LA ESCUELA EMPRESARIAL

Based on a very recent estimates, at least one birth giving woman and eleven newborn babies dies every two minute somewhere in the world from complications of pregnancy and childbirth; that is, well over a quarter million women and nearly 6 million babies under one month, at a minimum, dying every year (Countdown Coverage Writing Group 2008:1247-59; Kassebaum et al 2014:980-1004; UNICEF 2009:117; UN IGME 2014:9;

WHO 2007a:9-14). There are more than 200 maternal deaths for every 100,000 live births. In least developed countries, however, the figure ascends to 1,000 for every 100,000 live births; whereas, in more developed countries there are only 16 maternal deaths for every 100,000 live births (Kassebaum et al 2014:980-1004; WHO 2007a:9-14).

Very surprisingly, the majority of these deaths are avoidable. Although the degree and type of risk related to pregnancy, birth, post-partum, and the early weeks of life differ between countries and settings, the need to implement effective, sustainable, and affordable improvements in the quality of care is common to all. And yet, new knowledge is needed to eliminate the avoidable maternal and newborn mortality and morbidity, and to inform decision making for universal health care and the UN post-2015 development agenda (WHO 2013b:57-65).

Reduction of maternal mortality and newborn death has long been a global health priority and are targets in the UN Millennium Development Goals (MDG) framework (UN 2013:11) and a key concern of the Global Strategy for Women’s and Children’s Health launched by the UN Secretary-General in September, 2010 (UN 2010a:1). Some progress towards maternal mortality and newborn death has been reported, especially in the past decade but further improvements are needed (Kassebaum et al 2014:384:980-1004; UN 2013:14; UN-IGME 2014:9).

Evidence shows that 15% of all pregnant women will develop sudden serious complications and require life-saving access to quality obstetric services (WHO 2009:5-115; Maine 1991:10-17). What’s more, 53% of women in developing countries have the assistance of a skilled attendant at birth and only 40% give birth in health institutions (WHO 2008a:3). Besides, the majority or more than 60 percent of maternal deaths take place soon after birth or during the postpartum period. And yet 70 percent or more women in developing countries did not receive any postpartum care (Koblinsky 2005:20-28; WHO 2007a:19).

More strikingly, the levels of maternal and newborn mortality differ greatly among the major regions of the developing world. Nearly, 11% of women globally live in Africa. But based on population alone, more than would be expected; an estimated more than 60%

of maternal, child and/or newborn deaths take place only in Sub-Saharan Africa (Black et al 2003:2226-2234; Ronsmans & Graham 2006:1189-1200; UN IGME 2014:9; WHO 2014b:22-27). The highest maternal mortality rates are found in Sub-Saharan Africa where in some countries more than 1,100 women die from every 100,000 live births.

Worldwide, 34% of deliveries have no skilled attendant (WHO 2008a:3). Based on this WHO estimates, these skilled attendants assist in more than 99% of births in more developed countries versus 62% in developing countries. In five countries including

Ethiopia, however, the percentage of delivery assisted by skilled birth attendants is less than 20%. Furthermore, African women of reproductive age have a much higher risk.

Women’s life-time risk of maternal death is over 150 times higher in least developed than in the more developed countries. The life-time risk for African women is 1 in 26 compared to 1 in 120 in Asia, 1 in 7,300 in the developed regions, and in stark contrast to Ireland, which had the lowest lifetime risk, 1 in 48,000 (WHO 2005:13).

Then again, there are 2.9 million early neonatal deaths and 2.6 stillbirths each year in addition to the prevailing maternal mortality (Lawn et al 2005:891-900; Renfrew, McFadden, Bastos, Campbell, Channon, Cheung, Silva, Downe, Kennedy, Malata et al 2014:1129-1145; UN IGME 2014:9). These deaths are largely the result of the same factors that causes the deaths and disabilities of mothers. Almost all (99%) neonatal deaths arise in low-income and middle-income countries, yet most epidemiological and other research focuses on the 1% of deaths in rich countries. Between 1990 and 2013, the number of neonatal deaths declined from 4.7 million in 1990 to 2.9 million in 2013.

