Maternal health econimics will we achieve millineum goals
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This document provides biographical information about Dr. Narendra Malhotra, an obstetrician and gynecologist from India. It lists his professional roles and accomplishments, which include positions at various universities and hospitals, editorships of medical journals, and awards received. It also provides contact information for Malhotra Hospitals and Rainbow Hospitals, where Dr. Malhotra practices in Agra, India.
![Present scenario of maternal health in Pakistan
• Adolescent health care – patchy
• Pre-conception care – not routinely practiced
•ANC by health prof. – 1 ANC -- 61% ; 4 & more ANC --28% ;
Urban: Rural = 48%: 20%
• Delivered by SBA --39% ; urban : rural = 60% : 30%
• Institutional delivery– 35 % ; Public 11%, Private 24%,
• Home delivery --65% ; urban : rural = 56% : 25%
•Postnatal check up -- 43%
• Referral system – informal, paid by patient’s relatives
[2006-7 PDHS,NIPS, Macro international ]](https://image.slidesharecdn.com/maternalhealtheconimicswillweachievemillineumgoals-130510051854-phpapp01/85/Maternal-health-econimics-will-we-achieve-millineum-goals-47-320.jpg)
Maternal health econimics will we achieve millineum goals
- 1. NARENDRA MALHOTRA M.D., F.I.C.O.G., F.I.C.M.C.H • Prof. Dubrovick International university,croatia • Indian FOGSI representative to FIGO • President FOGSI (2008) • Dean of I.C.M.U. (2008) • Director Ian Donald School of Ultrasound • National Tech. Advisor for FOGSI-G.O.I.—Mc Arthur Foundation EOC Course • Hon Prof Ob Gyn at DMIMS,Sawangi,Advisor ART unit at MAMC & SMS Jaipur • Editor od SAFOG journal • Chairman publication committee of AOFOG • Practicing Obstetrician Gynecologist at Agra. Special Interest in High Risk Obs., Ultrasound, Laparoscopy and Infertility, ART & Genetics • Member and Fellow of many Indian and international organisations • FOGSI Imaging Science Chairman (1996-2000) • Awarded best paper and best poster at FOGSI : 5 times, Ethicon fellowship, AOFOG young gyn. award, Corion award, Man of the year award, Best Citizens of India award • Over 30 published and 100 presented papers • Over 50 guest lectures given in India & Abroad.Presented 10 orations. • Organised many workshops, training programmes, travel seminars and conferences • Editor 8 books, many chapters, on editorial board of many journals • Editor of series of STEP by STEP books • Revising editor for Jeatcoate’s Textbook of Gynaecology (2007) and DONALD OBS MANNUAL(2012) • Very active Sports man, Rotarian and Social worker MALHOTRA HOSPITALS & RAINBOW HOSPITALS ,Agra-282 010 Phone : (O) 0562-2260275/2260276/2260277, (R) 0562-2260279, (M) 98370-33335; Fax : 0562-2265194 [email protected];[email protected];[email protected] www.malhotrahospitals.com;www.rainbowhospitals.org jallandhar,ludhiana,ambala,bhiwani,gwalior,allahabad,gorakhpur,kolkata,bariely,jaipur,delhi,sirsa Neapal & Bangladesh
- 2. MATERNAL HEALTH ECONOMICS IN SOUTH ASIA WILL WE ACHIEVE MILLINIUM DEVELOPMENT GOALS 5 ? Narendra Malhotra Jaideep Malhotra Neharika Malhotra Keshav Malhotra www.rainbowhospitals.org Prof Alokendu Chatterjee Prof Rubina Sohail www.safog.org “Small opportunities are often the beginnings of great enterprises” (Helen Keller)
- 3. "Children are our future, and their mothers are its guardians.” Kofi Annan
- 5. • Each year more than half a million women die from pregnancy related causes and 10.6 million children die, 40% of them in the first month of life. • Almost all of these deaths are in developing countries. Many could be pre- vented with well-known interventions, if only they were more widely available. • In establishing the Millennium goals,years ago, the international community made a commitment to reducing maternal deaths by three quarters, and reducing child mortality by two thirds by the year 2015.
- 6. EVERY DAY A JUMBO JET FULL OF PREGNANT WOMEN CRASHES IN THE WORLD DAILY,KILLING OVER 400 WOMEN DURING PREGNANCY AND CHILDBIRTH THIS NEWS NEVER MAKES DAILY HEADLINES WHY ??
