Symposium on Maternal Child Health in Nebraska 9/30/10

8/8/2019 Symposium on Maternal Child Health in Nebraska 9/30/10

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Symposium onMaternal Healthin Nebraska

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Symposium Schedule11:00 - 11:20 am RegistrationNoon - 12:45 pm Keynote

'Reaching Our Goals in Maternal and Reproductive Health:Where do we go from here?'

Jean Amoura is an associate professor of obstetrics and gynecology at the University of Nebraska MedicalCenter. She is a native of Omaha where she completed her bachelor's degree in Spanish at UNO and her

medical degree at UNMC. She then went to the University of Michigan for her training in obstetrics and gyne-cology. After returning to Omaha tojoin the faculty at UNMC, she decided to pursue study in publichealth. She completed a master's degree in Reproductive and Sexual Health Research at the London Schoolof Hygiene and Tropical Medicine in the UK in 2003, then returned again to practice and teach OB/GYN atUNMC. She has been the director of Family Planning at UNMC since 2007, was previously on the board ofdirectors for Planned Parenthood of Nebraska and Council Bluffs, and serves as the Medical Director of theNebraska Reproductive Health Program at DHHS. Dr. Amoura has also participated extensively in researchethics, serving as vice-chair of the Institutional Review Board at UNMC since 2006. She was recently ap-pointed to the Ethics Review Committee for Marie Stopes International, a non-profit organization based in theUnited Kingdom with family planning and reproductive health programs in 43 countries worldwide.

12:45 - 2:00 pm Panel Discussion & Introductionof Topics• Prenatal Care for Vulnerable Mothers and Babies

• Kathy Bigsby Moore, Executive Director of Voices for Children in Nebraska• Access to Family Planning Services

• Kyle Carlson, J.D., Planned Parenthood of the Heartland• Impact of State Budget and Medicaid Policy on Maternal and Child Health

• Sarah Ann Kotchian J.D., Director of Early Childhood Policy and Public Relations at Build-ing Bright Futures

• Implementation of the Health Care Law (the Affordable Care Act) in Nebraska• Jennifer A. Carter, J.D., Director, Public Policy and Health Care Access

• STls and the Effect on Maternal and Child Health• Valda Boyd Ford, MPH, MS, RN, CEO, Center for Human Diversity, Inc

• An International Perspective on Maternal and Child Health Care in the US• Robert Haller, Ph.D., President of the United Nations Association of Nebraska

2:00 - 2:10 pm Break

2: 10 -3:00 pm Imperative Breakout #1• Palace E STls and the Effect on Maternal and Child Health

• Valda Boyd Ford and Laurel Marsh

• Palace 0 Impact of State Budget and Medicaid Policy on Maternal and Child Health- ..._.._ • Sarah Ann Kotchian and Becky Gould

ay B-~ An International Perspective on Maternal and Child Health Care in the US~. Robert Haller



..c;

3:00 - 3:10pm

3:10 - 4:00 pm• Palace E

Symposium ScheduleBreak

Imperative Breakout #2Prenatal Care for Vulnerable Mothers and Babies• Kathy Bigsby Moore and Aubrey Mancuso

Access to Family Planning Services• Kyle Carlson and Susan Hale

Implementation of the Health Care Law (the Affordable Care Act) inNebraska• Jennifer Carter and Becky Gould

• Palace 0

~

4:00 - 4:30 pm Reconvene in Palace E for the FinalImperative Presentation by the Panelists

"I call on everyone to play their part. Success will comewhen we focus our attention and resources on people,not their illnesses; on health, not disease. With the

right policies, adequate and fairly distributed funding,and a relentless resolve to deliver to those who need itmost - we can and will make a life-changing difference

for current and future generations. "- Ban Ki-moon, United Nations Secretary General

GOALSImprove Maternal Health

TARGETS1. Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio2. Achieve, by 2015, universal access to reproductive health

Quick Facts:I <More than 350,000 women die annually from complications during pregnancy or childbirth, almost allof them - 99 per cent - in developing countries._• The maternal mortality rate is declining only slowly, even though the vast majority of deaths are avoid-able. . .

• In sub-Saharan Africa, a woman's maternal mortality risk is 1 in 30, compared to 1 in 5,600 in developedregions.• Every year, more than 1 million children are left motherless. Children who have lost their mothers areup to 10 times more likely todie prematurely than those who have not.



Proposed Imperatives• Prenatal Care for Vulnerable Mothers and Babies

1. Effectively allocate spending on health care by focusing on prevention rather than treatment.2. Increase access to prenatal care in the state by enacting a rule change to cover unborn babies.3. Expand prenatal coverage in Nebraska to cover unborn children in all low-income families up to 200% of

the poverty level ($44,100 for a family of four). .

• Access to Family Planning Services1. Increase access to family planning services under Medicaid in keeping with state, national and international

goals to improve maternal and chi ld health.2. Broaden the population eligible for family planning services under Medicaid to improve maternal and child

health and save Nebraska taxpayers dollars by avert ing unintended pregnancies.3. Increase access to Medicaid family planning services to reduce unintended pregnancies and the need for

abortion, improve maternal and child health and save taxpayer dollars.

• Impact of State Budget and Medicaid Policy on Maternal and Child Health1. Restore prenatal care for all pregnant low-income women.2. Restore presumptive eligibility for children and families.3. Educate leaders in regard to preventing proposed cuts to services for pregnant and breastfeeding women

and their children.4. Increase access to children's mental and behavioral health services.

• Implementation of the Health Care Law (the Affordable Care Act) in Nebraska1 .. Ensure that there is balanced and consistent stakeholder input from a wide variety of Nebraskans on imple-

mentation.2. Create a task force or working group on health care reform implementation in Nebraska that includes advo-

cates for women, children, low-income persons and families, persons with disabilities, seniors, the businesscommunity, state senators, state agency decision makers, the Department of Insurance, etc.

3. Ensure that the "Exchange" (the new marketplace for purchasing coverage and accessing tax credits) isconsumer-friendly and works seamlessly with Medicaid.

• STls and the Effect on Maternal and Child Health1. Increase access to STI prevention, education and treatment by providing comprehensive education and

treatment programs for all through Department of Education policies and State laws2. Increase access to vulnerable populations by providing free treatment and counseling for pregnant mothers

• An International Perspective on Maternal and Child Health Care in the US1. There is a need to publicize MDG 5 as a part of a world-wide effort to reduce poverty to make Nebraskans

aware that we are behind developed countries in preventing death in childbirth and that lack of access toreproductive health care and inequity in the conditions of delivery promote poverty in this country as in therest of the world.

