Colombian Experience In Pursuit of MDG 5: Reducing Maternal Mortality

[This post was written jointly by María Fernanda Escobar, Edgar Iván Ortiz Lizcano and Germán Gallego Vega.  María Fernanda Escobar was one of the professionals selected to participate in the first edition of the workshop Safe Mothers & Newborns: A Leadership Workshop, which took place in Barcelona from June 28 to July 3, 2015.]

In 2000, Colombia was one of the 189 countries that endorsed the United Nations Millennium Declaration, making a commitment to meeting the Millennium Development Goals (MDGs). One of the targets of MDG  5 (Improve Maternal Health) was to reduce by three quarters the worldwide maternal mortality ratio (the number of maternal deaths per 100 000 live births) between 1990 and 2015. Taking the national ratio recorded in 1998 as a baseline, the target set by Colombia was to reduce the country's maternal mortality ratio to 45 deaths per 100 000 live births.

In 2014, the country’s national statistics body (DANE-Departamento Administrativo Nacional de Estadística) reported a maternal mortality ratio of 53.4, corresponding to 344 maternal deaths occurring within 42 days of delivery and an average of 6.6 early maternal deaths per week. This reduction represented 85% of the national target.

A significant reduction has been achieved in early maternal deaths over the five-year period 2011-2015A significant reduction has been achieved in early maternal deaths over the five-year period 2011-2015. The outcomes observed at epidemiological week 24 in 2015 (SIVIGILA: National Institutes of Health) show an average of 6.0 early maternal deaths a week, a figure lower than the weekly average of 6.5 deaths calculated as meeting the Millennium Development Goal. Thus, if this trend is maintained, Colombia will reach its national target of 45 maternal deaths per 100 000 live births. What were the measures that made this progress possible? This improvement was the result of implementing a series of interventions, protocols and processes designed to respond to the needs of the country, which included the following:

• Achieving access to modern contraceptive methods for 75% of women of childbearing age (Colombia is the sixth country in the Americas to achieve this level of coverage)
• 99% of births in an institutional setting, attended by qualified personnel in 99% of cases
• Developing technical standards and care guidelines for the early detection of abnormalities during pregnancy, the care of normal deliveries and those involving shoulder dystocia applying the principles of humanized birth, the care of pregnant girls under 15 years of age, preconception health care, and elective termination of pregnancy

·         Since 2010, a clinical safety model for dealing with obstetric emergencies has been implemented through a partnership between the Ministry of Health and the Colombian Federation of Obstetrics and Gynecology (FECOLSOG). The model incorporates an assessment of the capacity of institutions to deal with these emergencies and to detect and analyse cases of extreme maternal morbidity and to identify opportunities for improving the quality of care. It also includes tools that facilitate the implementation of the action plans for improvement, including checklists, flowcharts for managing emergencies and kits containing necessary supplies. Finally, in an initiative entitled “Key Practices that Save Lives”, personnel received training that improved their capacity to recognise, manage and report on morbidities.

These advances in the creation of an effective public policy include the principal elements necessary to further improve Colombia's maternal and perinatal health indicators. While MDG 5 may be past history, the future may bring major challenges but it will not slow down the successful processes that have been shown to be effective.

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