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Snapshots: UNICEF and Emergency Obstetric Care

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UNICEF is currently supporting seven countries in South Asia in the implementation of emergency obstetric care: Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan and Sri Lanka. Between 2002 and 2003, the strategy has been expanding to Benin, Tchad, Guinea Conakry and Mali in West and Central Africa and Uganda in East and Southern Africa.

In West and Central Africa, the Ministries of Health of Benin, Chad, Guinea Conakry, and Mali have given their commitments to pursue national needs assessments on Emergency Obstetric Care, which would result in detailed workplans and budgetary requirements.

In East and Southern Africa, the UNICEF Task Force on Maternal Mortality for the region has adopted emergency obstetric care  as the key strategy to reduce maternal deaths. In Uganda, the Ministry of Health has decided to focus on the prevention of maternal deaths and disabilities and, together with the UNICEF Country Office, has conducted a needs assessment on  emergency obstetric care.

In the early 1990s, the UNICEF Country Office in Egypt collaborated with the Ministry of Health and John Snow, Inc in providing  emergency obstetric care services. A study conducted in year 2000 showed that maternal mortality had declined dramatically over the last decade, from 174 per 100,000 live births in 1992 to 1993 to 84 in 2000, showing a decrease of more than 50 per cent.

In Bangladesh, as part of a national initiative assisted by UNICEF, 123 emergency obstetric care facilities were equipped with operating theatres. From 1999 to 2002, births at the facilities increased by more than 25 per cent, the number of women admitted with birth complications increased by almost 90 per cent and the number of Caesarean sections increased by more than 40 per cent.

In India, the programme made good progress in improving obstetric emergency care services between 2000 and 2002. Supported by UNICEF, the Government of India provided services in six districts in Rajasthan and Maharashtra, which led to improved outpatient department attendance, a greater number of referrals and more women with obstetric complications being treated. UNICEF further supported a series of training workshops for the management of emergency obstetric care and anesthesia. 

Since its needs assessment in 2000, the UNICEF Country Office in Bhutan, together with the Ministry of Health, has helped to more than double the number of basic  emergency obstetric care facilities there. Eight comprehensive and 14 basic centers have been established and are now open and working round-the-clock. .

UNICEF provided technical and financial support to the Ministry of Health in renovating the district hospital in Panchthar, Nepal. This hospital is the only facility available to a population of 205,000. With the arrival of trained staff, the health facility is now capable of providing emergency obstetric care services. The Ministry has recently made this hospital the model in providing both basic and comprehensive emergency obstetric care services for all heath facilities in Nepal.

In Sindh, Pakistan, comprehensive and basic emergency obstetric care coverage increased. In the implementation districts, the number of births at facilities increased between 2000 and 2002, and the proportion of women with complications who died (measured by case fatality ratio) has decreased. In Hyderabad District, the average case fatality rate has declined from 4.7 per cent to 2.6 per cent (the minimum accepted level is 1 per cent).

In Sanghar district, the percentage of births in facilities increased from 5.1 per cent (2000) to 8.7 per cent (2002), while in Karachi West, the same percentage has increased from 4.4 per cent to 8.1 per cent.