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WomenWomen’’s Reproductive Morbidity and s Reproductive Morbidity and

MortalityMortalitySeminar on Population and Development, New York, 1 December 2009Seminar on Population and Development, New York, 1 December 2009

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What is sexual and reproductive health?What is sexual and reproductive health?

It is about helping people to lead healthy It is about helping people to lead healthy sexual and reproductive lives and to safely sexual and reproductive lives and to safely achieve their fertility goals. It is a health and achieve their fertility goals. It is a health and development issue which empowers development issue which empowers individuals and communities to fully engage individuals and communities to fully engage in society.in society.

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Areas of sexual and reproductive healthAreas of sexual and reproductive health**

Maternal and perinatal healthMaternal and perinatal health

Family planningFamily planning

Prevention of unsafe abortionPrevention of unsafe abortion

Prevention and treatment of sexually Prevention and treatment of sexually transmitted infections, and other reproductive transmitted infections, and other reproductive morbidities such as cervix cancermorbidities such as cervix cancer

Sexual healthSexual health

* Based on the ICPD definition and structured within the Global Reproductive Health Strategy

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MDG 5: improve maternal healthMDG 5: improve maternal health

Target 5.A: reduce the maternal mortality Target 5.A: reduce the maternal mortality

ratio by three quarters between 1990 and ratio by three quarters between 1990 and

20152015

Indicators Indicators

–– 5.1 Maternal mortality ratio5.1 Maternal mortality ratio

–– 5.2 Proportion of deliveries attended by skilled 5.2 Proportion of deliveries attended by skilled

health personnelhealth personnel

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MDG 5: improve maternal healthMDG 5: improve maternal health

Target 5.B: achieve, by 2015, universal Target 5.B: achieve, by 2015, universal

access to reproductive healthaccess to reproductive health

IndicatorsIndicators

–– 5.3 Contraceptive prevalence rate5.3 Contraceptive prevalence rate

–– 5.4 Adolescent birth rate5.4 Adolescent birth rate

–– 5.5 Antenatal care coverage5.5 Antenatal care coverage

–– 5.6 Unmet need for family planning5.6 Unmet need for family planning

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Maternal mortality in 2005Maternal mortality in 2005Estimates developed by WHO, UNICEF, UNFPA and The World Bank Estimates developed by WHO, UNICEF, UNFPA and The World Bank

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Comparison of 1990 and 2005: Progress in regional and global levComparison of 1990 and 2005: Progress in regional and global levels of els of

maternal mortality* maternal mortality*

1990 2005% Change

in MMR

1990-2005

MMR Maternal

deaths

MMR Maternal

deaths

WORLD TOTALWORLD TOTAL 430 576,000 400 536,000 -5.4

DEVELOPED REGIONSDEVELOPED REGIONS 11 1,300 9 960 -23.6

Countries of the CIS 58 2,800 51 1,800 -12.5

DEVELOPING REGIONSDEVELOPING REGIONS 480 572,000 450 533,000 -6.6

North Africa 250 8,900 160 5,700 -36.3

Sub-Saharan Africa 920 212,000 900 270,000 -1.8

Asia 410 329,000 330 241,000 -19.7

Latin America and the

Caribbean

180 21,000 130 15,000 -26.3

Oceania 550 1,000 430 890 -22.2

* Numbers are rounded* Numbers are rounded

(Source: WHO/UNICEF/UNFPA/The World Bank, 2007)

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Why do women die during pregnancy and childbirthWhy do women die during pregnancy and childbirth

–– a WHO systematic reviewa WHO systematic review

Africa Asia

Latin America and the Caribbean Developed countries

Unclassified deathsOther indirect causes of deathAnaemiaHIV/AIDSOther direct causes of deathEmbolismEctopic pregnancyObstructed labourAbortionSepsis/InfectionsHypertensive disordersHaemorrhage

(Khan et al., Lancet,2006)

(Khan et al., Lancet,2006)

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When do women die?When do women die?

