This program is brought to you by Emory University. >> Welcome to Week 4 of Childbirth: A Global Perspective. My name is Sydney Spangler. I am a Certified Nurse Midwife and Assistant Professor at Emory University here in the Nell Hodgson Woodruff School of Nursing. I also have a secondary joint appointment in the Hubert Department of Global Health Rollins School of Public Health. This week of the course, we will be covering emergency obstetric care, which I will define more specifically momentarily. But for now will broadly refer to as an intervention that takes place in health facilities, and supports maternal health and survival throughout the world. A quick note of syntax, during the lecture, I will often refer to as emergency obstetric care by its acronym EmOC. The specific objectives for this lecture are as follows. First, to define EmOC, and describe why this intervention is essential for improving maternal health and survival worldwide. Next, to identify the EmOC signal functions, which are specific clinical services that have been proven to reduce maternal mortality, and save women's lives. Third, to review the United Nations' EmOC process indicators. These are indicators that serve to monitor progress in the provision of the EmOC, both at the country level as well as within regions, provinces, states, and districts in countries. Fourth, to discuss monitoring, assessment, and quality improvement for EmOC, including specific tools that can be used to evaluate the EmOC implementation in local health facilities. Finally, to recognize some of the key challenges to the implementation of EmOC in developing countries contexts. So for example, what issues stand in the way of making the service available to all women? Can these issues be realistically resolved and how? Prior to the mid 1980s, maternal health was not a global health priority, and was rather overlooked as a significant problem in many Maternal Child Health or MCH programs at the time. This issue was brought to light in the global community when Deborah Maine and Alan Rosenfield published their 1985 article, Where is the M in MCH? As a result of the growing awareness about this problem, which was in part motivated about this article, a group of international agencies, national policy makers and expert in health and development, gathered in Nairobi Kenya, at the first international meeting focused on improving maternal health. This meeting marked the initiation of the Safe Motherhood Initiative, a global movement specifically committed to reducing the burden of maternal death and disability in developing countries. In the past 25 plus years since the Safe Motherhood Initiative launched, considerable efforts have been made to improve the health and survival of pregnant and childbearing women. This issue has remained a global health priority as indicated by the inclusion of maternal health as one of eight United Nations' Millennium Development Goals, which are also known as the MDGs, to be achieved by the year 2015. More specifically, MDG-5A aims to reduce the maternal mortality ratio by three quarters globally, and MDG-5B aims to achieve universal access to reproductive health. Some amount of progress has been made towards these goals. Global maternal mortality has declined an estimated 47% between 1990 and 2010, with declines in Southeast Asia and North Africa being closer to 2 3rds. In addition, more women seem to be receiving antenatal care in family planning than they were in previous decades. However, MDG-5 is still falling short. The maternal mortality ratio in developing regions remains 15 times higher than that of developed regions. Sub-Saharan Africa alone accounts for over half of all maternal deaths. One of the reasons for this state of affairs is a lack of functioning health systems that addresses the problem horizontally or systematically, as opposed to interventions that take more targeted or vertical approaches. Saving women's lives at birth requires multiple components, including professional health workers proficient in basic midwifery, and advanced obstetrical skills. Technical supports that allow for the provision of essential services at every level, and referral and transportation systems that help women who do have complications to reach higher level care. So, in conjunction with alleviating the shortage and maldistribution of maternal health workforce in developing countries, which was covered in week three of this course, health systems must be strengthened to enable the reliable provision of specific health services for pregnant women. Collectively known as emergency obstetric care, or EmOC, these services are implemented within existing health systems to treat the most common, life-threatening complications arising during pregnancy and childbirth. By improving the implementation of EmOC in Health Systems, and ensuring that this care is made available and accessible to all women who need it. It should be possible to greatly reduce the partic, the persistent problem of high maternal mortality and morbidity. And then to better understand this evidence that we have for EmOC in reducing maternal mortality, please refer to the Paxton articles fro 2005 and 2006 that are included in the reading list. So to review for week one, the most common cause of maternal mortality include obstetric hemorrhage, especially postpartum hemorrhage which is the excessive bleeding that occurs after birth. Preeclampsia and eclampsia are hypertensive disorders of pregnancy. Prolonged or obstructed labor which can result in hemorrhage. Severe infection or sepsis. Unsafe abortion, which can also result in hemorrhage or sepsis, and then HIV/AIDS related complications. Currently, EmOC, is primarily focused on addressing the first five of these conditions, most of which, very often present as emergencies that cannot be reliably predicted for prevented. The specific clinical services that comprise EmOC will be covered in the next section of this lecture.
