2022 UNFPA Report: Maternal Mortality – West Bank

19 September 2024

The reported MMR figure in Palestine in 2019 was below the SDG target at 19.9 per 100,000 live births. The overall MMR in both the WB and Gaza has improved, decreasing by around 48% from 38 per 100,000 live births in 2009 to around 19.9 in 2019. But in 2020 and 2021 there was a noticeable increase in MMR to 28.5 and 47.7 per 100,000 live births, respectively. This reflects the negative impact of the corona pandemic on the number of maternal deaths.

Maternal mortality reflects women’s overall access to healthcare as well as the quality and responsiveness of the healthcare system to their needs.  Therefore, analysis of maternal mortality is not only crucial for identifying the factors contributing to maternal mortality, but also for evaluating the existing interventional programs.

The objectives of this report are:

1.1 Explore clinical characteristics of maternal deaths.
1.2 Explore the underlying causes of maternal deaths.
1.3 Explore the factors contributing to maternal death.
1.4 Form recommendations for corrective measures.
1.5 To explore whether MMR has recovered right after the corona pandemic.

Recommendations

For policymakers, service planners, and service managers:

• Improve the gaps in the hospital health information system.
• Closely monitor ANC provided at private sectors by the MOH and implement actions regarding including licensing these clinics if not abiding to unified protocols and standards.
• Ensure that women’s electronic records can be easily accessed and shared when they receive care in different settings regardless of the place of antenatal care. This requires that governmental and private antenatal care clinics be part of the electronic system.
• Improve communication between governmental and private sector.
• Propose recommendation and implementation by government towards private health insurance i.e. coverage of high-risk maternal condition should be imposed and requested as part of any private insurance.
• Improve screening and management of high-risk pregnancies and ensure that they are transferred at a timely manner to be followed up in the hospital where childbirth is expected to allow adequate preparation and planning for birth.
• Speed up the maternal death notification process, where the file is followed up in less than a week of death and participation of all the medical team involved in the care of the deceased woman in each city.
• Implementing maternal clinical audit in each maternity ward that should include all physicians (consultants, seniors, juniors, medical students) and midwives (maternal mortality review committee), to stand on the causes that led to death in addition to considering the circumstances of death and if there is any failure to learn the lesson and correct the mistake in the future.
• Consider skills and drills training on the risk assessment and management of pre-eclampsia, PPH, sepsis, and venous thromboembolism as per national guidelines.
• Improve coverage and quality of postnatal care.
• Form supervising committees to monitor the residency program in the specialty of obstetrics and gynecology

For health professionals and those designing professional education programs:

• All health professionals should manage pregnant women with chronic diseases in a multidisciplinary manner.
• Proper patient counseling and education on signs and symptoms necessitating seeking medical care.
• All women should undergo a regular ongoing documented assessment of risk factors for high-risk conditions such as venous thromboembolism, in the antepartum, intrapartum and postpartum periods.
• All health professionals should remember that perimortem cesarean section is a resuscitative procedure to be performed primarily in the interests of maternal, not fetal, survival.
• Improving the care of women with mental health problems so healthcare professionals need to be alert that any new expressions or acts of violent self-harm or new persistent expressions of incompetency as a mother are red flag symptoms and should always be regarded seriously.