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Removal of retained products following miscarriage or abortion Assisted vaginal delivery, preferably with vacuum extractor. Newborn care
Comprehensive emergency obstetric and newborn care, typically delivered in district hospitals, includes all basic functions above, plus Caesarean section, safe blood transfusion and care to sick and low-birthweight newborns, including resuscitation. Guidelines jointly issued in 1997 by WHO, UNICEF, and UNFPA, recommended that for every 500,000 people there should be four facilities offering basic and one facility offering comprehensive essential obstetric care. These guidelines were revised in 2009 with additional support from AMDD (the Averting Maternal Death and Disability Programme of Columbia University) and published in Monitoring Emergency Obstetric Care: A Handbook. The handbook details the newly revised indicators for assessing the availability, use and quality of obstetric services. To manage obstetric complications the life-saving component of maternity care a facility must have at least two skilled attendants covering 24 hours a day and seven days a week, assisted by trained support staff. To manage complications requiring surgery, the facilities must have a functional operating theatre, more support staff and must be able to administer blood transfusions and anaesthesia. Existing facilities (district hospitals and health centres) can often, with just a few changes, be upgraded to provide emergency obstetric and newborn care.
The first two "delays" (delay in deciding to seek care and delay in reaching appropriate care) relate directly to the issue of access to care, encompassing factors in the family and the community, including transportation. The third "delay" (delay in receiving care at health facilities) relates to factors in the health facility, including quality of care. Unless the three delays are addressed, no safe motherhood programme can succeed. In practice, it is crucial to address the third delay first, for it would be useless to facilitate access to a health facility if it was not available, well-staffed, wellequipped and providing good quality care.
UNFPA at work
UNFPA works at many levels and with many partners to expand access to obstetric care from advocating health reform policies and upgrading health facilities to mobilizing communities to prepare for and respond to obstetric emergencies. UNFPA is an active member of the Partnership for Maternal, Newborn and Child Health and the Women Deliver initiative. Its work contributes to the Every Woman Every Child effort in support of the Global Strategy for Womens and Childrens Health. The Fund spearheaded the Campaign to End Fistula, which aims to prevent this debilitating injury of childbirth by ensuring that all women who experience complications during delivery can get to emergency obstetric care. UNFPA also seeks to raise nearly $500 million to save the lives of women who experience complications during pregnancy and childbirth through the Thematic Fund for Maternal Health.