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Emergency Contraception : Global Activity

EC : a step towards making pregnancy safer in the South-East Asia Region
– Dr Rita Thapa, SEARO, WHO

This topic of EC is very important. There are two important aspects to be dealt with (a) technology aspect, its application and information sharing, and (b) policy-related issues.

It is not due to the absence of technology that our women are dying in the dawn of 21st century, rather it is the lack of policy. The contextual situation in our country has two important constraints :

(i) Poverty – Women are the poorest lot. 70% of 3 billion poor in the world are women (World Health Report). In our region, as it is, 40% of world’s poor are living. Of these, women are the poorer lot. This is despite the increasing globalisation and privatization.

(ii) Gender – for centuries, values put by society to men and women are different. There is a marked disparity being reflected in gender development index in UNDP report (UNFPA), men’s words are always valued more, and gender discrepancy continues, despite marginal improvement in recent years.

These contextual situations relate to women and influence their access and bargaining power to good reproductive healthcare which directly affects their life. We have good technology, but it is not reaching women in a cost effective way.

EC relates to several issues related to women’s health. WHO strategy is :

“Every pregnancy should be wanted, unwanted pregnancies directly relate to the risk of death”.

Pregnancy-related deaths constitute the leading cause of loss of healthy lives among women of reproductive age in the South-East Asia Region. This Region alone accounts for 40% of the global maternal deaths.

The national estimate of maternal mortality rate (MMR) is just the tip of the iceberg as maternal deaths are grossly under-reported due to non-registration and/or incorrect classification. Studies in the Region have indicated that over 70% of maternal deaths are under-reported. Besides, the national MMR averages vary according to socio-economic conditions, gender, geographical location, ethnicity and other variables. For example, the national MMR average of 408 for India includes variations ranging from 29 in Gujarat to 707 in Uttar Pradesh.

Safe and affordable health technologies for preventing almost 80% of all maternal and early neo-natal deaths exist. However, the capacity of health systems to provide such essential maternal and newborn health services, especially essential obstetric care, is often lacking. Even where such services are available, women in need cannot access them on time, mainly due to lack of referral systems and their poor socio-economic status.

Making Pregnancy Safer [MPS] offers a health sector strategy to resolve the twin problem of maternal and neo-natal morbidity and mortality. The MPS strategy calls for incorporating three evidence-based action messages within health systems.

One, every pregnancy ought to be wanted. Globally, evidence shows that out of 210 million estimated pregnancies, 39% are unplanned. Such a high proportion of unplanned pregnancies relates, among others, to a high level of unmet needs for family planning services of one’s choice and associated risk of death due to unsafe abortion. Though not reported widely, unsafe abortion constitutes a major cause of maternal death ranging from 10 to 40% in the Region. Deaths due to unsafe abortions indicate, among others, a high level of ‘Unmet Need’ for family planning services of good quality.

Easy accessibility to Emergency Contraception would make a huge difference in preventing unwanted pregnancies and deaths due to unsafe abortions.

Two, all pregnant women and their newborns should have access to skilled care. Evidence shows that higher the proportion of skilled attendants at birth, lower is the maternal mortality ratio.

Three, every woman should be able to reach a functioning health facility in order to obtain appropriate care when complications arise. Research shows that higher the health systems performance index, lower is the MMR.

The prevention of maternal deaths requires timely access to both preventive and clinical interventions. The proven cost-effective interventions needed to prevent maternal deaths do exist. They are not new. MPS calls for having these essential services incorporated within the health systems.

The on-going health sector reform in high MMR countries should take into account a few imperatives, a few pressing examples of which are fairness in the provision and financing of maternal health and newborn care services, physical and human resources, advocacy with matching policy and legislation.

At the 53rd Session of the WHO Regional Committee, the Governments in the South-East Asia Region have endorsed an MPS-based Regional Strategy for the Reduction of Maternal Mortality for the Region and, accordingly, adopted a Resolution (with 10 member-states, 25% of world’s population and 30% of global maternal deaths) (SEA/RC53/R9).

The most important key message of making pregnancy safer is “Every pregnancy should be wanted” and the initiative suggests to “establish (or update) national policy and standards for family planning”.

The proposed regional strategy calls for concerted efforts from all partners in putting the existing proven interventions into a single package, and mainstreaming it through different levels of health systems. Its effective application at the ground level would make a difference - difference in making every pregnancy safer, in saving lives and in improving the potential of future generations.

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