(Maternal Child Health & Family Planning) Titik Kuntari Departemen Ilmu Kesehatan Masyarakat FK UII

Transkripsi

1 MCH dan FP (Maternal Child Health & Family Planning) Titik Kuntari Departemen Ilmu Kesehatan Masyarakat FK UII

2 MDGs

3 PR Menurunkan AKB menjadi 2/3 nya pada tahun kematian per 1000 kelahiran hidup pada tahun Menurunkan AKI sebesar ¾ nya antara tahun 1990 dan 2015, 97 kematian per 1000 kelahiran hidup.

4

5

6 Kematian Maternal? => kematian yang dialami seorang perempuan yang sedang hamil atau dalam 42 hari setelah terminasi kehamilan, oleh sebab- sebab terkait kehamilan atau manajemennya tetapi bukan karena kecelakaan (WHO, 2010)

7 Maternal Mortality Ratio Jumlah kematian ibu per kelahiran hidup Indonesia tertinggi se Asteng Saat ini angka Kematian Ibu di Indonesia masih tinggi yaitu sebesar 228 per kelahiran hidup (SDKI 2007), sedangkan target MDGs 2015, angka kematian ibu saat melahirkan harus diturunkan menjadi 102 per kelahiran hidup.

8

9 Penyebab Direct Those resulting from obstetric complications of the pregnant state (pregnancy, labour and the puerperium), from interventions, omissions, incorrect treatment or from a chain of events resulting from any of the above Indirect Those resulting from previous existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but was aggravated by physiologic effects of pregnancy

10 Penyebab Kematian Ibu Hemorrhage 24.8% 7,9 19,8 12,9 12,9 24,8 14,9 Infection 14.9% Eclampsia 12.9% 6,9 Obstructed Labor 6.9% Unsafe Abortion 12.9% Other Direct Causes 7.9% Indirect Causes 19.8%

11

12

13 Faktor Risiko Usia Ibu = terlalu TUA, terlalu MUDA Paritas (terlalu Banyak) Jarak persalinan (terlalu Sering) Unwanted pregnancy

14 Distant Determinants Intermediate Determinants Outcomes Health status Pregnancy Socioeconomic and cultural factors Reproductive status Access to health services Complication Health care behavior/use of health services Death/disability Unknown or unpredicted factors

15 Causal Pathways in the Reduction of Maternal Mortality Reduce the likelihood that a woman will become pregnant Reduce the likelihood that a pregnant woman will experience a serious complication of pregnancy or childbirth Reduce the likelihood of death among women who experience complications

16 Safe Motherhood A woman s ability to have a SAFE and healthy pregnancy and childbirth.

17 family planning Four pillars of safe motherhood antenatal care clean & safe delivery essential obstetric care safe motherhood basic maternity care PRIMARY HEALTH CARE EQUITY FOR WOMEN WHO 1998

18 UPAYA MENURUNKAN AKI 1. KB 2. ANC 3. Pelatihan dukun tradisional 4. Distribusi tenaga kesehatan terlatih

19 FAMILY PLANNING (KB)

20 Perubahan Pada kurun waktu 1970-an hingga 1990-an, aspek demografis semata yaitu pengendalian angka kelahiran. Pasca ditandatanganinya International Conference on Population and Development (ICPD) di Cairo Tahun 1994, telah terjadi pergeseran paradigma yang cukup signifikan dalam pelaksanaan program KB yaitu dari pendekatan demografis menjadi mengedepankan aspek hak-hak asasi manusia.

21 Undang-Undang Nomor 10 Tahun 1992 tentang Perkembangan Kependudukan dan Pembangunan Keluarga Sejahtera Undang Nomor 52 Tahun 2009 tentang perkembangan Kependudukan dan Pembangunan Keluarga Keluarga Berencana adalah upaya mengatur kelahiran anak, jarak dan usia ideal melahirkan, mengatur kehamilan melalui promosi, perlindungan dan bantuan sesuai dengan hak reproduksi untuk mewujudkan keluarga berkualitas.

22 ISU penting 1. Jumlah penduduk di atas proyeksi 2. Disparitas TFR masih tinggi dan meningkat pada status sosial ekonomi 3. menengah ketas. 4. Kenaikan CPR 1,1 persen dalam 5 tahun 5. Unmet need tinggi 6. Kesertaan MKJP rendah (Metode Kontrasepsi Jangka Panjang) 7. Tingkat Ketidaklangsungan Pemakaian (drop out) Kontrasepsi Meningkat 8. Pelayanan KB di fasilitas pelayanan kesehatan menurun 9. Angka Kematian Ibu tinggi

23

24

25

26

27 Historical Review of Interventions The flawed assumption: Most life-threatening obstetric complications can be predicted or prevented

28 Interventions: Traditional Birth Attendants Advantages Community-based Sought out by women Low tech Teaches clean delivery Disadvantages Technical skills limited May keep women away from life-saving interventions due to false reassurance

29 Interventions: Traditional Birth Attendants Conclusion: TBAs are useful in the maternal health network, but there will not be a substantial reduction in maternal mortality by TBAs delivering clinical services alone

30

31

32

33 Interventions: Antenatal Care Antenatal care clinics started in US, Australia, Scotland between New concept - screening healthy women for signs of disease By 1930 s large number (1200) ANC clinics opened in UK No reduction in maternal mortality However, widely used as a maternal mortality reduction strategy in 1980 s and early 1990 s Is ANC important? YES!! Early detection of problems and birth preparation

34 Maternal Mortality: UK Improvements in nutrition, sanitation Antenatal care Antibiotics, banked blood, surgical improvements Maternal Deaths Maine 1999.

35 Interventions: Risk Screening Disadvantages Very-poorly predictive Costly: Removes woman to maternity waiting homes If risk-negative, gives false security Conclusion: Cannot identify those at risk of maternal mortality every pregnancy is at risk

36 Interventions: Skilled Attendant at Childbirth Proper training, range of skills Assess risk factors Recognize onset of complications Observe woman, monitor fetus/infant Perform essential basic interventions Refer mother/baby to higher level of care if complications arise requiring interventions outside realm of competence Have patience and empathy WHO 1999.

37 The higher the proportion of deliveries attended by skilled attendant in a country, the lower the country s maternal mortality ratio Maternal deaths per live births R 2 = 0.74 Y Log. (Y) % skilled attendant at delivery

38 Summary Skilled attendant at childbirth is the most effective intervention WHO 1999.