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Notable progress has been made in reducing the maternal mortality ratio (MMR) in sub-Saharan Africa, which declined by 49 per cent over 23 years, from 990 deaths per 100,000 live births in 1990 to 510 per 100,000 in 2013. In the East and Southern African region, several countries have made progress towards MDG 5, in particular Rwanda, Ethiopia, Eritrea and Angola.

Despite this good news, much remains to be done. An estimated 64,000 women died in childbirth in East and Southern Africa in 2013. Moreover, the majority of countries are far from reaching the Millennium Development Goal 5 target to improve maternal health.

Countries heavily affected by HIV in East and Southern Africa have made little or no progress since 1990. Some ESA countries initially saw an increase in their MMR due to HIV & AIDS. However, this trend is now reversing in the context of increasing HIV testing and ART initiation for pregnant women.

Conflict and political instability also negatively affect the MMR in the region. South Sudan, for instance, initially reported an extremely high MMR rate but this is now reversing.

Although women who receive regular antenatal care are far more likely to give birth with a skilled health attendant and are better able to recognise the signs of complications before, during and after delivery, antenatal care coverage remains very low. In nearly half of all countries in the ESA region, more than 90 per cent of women make at least one antenatal visit.

However, in countries where maternal mortality presents the biggest challenge among women of reproductive age, such as Ethiopia, fewer than half of all women make even one antenatal visit. In many countries, the quality of care is poor and while the first antenatal check-up may be free, women must pay for subsequent visits.

Postnatal care coverage is not reported on by most countries in the region, particularly coverage for the 2-3 day postnatal visit. Where reported, the percentage is extremely low.

Bleeding during pregnancy or childbirth accounts for one quarter of all maternal deaths in East and Southern Africa. Many lives are also claimed by high blood pressure, obstructed labour, HIV, malaria, tuberculosis and infections. Other important risk factors include women marrying and having babies while still in their teens, short intervals between births, and high numbers of lifetime pregnancies.

UNFPA works to promote the four pillars of maternal health. These include timing and spacing of pregnancies through the use of modern contraceptives, antenatal care, safe delivery and emergency obstetric care. In addition, UNFPA uses advocacy for high-level policymakers and opinion leaders, and community mobilization. For instance, international initiatives such as the UN Secretary-General’s Global Strategy on Women’s and Children’s Health, and continental initiatives such as the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA), as well as the Maputo Plan of Action, besides other national and local projects and programmes, have raised awareness and contributed to increased financing for maternal health. 

In the East and Southern Africa region, UNFPA advocates for greater support for sexual and reproductive health as a basic human right and a health sector priority. The Fund supports family planning services, including high quality contraceptive methods; develops the capacity of skilled birth attendance for maternal health care through training programmes and encouraging the use of international clinical standards; and promotes laws and policies that ensure the reproductive rights of women and adolescents. UNFPA works to end child marriage, female genital mutilation and gender-based violence. The Fund also advocates for programmes to expand basic health coverage for the most impoverished and marginalized communities.