However, the decline in neonatal mortality over 1990–2013 has been slower than that of post-neonatal mortality. The share of neonatal deaths among under-five deaths increased from about 37 percent in 1990 to 44 percent in 2013 (Lawn, Blencowe, Oza, You, Lee, Waiswa, Lalli, Bhutta, Barros, Christian et al 2014:189-205; Renfrew et al 2014:1129-1145). Similarly, between 1980 and 2000, child mortality after the first month of life − i.e., from month 2 to age 5 years − fell by a third, whereas the neonatal mortality rate (NMR) was reduced by only about a quarter. Hence, an increasing proportion of child death is now in the neonatal period. Estimates show that about 40%

of all deaths in children younger than age 5 years happen in the first month of life (Lawn et al 2005:891-900; WHO 2007c:38). A similar number of babies are stillborn – dying in utero during the last 3 months of pregnancy. More specifically, deaths in the first week of life particularly have shown the least progress. In 1980, only 23% of deaths arose in the first week of life; after two decades, this figure had risen to an estimated 28% [3 million deaths] (Lawn et al 2005:891-900); in 2013 almost 1 million newborns (36 percent) died on the day they were born, and another 1 million (37 percent) died within the next six days of birth. Some 0.8 million neonatal deaths (27 percent) occurred between day 7 and day 27 of life (Lawn et al 2014:185-205).

Ethiopia is one of the four countries that contribute about 45% of both the world maternal mortality and children deaths; the others being India, Nigeria and the

Democratic Republic of Congo (WHO 2014a; Hogan et al 2010:60518-1; Black et al 2003:2226-2234). The Ethiopian Demographic and Health Surveys (EDHS) of the 2000/1, 2005/6 and 2011 are the three biggest ever conducted surveys for the country, gave figures of maternal mortalities and newborn deaths for the period of 5-6 years prior to the surveys. The maternal mortalities are escalating as evidenced in the 2011 EDHS, maternal deaths represent 30 percent of all deaths to women age 15-49 (CSA 2011:267-271), compared with 21 percent in the 2005 EDHS (CSA 2006:102-120); and, 25 percent in the 2000 EDHS (CSA 2001:97-110). This may shows that the situation of maternal mortality in Ethiopia remains unmerited tragedy.

The maternal mortality ratio, which is obtained by dividing the age-standardised maternal mortality rate by the age-standardised general fertility rate, is often considered a more useful measure of maternal mortality since it measures the obstetric risk associated with each live birth. The maternal mortality ratio figure of the 2011 EDHS (676) is slightly greater than the 2005 EDHS (673) which may further prove that maternal mortality situation in Ethiopia is not getting better. The 2000 EDHS show the maternal mortality ratio for Ethiopia for the period 1994−2000 to be 871 deaths per 100,000 live births (CSA 2001:97-110). Although it appears that maternal mortality ration of 2005 may be declining in Ethiopia in comparison to the 2000, the rates are both subject to a high degree of sampling error and 95 percent confidence intervals around the two estimates partakes overlapping intervals, it is not possible to conclude that there has been a decline at all. A similar conclusion can be drawn comparing the maternal mortality ratios measured in the 2011 EDHS (676) with those in the 2000 EDHS (871). The confidence interval surrounding the maternal mortality ratio of 676 deaths per 100,000 live births is 541-810, while the confidence interval for the 2005 ratio of 673 deaths per 100,000 live births is 548−799 deaths. The maternal mortality ratio obtained from the 2000 EDHS is 871 deaths per 100,000 live births; and, the true ratio of the 95 percent confidence intervals ranges between 703 and 1,039. Since the confidence intervals among the three estimates significantly overlap; there is no evidence to suggest that the maternal mortality ratio have ever decreased in Ethiopia between each survey periods.

For neonatal mortality, the national rates are 49/1000, 39/1000 and 37/1000 live births as reported in the EDHS 2001, 2006 and 2011 respectively. High fertility potentially increasing obstetric risk, add an extra burden to overstretched maternity services, and it

will also have a major impact on the health and well-being of both the mother and the child. When it comes to Ethiopia, the value for having many children is very common in the country with total fertility rate of 5 (five) children per women. Some populous regional states even have current total fertility rate estimate of more than seven (7.1) children per women; fertility rates are, thus, comparatively very high (CSA 2011:71).

Generally, the levels of maternal and newborn mortality in Ethiopia, like many other countries in Sub-Saharan Africa are unacceptably very high. This nationally high level maternal mortality and newborn death rates become more alarming when it comes to the densely inhabited Regional States of Ethiopia such as Oromiya, Amhara, and Southern nations and Nationalities peoples (SNNP) regional states