maternal and newborn health country profiles lao … · 2 maternal and newborn health country...

Maternal and Newborn Health Country Profiles: Lao People’s Democratic Republic 1

1990 2012 LSIS MDG target 2015

Under-5mortality rate

Infantmortality rate

Neonatalmortality rate

Trends in child mortality

1990 2012 LSIS MDG target 2015

Trends in maternal mortality

Trends in maternal indicators

Maternal mortality ratio

Contraceptiveprevalence rate

(met need)

Unmet familyplanning need

Women 20-24married before

age 18

Adolescentbirth rate

RHS 2005 NS 2007 LSIS 2012

Dea

ths

per 1

,000

live

birt

hs

Dea

ths

per 1

00,0

00 li

ve b

irths

Pe

r cen

t (%

)

1600

357* 400

38.4 27.3

110

49.8 19.9

37

94

*MDG target achieved in 2011

145

100

39

89 76

36 48 45

Lao PDR is among the top 10 countries achieving the highest reduction in under-5 mortality between 1990 and 2011, with an annual rate of reduction of 6. The country is on track to achieve MDG 4 but will require further investments in health care to impact its high neonatal mortality and to reach deep into the rural and remote populations, including among its many ethnic minorities. Lao PDR has achieved MDG 5, although the maternal mortality ratio is still among the highest in the East Asia region. Increasing coverage of skilled birth attendants in rural areas, investing in community health services and promoting nutrition are important. Reducing the cultural, geographical and financial barriers to skilled attendance at delivery and lifesaving emergency obstetric care services is critical to reduce the many preventable maternal and newborn deaths. The high rate of adolescent births merits attention, together with the expansion of quality services that promote optimal birth spacing.

Lao People’s Democratic Republic

TRENDS AND POLICIES

Maternal and Newborn Health Country Profiles

Sources: 1World Health Organization National Health Account database 2012 (retrieved from www.data.worldbank.org); 2United Nations Population Fund, The State of the World’s Midwifery 2012.

Sources for figures: Trends in child mortality: 1990 child data from UN Inter-agency Group for Child Mortality Estimation, Levels & Trends in Child Mortality, 2011; 2012 data, Lao Social Indicator Survey (LSIS) 2012. Trends in maternal mortality: LSIS 2012. Trends in maternal indicators: 2005 Reproductive Health Survey (RHS), 2005 National Statistics (NS) and LSIS 2012. Notes: Contraceptive prevalence rate proportion of currently married women aged 15–49 who were using some method of family planning at the time of the survey; unmet family planning need: % of women with an unmet need for family planning (spacing or limiting); adolescent birth rate: annual number of births among women aged 15–19 per 1,000 women in the age group.

National health policies and services Availability

Per capita total expenditure on health (US$), 2007–20111

46

Out-of-pocket expenditure (% of private expenditure on health), 2007–20111

76.7

Specific notification of maternal deaths Partial

Midwifery personnel authorized to administer core set of lifesaving interventions

Yes

Costed national implementation plans for maternal, newborn and child health available

Yes

Number of basic emergency obstetric and newborn care facilities2

150

Facilities per 1,000 births -

Community treatment of pneumonia with antibiotics

Partial

Oral rehydration solution and zinc for management of diarrhoea

Yes

Maternal and Newborn Health Country Profiles: Lao People’s Democratic Republic2

Indicators of quality of care

0

100

20

40

60

80

Antenatal care Intrapartum/delivery Postnatal care

Per c

ent (

%)

7.4 3.1

38.1

72

54.2

36.9

18.3

46.9

23.2 22.6

41.5 37.5

3.7

17

ANC1+ ANC4+ BPUA Bl

BPmeasured

Bloodsample

Urinesample

SBA Inst.Delivery

C-section BF(excl.)

PNCwithin2 days/

newborn

PNCwithin2 days/mother

PNCwithin2 days/

newbornand

mother

Birthreg.

Source: LSIS 2012. Notes: Lao PDR LSIS 2011-2012. ANC1+: % of women who received ≥1 ANC visit; ANC4+: at ≥4 ANC visits; *% of ANC visit that included measuring blood pressure (BP) and collecting blood and urine samples; SBA: % of births delivered by a skilled birth attendant (doctor, nurse, midwife); inst. delivery: % of births delivered at a health facility; C-section: % of births delivered by caesarean section; BF (excl.): % of children younger than 6 months who were exclusively breastfed; PNC within 2 days/newborn: % of women who recieved a postnatal check-up within 2 days for newborn only; PNC within 2 days/mother: PNC within 2 days for mother only; PNC within 2 days/newborn and mother: PNC within 2 days for newborn and mother both; birth reg.: % of children younger than 5 years whose birth was registered with the State.