2. The recognition of a right to the presence of a trained health care professional before, during and after de-livery should be mandated by legislation for every public and private insurance program and provider of ma-ternal care.

3. Sound reproductive health information provided by schools and medical facilities ,which leads to the spac-ing of children and fewer premature births and pregnancy complications, promotes both maternal and childhealth.



Diagnostic Statements• What can be done to help Nebraska reach the goal of universal access to prenatal care by 2015?

1. A mother's health, environment, and knowledge about pregnancy shape fetal development.2. Risks to moms and babies can be identified early.3. It can mean the difference between lifeand death for some moms and babies.4. The likelihood of undesirable birth outcomes like low birth weight and premature birth can be decreased.5. It is cost-effective to provide prenatal care when compared to the economic cost of unhealthy babies:

• The CDC has estimated a savings of $14,755 pre low birth weight prevented if all U.S. women received adequate prenatal care.• A study of Medicaid births in Missouri found that every $1 spent on prenatal care resulted in a savings of $1.49 in newborn and

post-partum costs up to 60 days after birth.• Costs for time spent in the neonatal intensive care unit (NICU) range from $1,000 to $2,500 per day. A severely ill newborn may

spend several weeks or months in NICU depending on the complexity of the health problem.

In spite of the benefits of prenatal care, not all Nebraska women are receiving it:

1. Even prior to changes in state Medicaid policy, in 2008 158 Nebraska women did not receive prenatal care. Although this number isrelatively small, the cost to the baby is significant.

2. An administrative policy change in Nebraska in 2010 will likely result in an increase in that number. It left an additional 1,619 preg-nant women without Medicaid coverage for prenatal care. Women without health insurance are less likely to seek and receive prena-tal care.

3. Lack of prenatal care is associated with an increased likelihood of maternal or infant death, preterm birth, and low birth weight in addi-tion to higher medical costs.

• Access to Family Planning Services: Expanding Eligibility for Services Under MedicaidInadequate funding for family planning is a major failure in fulfilling commitments to improve women's reproductive health as promoted by (1)United Nations Millennium Development goals; (2) Healthy People 2010, a program of the Office of Disease Prevention and Health Promotionin the U.S. Department of Health and Human Services; and (3) Nebraska's stated priority to decrease the rate of unintended pregnancies dur-ing 2010-2015 as put forth by the Nebraska Department of Health and Human Services (DHHS).

Need• In 2008, 102,500 Nebraska women needed publicly supported contraceptive services; 30,000 because they were sexually activeteenagers and 72,400 because they had incomes below 250 percent of the federal poverty level which presented a financial barrier toservices.

• In 2009, DHHS estimated that ifthe state expanded Medicaid coverage for family planning services to 185 percent of the federal pov-erty level, approximately 24,725 additional women would become eligible for services.

• In 2008, family planning services helped Nebraska women avoid 5,000 unintended pregnancies that would likely have resulted in2,200 unintended births and 2,100 abortions.

• Currently, Nebraska provides family planning services for low-income women who make up to $6,000 per year. By changing the eli-gibility standard to 185 percent of the federal poverty level, women making up to $20,000 per year would be eligible for services.

Benefits• Improves maternal health and child health and reduces the need for abortion

• Family planning is vital to assuring healthy women, babies and families. When women plan their pregnancies, they aremore likely to seek prenatal care, which improves their own health and the health of the baby.

• Planned pregnancies reduce the risk of neonatal problems including prematurity and low-birth weight.• Helping women avoid unintended pregnancies for which they are unprepared mentally, physically or financially and reducing

the need for abortion.

• Saves taxpayers money• The federal government pays 90 percent of the costs of family planning services under Medicaid; the state pays 10 percent.

For every $1 the state invests, $10 of services can be provided.• For every $1 invested in family planning services, Nebraska would save nearly $4 in costs by averting unintended pregnan-

cies for low-income women that otherwise would require government services (health care, child care, cash assistance, foodassistance). A study in neighboring Iowa revealed that over five years those savings grow to $15.12 for every $1 invested.



What The Patient Protection and Affordable Care ActMeans for Nebraska Women

Examining what health care law means for women is important because:

Women are less likely to be employed full-time and more likely to be dependent onsomeone else's plan.

~; Health insurance companies have traditionally charged women higher rates andtreated pregnancy, C-sections, and domestic violence as pre-existing conditions.

Women are more likely to be underinsured. (In 2007,45% of women wereunderinsured compared to 39% of men.)

~ Women spend a greater share of their income on health care since they receive lessincome than men on average and because they use the health care system more.

TheAffordable CareAct (ACA)Levels the Playing Fieldfor Women

In 2014, insurers will no longer be able to consider gender when setting premiums.

l§i: In 2014, insurers will also be prohibited from excluding women or denyingcoverage for "pre-existing conditions" such as pregnancy, having had a C-section,breast or cervical cancer, or being a survivor of domestic or sexual violence.

TheACAEnsures that Insurance Covers Many of the Benefits Nebraska Women Need

New health plans will be required to cover a broad range of health services that areparticularly important for women. These new coverage requirements include

maternity care, prescription drugs (which should include contraceptive drugs anddevices) and mental health care.

E 2 In Nebraska, 25 percent of women over 50 have not had a mammogram in the pasttwo years. Health insurance reform will ensure that people can access preventiveservices. As of September 23 rd, all news plans must cover certain preventative careservices without co-pays or out-of-pocket expenses, including mammograms. Itwill also invest in a prevention and public health fund to encourage prevention andwellness programs.

Women will have "direct access" to obstetrical and gynecological care. The newhealth reform law explicitly prohibits any health plan from requiring women to seek

a reference from a primary care doctor in order to see an obstetrician orgynecologist.

G il Nursing mothers and their infants will gain from a requirement that employers withover 50 employees provide a reasonable break time and location for breastfeeding.



New health insurance exchanges, which will be established in 2014, will ensure thatwomen still have access to health insurance despite life changes. For example, if awoman is a dependent on her husband's health care plan but they then divorce, shewill know that affordable coverage will still be available.

States have new and immediate opportunities to expand Medicaid coverage forfamily planning to women and men at the same income eligibility level.

Medicaid will also now cover smoking cessation for pregnant women.

