1. Maternal Care Access
in Sudan
Geneva Foundation for Medical
Education and Research
GFMER Sudan 2012
Forum No: ( 1 )

2. Name of presenter
Name Position Institution
Sawsan Mustafa Abdalla Associated Professor National Ribat University
Name of contributors
Name Position Institution
Sawsan Mustafa Abdalla Associated Professor National Ribat University
Asharaf Ahmed

3. Content of the presentation
 Background
 RH services current status
 National monitoring indicators
 Health status
 Safe motherhood: A human right yet to be fulfilled
 Previous studies
 References

4. Maternal Care Access
The International Conference on Population and
Development, drawing on the WHO definition
of health, defined reproductive health as a
‘state of complete physical, mental and social
wellbeing and not merely the absence of
disease or infirmity, in all matters relating to
the reproductive system and to its functions
and processes’(1).

5. Reproductive health

6. Maternal Care Access
The availability of good quality reproductive
health (RH) services is a vital social and
economic investment.
provision of efficient, equitable and quality
reproductive and sexual health services will go
a long way in improving the health of the
population.

7. Maternal Care Access
the national policy of RH Stated that: shall
provide maternity and child care and medical
care for pregnant women’.

8. Maternal Care Access
The policy document provides direction to
Sudan national health system setting an
agenda for reforms assuring the reproductive
health services are available not only
throughout a woman’s life-cycle but ensuring
her the right to survive pregnancy and
childbirth and enjoy a good family life

9. Maternal Care Access
Maternal mortality figures for Sudan are one of
the highest in the world. On average,
according to Sudan Household Health Survey
(2006), every day about forty women die due
to causes associated with birth

10. Maternal Care Access
While in certain parts of country, situation could
even be worse, these figures might only be a
tip of the iceberg due to underreported
maternal deaths and or incorrectly attributed
and classified as cause. High maternal
mortality is also an indication of high infant
mortality

11. Maternal Mortality Ratio in the EMR: 2006
1800
16001600
1600
1400
1200 1107
1000
800
600 546
465
395
350 366 370
400 294
227
200
68 104
0 0 7 13 18 21 23 37 40 41 45 65
0
KUW
UAE
EGY
JOR
SUD
TUN
LEB
IRQ
AFG
DJI
BAA
SYR
IRA
MOR
PAK
QAT
LIY
YEM
SOM
OMA
SAA
PAL
AVG(90)
AVG(00)
AVG(04)

12. National monitoring indicators
• % pregnant women who have at least one
antenatal visit 94.8%
• % of pregnant women who have a trained
attendant at delivery 89%
• % of pregnant women immunized against
tetanus 74%

13. National monitoring indicators
Contraceptive prevalence rate 20%
% of infants weighing less than 2500 g at birth
prevalence of female genital mutilation 70.3%
Maternal mortality ratio 1107/100.000

14. Health status
-Sudan is lagging behind the target for achieving
MDGs, particularly for the health
related MDGs.
-The national maternal mortality ratio averages
1,107 deaths per 100,000 live births with wide
interstate variations

15. Health status
The infant mortality rate is estimate at 81 per 1000
live births and about half of these are neonatal
deaths (41/1000 live birth)
occurring during the first month of life
(SHHS, 2006).
Under 5 mortality is 105 and 126 per 1,000 live
births in north and south respectively, while
comparable figures for infant mortality are 70
and 89.

16. Health status
Sudan has three layers of care provision.
At the apex of pyramid are the teaching, general
and specialist hospitals rendering
secondary and tertiary care
For primary care, the rural hospitals are first
referral care with indoor and diagnostic
facilities.

17. Health status
Primary care is provided through a variety of
outlets:
PHC unit:- staffed by a community health
worker.
dressing station:-staffed by a trained nurse or
experienced community health worker.
Dispensary:-
staffed by a medical assistant and a nurse, and
provide PHC services.

18. Health status
The health centers:- which are referral for
primary health care facilities
staffed by two medical officers, and paramedics,
i.e. medical assistant, health visitor, nutrition
instructor and vaccinator

19. Health status
45-65% of population has access to PHC
services, i.e. on average, 1 facility serves
12,000 people.

20. Health status
The policy supports comprehensive reproductive
health care which is accessible, affordable,
appropriate, efficient and effective; and for
that purpose, it can be delivered through

21. The Reproductive Health Package
 Safe motherhood services
 family planning
 harmful practices
 unwanted pregnancy
 unsafe abortion
 reproductive tract infections including sexually
transmitted diseases and HIV/AIDS
 gender-based violence
 infertility
 reproductive tract cancers
 Violence against women
 Women empowerment

22. Health status
it can be delivered through:
Integration of reproductive health services with
mainstream primary health care

23. The neglected tragedy of maternal
mortality
Safe motherhood: A human right yet to be
fulfilled
• “When reporting on the right to life
protected by article 6, States Parties should
provide data on …..pregnancy and childbirth-
related deaths of women……..”
UN Human Rights Committee, General Comment 28 (2000): Equality of rights between
Men and Women (Article 3). 10

24. Safe motherhood: A human right yet
to be fulfilled
• Mothers have a right to life
• Maternity is not a disease
• Motherhood can be made safer
• Millions of women are denied exits from the
maternal death road
• A question of how much a woman’s life is
considered worth

25. Motherhood can be made safer
The interventions that make motherhood
safe are known and the resources needed are
obtainable. The necessary Services are
neither sophisticated nor very expensive,
and reducing maternal mortality is one of the
most cost-effective strategies available in the
area of public health.
Message from WHO Director-General, World Health Day, 1998

26. Previous study
• A cross-sectional community-based study was
carried out in Kassala, eastern Sudan.
• The aim of this study was to investigate
coverage of antenatal care and identify factors
associated with inadequacy of antenatal care
in Kassala, eastern Sudan

27. Previous study
811(90%) women had at least one visit. Only
11% of the investigated women had ≥ four
antenatal visits, while 10.0% had not attended
at all. Out of 811 women who attended at
least one visit, 483 (59.6%), 303 (37.4%) and
25 (3.1%) women attended antenatal care in
the first, second and third trimester,
respectively.

28. Previous study
Antenatal care showed a low coverage in
Kassala, eastern Sudan. This low coverage was
associated with high parity and low husband
education.

29. References
1-Programme of Action of the International Conference on
Population and Development (ICPD), New York, United Nations,
1994
2-National health policy, Sudan 2007
3-UNDP, MDGs in Sudan, http://www.sd.undp.org/mdg_sudan.htm
accessed on 27 March, 2010
4-Federal Ministry of Health (2007), Annual Health Statistical Report,
2007, National Health Information Centre, Federal Ministry of Health
Khartoum