Safe Motherhood Initiative:

Definitions and Pillars

Dr. Olive Sentumbwe-Mugisa

Family Health and Population Officer,
World Health Organisation

Components of Reproductive
Health

Safe motherhood
Family Planning
Unsafe abortion
STIs including HIV/AIDS
Adolescent Health
Infertility
Menopause and Andropause
Cancers of the RH Organs( Cervix and breast)
Gender Issues (Gender Based Violence, Obstetric
Fistula, Female Genital Mutilation, Male Involvement)

Definition of Safe Motherhood

Safe Motherhood means that no woman, fetus
or baby should die or be harmed by pregnancy
or birth. Safe Motherhood begins with the
assurance of basic safe living as a girl and a
woman in society.
Safe Motherhood is founded on freedom to
choose when and whether to have children, and
encourages active participation during health
care. Safe Motherhood is founded on freedom
from discrimination of any form.
Safe Motherhood values the girl child, respects
the freedom to choose when and whether to
have
children,
and
encourages
active
participation during health care.

Definition of Safe Motherhood

Safe Motherhood implies the availability,
acceptability, and easy access to health care for
a womans prenatal, birth, postpartum, family
planning and gynaecological needs
Safe Motherhood requires involvement and
commitment from each community and the
nation to fairly allocate resources that promote
the health of all women and infants.
Safe Motherhood means: social equity for
women, maternal health care in Primary Health
Care, Essential Obstetrics for all and Family
Planning for all couples.

Why is maternal mortality an

important issue? 1
Pregnancy is not a disease, it is one of
the most important moments in the life
of a woman,perhaps one of the noblest
achievements
The birth of a baby is a moment of
great joy for the mother, the father, the
rest of the family, the village, the
whole community
Reproduction is key to society
5

Introduction
Making motherhood safe for the worlds women calls
for national governments, multi-lateral and bi-lateral
agencies , non-governmental organisations
(NGOs)and civil society to make maternal health a top
priority
There is a need to ensure that the necessary political
and financial resources are dedicated to this effort.
Safe motherhood is a vital, compelling and costeffective economic and social investment. Promoting
womens health improves not only individual health,
but also the health and survival of womens families,
labour force and the well-being of communities and
countries.

The Health of the mother and

newborn are entwined

Source: WHO estimates 2000

The burden
For women of reproductive age,
pregnancy and childbirth are the
leading causes of death, disease and
disability, accounting for at least 18%
of the global burden of disease in this
age group.
Yet pregnancy is perceived to be a
normal event

African countries with greatest numbers of neonatal deaths

country

Range in neonatal deaths

Number of
deaths

Range in
maternal deaths

Nigeria

255,500

RD Congo

130,900

Ethiopia

119,500

44,900

Uganda

44,500

Kenya

43,600

Cte d'Ivoire

42,800

16

Angola

40,100

Mali

36,900

Niger

10

31,700

Ghana

11

29,200

24

Mozambique

12

28,500

10

South Africa

13

23,000

27

Madagascar

14

22,500

21

Burkina Faso

15

18,600

11

Tanzania

50%

90%

When are the world 4 million newborn deaths occurring?

About 30%
of neonatal
deaths are on
the day of birth

:
y
e
k

is
k
e e d ie

More than 70% of

neonatal deaths are
in the first week
~ 3 million deaths

w ie s
t
s
fir
bab e

g r
t
d
a
s
r
n
o
e
a n m ov
o
f
h
t
t
c
s es
n
he
Bir
we
w whe is lo babi
re and
a
c
of thers
mo

Daily numbers of death in 37 countries during the first month of life - based on 38 DHS datasets (2000 to 2004) with
5,763 neonatal deaths

4 million newborn deaths Why?

