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Maternal mortality is responsible for over 514,000 women’s lives every year. Almost all of these lives can be saved in case an affordable, high quality obstetrics care is made available 24 hours a day, every week.
Most of these deaths are as a result of hemorrhages, sepsis (infection), eclampsia, obstructed labor, and unsafe abortion (Lobis, Fry & Paxton 204). There are also other indirect causes of deaths which included anemia, malaria and even HIV. For this reason, there is the need to have a system that can address these issues.
There are basic EmOC facilities that perform critical services to clients without the need for operations. They offer intra venous antibiotics, IV and IM oxytoxis, anticonvulsants, assisted delivery, cleaning of retained products and removal of the placenta (Lobis et al 204).
The recommendations of the UN and World Health Organization are that there should be at least four basic facilities for 500,000 people and at least one comprehensive Emergency Obstetric care (EmOC) for the same population size. The comprehensive EmOC is a facility that needs an operating theatre and this is basically done in major district hospitals (Lobis et al 204).
EmOC is described as a set of health services that are lifesaving and needs to be available in health facilities to react to emergencies that come about during pregnancy, time of delivery an even at the period of postpartum (Nirupam & Yuster 79)..
The situation in Palmatia is almost similar to that in my home country, the United States. However, this seems to have very little facilities for the population in question. There are process indicators that are used for assessing the EmOC, especially the maternal mortality. These indicators are critical for planning and there needs to be actions taken to enable reduction of maternal deaths (Lobis et al 204).
Palmatia in scenario 3 is a good choice as it highlights the situation that can be compared to the position in the United States. The process indicators as set by the United States are that;
Availability of EmOC show that there are 3003 comprehensive EmOC facilities and that the basic EmOC form 92.2% (Nirupam & Yuster 79). The United States has a population of over 291 million inhabitants and according to the UN standards the country is doing better as it has over 3000 basic facilities against the required 2259.
It should also have at least over 568 comprehensive emergency obstetric services. That number is far much higher than the recommended number (Lobis et al 205). On the other hand, the Palmatia statistics basic care for the emergency case of delivery for a population of 950,000 people.
This is above the recommended four facilities for 500,000 people. There are three comprehensive EmOC facilities for the 950,000 people which are a greater progress against the recommended one facility for 500,000 people (Nirupam and Yuster 79).
On strict investigation, research has shown that the United States does not meet the required standards or number of facilities that can be categorized as basic EmOC. This is because according to the above functions.
Many of the so called basics EmOC facilities do not actually offer all of the six services identified above. Most of the birth centers handle the normal maternal services like normal deliveries and most of the complications that need specialized services are usually referred to major hospitals (Bailey and Paxton 300).
By reconfiguring the statistics of basic and emergency EmOC centers, the US has at least 10% more maternal care facilities than the recommendations by the UN.
Whereas, the US has enough EmOC facilities in general, the position is so different at the state level (Bailey and Paxton 300). It’s estimated that about thirty one percent of these individual states including the District of Columbia do not meet the required minimum number of the EmOC facilities as recommended by the UN standards.
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However, there are cases of very larger hospitals that serve even more women that two smaller obstetrics centers (Bailey & Paxton 300).
It is expected that 92.2 percent of the births in the US are expected to be in the EmOC facilities while the rest only take place in freestanding birth centers, in doctors’ offices and also at home (Lobis et al 206). The meet need for the emergency obstetric care unlike Palmatia which is at 65%, the US has about 98.8%, almost every woman are expected to suffer some form of complication in obstetrics.
The most common type of complication that is usually treated includes obstructed labor, prolonged pains and excessive bleeding. It’s also estimated that about 21 women have caesarian section and this is beyond the usually range of 5 to 15 % of the expected deliveries (Bailey and Paxton 301).
The deaths as a result of direct obstetric complication are about 0.06% in the facilities. This is at least lower than the acceptable mortalities of 1% as recommended by the UN guidelines. The common cause of the deaths is chiefly in puerperium and then followed by complicated conditions of eclampsia (Nirupam and Yuster 83).
The United Nations indicators are used for examining the availability, usability and the quality of the emergency obstetrics services in developing nations where maternal deaths are very high. Studies have shown that the counties that have less coverage of the emergency obstetrics services also have very poor maternal care (Nirupam and Yuster 83).
However for Palmatia in scenario three of module two and home country, the US, this situation is better addressed as the EmOC facilities are above the recommended number by the UN.
Access to emergency services is excellent in the US and a greater Majority of women give birth in well equipped hospitals where they receive the best obstetrics treatment (Nirupam and Yuster 843). However, getting the statistics on the real people who can access the EmOC could be very hard. For instance, women living in the rural areas could find access limited. Insurance can also affect access though it is should not (Bailey and Paxton 302).
Another critical data is the conservative delivery culture that has developed in America is the increasing cesarean section delivery. Several groups have expressed their concern for this. Palmatia has about 12% while the US has 21%. This difference can be attributed to cultural difference.
Policies that could Hinder EmOC
If the EmOC can be able to reduce deaths due to pregnancy complications and delivery at a substantial amount, then women that need prompt medical access due to the complications need to be able to access EmOC (Bailey and Paxton 303).
In order to reduce the maternal deaths in this manner, the US government placed much emphasis on the implementation of care for women so that they can access the best quality of EmOC (Bailey and Paxton 305). This includes upgrading health facilities to offer basic care and also the comprehensive obstetric care.
