X
preeclampsia and eclampsia
Perform manual removal of placenta X X
Perform removal of retained products X X
Perform assisted vaginal delivery X X
Perform blood transfusions X
Perform surgery (Caesarean sections & X
laparotomy)

Obstetric First Aid (OFA)
Part of EmOC that is performed at the more peripheral levels
 Early recognition of obstetric emergencies
 Administration of parenteral antibiotics
 Administration of parenteral oxytocic
 Administration of parenteral anticonvulsants
 Referral & transport arrangements

Models of Successful Delivery Care
Delivery Place of Delivery
attendant
Home BEOC facility CEOC facility
Non- Model 1
Professional lay provider recognizes
complications; family
organizes access to EOC
Facility
Professional Model 2 Model 3 Model 4

professional recognizes Professional Professional
comps, family or recognizes comps, recognizes comps,
provider organizes EOC provides BEOC; prof. provides B
referral facility organizes and C EOC care
referral to CEOC

POSTPARTUM CARE (PNC)
 Is Care given after delivery for mother & new born.

 The main life threatening complications
 Haemorrhage,
 Anaemia,
 Genital trauma,
 Hypertension,
 Sepsis
 UTI &
 mastitis.
• Therefore, all women should be assessed within 24 hours after
delivery & within the first week of delivery.
Aims of PNC
Maternal care
 Early detection & Mgt of Complications
 Promotion & support to breastfeeding
 Information & services for family planning, nutrition,
hygiene etc.
 STD/HIV prevention & management
 TT immunization

Aims of PNC
Newborn care
 The main components of newborn care include:
 Resuscitation
 Prevention & mgt of:
Hypothermia

 Ophthalmianeonatorum
 Cord infections
 Early & exclusive breastfeeding

 Recording of birth weight & referral of newborn for
immunizations & growth monitoring

PNC frequency
 At least 2 times
In first day, if not, in first week
 Check for complications

 Establish BF
 Family Planning Information
With in 6 weeks
 Maintain care given during 1st visit

 Advise on breast feeding, immunization, personal care & family planning

Family Planning
 Refers to the use of various methods of fertility control that

will help individuals or couples to have the number of
children they want when they want them in order to assure the
well being of children & the parents.

Family planning con…
 Family planning programs provide services that help people to
achieve:
 The number of children they desire
 Reduce the number of unwanted pregnancies
 Reduce the risk of STI(especially condom), and
 Improve the health of women and children by spacing birth.

Rationale for FP
1. Demographic rationale
2. Health rationale
3. Human rights rationale

1. Demographic rationale
 The main intention of FP during (1960s-1970s)
 Reducing high fertility rates and slowing population growth rate
 High fertility and rapid population growth has negative effect on:
 Standards of living & human welfare
 Economic productivity
 Natural resources
 Environment

2. Health rationale
Became prominent during the 1980s
The public health consequences of high fertility became
paramount
 High rates of infant, child, and maternal mortality
 Abortion and its health consequences
 High number of pregnancy
 Births to young or old mothers
 Unintended pregnancy

3. Human rights rationale
Became preeminent in 1990s.
This rests on the belief that individuals and couples have a
right to control reproductive decisions including family size

and timing of birth.
Found strongest articulation at the ICPD.

Challenges

Safe abortion & comprehensive PAC
Abortion:-Termination of pregnancy before fetal viability
before 28 weeks of GA or birth weight of <1000gm.
Types of abortion
Spontaneous:-termination is not provoked deliberately(threatened,
inevitable, incomplete, complete or missed abortion).
Induced: deliberate interference with the pregnancy for the sake of
terminating it.
Abortion…
Induce abortion may be either safe or unsafe

 Safe abortion:-Performed by qualified persons using
correct techniques and in sanitary conditions.

 Unsafe abortion:- Terminating an unintended pregnancy
either by person without the necessary skills or in an

environment that does not conform to minimum medical
standards, or both (WHO).

Abortion…
Unsafe abortion- is a critical public health concern in many
developing countries, causing the deaths of 10,000 of women

worldwide each year.
In Ethiopia, unsafe abortions account for approximately 25-
50% of maternal deaths.

 Abortion complications are a leading cause of hospitalization
for Ethiopian women.

Share of abortion for maternal death in
Ethiopia

Abortion…
• There are two types of care related to termination of
pregnancy:
A. Women centred comprehensive abortion care
B. Women centred Post abortion care

A. Women centred comprehensive abortion care
 It is an approach to providing abortion services that takes into

account the various factors which influence a woman’s
individual health needs-both physical and mental as well as her
personal circumstances and her ability to access services.
 It comprises three key elements:
 Choice – the right & opportunity to select b/n options
(concerning RH)
 Access – having access to the needed service
 quality- having respectful and confidential service

B. Post abortion care (PAC)
A comprehensive service for treating women that present to

health facilities after abortion has occurred.
PAC is an approach for
 Reducing morbidity and mortality from complications of unsafe

and spontaneous abortion,
 Improving women’s SRH and lives

Essential elements of post abortion care
Community and service providers partnership
Counseling
Treatment
Contraceptive and family planning services
Link to Reproductive and other health services

REFERENCES
1. Federal Democratic Republic of Ethiopia (FDRE). 2016. National Guideline on

Adolescent, Maternal, Infant and Young Child Nutrition. Addis Ababa, Ethiopia:
FDRE
2. Ethiopia mini demographic health survey (EDHS ).2019
3. FDRE MOH.National Norms & Guidelines for Safe Abortion Services in
Ethiopia second edition,2014
4. FDRE MOH ,National Antenatal Care Guideline | February 2022
5. United Nations, Department of Economic and Social Affairs, Population
Division (2015). World Population Prospects: The 2015 Revision.

