They are the general guidelines for the organization and standardization of emergency obstetric care (2000), the protocol for obstetric and paediatric care (2001) and the abortion care protocol (2002).

Deeply concerned that early childbearing and limited access to sexual and reproductive health care, including in the area of emergency obstetric care, causes high levels of obstetric fistula and maternal mortality and morbidity,

Develop women friendly district health systems providing quality women's health care from the community to first referral level including emergency obstetric care.

With respect to the Goal on maternal health, all women should have access to skilled care during childbirth, as well as to emergency obstetric care.

In 2004, Mozambique introduced a new health care initiative to train midwives in emergency obstetric care in an attempt to guarantee access to quality medical care during pregnancy and childbirth.

Emergency obstetric Care facilities through Women friendly hospitals in 20 districts of Pakistan under the Women Health Project.

In February 2004, a National Seminar on Obstetric and Neonatal care was held to establish the Pact's strategic actions.

In the health sector, the United Nations Population Fund (UNFPA) supported the improvement of emergency obstetric care in district hospitals.

Deeply concerned that early childbearing and limited access to sexual and reproductive health care, including in the area of emergency obstetric care, causes high levels of fistula and maternal mortality and morbidity,

(c) To redouble their efforts to meet the internationally agreed goal of improving maternal health by increasing access to skilled attendance at birth and emergency obstetric care, and appropriate prenatal and post natal care

UNICEF will also support pilot and other initiatives for Goal 5, including emergency obstetric care and training of skilled birth attendants, where warranted by country circumstances.

(i) To develop means of transportation and financing that enable women and girls to access obstetric care and treatment, and provide incentives and other means to secure the presence in rural areas of qualified health professionals who are able to perform interventions to prevent obstetric fistula

Of the 146 maternal deaths recorded in 2002, 116 were due to obstetric causes and 30, to non obstetric causes. The following table shows the distribution of direct and indirect obstetric deaths.

Examples of synergies are found in the IMCI and ACSD initiatives, in some obstetric care programmes and as described in paras. 63 86 below on immunization plus .

In addition, the presence of a trained attendant at delivery and access to emergency obstetric care are essential to preventing deaths occurring because of complications during delivery.

Manual for dealing with obstetric emergencies.

The Government was committed to reducing maternal mortality by improving obstetric care and providing assistance for abortions, and was reviewing punitive legislation on the voluntary termination of pregnancy.

There are 3 upper level obstetric centres. Obstetric wards of county hospitals and private hospitals are institutions of the secondary level.

Deeply concerned that early childbearing, malnutrition and limited access to sexual and reproductive health as well as emergency obstetric care causes high levels of fistula and maternal mortality and morbidity,

62 138. Supporting efforts to end obstetric fistula

Table 11 Maternal mortality, by obstetric cause, 2002

Table 13 Non obstetric maternal mortality, 2001 2002

Collaborating with UNFPA and others, UNICEF supported capacity building and services for emergency obstetric care in some 65 countries and roughly 3,700 health facilities, an increase of over 300 since 2003.

Most maternal deaths are directly due to obstetric complications.

There are obstetric and gynae wards in most major hospitals.

10. Urges the international community to address the shortages of doctors, nurses and other health workers trained in lifesaving obstetric care, and of space and supplies, which limit the capacity of most of the fistula centres

To implement the provisions of the Pact, different Ministry of Health's departments and coordinating agencies involved in the effort to improve the quality of obstetric care and family planning allocated resources from the Federal Government budget.

From 2001 to 2004, the Ministry of Health, through the Technical Area for Women's Health, facilitated the realization of various capacity building efforts in order to change the paradigm for obstetric care and humanize the assistance provided.

The following table shows the primary causes of direct obstetric death in 2002

The number of obstetric wards (maternity hospitals) has remained unchanged (19 in total).

These services, based on the concept of informed choice, should include education on safe motherhood, prenatal care that is focused and effective, maternal nutrition programmes, adequate delivery assistance that avoids excessive recourse to caesarean sections and provides for obstetric emergencies referral services for pregnancy, childbirth and abortion complications post natal care and family planning.

One of the consequences of such traditional practices, particularly early marriage, is obstetric fistula.

This will ensure provision of Safe Motherhood facilities to the majority of mothers, thereby enhancing child survival rates and Emergency Obstetric Care facilities provided through the establishment of Women friendly hospitals in 20 districts of Pakistan under the Women Health Project.

By 31 December 2003, 93.2 of ward clinics have midwives and obstetric pediatric assistant doctors.

For example, the provision of maternal health services, including emergency obstetric services, must be available to all young women.

(d) To develop a national strategy of prevention and treatment to effectively address the condition of obstetric fistula and to further develop a multisectoral, comprehensive and integrated approach to bring about lasting solutions and a meaningful response to the problem of obstetric fistula and related morbidities

Lastly, a survey had been conducted in 2003 with a view to measuring the availability and use of emergency obstetric services.

Among the main causes of maternal mortality, the most prevalent are obstetric haemorrhaging, severe forms of gestosis, and other complications of pregnancy.

In 1844, Ignaz Semmelweis was appointed assistant lecturer in the First Obstetric Division of the Vienna General Hospital (Allgemeines Krankenhaus), where medical students received their training.

In 61 Centers for Mother and Child Protection and Family Planning, there are 321 obstetric doctors, 60 pediatric doctors, 228 pediatric assistant doctors and 367 midwives.

Perioperative care Peri op care is the care that is given before, during and after surgery.

Another way to categorize health care practitioners is according to the sub field in which they practice, such as mental health care, pregnancy and childbirth care, surgical care, rehabilitation care, or public health.

Care

Medical care includes general practitioner care, specialist care in hospitals, essential pharmaceutical supplies, hospitalization where necessary including in cases of pregnancy and confinement and pre natal and post natal care.

Take care!