Most maternal deaths are directly due to obstetric complications.

Among the main causes of maternal mortality, the most prevalent are obstetric haemorrhaging, severe forms of gestosis, and other complications of pregnancy.

Apart from these measures, the Government has encouraged the establishment of Mother Friendly Hospitals and Mother Friendly Sub Districts that provide appropriate obstetric emergency care and monitor pregnant women for early detection of obstetric complications, referrals and emergency preparedness.

In addition, the presence of a trained attendant at delivery and access to emergency obstetric care are essential to preventing deaths occurring because of complications during delivery.

Recognizing also that early pregnancy and early childbearing entail complications during pregnancy and delivery and a much higher risk of maternal mortality and morbidity, and deeply concerned that early childbearing and limited access to the highest attainable standard of health, including sexual and reproductive health, including in the area of emergency obstetric care, cause high levels of obstetric fistula and other maternal morbidities as well as maternal mortality,

Of the 146 maternal deaths recorded in 2002, 116 were due to obstetric causes and 30, to non obstetric causes.

Manual for dealing with obstetric emergencies.

As a support to training in emergency obstetric care, WHO has, to date, provided 3,000 copies of the manual, Managing complications in pregnancy and childbirth in Dari, which has been endorsed by the Ministry of Public Health as the national standard training manual for emergency obstetrics care.

There are 3 upper level obstetric centres.

We haven't had that many complications.

And the most devastating injury is obstetric fistula.

62 138. Supporting efforts to end obstetric fistula

Table 11 Maternal mortality, by obstetric cause, 2002

Table 13 Non obstetric maternal mortality, 2001 2002

Dealing with obstetrical complications and neonatal emergencies.

There are obstetric and gynae wards in most major hospitals.

However, there's always kinds of complications in this.

These services, based on the concept of informed choice, should include education on safe motherhood, prenatal care that is focused and effective, maternal nutrition programmes, adequate delivery assistance that avoids excessive recourse to caesarean sections and provides for obstetric emergencies referral services for pregnancy, childbirth and abortion complications post natal care and family planning.

They are the general guidelines for the organization and standardization of emergency obstetric care (2000), the protocol for obstetric and paediatric care (2001) and the abortion care protocol (2002).

The following table shows the distribution of direct and indirect obstetric deaths.

Deeply concerned that early childbearing and limited access to sexual and reproductive health care, including in the area of emergency obstetric care, causes high levels of obstetric fistula and maternal mortality and morbidity,

The following table shows the primary causes of direct obstetric death in 2002

The number of obstetric wards (maternity hospitals) has remained unchanged (19 in total).

Obstetric wards of county hospitals and private hospitals are institutions of the secondary level.

One of the consequences of such traditional practices, particularly early marriage, is obstetric fistula.

And during that learning curve the complications went quite a bit higher.

By 31 December 2003, 93.2 of ward clinics have midwives and obstetric pediatric assistant doctors.

In cases of pregnancy and maternity complications, the compensation is 100 per cent.

(b) To strengthen the capacity of health systems to provide the essential services needed to prevent obstetric fistula and to treat those cases that do occur by providing the continuum of services, including family planning, prenatal care, skilled birth attendance, emergency obstetric care and post partum care, to young women and girls, including those living in poverty and in underserved rural areas where obstetric fistula is most common

Further complications arise in cases where tissues donated without compensation are later sold for profit.

The total collapse of the State and its institutions has created internal complications and instability.

Emergency obstetric Care facilities through Women friendly hospitals in 20 districts of Pakistan under the Women Health Project.

I think that this will result in my surgeries with a better outcome and fewer complications.

(c) Sick leave shall not normally be granted for maternity cases except where serious complications arise.

(d) To develop a national strategy of prevention and treatment to effectively address the condition of obstetric fistula and to further develop a multisectoral, comprehensive and integrated approach to bring about lasting solutions and a meaningful response to the problem of obstetric fistula and related morbidities

(i) To develop means of transportation and financing that enable women and girls to access obstetric care and treatment, and provide incentives and other means to secure the presence in rural areas of qualified health professionals who are able to perform interventions to prevent obstetric fistula

For example, the provision of maternal health services, including emergency obstetric services, must be available to all young women.

In February 2004, a National Seminar on Obstetric and Neonatal care was held to establish the Pact's strategic actions.

Another consequence of rape is increased maternal mortality related to the higher risk of complications during childbirth.

12. Invites Member States to contribute to efforts to end obstetric fistula, including, in particular, the United Nations Population Fund global Campaign to End Fistula, with the goal of eliminating obstetric fistula by 2015, in line with the targets of the millennium development goal of improving maternal health

In the health sector, the United Nations Population Fund (UNFPA) supported the improvement of emergency obstetric care in district hospitals.

Annually, more than 525,000 women worldwide die from complications of pregnancy or delivery, almost all in developing countries.

Examples of synergies are found in the IMCI and ACSD initiatives, in some obstetric care programmes and as described in paras.

Lastly, a survey had been conducted in 2003 with a view to measuring the availability and use of emergency obstetric services.

There is a high unmet need for contraception, and complications from unsafe abortion pose a serious public health problem.