3 Dr. Malhotra MH

Maternal Health-ARSH : 

Maternal Health-ARSH Dr Manisha Malhotra Maternal Health Division Ministry of Health & Family Welfare July 24, 2009

Who is an adolescent? : 

Who is an adolescent? WHO definition: 10-19 years old Adolescence - a life stage as well as a chronological age Conceptual Framework

Adolescence ……Pregnancy : 

Adolescence ……Pregnancy

Where does pregnancy fit in? : 

Adolescent health and development Sexual and reproductive health Pregnancy Where does pregnancy fit in?

Circumstances for adolescent pregnancy : 

Circumstances for adolescent pregnancy Framework Sex within marriage Sex outside a Recognized union Consensual sex: --Within or outside marriage Non-consensual sex Planned pregnancy Unplanned pregnancy Adolescent pregnancy

Current adolescent birth rates : 

Current adolescent birth rates World adolescent fertility rate = 55.3 per thousand i.e., 5.5% of adolescents 15-19 years old gave birth each year By comparison, about 16% of women ages 20-24 give birth each year

Proportion of women who give birth in adolescence : 

Proportion of women who give birth in adolescence In developing countries, about one-fourth of women have given birth by age 18 Roughly half of women have already given birth by age 20

Current and projected adolescent births : 

Current and projected adolescent births Trends in Births to 15-19 Year-olds, Developed and Developing Countries, 1995-2050 0 2000 4000 6000 8000 10000 12000 14000 16000 18000 1995- 2000 2000- 2005 2005- 2010 2010- 2015 2015- 2020 2020- 2025 2025- 2030 2030- 2035 2035- 2040 2040- 2045 2045- 2050 Thousands of births yearly Developed Developing

How many pregnancies? : 

How many pregnancies? Millions of Pregnancies Yearly for 15-19 Year-olds Worldwide, by Outcome, for the 2000-2005 period Live births, 15.8 Induced Abortion, 5.5 Miscarriage or stillbirth, 3.8 Total = 25.1 million

Where are adolescents giving birth? : 

Where are adolescents giving birth?

Abortion in adolescents : 

Abortion in adolescents Adolescent Birth Rates Rates of Induced Abortion Induced abortion: 5.5 million yearly Safe abortion: 3.0 million Unsafe abortion: 2.5 million 14% of unsafe abortions in developing countries …in women <20 years

Percent of births that are unwanted, adolescents vs. older women : 

Percent of births that are unwanted, adolescents vs. older women Source: Bangladesh DHS 2004; India NFHS-3 2005-06; Indonesia DHS 2002-03; Nepal DHS 2006; Sri Lanka DHS 2000; Timor-Leste DHS 2003a

Percentage of women with delivery complications in last live/still birth … India : 

Percentage of women with delivery complications in last live/still birth … India Source: DLHS 2002, India

Use of antenatal care, adolescents vs. older women : 

Use of antenatal care, adolescents vs. older women Source: Bangladesh DHS 2004; India NFHS-3 2005-06; Indonesia DHS 2002-03; Nepal DHS 2006; Sri Lanka DHS 2000; Timor-Leste DHS 2003

Use of skilled delivery care, adolescents vs. older women : 

Use of skilled delivery care, adolescents vs. older women Source: Bangladesh DHS 2004; India NFHS-3 2005-06; Indonesia DHS 2002-03; Nepal DHS 2006; Sri Lanka DHS 2000; Timor-Leste DHS 2003

Births in health facility, adolescents vs. older women : 

Births in health facility, adolescents vs. older women Source: Bangladesh DHS 2004; India NFHS-3 2005-06; Indonesia DHS 2002-03; Nepal DHS 2006; Sri Lanka DHS 2000; Timor-Leste DHS 2003

Proximate factors influencing the context for adolescent pregnancy : 

Proximate factors influencing the context for adolescent pregnancy Age at puberty is dropping Age at marriage is rising (more in urban than rural areas in India) Age at sexual debut remains steady Rates of premarital sex are up Contraceptive use rising, but still low Unmet need for contraception is high