Sources"Health Care Reform at a Glance." National Women's Law Center. March 2010.http://nwlc.org/reformmattersjpdf/HCR_AtAGlance_Fact%20Sheet.pdf

"Health Insurance Reform and Nebraska." HealthReform.gov.http.y/www.healthreform.gov /reportsjstatehealthreformjnebraska.html

Waxman, Judy and Lisa Codispoti. The New Health Reform Law: What Does It Mean for Women.National Women's Law Center. April 2010.http://nwlc.org/reformmatters/pdf/NWLCWebinaron Womenandthenewhealthreformlaw481 O .pdf

"Women Need Health Care Reform." National Women's Law Center. March 2010.

http://nwlc.org/reformmattersjpdf/statewhywomenneedhcr/NATIONALHCRFactSheet_FinalPush.pdf

http://http.y/www.healthreform.gov

http://nwlc.org/reformmatters/pdf/NWLCWebinaron

http://nwlc.org/reformmattersjpdf/statewhywomenneedhcr/NATIONALHCRFactSheet_FinalPush

http://nwlc.org/reformmattersjpdf/statewhywomenneedhcr/NATIONALHCRFactSheet_FinalPush

http://nwlc.org/reformmatters/pdf/NWLCWebinaron

http://http.y/www.healthreform.gov



2 D E A D LY D E L IV E RYTHE MATERNALHEALTHCARE

CRIS IS INTHE USA :SUMMARY

Cover and detai l above: The Safe Motherhood Quilt

Projec t, a nat ional ini ti at ive developed by midwife and

author Ina May Gaskin to honor women who have died of

pregnancy-related causes since 1982.

This summary is based onDeadly delivery:The maternal health care crisis in the USA

(Index: AM R51/007/2010) w hich contains full

citations an d sho uld be co nsulted for furth er

information."

A mnesty International M arch 2010 Index: A MR5 1 1 0 1 9 1 2 0 1 0



D E A D LY D E L IV E RY3TH E M ATE RN AL H EA LT H C A

C R IS IS IN T HE U SA : S UM M AR

D E AD LY D E LIV ERYTH E M ATE R N A L H EA LTH C A R E C R IS IS IN TH E U SA

More than two women die every day in the USAfrom complications of pregnancy and childbirth.Approximately half of these deaths could be preventedif maternal health care were available, accessible andof good quality for all women in the USA.

Maternal mortality ratios have increased from 6.6deaths per 100,000 live births in 1987 to 13.3 deathsper 100,000 live births in 2006. While some oftherecorded increase is due to improved data collection,the fact remains that maternal mortality ratios haverisen significantly.

The USA spends rnore than any other country onhealth care, and more on maternal health than anyother type of hospital care. Despite this, women in theUSA havea higher risk of dying of pregnancy-relatedcomplications than those in 40 other countries. For

example, the likelihood of a woman dying in childbirthin the USA isfive times greater than in Greece, fourtimes greater than in Germany, and three times greaterthan in Spain.

African-American women are nearly four times morelikely to die of pregnancy-related complications thanwhite women. These rates and disparities have notimproved in more than 20 years.

During 2004 and 2005, more than 68,000 womennearlydied in childbirth in the USA.Eachyear, 1.7million women suffer a complication that has anadverse effect on their health.

This isnot just a public health emergency - i t is ahuman rights crisis. Women in the USA face a rangeof obstacles in obtaining the servicesthey need. Thehealth care system suffers from multiple failures:discrimination; financial, bureaucratic and language

barriers to care; lack of information about maternalcare and family planning options; lack of activeparticipation in care decisions; inadequate staffingand quality protocols; and a lack of accountabilityand oversight

M ATE R NA L H EA LT H A ND H U M AN R IG H T

Mat?r~a l hea lt h is a human r igh ts i ssue . R r el Jen tbh le

maternalmor t a l i t ycanresulthombrreilestvi61~tidn,'>ofa var ie ty of humaD rights , inc lud ing t l1er ighUol!fe ,t ll er igh t t o f re edomf rom q is c rim ina ti oli ;a~d 't he r igb tt ot heh ighe st a t ta in ab le s tanda rd o f hea J th .Gove rnmeMs haveanobligatl6nto resp' i)qt ,protect and .fulfirthesearido the r hu rna rt r i gh ts and a r e' ul tima t e ly ac~oun tab le t or .gua ran te e jng ahea lt hea re sy s tem that en s iJ re s th e s erightsuniversaliyalidequitablY.

:,;_' '~, ':_:' r

TheU S Ahas r~t if ied twirkey in te rna tionaJhutnao:r igb tst re a ti es t ha t gua ran te e t he s e . ri gh ts ; t he Int ernat iona iCovenan ton C ivi l and Po iit i~ al R igh ts and the'l nt er uat iona l Conven t ion on the E lim ina ti on o f A ll f ormso f R a cia l D is c rim in a tio n , I t h a s a ls o s ig ne d two

int ernat iona l t re a ti es t na t add re s s -t he s e r igh ts~ theln temat inria l Covenant0)1 Economic, 'S.otialanclCulturalR ig hts a nd th e CQnv en ti;n o n t h e E li'm in atio n MA il' .Fo rms o f ! li sc r im inat io r iaga in s tWomen i andsoha san obl iga t ion to .re fra in f romacts .tha t WQuiddefea itheob je c t and pu rposeo f t he s e t re a ti es .

I n d e x ,AM R51 /019 /2010 Amne st y I nt er na tio n al Ma rc h 2 010



4 D E A D LY D E LIV E R Y

THEMATERNALHEALTHCARE

CRISISINTHEUSA:SUMMARY

U N EQ U A L C A R E

"O f a ll th e fo rm s o f in eq ua lity , in ju stic e in h ea lth c areis th e m o st s ho ck in g a m i in hum an e."

D r M artin Luthe r K ing Jr, 25 M arch 1966

The US government has a responsibility to ensure

equal access t o quality health care services for all,

withou t di sc rimina tion . However, gender, race,

e thnici ty, immigrat ion s tatus , Ind igenous s ta tus and

income level can affect a woman's access t o adequate

health care services in the USA.

Discr iminat ion profoundly affec ts a woman 's chances

of being healthy in the first place. Women of color are

less likely t o go into pregnancy in good health becaus e

they are more likely to lack access to primary health

care services. Despite representing only 32 percent of

women, women of color make up 51 percent of women

without insurance.

Women of color are also less likely to have access to

adequate materna l hea lth care services . Nat ive

American and Alaska Native women are 3.6 times,

Af rican-American women 2.6 times and Lat ina women

2.5 times as likely as white women to receive late or no

prenatal care. Women of color are more likely to die in

pregnancy and childbirth than whit e women. In high-

risk pregnancies, African-Americ an women are 5.6

times more likely to die t han white women.

Women of color are more likely to experience

disc rimina tory and inappropr iate t rea tment and poorer

qual ity of care.