- 7. “mothers are not dying because of disease we cannot treat.They are dying because society has to decide whether their lives are worth saving” -Prof Fathalla
- 8. MAJORITY SOUTH ASIAN WOMEN ARE POOR , POWERLESS & PREGNANT
- 9. It is a call for radical progress in ensuring the health of women and their children. These members of society are often neglected because they are vulnerable. But wherever that happens the whole society is harmed. Today we want to make it absolutely clear to everyone that the health of women, the newborn and children are a priority for our world as a whole, and for every society, every community, and every family. "Make every mother and child count"
- 10. Millennium Goals 2015 GOAL 1: Eradicate extreme poverty & hunger GOAL 2: Achieve universal primary education GOAL 3: Promote gender equality & empowering women GOAL 4 Reduce child mortality
- 11. Millennium Goals 2015 GOAL 5: Improve maternal health GOAL 6: Combat HIV/AIDS, Malaria & other communicable diseases GOAL 7: Ensure environmental sustainability GOAL 8: Develop a global partnership for development
- 14. ASSESMENT OF HEALTH OF A COUNTRY ____ • Adolescent health care – routinely practiced or not • Pre-conception care – routinely practiced or not • Ante Natal Care % -- 1 visit, 3 /4 visits & by whom • Skilled Birth Attendance – % delivered by SBA • Institutional Delivery -- % of Inst delivery • Post natal care -- % of PN care & when • Functional referral system -- how much functional & how quick; who pays for it • MMR – current estimate i.e. for 2011
- 15. BANGLADESH
- 16. Maternal health care scenario is dismal in all South Asian countries (except Sri Lanka) the reasons in Bangladesh • Political will • Infrastructural issues, including basics • Dr/Nurse strength—human resources • Organisational failures • Social evils –female education (%), early marriage (age & %), domestic violence (%) & attitude of your society, particularly attitude of men, on women’s health
- 17. Maternal health scenario- Bangladesh Political will -very much positive in improving MCH Infrastructural issues- CMOC services in: • Community clinic • Upazilla health complex-132 (BMOC in rest UHC) • General hospitals-3 District hospitals - 59 • MCWC-under DG family planning -63 • All medical colleges & specialized hospitals-95
- 18. Human Resources in Health in Bangladesh • Doctor : Patient – 1:4000 • Nurse : Patient - 1:8000 • Nurse : Dr – 1 : 4 • Private Dr : Pt at rural area – 1: 29000 • Health care provider : Population -1:10000 • 5 physicians & 2 nurses /10000 population
- 19. Organizational failure • Failure to increase the budget for MOHFW • Health Workers shortage (specially in rural areas) • Unable to retain trained HWs at EmONC centers • Hard to reach areas ; Logistic ; scarcity • Failure of monitoring • Failure to co-ordinate between H & FP of MOHFW
- 20. Social evils Female education- • Primary education (complete)-14.3% • Secondary education (complete) or higher-9% • No education-27.7% Rest ??? Early marriage- • At 13-14 yrs - 4% • At 15-19 yrs -10.6% • 25% become mothers before 20 years Source-(BDHS 2011) Domestic violence- high ,mainly unrecorded. Attitude of society towards women’s health - Unsatisfactory • women has No decision making power -so repeated child birth. • No regular ANC, under nutrition, anemia • women not allowed to attend hosp even during emergency
- 21. Health economics National health expenses as % of GDP- 1.03% • Health budget - 5.4% total budget in 2011-12 & 4.9% in 2012- 2013 . $ 16 per capita for health/yr • Maternal health budget- 15% of total health budget • Public expenditure as % of total health exp. 33.59% • Private expenditure as % of total health exp. 2.29% • External support as % of total health exp 30% • Health insurance in Preg & child birth No provision
- 22. Strategies to improve Maternal health scenario in Bangladesh • Strengthen health facilities for EmONC services (1994) • Demand Side Financing: Maternal Health Voucher Scheme (DSF:2006) • Maternal & neonatal health (MNHI) program 2007 • Free Tetanus Toxoid for women of child bearing age:2008 • Community based SBA (C-SBA) Program 2003(Target 13,500) • Nurse midwifery training :2010 (Target 3,000)