Ronsmans & Campbell, Lancet Maternal Survival

Series 2006

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0

2000000

4000000

6000000

8000000

10000000

12000000

14000000

16000000

18000000

20000000

536000 maternal deaths

1.4 million near-miss

9.5 million other

complications

20 million long term

disabilities

Magnitude of maternal mortality, morbidity & disabilities

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The burden of sexual and reproductive illThe burden of sexual and reproductive ill--

healthhealth

Over half a million women die each year because of Over half a million women die each year because of complications of pregnancy and childbirthcomplications of pregnancy and childbirth

–– 99% these deaths occur in developing countries99% these deaths occur in developing countries

3 million stillbirths occur each year3 million stillbirths occur each year

200 million couples have unmet need for effective 200 million couples have unmet need for effective contraceptioncontraception

80 million unplanned pregnancies occur each year, 42 80 million unplanned pregnancies occur each year, 42 million end in abortionmillion end in abortion

457 million new cases of 457 million new cases of STIsSTIs and 5 million new HIV and 5 million new HIV infections each yearinfections each year

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Priority actions to reduce the burden due to sexual Priority actions to reduce the burden due to sexual

and reproductive illand reproductive ill--healthhealth

Increasing the number of births attended by skilled health Increasing the number of births attended by skilled health workers in all countries workers in all countries –– in particular those with high maternal in particular those with high maternal mortality ratesmortality rates

Ensuring that a continuum of antenatal, delivery and postpartum Ensuring that a continuum of antenatal, delivery and postpartum care with effective interventions is available and accessible tocare with effective interventions is available and accessible to all all pregnant womenpregnant women

Ensuring that all women have access to Ensuring that all women have access to

–– modern contraceptionmodern contraception

–– safe abortion services (to the fullest extent permitted by law),safe abortion services (to the fullest extent permitted by law),including postincluding post--abortion careabortion care

–– screening and treatment for screening and treatment for STIsSTIs, including HIV and HPV, including HIV and HPV

Removing financial barriers to receiving above services includinRemoving financial barriers to receiving above services including g provision of free delivery care and other schemes for improved provision of free delivery care and other schemes for improved access access

Empowering women to negotiate safe sex to prevent unplanned Empowering women to negotiate safe sex to prevent unplanned pregnancies and pregnancies and STIsSTIs, and to increase demand for accessing , and to increase demand for accessing reproductive health care reproductive health care

Today's Evidence, Today's Evidence,

Tomorrow's AgendaTomorrow's Agenda

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Understanding women's healthUnderstanding women's health

in the world todayin the world today

� Increasing life expectancy

� The health transition

� Diversity and inequities between countries

and within countries

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Life expectancy at birth is increasingLife expectancy at birth is increasing

--in most, but not all parts of the worldin most, but not all parts of the world

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The health transition: the rise in significanceThe health transition: the rise in significance

of noncommunicable diseasesof noncommunicable diseases

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The girl child (0The girl child (0--9 years)9 years)

� Still too many infants and children are dying

� The leading causes of death are pneumonia, diarrhoea

and neonatal conditions

� Malnutrition is associated with many deaths

� Girls start life with a biological advantage but this is

over-ridden in some countries

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Adolescent girls (10Adolescent girls (10--19 yrs):19 yrs):

a time of good health but also riska time of good health but also risk

� Too often, societies are failing to provide the support

that these girls need

� Unhealthy lifestyles can take hold

� In high and middle income countries, deaths from road

traffic accidents and suicides predominate but they are

common everywhere

� In developing countries, communicable diseases

remain common and complications of pregnancy and

childbirth are the leading cause of death among 15-19

yr-olds

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Adult women (20Adult women (20--59 yrs)59 yrs)

� The risk of premature death varies enormously, from only

6% in high-income countries, to 42% in the African region

� Infectious diseases, such as HIV/AIDS and tuberculosis

take a great toll, especially in Africa

� Half of all deaths among adult women globally are caused

by non-communicable diseases

� Mental health problems (depression, suicide) loom large

� Violence against women is a major risk factor for ill-health

20

Violence against womenViolence against women

is common is common worldwideworldwide

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Leading causes of death in older women (60+)Leading causes of death in older women (60+)

3.3499Diabetes mellitus5

5.3818Lower respiratory

infections

4

8.21254Chronic obstructive

pulmonary disease

3

17.52677Stroke2

19.22933Ischaemic heart

disease

1

%Deaths(000s)CauseRank

World

Women are living longer but not necessarily in good

health

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AgeingAgeing-- a story of neglecta story of neglect

� Many of the health problems faced by women in old age

are the result of risk factors experienced when they

were younger – smoking, sedentary lifestyles,

unhealthy diets

� Disabilities remain unprevented and unmanaged

� Because many older women have worked all of their

lives in the informal sector or in unpaid activities,

health care is inaccessible, unaffordable or both

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A shared agendaA shared agenda

for women's healthfor women's health

� Building strong leadership and a coherent

institutional response

� Making health systems work for women

� Leveraging changes in public policy to build

healthier societies

� Building the knowledge base and monitoring

progress