Because women of color make up a disproport ionate

percentage of t hose who receive publicly funded care,

they are most aff ect ed by barriers to accessing health

care services through these programmes. The Indian

Amne st y I nt er n at io n al Ma r ch 2 010 Index: A M R5 1 1 0 1 9 1 2 0 1 0

I na m a r ie S t ith -R o u se , a 3 3-y eilf-o ld A f ric an -A m e ric an .w o m a n , d e liv e re d a h e a lth y b a by g ir l, T r in it y, b yc-sectiona t a h os pita l in M a s s ac hu se tts in J un e2003.H e r

h us ba nd , A n d re R d u se , s aid th a t a fte r th e b ir th s he '{ lia sd is tr es s ed a n d s tr ug g lin g t o b re a th e , b u t t ha t s ta ffd is m is s ed th e ir r eq u e st s fo r h e lp . A n d re R o u s e t o ldAm n e s t ylntemationalhe fe lt ra ce p la ye d apartin th es t a ff 's f a il u retoreact.nccoroingto c ou rt p ap e rs file d b y. .h er fa m ily , it w a shou r sb e fo re a p pr op ria te t es ts a n ds urg ery w e re u n de rta ke n , a nd b y t he n it w a s to o la te .I na m a rie S t ith -R o u s e h a d s u ff er ed m a s s iv e in te rn a lb le ed in g , a nd s lip pe d in to a c om a . S h e d ie d fo ur d ay sla te r. A n d re R o u se s a id , "H e r la s t w o rd s to m e w e re ,'A n d r e , I 'mafraid."

Heal th Service has suffe red f rom severe long- te rm

under- funding and lacks resources and s ta ff . Federa l

spending on health services f or Native American and

Alaska Native peoples is far below spending on all

other groups A report by the US Commission on Civil

Rights f ound that in 2003 national per capita health

expenditure averaged US$5,775, but t hat the

comparable figure for the Indian Health Service

was US$1,900.

'Ye s . I s pe ak S p an is h . B u t a t th ish o s p ita l w e o n ly s p ea k E n g lis h .'Woman r e c a ll in g t he r e sp o ns e o f a n i nt ak e c o or d in a to r t o a woman s e ek in ga n u lt ra s ou nd in 2 00 8 a t a p riv at e h os pit al in t he D is tr ic t o f C o lum bia



BA R R IE R S TOM ATE R NA L H EA LTHC A R E

"The fear of the bill that is sent to them [is a barrierto se ekin g se rvic es ]. W he n s om eb od y g oe s fo r a nu ltra so un d a nd th ey g et a b ill fo rUS $ l,000 - th eyf re a k ou t. "

Fel ic ia Marboah, midwife , Mary' s Center fo rMaternal and Chi ld

Care, Washington, DC

The way in which the health care system isorganizedand financed fails to ensure that all women haveaccess to affordable, timely and adequate maternalhealth care. For many women, health care costs arebeyond reach.

Half of all births are covered by private insurance.However, policies that exclude maternal care arenot uncommon and most insurance companies will notprovide coveragefor a pregnant woman unless she hadinsurance before she became pregnant.

'W e d on 't in su re a h ou se o n fire . 'S t at emen t r e po r te d ly mad e b y a n i ns u ra n c e c ompany r e pr e se n ta ti ve wh e nt ur nin g d ow n a r eq ue st f rom Ta ny a B lum st ein . I n J u ly 2 00 8 it w a s r ep or te dt ha i s he w a s u n ab le t o p ur ch as e p ri va te h e alt h c ar e in su ra nc e w it h a ny U Scompany wh il e s h ewa s p r eg n a nt

Some42 percent of births are covered by Medicaid,the government-funded program for some people onlow incomes. However, complicated bureaucraticrequirements mean that eligible women often facesignificant delays in receiving prenatal care.Undocumented immigrants are not eligible forMedicaid.

Over4 percent of women give birth without eitherprivate insurance or government medical assistance.

D E A D LY D E L IV E R Y5T HE M AT ER NA L H EA LT H C AR

C RIS IS IN T HE U SA : S UM M AR Y

T RU D Y LA G RE W

Trudyt aGrew, a Na ti ve Americ an woman li ving on the Red

C li ff r es e rva tion i n Wi scons in , d ied on 7 Janua ry 2008f rom an undiagno sed hear ! p rob lem ;mon th s a ft er g iv ingb irth to h er s ec on d c hild . A lth ou gh h er p re gn an cy wa scons id e red h igh r is k becau se o f compli ca tion s du ring he rfi rs t p regnancy and obes it y, TrudyLaGrewd id no t s e e anobst et ric ian o r h igh r is k spec ia li st f or p renat al c a rebecau se t h e c lo s es t onewas 11two-hou r d ri ve away.

'I f y o u g o to a p ply to th e M e d ic a ids y s te m , y o u n e e d a " p ro o f o fp re gn an cy " le tte r, w ith th e d ue d a te ,th e d a te o f y o u r la s t p er io d , a n d th eg e s ta t io na l a g e o f th e b a b y . W h e re d oy o u g e t th a t k in d o f a le t te r? - A d o c to r .If y o u h a v e n o M e dic a id , h o w a re y o ug o in g to g e t to th e d o c to r to g e t th a tl e t t e r ? 'J enn ie Joseph, ce r ti fi ed p ro fe s s iona l midwif e , Win te r Ga rden , F lo ri da

I n d ex :AMR5 1 / 0 1 9 / 2 0 1 0 Amne s ty I nt er n at io n a l Ma r ch 2010



6 D E A D LY D E L IV E RY

TH E M AT ER NA L H EA LTH C AR E


LA CK O F C O VE RA GE

In 2009, an estimated 52 million people in the USA-more than one in six - had no health insurance. Asmany as87 million people havefound themselveswithout heal th insurance at some point in the last

two years.

Community health clinics, including Federally QualifiedHealth Centers (FQHCs), are an important source ofcare for people on low incomes. Such clinics servedover 16 million patients in 2007, almost three quartersof whom were either uninsured or covered by Medicaid.However, FQHCsare only available in about 20 percentof medically under-served areas, leaving many people

without this critical safety net.

Uninsured individuals who need health care havelimited options. The cost of care can drive familiesinto poverty While nowoman in "active labor" may O T H E R B A R R IE R Sbe turned awayfrom a hospital emergency room underfederal law, s he may later be billed for that care. A central component of the right to health is t he

availability of sufficient health facilities and trainedprofessionals. In the USAthe shortage of health care

professionals is a serious obstacle to timely andadequate health care for somewomen, particularly inrural areas and the inner cities. Finding specialists forwomen presenting complications or risk factorsaffecting their pregnancy is particularly difficult.

Women, especially women on low incomes, can faceconsiderable obstacles in obtaining maternal healthcare, particularly in rural and inner-city areas. Doctorsmay be unwilling or unable to provide maternal heat thcare IJecauseof bureaucratic complexities and low'fees for the services they provide to women covered

by Medicaid.

