Looking “beyond the numbers” to save mothers’ lives in Ukraine


On 13–16 September 2011, the Ministry of Health of Ukraine hosted a three-day technical workshop and one-day national conference to discuss and adopt new ways to reduce maternal mortality and morbidity in the country. More than 80 national experts from all 27 administrative territories of Ukraine attended; WHO/Europe, the Swiss Agency for Development and Cooperation (SDC) and the United Nations Population Fund (UNFPA) supported the events.

Reducing maternal mortality is a Millennium Development Goal. The Ministry, supported by international partners, sought modern answers to the questions of where things go wrong and what can be done about it. Answering these questions is as important as knowing the precise level of maternal mortality. Beyond the Numbers, a WHO approach to analysing maternal deaths and severe obstetric complications, proposes ways to find what goes wrong and offers diagnostic tools to indicate what needs to be done to prevent severe maternal morbidity and death.

“Beyond the Numbers is a logical and very timely step forward, following the significant improvement in birth practices in the country in recent years. This improvement is related to the implementation of the WHO effective perinatal care package: evidence-based, family-oriented obstetrical and neonatal interventions,” said Dr Raisa Moiseenko, First Deputy Minister of Health of Ukraine, in her speech opening the workshop.

Speaking at the event, Dr Igor Pokanevych, Head of the WHO Country Office, Ukraine, emphasized: “It is my great belief that this method of analysing maternal deaths and severe complications, which is about to be adopted in Ukraine over the coming months, will help to save hundreds of women’s lives and improve their health and access to health services.”

During the workshop, professionals from the Ministry of Health of Ukraine, leading medical institutions and four pilot maternity units committed themselves to implementing these modern auditing methods very soon, to achieve high-quality birth care in the country that meets the highest international standards.

Behind the Numbers

Confidential enquiry into maternal deaths (CEMD) and near-miss case review (NMCR) are two new procedures that were presented and discussed during the event. CEMD has proved to be a powerful instrument in reducing maternal deaths and improving health systems’ performance since it was first introduced in the United Kingdom several decades ago. CEMD recognizes that every maternal death tells a story that provides valuable information to improve the quality of health care. Its power resides in the recognition that maternal losses are more often failures of the health system, rather than individual providers, so the approach should focus on system actions, rather than seeking to lay blame on an individual.

For every woman that dies in childbirth, 100 survive life-threatening conditions. These women are considered near-miss cases, and WHO has developed NMCR as a systematic method to analyse and learn lessons from them, and find ways to improve the quality of obstetric care.