News

Submitted by Dr. Saradha Narayanan (Consultant Physician and President 2010- 2012, SI Damansara)

The Intercountry Workshop on Maternal Death Review was held in Kuala Lumpur in November 2011. Participants at the workshop included WHO Representatives from Malaysia, Philippines, Cambodia, Lao PDR, Vietnam and Papua New Guinea. In addition, Government Health officials, O & G Consultants and representatives from the National Population and Family Development Board, UNFPA, Sexual & Reproductive Health and Rights Subcommittee and USAID also attended this highly exciting and interactive workshop. I attended on behalf of Puan Sri Siew Yong Gnanalingam, President-Elect of Soroptimist International South West Pacific- a concerned NGO hoping to reduce maternal mortality in Papua New Guinea.

Papua New Guinea was represented by the following officers:

Dr. Laura Guarenti, Technical Officer, Maternal Health.

Dr. Lahui Geita, Technical Advisor, Maternal Health

Dr. Ligo S. Augerea Chief Obstetrician/ Gynaecologist at Port Moresby General Hospital

The first day’s programme included an Overview of the Implementation of Maternal Death Reviews (MDR) by Dr. Ardi Kaptiningsih who is the Regional Adviser on Women and Reproductive Health at the WHO Regional Office in Manila. This was followed by country presentations from representatives of Cambodia, Lao PDR and Papua New Guinea – the three countries with the highest Maternal Mortality Rates in the Western Pacific Region (WPR)! These 3 countries together account for 20% of the Maternal Deaths in the region.

WHO’s figures show that there were more than 13,000 maternal deaths in WPR in 2008. The most common causes of Maternal Mortality are as given below:

1) Haemorrhage 24.8%

2) Infection 14.9%

3) Eclampsia 12.9%

4) Unsafe Abortion 12.9%

5) Obstructed labour 6.9%

6) Other Direct causes 7.9%

7) Indirect Causes 19.8%

Clearly, actions to reduce maternal mortality need a clear understanding of the factors leading to death. This is the basic underlying principle of the MDR. The right kind of information will in turn facilitate and form the basis for any remedial action that needs to be taken. Each maternal death has a story to tell and can provide solutions on practical ways to address the problem.

Malaysia was singled out as a country that has made great strides in implementing Maternal Death Reviews at the district, state and national levels. Participants at the workshop were taken to visit a District Health Facility and a health clinic in another state to see how this facility-based MDR is conducted. Consultant Obstetricians from Malaysia also presented case histories of maternal deaths and invited the audience to participate in the discussion. This was done to illustrate how such an inquiry can be conducted and to allow participating countries to adapt from the Malaysian model in implementing their own policies.

In Malaysia, all maternal deaths must be notified to the district and or state Family Health Officer within 24 hours of occurrence. This has greatly improved the accuracy of the data collected and allowed policy makers to separate and identify both avoidable and unavoidable causes of mortality. The reporting form has been fine tuned to make it less cumbersome and user-friendly.

Malaysia is on target to achieve MDG5 and hopes to reduce its MMR from 29 per 100,000 live births in 2009 to 11 per 100,000 live births in 2018. Nearly 100% of births in 2010 were attended by skilled health personnel. In contrast, only 39% of births in PNG were similarly attended by skilled health personnel.

All parties present were very focused and convinced in their belief that Maternal Death Reviews are vital and essential in addressing the issues surrounding maternal deaths and how they can be reduced. This is so even in resource-poor countries like PNG that lack skilled manpower such as trained birth attendants and obstetricians as well as basic infrastructure such as a good transport system, electricity or clean water.

I took the opportunity to distribute several pamphlets and bookmarks to participants from the various countries and to raise awareness of SISWP and the SI December 10th project “Birthing in the Pacific” during coffee breaks. The postcards with the baby in the bilum were a great hit! For more information, visit the dedicated Birthing in the Pacific project page.