- 23. Regular financial flow is maintained by • Government’s own fund • Aids from Donor agencies • Development partners (USAID,DFID,CIDA,WHO,UNFPA) • Partial cost recovery • GOB finances 70% (93.55 billion for this fiscal year) and parallel funders contribute remaining 30%, including 15% loans by World Bank
- 24. Role of Bangladesh OBGY Society * OGSB working on Maternal health programs along with GOB, NGOs, UN agencies and development partners • EmoNC-training & monitoring of doctors , paramedics • C-SBA training and monitoring at govt .& private level • Treatment of Eclampsia at community level • Prevention of unsafe abortion –IPAS,FIGO • Human resource development - LSTM, UNICEF • F.P-Training on long acting contraceptions etc
- 25. Will MDG 5 targets be reached by Bangladesh Targets & indicators Unlikely Potentially No data 5A: Reduce MMR by 75% between 1990- 2015 Maternal mortality ratio ✓ most births attended by SBA ✓ 5B: Achieve universal access to reproductive health by 2015 Contraceptive prevalence rate ✓ Adolescent birth rate ✓ ANC (one/ four visits) ✓ Unmet need or family planning ✓ Achieving Millennium Development Goals 4 and 5 in Bangladesh S Chowdhury,LA Banu,TA Chowdhury, S Rubayet, S Khatoon BJOG Sep, 2011
- 27. Per100000livebirths CHANGING TRENDS IN MMR IN INDIA (1950-2011) Target- M M R 109 by 2015 Source- RGI, Lancet, vol 378 ; sept, 2011
- 28. Unfavorable maternal health in India Reasons ---Political Will • Not a priority agenda for any political party • National opinion has never focused on maternal health as a burning issue • We need to decide to save women’s lives
- 29. Unfavorable maternal health in India Reasons -- Infrastructure • Nearly 80% of Mat Health care provided by private sectors in India • Dr :Pt 1:1953 or 0.5 Dr /1000 Indian (WHO-- 1/ 1000) • Only 0.86 hospital beds per 1000 people • Health facilities maldistributed & mostly in urban areas • Transport & connectivity need vast improvement Times of India, March 6, 2012 Financial Express, July 8, 2009
- 30. Unfavorable maternal health in India Reasons-- Organisation • No central theme • Diffusion of focus from EmOC and SBA cares • Lack of integration • Inadequate monitoring and evaluation
- 31. Unfavorable maternal health in India Reasons -- Social Issues Female Education - Adult literacy rate: females as a % of males, 2005-2010, is 68% • Age at Marriage – 18% by age 15, 47% by age 18 • Domestic violence – ‘Wife beating’ justified by 51% of men and 54% of women. violence by husband on > 40% married Indian women • Sexual violence -- 1 in 2 women suffer in India NFHS III, 20005 – 6 http://www.unicef.org/infobycountry/india_statistics.html
- 32. Health Economics -- lop sided State health exp as % of GDP: 1. 4%(2011)-- 3%(2022) Public expenditure on health: 20. 3% ** Private expenditure on health: 77.4% mostly own/family exp External Support: 2.3% Source : National Health Accounts India (2001 – 2002), NHA Cell, MoHFW, GOI Effect of hospitalisation – 35% pt drop to BPL , 40% borrow/sale assets, 20% (U) 28%(R)- no funds for health care. Insurance coverage -just 1% ** USA Public health exp. 50% ; West European states > 80% (Scieber & Poullier, 1988)
- 33. Health Economics - Insurance • Chiranjeevi Scheme of GOI--PPP model, where fees paid to Drs. For Obst & other RH services • In private insurance, most policies exclude pregnancy and childbirth related expenses • Corporate employees & members of certain large groups, health policies cover pregnancy
- 34. Strategies to improve Maternal Health & its financing, in India Janani Suraksha Yojana--Encourages Inst.delivery through cash incentives by central Govt, to Pt.& female community health workers • Chiranjeevi scheme – PPP model; Govt pay Private empanelled Drs for every delivery in their hospital to encourage institutional delivery • Benefits from other schemes aimed at population stabilization, reducing neonatal & infant mortality
- 35. Strategies to improve Maternal Health in India • Upgradation of physical facilities at all PHCs • Skills upgradation of PHC workers • Training in obst. & anesthesia skills • Over 35000 personnel trained as health workers