AvAILAbILITy Of NATIONAL POLICIES1 fOR hIGh-IMPACT INTERvENTIONS ShOwN TO

IMPROvE NEONATAL SuRvIvAL ThROuGhOuT ThE CONTINuuM Of CARE2

Postnatal

- Resuscitation of newborn baby

- breastfeeding- Prevention and management

of hypothermia- Kangaroo mother care - Community-based

pneumonia management - Emergency neonatal care

Legend: green: intervention addressed in the MNCH strategy; red: intervention has no clear guideline/policy.Sources: 1Lao PDR Ministry of Health, Strategy and Planning Framework for the Integrated Package of Maternal, Neonatal and Child Health Services 2009–2015; 2Darmstadt et al., 2005. Notes: PROM: premature rupture of membranes; emergency obstetric care: management of complications-obstructed labour, haemorrhage, hypertension, infection; C-section: caesarean section (detection and management of breech); PMTCT: prevention of mother-to-child transmission of human immunodeficiency virus (HIV); labour surveillance (including partograph) for early diagnosis of complications); kangaroo mother care (care for low birth weight infants in health facilities); emergency neonatal care: management of serious illness (infections, asphyxia, prematurity, jaundice).Reference: Darmstadt, G.L. et al., ‘Evidence-Based, Cost-Effective Interventions: How many newborn babies can we save?’ The Lancet, 2005: 365 (9463).

Preconception

- folic acid supplmentation

Intrapartum

- Skilled maternal and neonatal care

- Emergency obstetric care- Antibiotics for PROM- Steroids for preterm labour- C-section- PMTCT- Labour surveillance- Clean delivery practices

Antenatal

- Tetanus toxoid immunization- Syphilis screening- Pre-eclampsia and eclampsia

prevention- Presumptive malaria treatment- Detection and treatment of

asymptomatic bacteriuria


READINESS fOR NATIONAL SCALING uP Of NEwbORN CARE

- Local evidence generated for newborn survival

- Existence of a convening mechanism for newborn health issues

- Focal person for newborn health in the Ministry of Health

- Maternal and newborn indicators included in national surveys (e.g. neonatal mortality rate)

- Newborn policy integrated into other health policies or strategies

- Essential drug list includes injectable antibiotics for primary level care

- Midwives authorized to perform neonatal resuscitation

- Primary-level cadres authorized to perform neonatal resuscitation

- Maternal and newborn indicators included in national health information systems

- Community-based cadres authorized to administer injectable antibiotics for newborn infections (for community midwives)

- Community-based cadres authorized to perform neonatal resuscitation (for community midwives)

- National behaviour change communication strategy

- Community-based cadres authorized to administer injectable antibiotics for newborn infections (not for village volunteers)

- Community-based cadres authorized to perform neonatal resuscitation (not for village volunteers)

- Costed implementation plan for maternal, newborn and child health (in process)

- Primary level cadres authorized to administer injectable antibiotics for newborn infections

- National targets to track newborn health established

- Reproductive, maternal, newborn and child expenditure per child younger than 5 and per woman aged 19-49

- National needs assessment for newborn care conducted

- Local evidence disseminated for newborn survival

- Cadre identified for home-based newborn care

- In-service newborn care training materials for community-based cadres

- In-service newborn care training materials for facility-based cadres (part of Integrated postpartum care training module)

- Pre-service newborn care education for facility-based cadres

- Pre-service newborn care education for community-based cadres

- Supervision system for maternal, newborn and child health established at primary health centre level

- Protocol or standard for district hospital care of sick newborns in place

- Resource requirement for primary health care level available for newborns (not sufficient)

- Resource requirement for secondary-level health care available for newborns (not sufficient)

- Resource requirement for scaling up home-based newborn care available (not sufficient)

- Integrated management of childhood illness algorithm adapted to include the first week of life

- System for perinatal death audits exists- System for neonatal death audits exists

(under development)

Legend: green: benchmark met; red: benchmark not met.Source: Moran, A.C. et al., 2012. Availability of benchmarks as per UNICEF Lao PDR Country Office.Reference: Moran, A.C. et al., ‘Benchmarks to Measure Readiness to Integrate and Scale Up Newborn Survival Interventions’, Health Policy Planning, 2012: 27 (iii29-iii39).

