Maternal health in Asia and the Near East : an assessment report

The report describes intervention strategies and lessons learned, and suggests future directions for ANE"s maternal health programming. Significant progress has been made in the last decade in reducing maternal mortality and morbidity, but preventable deaths and complications remain unacceptably high. Lessons learned in the past decade include the following: all pregnancies carry risk; having trained attendants at delivery saves lives; complications are generally neither preventable nor predictable; all pregnant women must have access to life-saving care; prenatal care should be evidence-based; community involvement is essential; and measuring success is possible with process indicators. Approaches that have achieved results and are ready for scaling up include the following: (1) ensuring trained attendance at birth via physician and midwifery training, deployment to peripheral sites, and thorough coordination between the levels of care, as guided by protocols; (2) improving the essential obstetric care (EOC) capabilities of (a) providers, through competency-based training based on national standards and protocols, and (b) facilities, through low-cost upgrades and improved health management information systems; (3) raising awareness and educating communities about maternal health issues, including emergency responses such as transportation, assistance with service and drug fees, and blood donations; (4) training women, families, and traditional birth attendants (TBAs) in birth preparedness, self-care, and newborn care, including early and exclusive breastfeeding; (5) providing evidence-based prenatal services and postnatal follow-up; (6) distributing iron folate tablets, designed for consumer appeal, through reliable distribution and supply mechanisms, including the commercial sector; (7) diagnosing and treating syphilis during prenatal care: (8) bringing appropriate technologies to the periphery, such as manual vacuum aspiration for post-abortion care; (9) establishing "no-fault" maternal and perinatal audits at district levels; (10) establishing maternal health coalitions as advocacy groups at the national level; and (11) strengthening the ability of professional organizations to provide continuing medical education and monitor the performance of their members. Improving maternal health in the ANE region, as elsewhere, requires a multisectoral and multilevel approach -- from community to hospital -- that has as its most fundamental tenets zero tolerance for preventable maternal death and disability and dedication to improving the economic, educational, and social status of women. The report includes subregional and country fact sheets where USAID has a Mission or population/health/nutrition (PHN) program. Appendices contain tools and indicators for use in maternal health planning and evaluation, along with a bibliography. (Author abstract, modified)