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 a 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% to nearer the WHO Target of 90% (WHO 2007) as well as encouraging more pregnant women to attend early antenatal visits and to make the four recommended visits (Jayaraman et al 2008). It is estimated that around 52% 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% 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% 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% 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% uptake by married women of child bearing age. However, there is still much room for improvement in order to reach the EDPRS 2012 Target of 70%. 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% in 2000, 36% in 2005 and 17% in 2010 (DHS 2000, 2005, 2010).
Between 2008 and 2010 the hospital-based MMR nearly halved from 400 to 217, which was 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, which accounted for 72% of all deaths, were a result of postpartum haemorrhage and obstructed labour.
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