Ending Preventable Maternal Mortality (EPMM)

Dr. Richard AyahSchool of Public Health, University of Nairobi

Safari Park Hotel13th November 2014

ADVOCACY MEETING FOR SENATORS AND MEMBERS OF NATIONAL ASSEMBLY ON

ACCELERATING THE ATTAINMENT OF MDG 5 & ADVANCE BEYOND ZERO CAMPAIGN IN KENYA

China Population 1.37 Billion

Births 18.5 million Maternal Deaths

<7,000

Kenya

Population 45 million

Births 1.5 million

Maternal Deaths ~7,000

Background

Number of women who die in China during child birth is roughly the same as Kenya despite Kenya having a population 30 times less.

Maternal Mortality Ratio Kenya vs. Global 1990 – 2008/9

1990 1993 2003 2008/90

100

200

300

400

500

0

100

200

300

400

500

600

700

800

Maternal Mortality Ratio Kenya vs. Global

Kenya Global

MM

R pe

r 100

,000

live

brt

hs

Taita Taveta

Garissa

Migori

Lamu

Siaya

Isiolo

Marsabit

Turkana

Wajir

Mandera

0 500 1000 1500 2000 2500 3000 3500 4000

10 Counties with the highest Maternal Mortality Rate

Kakamega

Homa Bay

Kisumu

Siaya

Nakuru

Migori

Nairobi City

Wajir

Turkana

Mandera

- 200 400 600 800 1,000 1,200 1,400 1,600

10 Counties with the highest number of maternal deaths

Why Mothers die giving birth

Quantity and quality of actual

resources for maternal health

Potential resources for

maternal health: Environment, technology,

Political, economic, cultural, religious and social systems, including women’s status limit the utilization of potential resources

Inadequate and/or inappropriate knowledge, discriminating attitudes limit household access to actual resources

Lack of education, health information and life skills

Insufficient access to maternity services including EMOC

Inadequate maternal health practices and care seeking

Insufficient access to nutritious food and essential micronutrients

Poor water & sanitation and inadequate basic health care services

Obstetric risks including complications of abortions

Diseases and infections

Inadequate dietary intake

Congenital factors Direct Causes

Underlying causes at the household/ sub-county

level

Basic cause at societal

level

Global• The EPMM Working Group proposes a

global MMR target of 50/100,000 live births by 2035 • Annual Rate of Reduction 5.75% between

2010 and 2035; > MDGs (5.5%). • By 2035, no country should have a MMR

>100.

Ending Preventable Maternal Mortality (EPMM) Target

KENYA’S EPMM TARGET132 PER 100,000

BY 2030

How can we achieve the EPMM target ?

By managing six factors. 1. Our Population2. The Economy3. An Equitable approach4. Access to Reproductive Health Services5. Socio-Cultural issues6. Political leadership

Population Age/Sex structure. Median age 18.7 years

19% of the economy23% of the economy

58 % of the economy

Equitable Approach

• Focus on the 10-15 counties that contribute the highest maternal mortality burden

Turkana

Lamu

MigoriSiaya

Isiolo

Marsabit

Nairobi

Samburu

Wajir

Taita-Taveta

Garissa

Homa Bay

KisumuWest Pokot

Kakamega

Mandera

Nairobi Central Coast Eastern Nyanza Rift Valley Western North-Eastern0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Level of Access and Quality of CareProportion of Health Facilities

% Skilled DeliveryNewborn Care

Addressing Maternal deaths beyond the

health system

Conclusion

• Provide and budget resources• Hold health system accountable • Save 5,268 mother’s lives a year.• EPMM 132 per 100,000 per 2030

THANK YOU FOR LISTENING

Dr. Richard Ayah Lecturer, School of Public Health, University of Nairobi andAdjunct Associate Professor, School of Public Health, Tropical Medicine & Rehabilitation Science, James Cook University, Australia