Almost all are due to preventable conditions

Definition of maternal death

The death of a woman while pregnant or
within 42 days of termination of
pregnancy, irrespective of the duration
and site of pregnancy, from any cause
related to or aggravated by the
pregnancy or its management but not
from accidental or incidental causes.
WHO-International Statistical classification of
Diseases and related Health Problems,tenth
Revision,1992 (ICD-10)
12

Where maternal deaths occur

13

It can be done, and it has been

done
It is not a matter of money only

MMR, deaths/100,000 live births

1960
1970
%
decline
Malaysia
250
150
66%
Sri Lanka
260
150
73%
Thailand
420
260
62%
Kerala state (India), figures of 2006, MMR of 95
when for
the whole of India is 254
Currently,
Malaysia-28, Sri Lanka-47,
Thailand-44

14

Causes of maternal deaths:

percent distribution

Four Pillars of Safe Motherhood

BASIC MATERNITY CARE

PRIMARY HEALTH CARE
EQUITY FOR WOMEN

EMERGENCY
OBSTETRIC CARE

CLEAN/SAFE
DELIVERY,
NEWBORN CARE
AND POSTNATAL
CARE

ANTENTAL CARE

FAMILY
PLANNING

SAFE
MOTHERHOOD

Family Planning
Family Planning is the practice of spacing
children that are born using both natural
(traditional) and modern (artificial) birth
control methods. Birth spacing promotes
the health of the mother, children and the
father. There are two types of birth control
methods: natural and modern (artificial).
The modern methods are further subdivided into short-term, long-term and
emergency contraception methods.

Antenatal Care
Ante-natal care is defined as a
planned programme of medical
management of pregnant women
directed towards making pregnancy
and labour a safe and satisfying
experience with an outcome of a
healthy baby and mother.

Safe Delivery
Refers to ensuring that the mother
experiences a clean and safe delivery
This area refers to both normal
vaginal birth and other modes such
as C/S and vacuum extraction
A Skilled attendant is recommended
Provision of emergency Obstetric and
newborn care when needed.

Postnatal Care
Postnatal care: This is health care
given to a mother and baby after
childbirth up to 6-8 weeks.

Emergency Obstetric Care

This is urgent medical care given to a
woman for complications related to
pregnancy, labour, delivery and
puerperium.
Basic EmOC includes parental (administered by
IV) antibiotics; parental oxytocic drugs; parental
sedatives for eclampsia; manual removal of
placenta; manual removal of retained products;
assisted vaginal delivery.
Comprehensive EmOC: includes surgery
(caesarean section); anaesthesia; and blood
transfusion in addition to all of the basic EmOC

Newborn Care

Ensure normal breathing

Thermal care-keeping baby warm
Cord care
Immunisation as per schedule
Appropriate infant feeding/breast
feeding

Evidence from the Lancet

Cause-specific effect of intervention packages delivered at different periods

Nature of intevention (main elements of intervention packages)

Reduction: all-cause
neonatal mortality

Antenatal/ intrapartum/
postnatal

Family care: clean home delivery, hygienic cord care, thermal care,
breastfeeding promotion

10-50%

Preconception

Folic acid supplementation

Antenatal

Antenatal care: physical exam, tetanus toxoid, detection and treatment

of syphilis and pre- eclampsia
Malaria ( intermittent presumptive treatment)
Detection and treatment of asymptomatic bacteriuria Incidence of
prematurity or low birthweight

Incidence of neural tube

defects: 40-85%

Skilled maternal and immediate neonatal care

Intrapartum

Postnatal

Emergency obstetric care: management of complications- obstructed

labour, haemorrhage, hypertension, infection
Extra care for low birthweight infants: extra warmth, hygiene, feeding
Case management for pneumonia
Emergency neonatal care: management of serious ilness

10-20%
10-30%
20-55%

Skilled birth care:20-30%;

Resuscitation: 5-20%;
10-15%

20-40%
10-35%
15-50%

Family and Community Practices

for promotion of New Born and Maternal
heath

Early initiation of and exclusive breastfeeding

Keeping the neonate warm
Hygienic cord and skin care
Routine postnatal care through home visits at critical moments
Home care for LBW infant -Skin to skin
Early recognition of danger signs by caregivers and prompt
care seeking
Antenatal visits, TT vaccination, IPT
ITN use by pregnant women, mothers and infants
Family Planning
Delivery by a skilled worker
Maternal Nutrition
Male involvement

The components
Family Planning
expansion of service delivery points;
improvement of communication through community based
and social marketing approaches;
training of service providers to enhance technical skills and
improve attitudes;
guaranteeing the availability of family planning commodities
and supplies at all levels;
improvement of family planning logistics management
(LMIS/HMIS);
enhancement of political and community support and
participation in family planning activities;
improvement of record keeping;
strengthening of the follow-up, supervision and referral
systems.