T R IN A B A C H TE L

I rin a Bach te l.a ~5-ye .a r- ol d wh it e woman, was ln sur eda t th e tim e o th er p re gn an cy,b utth e lo ca l c lln ie h ad

r epo rt ed ly t old he r t h at it r equ ir ed a US$ lOOdeposittose eher,because she had incurred1:1 med ic a l d ebt someyear se ar lie r - o ve nth ou gh th e d eb t h ad s in ce b ee n r e pa id .I rin a Bach te l d e layed s eek ing ca re , unab le t o a ff ord t hef ee a t t he l oc a l c l in ic . She f in a ll y r ec e iv ed med ic a la tt en tion i n a ho sp it al bu t h e r son was s til lbo rn .. Shewasla te r t ran sfe rr ed t o anothe r ho sp it al i n Oh iowhe r e shed ied i n Augus t 2007 , two weeks a ft er t he b ir th .

Amnes ty I nt er na tio n al Ma rc h 2 010 Index:AMR51 / 0 1 9 / 2 0 10

Women interviewed by Amnesty International also citedlack of transport to clinics, inflexible appointmenthours, difficulty in taking time off work, lack of childcare for other children, and the absence of interpretersand information in languages other than English, as

major barriers to health care.

'We 'v e h ad w o m e n te ll u s th a t th ey 'r ea fra id to m is s t im e fro m w o rk w h enth e y h a ve p re n ata l a p po in tm e n ts . T h e ya re fa ce d w ith th e c h o ic e o f c o m in g tow o rk o r m is s in g w o rk a nd lo s in g th e irjo b s . T h a t is th e ir re a lity .'E l e an o r H i n to n H o y tt , P r es id e nt , B l ac k Wo m e n ' s H e a lt h I m p er at iv e



S Y S TE M FA IL U R E S

US federal agencies developed national health objectives

in 1998 - the Healthy People 2010 goals. These aimed

to reduce maternal deaths to 4.3 per 100,000 live

birt hs by 2010. Figures for 2006 (the latest national

s ta ti st ics avai lab le ) show a na tiona l mate rna l mor tal ity

ratio of 13.3 deaths per 100,000 live births. Only five

states have achieved the 2010 goal: Indiana, Maine,

Massachuset ts , Minnesota and Vermont . In sorne areas

rat ios are significantly higher: in Georgia it is 20.5; in

Washington, DC, 34.9; and in New York City the ratio

for black women is 83.6 per 100,000 live births.

FAM ILY P LA N N IN G G A PS

In the USA. nearly hal f of a ll pregnancies a re un intended.

The rat es are significantly higher for women on low

incomes and women of color. Women with unintended

pregnancies are more l ikely to develop compl icat ions

and f ace worse outcomes for themselv es and their

babies.

Access to fami ly p lanning services i s cons tra ined

by budgetary res tr ic tions and policy and leg is la tive

measures.

The federal government has failed t o ensure that family

p lanning services and contracep tives are adequately

covered by privat e insurance prov iders. Only 27 st atesrequi re hea lth insurance pol ic ies tha t cover o ther

prescription drugs to include prescription contraceptives.

About 17.5 million women in the USA are estimat ed

t o be in need of publicly funded family planning

serv ices and supplies. However, Medicaid and

government -f unded clinics (known as Title X clinics)

cover just over half of them, leaving more than 8

mi ll ion women without affordab le family p lanning

information and services.

D E A D LY D E L IV E RY7TH E M ATE RN AL H EA LT H C A

C RIS IS IN T HE U SA : S UM M AR

. Ju lie [eMaul t ~olds her baby bayShor t lybef~re .herdea thi n~p ii I2003 .Men ing it is due to an in fe c ti on Was 'd is cove r ed too la t e and she su ff e red mas s ive b r ai ndamage . The hospita l has s ince t igh tened l fp i ts ' e ffort sto main ta in a ~te ' ri leenvironment .

In de x: A M R5 1 / 0 1 9 1 2 0 1 0

Am n e s t y I nt er na tio n a l M a r G h 2



and managing obstetric emergencies. There is an

urgent need for a coordinat ed, comprehens ive system

of mat ernal healt h care.

According to some es timates, improving the quality of

maternal care could prevent 40 to 50 percent of

deaths . For example, studies in other medical fields

show that embolism (blood ciot) following surgery has

been reduc ed by approximately 70 percent by using

ei ther com pression s tock ings or drugs . However, these

s imple measures are not rou tine ly used fol lowing

c-scctions, which account for 32 percent of births.

UND E R S TA F F I N G

"T he p olic y n f th e h os pita l, d ueto .f in a nc e s, isto .keep

th efewest

n urs es o n th efloor."

Retired maternity nurse, Minnesota

Unders ta ff ing resul ts in fat igue , s tress , inc reased s ta ff

turnover and little time for ongoing t raining. St af fing

shortages also mean that nurses work more overtime.

There is litt le regulation of overtime. Pat ients and

heal th professiona ls have ident if ied the inadequate

number of nurses as a key cause of poor quality care

and medica l er rors.

PAT IE N T PA RT IC IPAT IO N R E S T R IC T E D

Many women are not given a say in decis ions about their

care and do not get enough information about the signs

of complications and the risks of interventions, such as

inducing labor or c -sec tions. C-sect ions are performed

in nearly one third of all deliveries in the USA - twice

as high as recommended by the World Health

O rganization. The ris k of deat h following c-s ect ions is

more than three t imes higher t han f or vaginal births.

D EA [ }LY D E L I V E RY9T HE M AT ER NA L H EA LT H C A


l inda CQa le ,a h ea lth y 3 5.ye ar"old w om an, g av e b irth to a

b ab y. b oy, Be njam in , b y G -s ec tio no n 2 7 S ep tem be r 2 00 7.

O ne We ek a ft er r etu rn in g h om e ,shed iedo f a b lo od c lo t.

S hewa sg iv en in fo rm a tio n a bo utacclimatizingpetsto a

n ew b ab y, b ut n o d eta ile d in fo rm ation on th e w arn in g

s ig ns fo r b lo od c lo ts , e ve n th ou gh sh e w as a t h eig hte ne dris k b ec au se o f h er a ge a nd th e su rg ery. H er sis ter L ori

s aid : "kn ow in g lin da w as on ce a n Eme rg en cy M ed ica l

Tech nicia n, if th os e d is cha rg e pa pe rs h ad s aid it c ou ld b e

a sign of a blood clot, in m y heart of hearts I believe that

s he w ou ld h av e a cte d o n it."