- 36. FOGSI and maternal health • To built a bridge between private Drs & Govt • Catalyst to bring about changes • Opinion creator and the leader • Advocacy-Advocate Central & state govts for changes to policies, laws, rules, regulations & practices to increase access to safe abortion services in public & private sectors
- 37. FOGSI & Maternal Health …contd • Emergency Obstetric Care ( EmOC ) Objective -- develop skills of non-specialist Drs.(GPs & MO), to provide high quality EmOC services in underserved areas to prevent maternal mortality & morbidity • Comprehensive Abortion Care( CAC ) District level model, to deliver safe abortion services, through public health system & expand use of MVA & MA
- 38. Will MDG 5 targets be reached by India ? Target 5A Unlikely Potentially No data Reduce MMR by 75% ✓ possible between 1990 to 2015 Most births by SBA ✓ possible Target 5B Increase CPR ✓ Possible Reduce Adolescent birth rate Unlikely ANC 4visits ✓ 1 visit Possible Unmet need for FP ✓ Possible Source :--Chatterjee A, Paily VP. Achieving MDG 4 and 5 in India. BJOG 2011;118 (Suppl. 2):47– 59
- 40. Maternal health care scenario in Nepal –reasons • Total Hospital Beds 6944 Community Hospital- 10-15 beds District Hospital 50 beds 2349 person for a single bed • Organizational failures – Availability of electricity, drinking water ,emergency medicines etc -- are available but sometimes there is shortage of medicine • Social evils Female education (%): 52% Literate Early marriage (age & %) Median age 17.5yrs; < 17 yrs-- 5% ; Domestic violence (15-49) (%) = 22% • Attitude of men on women’s health --in 35% cases men decides for women and in 65% cases she decides
- 41. Total health expenditure by function 2005/6
- 42. Total health expenditure by source 2005/6
- 43. CEOC/BEOC/BC-making it functional Human resources-train/in place/transfer Tertiary Level hospitals are too busy Equity access/demand/need Flow and monitoring of fund Sustainability-tapping local resources Involvement of private/medical colleges health facilities 33 CEOC functioning-HR/quality Poor Monitoring and Evaluation Poor reporting and recording How to reach special groups Integration with SRH/FP Referral mechanisms Policy Program Major Challenges in Ama Surachha Program
- 44. NESOG ROLE Advocacy Work with Ministry of Health, Govt of Nepal Identify short comings & Propose for changes Prepare Guide books for training purposes To cope with the demands & support Ministry of Health’s initiative
- 45. Will MDG 5 targets be reached by Nepal? Target Unlikely Potentially No data 5A: Reduce MMR by 75% between 1990 & 2015 Maternal mortality ratio ✓ most births attended by SBA ✓ 5B: Achieve universal access to reproductive health by 2015 Contraceptive prevalence rate ✓ Adolescent birth rate ✓ ANC (one/ four visits) ✓ Unmet need or family planning ✓ Achieving Millennium Development Goals 4 and 5 in Nepal-- D S Malla, K Giri, C Karki, P Chaudhary BJOG Sep, 2011
- 47. Present scenario of maternal health in Pakistan • Adolescent health care – patchy • Pre-conception care – not routinely practiced •ANC by health prof. – 1 ANC -- 61% ; 4 & more ANC --28% ; Urban: Rural = 48%: 20% • Delivered by SBA --39% ; urban : rural = 60% : 30% • Institutional delivery– 35 % ; Public 11%, Private 24%, • Home delivery --65% ; urban : rural = 56% : 25% •Postnatal check up -- 43% • Referral system – informal, paid by patient’s relatives [2006-7 PDHS,NIPS, Macro international ]
- 48. MMR By Province Punjab 227 Sindh 314 Balochistan 785 NWFP 275 MMR for 3 yrs prior to survey . MMR 260 in 2010 MMR is significantly higher in the RURAL areas and in BALOCHISTAN province 2006-07 PDHS, NIPS and Macro International Present scenario of maternal health in Pakistan ……contd
- 49. Poor Maternal Health Care in Pakistan- Reasons Political Will In theory only Infra structure Exists, not utilised. Inadequate equipment; lack of staff & quality training; lack of public confidence does not operate 24X7 Drs : nurses 1 : 1.4 Organisational failure Inferior health care in rural & urban areas, lack of adequate community & Pvt sector involvement, lack of strong DHS & implementation of short / long term policy measures.