Antenatal Care

Information, education and communication on risk factors

and warning signs and symptoms during pregnancy.
prevention and management of anemia;
provision of iron and folic acid supplement;
screening for pre-eclampsia and diabetes;
Examination of the mother to evaluate the pregnancy;
early detection and referral or management of mothers with
high risk pregnancies;
immunization against tetanus;
syphilis screening and treatment;
HIV information, testing, treatment and referral;
prevention and management of malaria;
ARVs for prevention of mother-to-child transmission of HIV
Infant feeding counselling

Delivery Care
Information on signs of labor, what to
expect and what to do
Monitoring labour and documenting
Referral if it becomes necessary
Clean supplies / Warm clothing
Drugs required for pain relief and delivery
Communication with the family members
especially the spouse
HIV testing and counseling
Infant feeding options

Post Natal care and newborn

care
Information on danger signs , what to
expect and what to do
Immunization for both mother and baby
Infant feeding options
Maternal wellbeing
Responsible fatherhood
Family planning options
Resumption of sex
Post Natal Clinic

Current status
Only 48% of Women attend the
recommended 4 times during ANC
Only 52% of women deliver in health
units
Only 14% of HFs offer EmOC
Only 23% of women get post partum
care during the first 2 days following
child birth

Challenges
Insufficient awareness on danger
signs, safe motherhood in general
Low status of women- decision
making
Inadequate male support
Poor Education level
Poor health seeking behavior
High/ uncontrolled fertility

Why we must take action

and The costs involved

While the needless suffering and death of a woman when

giving life to the next generation is sufficient cause for action
in itself, there are also other significant social and economic
considerations.
Families lose her contribution to household management
and provision of care for children and other family
members;

Children suffer most: when a mother dies, surviving

children are 3 to 10 times more likely to die within two
years than children who live with both parents;
motherless children are likely to get less health care and
education as they grow up.

Communities lose a vital member whose unpaid labour is

often central to community life;
The economy loses her productive contribution to the work
force

What Can Be Done

Even in low resource settings, improving
maternal health is possible. What is needed
is a strong political commitment.
Governments, international agencies, NGOs
and other development partners need to
make concerted efforts to safeguard
maternal health by;
Reallocating investment in health care to support
the most cost-effective interventions
Investing in maternal health care services and
making them available, especially in poor and
rural areas

Framework for Promotion and Implementation

of Community-based interventions

Information and Education Materials:

danger signs, birth preparedness and
emergency plan
Mobilisation of key stakeholders and
community leaders
Support to existing community
organizations and structures:
associations, NGOs, etc.

Proposed ways to accelerate the

change of the situation

Government Stewardship
Parliaments and similar institutions should step
into the process
The importance of functioning health systems
Integrated approach
Introduction of mandatory regular analysis of
maternal deaths
Active involvement of civil society
Local research to inform the people and local
institutions/entities
Additional resources and International Solidarity

34

Framework for Promotion and

Implementation of Community-based
interventions
Community component in referral system
Organisation of transport (common transport
mechanisms)
Communication systems (telephone, radio
communication)

Community-based financing schemes

Community-based surveillance system for
the health of the mother and newborn (birth
and death registrations, audits)

Strengthening the referral system

Emergency
transportation
Communication

The Safe motherhood day and

commemoration week
Annual events have been held in
Soroti, Kamwenge ,Kayunga Mayuge
etc.27th October
Patron is the first lady
A national report is usually produced
We are in preparation for this year
Districts are encouraged to conduct
district specific activities

For Change to Happen

We need to follow it up

Accountability at all levels

38

Thank you!

WHO, Rivers of life