70
PRIORITYMEASURE40
“Eliminate preventable cases ofmaternal morbidity andmortality, including, within the set of integrated benefits of sexual healthand reproductive health services,
measures for preventing andavoiding unsafe abortion, including sexual health and reproductive health education, access tomodernand effective
contraceptivemethods, counselling and comprehensive care in cases of unwantedand unacceptedpregnancy, aswell as comprehensive
post-abortion care, where necessary, on the basis of a risk- andharm-reduction strategy.”
Possible lines of action
1. Strengthen primary care, establishing standards, guidelines, training for personnel, supervision of service quality and participation of
community-based organizations; 2. Ensure free and compulsory care for pregnant women throughout the national territory; 3 Implement
pregnancy care programmes that guarantee a minimum number of prenatal checkups as well as quality institutional care at childbirth to
prevent avoidable deaths; 4. Take the measures necessary to reduce delays in identifying and responding to obstetrical emergencies;
5. Have in place strategies for targeting prevention and care among subgroups of women for whichmaternal mortality rates are highest:
indigenous women, Afro-descendent women, rural women and others that the country may have identified; 6. Earmark the necessary
resources for the functioning of sexual and reproductive health programmes and services, and in particular those for maternal care, with
high standards of quality including the various measures of prevention for women of reproductive age; 7. Promote measures to prevent
unwanted pregnancies.
Targets
1. To have in placematernal health programmes and services at the local level (in all municipalities); 2. To eliminate preventablematernal
deaths and reduce other causes ofmaternal death to virtually zero; 3. By 2030, reduce thematernalmortality ratioby at least two-thirds from
the2010baseline (for an annual rateof reductionof 5.5%).
Tentative indicators
1. Percentage of preventablematernal deaths, by cause of death and disaggregated by race or ethnicity, place of residence, age, education
level; 2. Maternal mortality rate (number of maternal deaths per 100,000 live births); 3. Percentage of births attended by skilled health
personnel; 4. Postnatal care (for mother and child; at home on in a health establishment) within the first two days of birth; 5. Percentage
of health centres (including primary care establishments) that have implemented updatedmaternal care protocols; 6. Existence of policies
to strengthen the role of midwives or obstetrical nurses in the health services; 7. Existence of a system of referral to emergency
obstetrical care services; 8. Existence ofmaternal death surveillance systems; 9. Legal status of abortion.
Related instruments,
forums andmechanisms
1. SDG 3, “Ensure healthy lives and promotewell-being for all at all ages”: target 3.1. “By 2030 reduce the globalmaternalmortality rate to
less than 70 per 100,000 live births;” 2. In the Inter-American system, the Protocol of San Salvador expressly enshrines the obligation of
States toprovide adequateprotection forwomen and inparticular toprovide special care and assistance tomothers before childbirth and for a
reasonable time afterwards, without discrimination of any kind (articles 3 and 15); 3. Santo Domingo Consensus C79: “Ensure effective
implementation and institutionalization of comprehensive education on sexuality in education systems, as ameans of preventing adolescent
pregnancy and maternal mortality, and to prevent unwanted pregnancies in general and guarantee women and adolescent girls the full
exercise of their sexual rights and reproductive rights such that they can take free, informed and responsible decisions in relation to their
sexuality, sex life and sexual orientation, including the right to motherhood of women with HIV/AIDS;” 4. Brasilia Consensus,
6g): “Strengthen and broaden plans and programmes that promote healthymaternity and prevent maternal mortality by ensuring universal
access tohealth-care services, especially for indigenous andAfro-descendent adolescent girls andwomen.”
Comments
PM 40 focuses onmaternal health care. Other components are developed in Prioritymeasures that deal with: (i) preventing and avoiding
unsafe abortion, including sexual and reproductive health education (PM 42); (ii) access tomodern and effective contraceptivemethods
and comprehensive advice and care in case of unwanted and unaccepted pregnancy (PM 44); 2. PM 40 is complementary to PM 11 on
comprehensive sexuality education, PM 37 on access to comprehensive SRH services, PM 87 on the rights and sexual health of
indigenous peoples, in particular as they relate to reducingmaternal mortality, and PM 95 on the sexual and reproductive health of Afro-
descendent persons.