Renovations and maintenance of the facilities and also supplying equipment is greatly supported. The government also offer training to practitioners on how to manage complicated cases of maternal conditions (Callaghan and Berg 132). However despite the efforts of government to have the best services, there are some policies that are hindering access to EmOC.
Considering that there is greater understanding of the need for preventing maternal mortality, it’s critical to address the policies that hinder this access (Callaghan and Berg 132). There are some health policies that are a barrier to the access and they include the following:
Obstetrics done only by obstetricians: only the postgraduate obstetricians are allowed carry out the caesarean section or some abdominal surgical processes.
Basic doctors are not usually allowed to do offer such services even in emergency cases. In the states where the EmOC does not meet the recommend numbers, it is very hard to offer these services when much the population is very high (Callaghan and Berg 135).
Anesthesia conducted only by Anesthetists: there are few anesthetists in some states especially those that do not meet UN standards of EmOC.
This therefore means that the populations in such areas will only have about 1 to 5 qualified practitioners in anesthesia. The anesthesia policy that nurses cannot be anesthetists and only doctors are allowed, though lately there is some training for the nurses to become nurse anesthetists (Callaghan and Berg 135).
This has brought fears on the quality of care that can be accessed. At some point, there can be doctors and surgeons but no qualified anesthetist hence major surgeries will have to be referred to other higher level hospitals (Callaghan and Berg 136). Giving anesthesia has very restrictive policy just for the sake of safety of the patient.
Recognition of Specialist: some US individual states have some criteria of acknowledging medical experts (Nirupam and Yuster 82).
Some require that the medical practitioners have to have worked for at least 5 to 10 years to be recognized as specialists in various fields.
Due to such regulations, doctors with qualifications as specialists can only work in some district hospitals but not to offer specialist services (Callaghan & Berg 137).
Access to Blood: anemia is a very common symptom in pregnant women and about 52% of the women suffer anemia. From the statistics about maternal deaths, it has been found that anemia was responsible for about 14 – 24% mortalities while excessive bleeding is responsible for 16 – 26%. Access to blood becomes a problem because of the blood banking mistakes.
There is also a problem of screening the blood and the government has in place utopian regulations to license blood banks (Callaghan and Berg 138). Though this was done to safeguard the interests of the public, screening for hepatitis or HIV has been already addressed well enough.
It has been stated in the US that the reason why such polices exists is mainly because of the fact that the policy makers are in most cases nontechnical people, hence cannot address the matters of emergency care in a proper manner as it happens in real practice (Callaghan and Berg 138).
Design of Effective Programs
There are currently set programs that are devoted to taking care of the emergency situations on obstetrics. The community is expected to be in an state of preparedness so that they can provide better EmOC (Nirupam and Yuster 85). There are an increasing number of these types of programs founded on the three Delays Model.
The three delays model is a construct that helps to explain the way the social factors bring about maternal mortalities. This helps in policy making and to target the resources and intervention and stoppage maternal deaths (Nirupam and Yuster 87). In some cases, mothers who die during child delivery are said to have gone through the following delays;
- Delayed decision on seeking care (UNFPA 9)
- Delayed access to adequate care (UNFPA 9)
- Delayed receipt of care at the healthcare facilities
Deciding to seek for medical care when one is experiencing an complicated obstetric problem can be delayed and this has been a very big problem in offering obstetric services (UNFPA 9). There are several reasons why this takes place, including fear of the expenses, fear of the healthcare facilities process, poor decision making ability, and late realization of the problem (UNFPA 9).
The government should set polices that communicate to the people concerning the need to seek assistance early enough in case they observe some unusually symptoms. The cost should be subsidized for obstetrics.
Delay to reach the facility: after a decision is made, reaching the births center or hospital can be a problem. Transport is usually a factor due to traffic of lack of ambulance to fetch patients (UNFPA 10).
Some communities have tried to deal with this including organizing prepaid transport or community transport to healthcare facilities.
The policies makers should design a system to have ambulance services on call to help fetch patient and offer first aid assistance before specialist can do their job (UNFPA 10).
Delay to get proper services: this is considered the most tragic incidence of maternal deaths incidences. In most cases, women will wait for long hours for specialist services because of staff problems and issues, prepayment policies or hardships in finding blood, proper equipment or a surgical theater (UNFPA 10).
In designing a better system of care, this is the easiest huddle to deal with since most of the social, cultural and economical obstacles have been faced and done with (UNFPA 10). Therefore equipping heath facilities is of major importance and designing polices to address the first two delays would make no sense if the medical facilities are not adequately equipped.
Bailey, Partrick, and Paxton, Arnold. Program Note: Using UN Process Indicators To Assess Needs In Emergency Obstetric Services. Int J Gynecol Obstet, 2.76(2002): 299—305.
Callaghan, Martin and Berg, Jerrad. Maternal Mortality Surveillance In The United States: Moving Into The Twenty-First Century. JAMWA, 57.3(2002): 131—5.
Lobis, Smith, Fry, Dendan and Paxton, Arnold. Program Note: Applying the UN Process Indicators for Emergency Obstetric Care to the United States. International Journal of Gynecology and Obstetrics, 88(2005): 203 – 207.
Nirupam, Sikhlar and Yuster, Ashvin. Emergency obstetric care: Measuring availability and monitoring progress. In: International Journal of Gynecology and Obstetrics, 50. 2(1995): 79- 88.
UNFPA. Maternal Mortality Update 2002: A Focus on Emergency Obstetric Care, 2002: 23 -36.