45th Annual Scientific Sessions of the Sri Lanka College of Obstetricians and Gynaecologists 17th - 23rd October 2012 "Investing in women's health": Abstracts
Sri Lanka Journal of Obstetrics and Gynaecology
Twelve years ago, the world united around Millennium Development Goal 5 (MDG 5) and committed to improving maternal health and reducing maternal mortality by 2015 to a level just 25% of the 1990 level. The basis for this initiative, recognized by country leaders, is that the health of nations rests upon the health of mothers. Moreover, saving a mother's life is not only intrinsically valuable; the impact extends to her family, her community and her country as a whole. Since the launch of MDG 5,
... he launch of MDG 5, dramatic progress has been made in saving women's lives. By 2010, maternal mortality had declined by 47% from the 1990 baseline. This success reflects the extraordinary dedication shown by numerous stakeholders within countries, from grassroots, NGOs to professional associations and from international donors to political leaders. However, even with this remarkable improvement, more than 780 women around the world still die every day from pregnancy -or childbirth -related complications, even though more than 80% of these deaths are preventable. While admiring the great progress made so far, we have to recognize that the current pace of improvement is insufficient. If it continues unchanged, nearly 90% of countries will fail to meet MDG 5 on time and more than half will probably still fall short in 2040. Maternal mortality remains one of the most unbalanced health indicators in the world, with 99% of deaths occurring in low-and middle-income countries. But the good news is that the handful of countries that have really transformed their record are drawn from every region of the world and every stage of economic development. In fact, almost half of the countries on track to meet MDG 5 have a per-capita GDP below $1,000.* Of course, their impressive improvement is often due in part to their starting point of very high maternal mortality, but their achievement still shows that a low level of economic development does not represent an insurmountable barrier to saving women's lives. Sri Lanka has achieved a notable success in reducing maternal mortality within a low resource setting . Far reaching policies which improved education and other determinants of maternal health along with the availability of free health service, provided through robust preventive and a curative health system was the key to this success . 4 Therefore it is important to recognize that the future interventions to reduce mortality should shift from antenatal surveillance to provision of improved facilities for critical care both for the mother and the neonate ,as it is the quality of neonatal support that is available to the obstetrician that influences the decision to deliver the premature baby and thereby stop the progress the condition. Since inception, SLCOG has focused its attention on the reduction of Maternal Mortality in Sri Lanka. With the united forces of all stakeholders, we, the SLCOG members can be justly proud of achieving significantly low Maternal Mortality rates very early. However, the usual complacence of the bureaucracy set in with the now blatantly obvious stagnancy of the MMR for decades. 7 How maternal health contributes to maternal mortality Professor Jim Dornan United Kingdom Psychiatric causes are the fourth commonest cause of MM in the UK, and have been consistently so for the past decade. In over half of cases, sub standard care can be attributed. Suicide makes up almost 50% of cases, and most are from 42 days post partum until 182 days. Accidental overdose and medical conditions make up the rest. Of those who commit suicide, about one third are associated with psychosis and one third with drug dependency. The commonest methods used are hanging, jumping and self immolation. Two thirds have a past psychiatric history. Most are married, educated and employed. Of substance abuse deaths, one third are suicide and the rest are due to misuse and when associated with other diagnoses such as anorexia being mistaken for TB or anxiety being mistaken for eclampsia. Per-conception counselling and PROMPT referral to specialised care are strongly recommended.