EXECUTIVE SUMMARY
Emergency Obstetric and Newborn Care (EmONC) is the package of clinical interventions required to manage life-threatening obstetric complications — the leading causes of maternal death. Approximately 15 per cent of pregnancies develop complications requiring emergency care; without it, women die from haemorrhage, eclampsia, sepsis, obstructed labour, and complications of unsafe abortion. The availability, accessibility, and quality of EmONC is the single most important determinant of whether a woman survives a complicated pregnancy.
EmONC is classified into two levels: Basic EmONC (BEmONC) — parenteral antibiotics, oxytocics, anticonvulsants, manual removal of placenta, removal of retained products, assisted vaginal delivery, and neonatal resuscitation; and Comprehensive EmONC (CEmONC) — all BEmONC functions plus C-section and blood transfusion. WHO recommends that every population of 500,000 should have at least 5 BEmONC facilities and 1 CEmONC facility.
UNFPA supports EmONC through: facility upgrading, health worker training (midwives and physicians), equipment and supply provision, EmONC needs assessments, and quality improvement. EmONC assessments — standardised surveys measuring the availability and functionality of EmONC facilities — are a key UNFPA contribution to maternal health planning.
KEY FACTS
- Obstetric complications rate: Approximately 15% of pregnancies develop complications requiring emergency care
- Leading causes of maternal death: Haemorrhage (27%), hypertensive disorders (14%), sepsis (11%), unsafe abortion (8%), obstructed labour (9%) — all require EmONC
- BEmONC signal functions: 7 clinical interventions that define a basic emergency obstetric facility
- CEmONC signal functions: BEmONC + C-section + blood transfusion
- WHO benchmark: At least 5 BEmONC and 1 CEmONC facility per 500,000 population
- Global EmONC availability: Many LMICs fall far below WHO benchmarks; in SSA, only approximately 2 CEmONC facilities per 500,000 population in some countries
- EmONC assessments: Standardised surveys measuring facility readiness; UNFPA has supported assessments in over 50 countries
- C-section rates: WHO recommends 10–15% of births by C-section as an indicator of adequate EmONC access; many LMICs are below 5% (indicating inadequate access) while some middle-income countries exceed 30% (indicating overuse)
- Blood transfusion: Haemorrhage is the leading killer; availability of safe blood supply is critical and often inadequate in rural LMICs
- Quality of care: Facility availability does not guarantee quality; many designated EmONC facilities lack trained staff, functioning equipment, or essential medicines
DETAIL
UNFPA's EmONC work spans facility upgrading, health worker training, equipment provision, and health system strengthening. EmONC needs assessments, which map the availability and functionality of facilities against population benchmarks, are a signature UNFPA contribution — providing the evidence base for government investment decisions.
Key challenges include: inadequate surgical workforce (many district hospitals in SSA lack physicians capable of performing C-sections), unreliable blood supply, medicine stockouts (particularly oxytocin, which requires refrigeration), poor referral systems (women arriving at CEmONC facilities too late), and quality gaps even in designated EmONC facilities.
SOURCES
- WHO, UNFPA, UNICEF, AMDD: "Monitoring Emergency Obstetric Care: A Handbook" (2009)
- WHO: "Standards for Improving Quality of Maternal and Newborn Care in Health Facilities" (2016)
- Paxton, A. et al.: "The evidence for emergency obstetric care" (International Journal of Gynecology & Obstetrics, 2005)
RELATED DOCUMENTS
- UNFPA-W-01 (Maternal Health)
- UNFPA-W-13 (MDSR)
- UNFPA-W-09 (Midwifery)
- UNFPA-T-04 (Supply Chain Innovation)
- UNFPA-G-01 (Sub-Saharan Africa)