6 Improve maternal health

Where we are

Women who live in urban areas are more likely to give birth in a health care facility than those who live in rural areas

There has been a significant decrease in the maternal mortality ratio, with Rwanda making good progress towards achieving the MDG Target of reducing the rate from 1,300 per 1000,000 live births in 1990 to 325 in 2015. By 2010 the MMR was 487. The main reason for the improvement is an increasing number of women giving birth in a health-care facility attended by a qualified health care professional and the introduction of maternal death audit.  However, to achieve the Target it will be necessary to significantly further increase the number of women giving birth in a health- care facility from 52 percent to nearer the WHO Target of 90 per cent (WHO 2007) as well as encouraging more pregnant women to attend for an early antenatal visit and make the four recommended visits (Jayaraman et al 2008). It is estimated that around 52 per cent of maternal deaths can be averted by providing extended obstetric care (Wagstaff and Claeson 2004).

There has been an increase in the proportion of births attended by skilled health personnel, with 69 per cent of mothers now being cared for by a skilled health-care worker during delivery (Figure3 8). However, accelerated progress will need to be made if the WHO Target of 90 per cent of births attended by skilled health personal is to be met by 2015 (WHO 2007).

By 2010, not only had the MMR declined significantly, but the proportion of maternal deaths due to postpartum haemorrhage had declined to 28 per cent showing that the hospitals had been able to develop procedures to reduce maternal mortality from this cause.

There has been a dramatic increase in the uptake of modern contraception mentods especially since 2005 when the rate was 10 per cent uptake by married women of child bearing age. However, there is still some way to of the EDPRS 2012 Target of 70 per cent. There remains an unmet need  for contraception, that is women saying they wish to use modern contraception but not doing so. The unmet need was 38 per cent in 2000, 36 per cent in 2005 and 17 per cent in 2010 (DHS 200, 2005, 2010).      

Between 2008 and 2010 the hospital-based MMR nearly halved from 400 to 217 almost certainly due to the introduction of Maternal Death Audit. Understanding the causes of maternal mortality enables providers to put in place preventive policies and strategies.The Ministry of Health, with the financial and technical support of WHO and UNFPA, introduced the Maternal Death Audit approach for reducing maternal mortality in 2008 in all district and referral hospitals.  All the maternal deaths that occurred were audited for the cause. The audit in 2008 showed that the two main causes of maternal mortality, accounting for 72 per cent of all deaths, were postpartum haemorrhage and obstructed labour.

Maternal Mortality Rate

Bar Chart
Targets for MDG 5
  1. Reduce by three quarters the maternal mortality ratio
    • Most maternal deaths could be avoided
    • Giving birth is especially risky in Southern Asia and sub-Saharan Africa, where most women deliver without skilled care
    • The rural-urban gap in skilled care during childbirth has narrowed
  2. Achieve universal access to reproductive health & inadequate funding for family planning is a major failure in fulfilling commitments to improving women’s reproductive health
    • More women are receiving antenatal care
    • Inequalities in care during pregnancy are striking
    • Only one in three rural women in developing regions receive the recommended care during pregnancy
    • Progress has stalled in reducing the number of teenage pregnancies, putting more young mothers at risk
    • Poverty and lack of education perpetuate high adolescent birth rates
    • Progress in expanding the use of contraceptives by women has slowed & use of contraception is lowest among the poorest women and those with no education