from Dr Archana

1.  Gender based and sexual violence
 As the situation stabilizes, pressure on women
increases to replenish lost population
 Fertility rates increases, this may increase the
obstetric risk – may have pregnancies at close
intervals
 No access to FP services
 Increase in traditional practices ex. deliveries at
home
 Risk of spread of RTI/STDs increases
immediately

2.  RH needs of men, adolescents and minority
groups are neglected
 The overwhelming trauma of loss, no hope for
future may affect the mental health status and
can lead to risk taking behaviour
 Young, single, widowed or disabled women are
at higher risks of GBSV
 Women who are singled may be forced to offer
sex in exchange of food, shelter and security
 Control of reproductive rights are lost with the
social disruption
 There is often a lack of RH care facilities

3. 1. In decision to seek care
“The three delays”
2. In reaching health facility
3. In receiving appropriate treatment

4. At health centers (1 per 30,000 people)
Provided by midwives and nurses
1. Parenteral antibiotics Kit 6
2. Parenteral uterotonic drugs (oxytocin)
3. Parenteral anticonvulsants for pre-eclampsia and eclampsia
(magnesium sulfate – MgSO4)
4. Perform manual removal of placenta Kit 8
5. Perform removal of retained products of conception
(MVA - manual vacuum aspiration, D&C dilatation &
curetage)
6. Perform assisted vaginal delivery, e.g. Vacuum
Kit 9 Kit 10

5. At hospital with operating theatre
(1 per 150,000 – 200,000 people)
Provided by team of doctors, anaesthetists,
midwives and nurses
Kit 11
BEmONC (steps 1-6), plus
7.Perform surgery(Cesarean section, laparotomy for
ectopic pregnancy, anaesthesia)
8. Perform safe blood transfusion Kit 12

6.  Establish referral system
 Supply referral level (CEmONC)
 Midwife delivery kits (health facility, BEmONC)
 Clean delivery kits (home deliveries in case access
to health facility not possible)
 Plan for antenatal care (ANC) and postnatal care
(PNC) integrated into primary health care (PHC)
services as soon as possible

7.  Globally, 9 to 33 babies out of every 1000 born die
in the perinatal period
 25% birth asphyxia
ADVOCACY
 25% birth injuries
 prematurity, low-birth weight
 hypothermia
 infections (sepsis, tetanus, syphilis)
Neonatal and perinatal mortality : country, regional and global estimates, WHO 2006