Underlying factors influencing the context for adolescent pregnancy : 

Underlying factors influencing the context for adolescent pregnancy level of education urban/rural residence ethnicity cultural and moral values and norms socioeconomic status Legal environment Framework

Slide 19: 

Maternal Health …… Situation & Strategies in India

Maternal Mortality in India-Magnitude and Causes : 

Maternal Mortality in India-Magnitude and Causes About 28 million pregnancies per year in India. 26 million deliveries 15% of these are likely to develop complications. Complications cannot be predicted. 67,000 maternal deaths per year Causes :Source:RGI-SRS 2001-03 Other Conditions includes Anemia.

MMR…we need to accelerate pace of decline : 

MMR…we need to accelerate pace of decline

Age distribution of Maternal Deaths : 

Age distribution of Maternal Deaths

Maternal Health Indicators: ANC : 

Maternal Health Indicators: ANC

Maternal Health Indicators: Delivery Care : 

Maternal Health Indicators: Delivery Care

Maternal Health Indicators : Postnatal Care : 

Maternal Health Indicators : Postnatal Care DLHS 3 2007-08

Anaemia in Women …Universal in all age groups : 

Anaemia in Women …Universal in all age groups NFHS 3(2005-06)

MATERNAL HEALTH STRATEGIES: Multi-Pronged Approach… : 

27 MATERNAL HEALTH STRATEGIES: Multi-Pronged Approach… Demand Promotion: Janani Suraksha Yojana. Services: Public sector Essential and Emergency Obstetric Care Quality ANC, PNC, Safe Delivery ,Institutional Delivery Skilled Attendance at birth (domiciliary & health facilities). Operationalise facilities- FRUs, CHCs, 24 x7 PHCs. Multi-skilling of doctors to overcome shortage of critical specialities (training on Life saving Anaesthesia Skills and Emergency Obstetric Care). Strengthen Referral Systems including transport. Outreach activities- Village Health and Nutrition Days. Management of RTIs & STIs at PHCs & CHCs/FRUs. Safe Abortion Services – PHC/ FRU level

MATERNAL HEALTH STRATEGIESMulti-Pronged Approach… : 

28 MATERNAL HEALTH STRATEGIESMulti-Pronged Approach… Services: Private sector Accrediting private health institutions for RCH services including JSY. Fixed package for contracting out services -Demand side financing Schemes (e.g. Chiranjivi scheme in Gujarat)

Slide 29: 

Challenges Antenatal,perinatal, postnatal care..prevent death and disability and improve neonatal outcomes Reduced nutritional stores at onset of pregnancy…threat to foetal and maternal health Special attention for adolescents <14 yrs…P-P period, delay 2nd pregnancy,Breastfeeding,nutrition, immunisation Prevention & Control of RTIs/STIs… lack of knowledge,hesitancy reduces chances of successful t/t Barriers to accessible ,quality, youth friendly care…avoid seeking care(stigma,fear of being chastised),apathy of service provider,lack of confidentiality Solutions Provide comprehensive care with specific medical, nutritional and social aspects in view…AN Care in 1st /early 2nd trimester,tracking of pregnancies Iron and nutritional supplementation Diagnose and treat complications- Hge or infection, provide contraception,counselling on exclusive breastfeeding and nutrition Provide evidence based package of services… information &counselling,address risk reduction(e.g.condom provision),diagnose and treat STIs and HIV/ AIDS Interventions to increase use of SRH Services… training for service providers,upgrade facilities,promote services with adolescents and gatekeepers in communities-BCC

Next Steps… : 

Next Steps… Focus on prevention of early pregnancy,STIs , spread of HIV Skillbuilding of health providers,teachers,programme officers, policymakers Access to quality clinical services coupled with sex education Multisectoral approaches-Health, WCD,education,youth affairs, tribal affairs,rural devpt. Community Approaches… Strategies tailored to developmental needs, contexts and cultures Framework of RCH Services in public and private sector

Slide 31: 

THANK YOU