'B la c k w om e n a re o fte n n ot ta k e ns er io u s ly a t h e a lth c are fa c ilit ie s ; o u rs ym p to m s a re ig n o re d . 'Sha fi a Monroe , P re s iden t, I n te rnat iona l Cen te r fo r Trad it iona l Ch ildbi rt h ,Po r tl and , Oregon

In de x: A M R51 /019 /2010 Amnes ty I nt er na tio n al Ma rc h 2 010



10 D E A DLY D E LIV E RY

TH E M ATE RN AL H EA LT H C AR E


ACCOUNTAB I L I T Y

"F o llow in g p os tp artum h emo rr ha ge s in tw o L atin aw om en , th ere w as a m ee tin g to lo ok a t w ha t w en tw ro n g. Bu t th e a ss es sm e nt p ro ce ss d id n't in clu dem u ch a bo ut 'le t's e xa m in e w hy th is h ap pe ne d to n on -

E n glis h s pe a kin g w om en : T he q ue stio nin g w a s, 'H owc an w e a vo id lia b ility in th e fu tu re ."

J il l Humphrey, labor and del ivery regis te red nurse , communi tyhospital, Washington State

Dis turb ing as the publ ished f igures for maternal

mortality are, they do not reflect the full extent of the

problem. There are no federal requirements to report

mat ernal deaths, and the authorities concede t hat the

number of maternal deaths may be twice as high.

Repor ting of pregnancy-related deaths as a distinct

category is mandatory in only s ix s tat es and despit e

volun ta ry effor ts in some other states, systematic

undercounting of pregnancy-related deaths pers is ts .

'W h en th ere is a p ro ble m a n d s om e o ned ie s , n o o ne ta lk s to th e fam ily . A s te e lc u rta in c o m e s d o w n , a n d th e o nly w ayfo r fam ilie s to g e t a n y a n s w e rs is to g eta la w y e r a n d s u e . 'Ma rs d en Wagn er , f ormer d ir ec to r o f Women a nd Ch ild re n' s H e al th a t t heWorld Heal th Organizat ion

Another significant factor contributing t o the failure to

improve maternal health is a lack of comprehensivedata collec tion and ef fective sy stems to analyze the

data. This masks the full extent of mat ernal mortality

and morbidity and hampers eff orts to analyze and

address the problems.

Amne st y I nt er na ti on a l Ma r ch 2 010 Index: AMR5 1 / 0 1 9 1 2 0 1 0

'T h e a bility to in ve s t ig a te d ea th s ind ep th d oe s n o t e xis t w ith th e e xc e p t io no f M a ss ac h u s e t t s , C a lifo rn ia a nd m a yb e

F lo rid a .. . F ra nk ly , it 's a d is g ra ce .'Federal offic ia l

Materna l mortal ity rev iew committees seek to ident ify

pat terns in prevent able deat hs and are an important

element in analyzing problems and proposing possible

solut ions t o improve maternal health. However, 29

st at es and the Distric t of Columbia reported to Amnesty

Internat ional tha t they have no materna l mor tal ity

rev iew proc ess at all. In the 21 states where maternal

mor ta li ty rev iew committees do exist , the ir effect iveness

is v ariable. They are not uniform in design or mandat e

and approach the work in different ways. Some rely

exclusively on volunteers; others have professional

st af f. Some review all maternal deat hs, while others

analyze a sample. In addition the work of the

committees is not coordinated nationally. which can

resul t in dupl icat ion of e ffort s.

'W h o o w n s re sp o ns ib ility fo r [b e s tp ra c t ic es n o t b e in g im p le m e n te d ]?T h e s h o r t a n sw e r is : "E v e ry bo dya n d n o b od y ". 'Carolyn Clancy, D i rec to r, Agency fo r Hea lt hca r e Resea r ch and Qua li ty



D E A D LY D E L IV E R Y11TH E M ATE RN AL H EA LT H C A


A C T IO N N E E D E D

For more than 20 years, t he US authorit ies have f ailed

to improve the outcomes and disparities in mat ernal

health care. Much of the debate in the USA around

health care focuses on improving ac cess to care andreducing t he growth in health care spending. However,

focusing on healt h care coverage alone would leave

largely unaddressed the issues of discrimination,

sys temic fai lures and accountabi lity. I t is essen tial that

the debate goes beyond hea lth care coverage and

addresses access to quality health care for all,

equitably and free from discrimination.

'M o t h e rs , th e n ew b o rn a nd c h ild re nre p re se n t th e w e ll-b e in g o f a s o c ie ty

a nd it s p o te n t ia l fo r th e fu tu re . T h e irh ea lth n ee d s c a nn o t b e le ft u nm e tw ith o u t h a rm in g th e w h o le o f s o c ie ty .'LeeJong -wook , D i rec to r-Gene ra l, Wor ld Hea lt h Organi zat ion , 2003 -2006

Index: AM R5 1 / 0 1 9 / 2 0 1 0 Amnesty Internat ionalMarch 2010



Women ral ly in New YorkCity in 2004 cal ling for a reduc tion in the ra te ofc-sections, currently performed in almost one in three births in the USA.

A C T N O WThe US government should realize the human rights st andard

of making good quality health care available, accessible and

accep table to al l, wi thou t d iscrimina tion .

T he fo llow ing s tep s shou ld be taken a s a m atte r o f u rge ncy:

1. T he U S C on gress shou ld d irec t a nd fund the D epartm en t o fHealth a nd H um an S erv ic es to e sta blis h a n O ffice o f M ate rn al

H ea lth w ith a m an da te th at in clu de s:

• im pro vin g m ate rn al h ea lth d ata c olle ctio n a nd re vie w, inc olla bo ra tio n w ith a ge nc ie s s uc h a s th e C en te rs fo r D is ea seC o ntro l a nd P re ve n tio n ;

• p ro te ctin g th e rig ht tC Dn on -d is crim in atio n in m a te rn alh ea lth ca re , in c olla bo ra tio n w ith th e D ep artm en t o f H ea ltha nd H um an S erv ice s' O ffice fo r C iv il R ig hts a nd th eD ep artm en t o f J us tice ; a nd

• re co mm en din g n ec es sa ry re gu la to ry a nd le gis la tiv ech an ge s to e ns ure th at a ll w om en re ce ive a cc es s to g oo dq ua lity m a te rn a l c ar e.

2 . T he U S C on gre ss sh ou ld in cre as e fu nd in g fo r th e F ed era llyQ ua lifie d H ea lth C en te r p ro gra m in o rd er to e ns ure a na de qu ate n um b er o f h ea lth s erv ic e fa cilitie s a nd h ea lthp ro fe ss io na ls in a ll a re as , in p artic ula r in m e dic ally u nd er-s e rv e d a re a s.