6. Ethiopia Demographic and Health Survey 2016 via the DHS
Program
7. United Nations Inter-agency Group for Child Mortality
Estimation (UNICEF, WHO, United Nations Population
Division and the World Bank).
8. United Nations Maternal Mortality Estimation Inter-agency
Group (WHO, UNICEF, UNFPA, United Nations
9. Population Division and the World Bank).
10. Trends in maternal mortality: 1990 to 2015: estimates by WHO,
UNICEF, UNFPA, World Bank Group and
the United Nations Population Division
11. Blencowe H, Cousens S, Oestergaard M, Chou D, Moller AB, Narwal R, Adler
A, Garcia CV, Rohde S,

12. Averting Maternal Death and Disability, United Nations Children’s Fund,
and United NationsPopulation Fund special data compilation, 2015.
13. Global Health Workforce Statistics database, World Health Organization,
Geneva.
(http://www.who.int/hrh/statistics/hwfstats/).
14. United Nations, Department of Economic and Social Affairs, Population
Division (2015).
15. WHO-MCEE estimates for child causes of death, 2000-2015.
(http://www.who.int/healthinfo/global_
2016
16. burden_disease/estimates_child_cod_2015/)
17. WHO. Standards for improving quality of maternal and newborn
care in health facilities. Geneva, Switzerland;
18. Ethiopian ministry of health, ETHIOPIAN NATIONAL HEALTH
CARE QUALITY STRATEGY,
Transforming the Quality of Health Care in Ethiopia, 2016–2020.
19. Banke-Thomas A, Ameh CA. WHO’s quality of maternal and
newborn care framework: is harmonization of tools best? Lancet
Glob Health. 2019;7(7):e841.
20. Ethiopian ministry of health, HEALTH SECTOR
TRANSFORMATION IN QUALITY, A guide to cascade
Quality Improvement activities in Ethiopian health facilities, 2016.
No mother will day when
giving life!
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MPH program

 What are components and importance of post-natal care

 Safe abortion & comprehensive PAC

02/17/2023 Maternal Health Serices 3

At the end of this session, students able to:

02/17/2023 Maternal Health Serices 4

Maternal health refers to a woman's health and well-being before,

For most women in the developing world the luck of regular

02/17/2023 Maternal Health Serices 5

 Most mothers receive insufficient family planning advice and

 Even in countries with relatively well-developed health

02/17/2023 Maternal Health Serices 6

 Based on the above issues the important and major purposes of

02/17/2023 Maternal Health Serices 7

• The SDGs prioritize maternal mortality reduction, with a

02/17/2023 Maternal Health Serices 8

 This is death of about 12,000 mothers every year.

 High maternal mortality rates are also directly related to high

02/17/2023 Maternal Health Serices 9

 Safe abortion & comprehensive PAC

02/17/2023 Maternal Health Serices 10

 ANC: Care given to pregnant Women so that they have safe

02/17/2023 Maternal Health Serices 11

• ANC is still a big pillar of Safe Motherhood.

02/17/2023 Maternal Health Serices 12

EMOTIONAL & PSYCHOLOGICAL SUPPORT

Essential Health Sector Interventions for Safe

 To advise the mother on ways of carrying for herself during

02/17/2023 Maternal Health Serices 14

 To give TT immunization for mothers.

 To help women limit harmful behavior such as smoking &

02/17/2023 Maternal Health Serices 15

 Preparation for birth & potential complications

 TT Immunization & education on nutrition, tobacco

& alcohol use & other behaviors

02/17/2023 Maternal Health Serices 16

 Early detection & management of complications

02/17/2023 Maternal Health Serices 17

1. Risk approach (standard western model)

2. Goal-directed approach (New WHO Model)

02/17/2023 Maternal Health Serices 18

02/17/2023 Maternal Health Serices 19

02/17/2023 Maternal Health Serices 20

previa, congenital malformation…

lie, cord prolapse

02/17/2023 Maternal Health Serices 21

2. Biological, medical & social conditions

• Medical: diabetes, obstetric complications

• Social: work load, economic status

02/17/2023 Maternal Health Serices 22

More than 10 years of experience has shown:

02/17/2023 Maternal Health Serices 23

Because of the above, limitations many literatures strongly

02/17/2023 Maternal Health Serices 24

02/17/2023 Maternal Health Serices 25

 As per the 2016 WHO recommendation, Ethiopia is

02/17/2023 Maternal Health Serices 26

02/17/2023 Maternal Health Serices 27

3rd 26 After 6weeks