- 50. Poor Maternal Health Care in Pakistan - Reasons Social issues Poverty, rapid urbanization, sizeable young population, large refugee population, Male gender preference Female education Female 46%, Total 58%. (2011) Early marriage Age of marriage - 21.8 years. 74% girls below 16 married in Charsadda & Mardan Domestic violence VAW – 8539, DV - 610 cases (2011) Better gender equality. 'Protection against Harassment of Women at Workplace Bill 2009’adopted in 2010 Attitude of society to women's health Low status, not enough emphasis, not the decision makers
- 51. Maternal Health Economics Pakistan State health expenses % of GDP 3.2% of GDP Share of maternal health 0.67% of GDP Public expenditure 33.32% Private expenditure 57.33% External Support 4-16% Health insurance for Preg & child birth 1.64% Employers contribution Social security 5.07% Philanthropy 0.92% Population not fully covered for health care costs 73.38 %
- 52. Maternal Health Economics Pakistan Other Issues • Limited commitment within system to generate resources for intended purpose •Poor correlation between spending & outcomes • Lack of efficient & equitable use of finances • Leakage of funds •Inequitable allocation of revenue-- 26.81% spent on 13% of population
- 53. Strategies to Improve Maternal Health Scenario in Pakistan Key working areas • Strengthening health systems & promoting interventions focusing on pro-poor policies • Monitoring and evaluating the burden of maternal & newborn ill-health and its socio-economic impact • Building effective partnerships to use scarce resources & minimize duplication in efforts.
- 54. Strategies to Improve Maternal Health Scenario Pakistan • Strengthening of MNCH, LHW and SBA programs • Strengthening contraceptive services • Management of unsafe abortions • Creating awareness amongst women • Opportunities for earning for women
- 55. Role of SOGP –Supportive Corporate Capacity • Leadership role • Advocacy – Dissemination among faculty and students in medical and public health institutions, information about: • Maternal mortality, Gyn oncology. Abortion DATA • PDHS and status of health indicators • MDGs and way forward, emphasizing their roles • Impart competency-based training to Drs.& Midwives • Support research to update clinical practice
- 56. Role of SOGP – Supportive Corporate Capacity • Practice best practices in clinical OB/GYN • Collaborate with Govt to develop health care policies • Collaborate with agencies & development partners • Support efforts to ensure quality
- 57. Will MDG 5 targets be reached by Pakistan ? Target Unlikely Potentially No data 5A: Reduce MMR by 75% between 1990 & 2015 MMR ✓ Most births attended by SBA ✓ 5B: Achieve universal access to reproductive health by 2015 Contraceptive prevalence rate ✓ Adolescent birth rate ✓ ANC (one/ four visits) ✓ Unmet need or family planning ✓ source :--Mahmud G, Zaman F, Jafarey S, Khan RL, Sohail R, Fatima S.Achieving Millennium Development Goals 4 and 5 in Pakistan. BJOG2011;118 (Supp. 2):69–77.