3. H ea lth d ep artm en ts in a ll s ta te s s ho uld e ns ure th atp re gn an t w o me n h av e "p re su m ptiv e e lig ib ility " o r te m po ra ry

a cce ss to M ed ic aid w hile th eir p erm an en t a pp lic atio n fo rc ov era ge is p en d i ng .

4. H ea lth d ep artm en ts in a ll s ta te s sh ou ld im pro ve m ate rn alh ea lth d ata c olle ctio n a nd re vie w b y:

• e sta blis hin g a m ate rn al m orta lity re vie w b oa rd ;

• In clu din g a m ate rn al d ea th ch eck bo x o n th eir s ta nd ardd ea th c ertific ate ; a nd

• m an da tin g re po rtin g o f m ate rn al d ea th s.

Am n es ty In te rn at io n al is a g lo ba l m o v em e n t o f2 .8 mi l li on suppor t e rs ,m em b er s a n d a ctiv is ts in m o re th a n 1 50 c ou n tr ie s a n d te rr it or ie s w h oc amp aig n t o e n d g r a ve a b u se s o f h uma n r i gh ts .

O ur v is io n is fo r e ve ry p ers on to e njo y a ll th e rig hts e ns hrin ed in th eU n iv er sa l D e cla ra tio n o f H um an R ig hts a nd o th er in te rn atio na l h um anr igh t s s t anda rds .

We are independen to f any governmen t ,po l it ica l ideo logy,economic in t e re s to rr e lig iona nd a re funded main lyby our mem bersh ipand pub l ic dona t ions .

Am n e s t y I n te r n a ti o n alU SAN a t io n a l O f f ic e5 P e nn P la z aN ew Yo rk , N Y 1 00 0IU SA

March2 0 1 0Index .AM R5 1 / 0 1 9 1 2 0 1 0

www. amn e s t y u s a . o r g

Printed on recycled paper us)n~ vegetable-based inks and 100% wind power.

http://www.amnestyusa.org/

http://www.amnestyusa.org/



GOALSImprove Maternal Health

FACT SHEET

TARGETS

1. Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

2. Achieve, by 2015, universal access to reproductive health

Ql!ick' Fad~.. .'.......•. ' •......' .....,'. . . .. . .'. ..... .'.. . . .... . .' ..' ..'HUiiCJr~dsolth9U$arid~()fwomeri di~annual'Yfro;"compli~tions duritigpregnancy or diildbirth, almost all ofth' em -

99·:j)~rc~~i;lt .,...ih,-d~yelopin9 CO!Jlltri~S;*<" " . '. '.' .. .... '.. .'

- r.H$mate~nal~ni9rtalityra.teis d~dhlii1ganlyslg\"Vly,e~enthOU9h the vast majejrity ofdeaths are avoidable.

Eve!"YYear;,fho~~tt, ' l~n1million Children i)re I~ft~~o,therl~ss. Children who have-lost their ri,qthers are up to 10 times more

lil<elyto die p;'~maturely than those who havel'lbt:

*

WHERE DO WE STAND?

Maternal mortality remains unacceptably high. New data show

signs of progress in improving maternal health - the health of

women during pregnancy and childbi rth - with some countr ies

achieving significant declines in maternal mortality ratios. But

progress is still well short of the 5.5 per cent annual decline

needed to meet the MDG target of reducing by three quarters

the maternal morta li ty rat io by 2015.

SO per cent. with coverage increasing to 70 per cent of pregnant

women in Southern Asia and 79 per cent in Western Asia.

In2008, skil led health workers at tended 63 per cent of bi rths

in the developing world, up from 53 per cent in1990, Progress

was made in all regions, but was especially dramatic in Northern

Afr ica and South-Eastern Asia, with increases of 74 per cent

and 63 per cent, respectively.

Progress has been made in sub-Saharan Africa, with some

countr ies halving maternal morta li ty levels between 1990 and Large disparities still exist in providing pregnant women with

2008. Other regions, inc luding Asia and Northern Africa , have antenatal care and skilled assistance during delivery. Poor

made even greater headway. 'women in remote areas are least likely to receive adequate

care. This is especially true for regions where the number of

Most maternal deaths could be avoided. More than 80 per skilled health workers remains low and maternal mortality high

cent of maternal deaths are caused by haemorrhage, sepsis, - in particular sub-Saharan Africa, Southern Asia and Oceania.

unsafe abortion. obstructed labour and hypertensive diseases

of pregnancy_ Most of these deaths are preventable when there HIV is also curtailing progress, contributing significantly to

isaccess to adequate reproduct ive heal th services, equipment, maternal mortali ty in some countries .

supplies and skilled healthcare workers.

More women are receiving antenatal care and skilled

assistance during delivery. In all regions, progress is being

made in providing pregnant women with antenatal care. In

North Afr ica , the percentage of women seeing a ski lled heal th

worker at least once during pregnancy jumped by 70 per cent

Southern Asia and Western Asia reported increases of a lmost

The risk of maternal mortality is highest for adolescent

gir ls and increases with each pregnancy, yet progress on

family planning has stalled and funding has not kept pace

with demand. Contracept ive use has increased over the last

decade. By 2007, 62 per cent of women who were married

or in union were us ing some form of contraception. However,

these increases are lower than in the 1990s.

---- ---- --------



Some 215m illion women who would prefer to delay or avoid

childbearing lack access to safe and effective contraception. It

i s estimated that meet ing the unmet needs for contraception

alone could cut, by almost a third, the number of maternal deaths.

Funding of reproductive and maternal health programmes

is vital to meet the MDG target. Yet official developmentassistance for family planning declined sharply between 2000

and 2008, from 8.2 to 3.2 per cent. Other external funding has

also decl ined . There isnow lessmoney avai lable to fund these

programmes than there was in 2000.

WHAT HAS WORKED?

Widening access to maternal heal th services in Egypt : The

Minist ry of Health and Population significantly increased

access to obstetric and neonatal care, in particular to

vulnerable populations in Upper Egypt. About 32 maternity

homes were constructed in rural areas.The number of births

attended by trained heal thcare workers in rural areas has

since doubled to 50 per cent.

Fighting fistula in sub-Saharan Africa, South Asia and the

Arab States: In 2003, the UN Population Fund (UNFPA),

together with government and private partners, launched the

Campaign to End Fistula, a childbirth injury that leaveswomen

incontinent, isolated and ashamed. The campaign is now

active in 49 countries across sub-Saharan Africa, South Asia

and the Arab States. More than 28 countries have integrated

the issue into relevant national policies and more than 16,000

women have received fistula treatment and care.

Investing in mobile maternal health units in Pakistan:

UNFPA-supported mobile cli nics were set up in Pakistan

in 2005 and had received nearly 850,000 patients by 2008.

Women can use them for antenatal consultations, deliveries,

post-miscarriage complications and referrals for Caesarean

sec tion . The mobile uni ts managed to provide ski lled bi rth

attendance to 43 per cent of pregnant women in remote

areas, 12per cent higher than the national average.

WHAT is THE UN DOING?

UN Secretary-General Ban Ki-moon, together with lead-

ers f rom governments , foundat ions , NGOs and business ,

launched in2010 a Global Strategy for Women's and Chil-

dren's Health, set ting out key act ions to improve the heal th

of women and children worldwide, with the potential of

saving 16million lives by 2015. The Global Strategy spells out

steps to enhance financing, strengthen pol icy and improve

service delivery, and sets in motion international institutional

arrangements for global roportino. oversight and account-

abi li ty on women's and chi ldren' s heal th.

UNFPA, the UN Children'S Fund (UNICEF), the World Health

Organization (WHO), and the World Bank, as well as the

Joint UN Programme on HIV/A.IDS (UNAIDS), have joined

forces as Health 4+ (H4+) to support countries with the

highest rates of maternal and newborn morta li ty. The H4+

partners support emergency obstetric and neonatal care

needs assessments and help cost na tional maternal , new-born and chi ld heal th plans, mobi lize resources, increase

the number of skill ed health workers, and improve access

to reproductive health services.

In 2009, WHO, UNICEF and UNFPA partnered wi th the Af-

rican Union Ministers of Health as wel l as bi lateral aid and

non-governmental organizations to launch the Campaign

on Accelerated Reduction of Maternal Mortality in Africa

(CARMMA). The campaign aims to save the lives of mothers

and newborns. It is active in 20 African countries, includ-

ing Chad, Ethiopia: Ghana, Malawi, Mozambique, Namibia,

Nigeria, Rwanda, Sierra Leone and Swaziland.

A programme led by UNFPA and the International Confed-

eration for Midwives is active in 15countries in Africa, the

Arab States and Latin America, working closely with Ministers

of Health and Education to increase the capacity and the

number of midwives. Under the programme, Uganda has

developed a plan to promote quality midwife training; North-

ern Sudan has developed the f irst ever national midwifery

st rategy; and in Ghana, a nat ionwide needs assessment of

all the midwifery schools will help strengthen training.

UNFPA's Global Programme to Enhance Reproductive

Health Commodity Securi ty and WHO's evidence-based

guidance in family planning have helped improve access

to reproductive heal th suppl ies in more than 70 countries,

including in Ethiopia, where the contraceptive prevalence

rate has more than doubled since 2005, and in Laos, Mada-

gascar and Mongol ia, where s igni ficant progress in the use

of voluntary fami ly planning was also noted .

Sources: The Millennium Development Goals Report 2010, UnitedNations; World Health Organization (WHO); UN MDG Database(mdgs.un.org); MDGMonitor Website (www.mdgmonitor.org), UNDevelopment Programme (UNDP); What Wil l I t Taketo Achieve theMillennium Development Goals? - An Intemational Assessment 2070,UNDP;Campaign to End Fistula Website (www.endfistula.org); UNPopulation Fund (UNFPA); Office of the UNHigh Commissioner for

HumanRights (OHCHR).

For more information, please contact [email protected] or see

www.un.org/millenniumgoals.

'Updated maternal mortality estimates will be released on 15September.An updated fact sheet ..... v · i l l be posted on www.un.orq/rnillenruurnqoals.

7 o f 11 . -Issued by the UN Department of Public lnformation - DPV2650 E - September 201 0

mailto:[email protected]

http://www.un.org/millenniumgoals.

http://www.un.org/millenniumgoals.

mailto:[email protected]



What are the Millennium Development Goals?

The Millennium Development Goals (MDGs) are the most broadly supported, comprehensive andspecific development goals the world has ever agreed upon. These eight time-bound goals provideconcrete, numerical benchmarks for tackling extreme poverty in its many dimensions. They

include goals and targets on income poverty, hunger, maternal and child mortality, disease,inadequate shelter, gender inequality, environmental degradation and the Global Partnership forDevelopment.

Adopted by world leaders in the year 2000 and set to be achieved by 2015, the MDGs are both global andlocal, tailored by each country to suit specific development needs. They provide a framework for the entireinternational community to work together towards a common end - making sure that human developmentreaches everyone, everywhere. If these goals are achieved, world poverty will be cut by half, tens ofmillions of lives will be saved, and billions more people will have the opportunity to benefit from theglobal economy.

The eight MDGs break down into 21 quantifiable targets that are measured by 60 indicators.

Goal I! Rradk~t.e e~treme poverty 1"10 l-!_un<Jer

Goal 2: Achieve universal primary education

" ,: x :? ' )" ; '; : :Goal 3: Promote gender equality and empower women

Goal 4: Reduce child mortality

Goal 7: Ensure environmental sustain ability

Goal 8: Develop a Global Partnership for Development



United Nations Millennium Development Goals http://www.un.org/millenniumgoals/maternal.shtml

MILLENNIUMDEVELOPMENT GOALSEnd Povertyand HungerUniversal EducationGenderEquality

ChildHealthMaternalHealthCombatHIV/AIDSEnvironmental SustainabilityGlobal Partnership

GOALS:IMPROVE MATERNAL HEALTH

M ·6G ·M ~n · it ~ · r· f~ r ·G o~ · I ·5 i

Target 1:Reduce by three quarters the maternal mortality ratio

Most maternal deaths could be avoided

Giving birth is especially risky in Southern Asia and sub-Saharan Africa, where most women deliverwithout skilled care

The rural-urban gap in skilled care during childbirth has narrowed

Target 2:Achieve universal access to reproductive health

More women are receiving antenatal care

Inequalities in care during pregnancy are striking

Only one in three rural women in developing regions receive the recommended care during pregnancy

Progress has stalled in reducing the number of teenage pregnancies, putting more young mothers atrisk

Poverty and lack of education perpetuate high adolescent birth rates

Progress in expanding the use of contraceptives by women has slowed

Use of contraception is lowest among the poorest women and those with no education

Inadequate funding for family planning is a major failure in fulfill ing commitments to improvingwomen's reproductive health

lof2 8/6/10 2:20 PM

http://www.un.org/millenniumgoals/maternal.shtml

http://www.un.org/millenniumgoals/maternal.shtml



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Symposium on Maternal Child Health in Nebraska 9/30/10

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Transcript of Symposium on Maternal Child Health in Nebraska 9/30/10