- 59. 1.Geographical variations : North & East-21% & Estate -18% of NMM 2. Poverty – 30% Estate, 28% Rural 3. Septic abortions- increasing (10-15%); PPH commonest 4. Contraceptive compliance - Poor 5. Inadequate health facilities few areas-EMOC, staff ,finance 6. Aftermath of ethnic conflict- IDP, single mother 7. Emerging communicable diseases- Dengue, H1N1, HIV 8. Increase Maternal mortality & morbidity due to NCD, Mental illnesses and Suicides 9. Domestic Violence – Incidence varied 5-47% during Preg; Highest among unmarried ,extremes of age. Adverse pregnancy outcome 3 times high. MMR is low in Sri Lanka but stagnant for last half decade
- 60. factors in Sri Lanka • Political will Good Political commitment to MDG 5 through Presidential task force, Health master plan and “Mahinda Chinthanya” • Infrastructural issues, including basics Except north & east most people live within 5km of health facility, but in some areas transport & road access are major problem. Estate & some rural areas – poor social indicators like sanitation ,safe drinking water and housing North & East- Disruption of homes( IDP) , roads , health facilities, local economy and community network • Dr/Nurse strength Medical Officers 49, Obstetrician 3, Nurses 87 & Midwifes 26 /100,000 pop Acute shortage of HR & EMOC in some rural areas, estates & north and east
- 61. factors in Sri Lanka • Organizational failure Decentralisation of health system slow and uneven. Reorganisation of hosp & referral system has not achieved good results. Existing health information system is outdated . . Social evils Female literacy -89% Female literacy (15-24y) 99% Female life expectancy -76yrs Marriage by age 15 - 2% Marriage by age 18 - 12% Poverty > 30% of estate pop & 28% rural pop are BPL 18% maternal deaths occur in Estates . Attitude of men GBV not uncommon but generally men respect women due religious and socio-cultural reasons
- 62. 0 10000 20000 30000 40000 50000 60000 70000 80000 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Total Health Expenditure (SLR Million) Increase government spending on health at least 2.5-3.0 % of GDP. Private spending would continue to be about 1.5-2.0 GDP so that the total expenditure would be 4.5- 5.0 of GDP ---2011 Government to maintain health care expenses at 8% --10% of total public outlays. Only 9% of the health budget allocated to preventive sector. No National data available for health budget allocation for Maternal Health
- 63. Role of SLCOG Advocacy and help in policy making Training and Education ; Service provider By 2013 all maternal death inquiries & by 2015 all severe acute maternal morbidity audit – SLCOG to audit in the internationally accepted standard of confidential reporting By 2014, SLCOG aims to set standard on :-- ANC, IPC,PNC ,EmOC, Post abortion care & Contraceptive services for all sexually capable people irrespective of age, parity & marital status
- 64. Will MDG 5 targets be reached in Sri Lanka ? Target Unlikely Potentially No data 5A: Reduce MMR by 75% between 1990 and 2015 Maternal mortality ratio ✓ Most births attended by SBA ✓ 5B: Achieve universal access to reproductive health by 2015 Contraceptive prevalence rate ✓ Adolescent birth rate ✓ ANC ( 1 & 4 visits) ✓ Unmet need or family planning ✓ Senanayake H, Goonewardene M, Ranatunga A, Hattotuwa R, Amarasekera S, Amarasinghe I. Achieving Millennium Development Goals 4 and 5 in Sri Lanka. BJOG 2011;118 (Suppl. 2):78–87.
- 65. All the SAFOG countries, except Sri Lanka, urgently need to expedite their efforts many folds, to reach their MDG targets, sooner than later. Need of the hour -- each constituent country of the South Asia, MUST politically, financially & sincerely, work hand in hand, with the Obstetricians of this region, to improve the health of their mothers. More Public expenditure needed on maternal health with all round Infrastructural improvements in health sector and more community involvement. we need --- POLITICAL WILL AT THE HIGHEST LEVEL SAFOG is ready to be the most important stake holder
- 66. Maternal health care strategies Improved Indirectly – by • Improvement of FP services • Free female education upto 12thstandard • Safe menstrual regulation services • Maternal nutrition project • Increase of Maternity leave upto 6 months • Day care center in public & private sectors
- 67. A strong Political will and society is needed to put the simple measure in place to save lives of women dieing in childbirth. We are not attempting to do the impossible. On the contrary, our aim is to do what is well known to be entirely possible. This approach has the potential to transform the lives of millions. Giving mothers, babies and children the care they need is an absolute imperative. PRIVATE SECTOR HAS A MAJOR C.S.R for this cause
- 68. how can we private sector help • Understand that this is our problem tooo?? • Keeping mothers alive and healthy is our responsibility to(cannot blame govt.for all ills) • Enroll in PPP janani suraksha yojanas • Form our own programmes to help BPL • Charity • Free camps and check ups and immunizations • Awareness • Save girl child programmes,walks,rally etc etc
- 70. how we are helping ..the 9th camps pregnancy ….nines
- 71. Its time for society to decide whether they want TAJ MAHALS or mothers and neonates AND IT IS TIME THAT SUMMITS LIKE THIS DISCUSS MATERNAL HEALTH IN ALL MEETINGS if we could have saved this beautiful queen during her 14th childbirth….there would have been no tajmahal……………….
- 72. “mothers are not dying because of disease we cannot treat.They are dying because society has to decide whether their lives are worth saving” -Prof Fathalla
- 73. Thank You All Long Live SAFOG