Agenda setting

Agenda setting

Policy formulation

Policy formulation

Policy implementation

Policy implementation


CONTINuING INEQuITIES: Indicators by residence, wealth quintiles and provinces

SBA Inst. Delivery PNC 2dNB PNC 2dM

Disparities by residence

Disparities by wealth quintiles

BP UA BI ANC4 Tet Prot

Dea

ths

per

1,0

00 li

ve b

irth

s


U5MR IMR NMR

Dea

ths

per

1,0

00 li

ve b

irth

s

ORT/CONT. Feed Tx PNA DPT3

SBA Inst. Delivery PNC 2dNBU5MR IMR NMR


Most and least affected provinces

Dea

ths

per

1,0

00 li

ve b

irth

s


Per

cen

t (%

)P

er c

ent

(%)

Per

cen

t (%

)

89

76

36

100

85

39

94

82

39

136

108

39

45

39 22

120

95

40

33 27 18

41.5

37.5

7.4

3.1 30.7

27 5.9

2.7 33.3

29.2 6.3

2.9 12.4 11.6 3.3

1.5

79.6

74.2

12.6

4.4 10.8 10.5

2.8

1.2

90.7

87.4

10.9

4.9

18.3

36.9

77.5

11.1 27.2

63.4

12.1 29.7

64.8

4 9.9 54.1

43.6

70.6

49.2

3.5 9.1 5.7 52

82.6

58.2

57.4

54.4

55.5

55.6

50.6

51.7

57.3

52.3

53.8

59.3

37.8

35.5

71.2

79

67.7

54.6

42.1

36.8

69.7

85.5

81.4

Country total

Rural

Rural road

Rural no road

Urban

Poorest

Wealthiest

Country total

Rural

Rural road

Rural no road

Urban

Poorest

Wealthiest

Country to

talRural

Rural road

Rural no road

Urban

Poorest

Wealthiest

Country total

Rural

Rural road

Rural no road

Urban

Poorest

Wealthiest

160

74

131

58 62

27

Chinese-Tibetan

Hmong-Mien

Chinese-Tibetan

Hmong-Mien

Chinese-Tibetan

Hmong-Mien

18.7

85.4

18.1

83.9

0 16.5

Phongsaly

Vientiane C

Phongsaly

Vientiane C

Attapeu

Borikhamxay

SBA Inst. Delivery PNC 2dNB PNC 2dM



BP UA BI ANC4 Tet Prot

Dea

ths

per

1,0

00 li

ve b

irth

s


U5MR IMR NMR

Dea

ths

per

1,0

00 li

ve b

irth

s

ORT/CONT. Feed Tx PNA DPT3

SBA Inst. Delivery PNC 2dNBU5MR IMR NMR



Dea

ths

per

1,0

00 li

ve b

irth

s


Per

cen

t (%

)P

er c

ent

(%)

Per

cen

t (%

)

89

76

36

100

85

39

94

82

39

136

108

39

45

39 22

120

95

40

33 27 18

41.5

37.5

7.4

3.1 30.7

27 5.9

2.7 33.3

29.2 6.3

2.9 12.4 11.6 3.3

1.5

79.6

74.2

12.6

4.4 10.8 10.5

2.8

1.2

90.7

87.4

10.9

4.9

18.3

36.9

77.5

11.1 27.2

63.4

12.1 29.7

64.8

4 9.9 54.1

43.6

70.6

49.2

3.5 9.1 5.7 52

82.6

58.2

57.4

54.4

55.5

55.6

50.6

51.7

57.3

52.3

53.8

59.3

37.8

35.5

71.2

79

67.7

54.6

42.1

36.8

69.7

85.5

81.4

Country total

Rural

Rural road

Rural no road

Urban

Poorest

Wealthiest

Country total

Rural

Rural road

Rural no road

Urban

Poorest

Wealthiest

Country to

talRural

Rural road

Rural no road

Urban

Poorest

Wealthiest

Country total

Rural

Rural road

Rural no road

Urban

Poorest

Wealthiest

160

74

131

58 62

27

Chinese-Tibetan

Hmong-Mien

Chinese-Tibetan

Hmong-Mien

Chinese-Tibetan

Hmong-Mien

18.7

85.4

18.1

83.9

0 16.5

Phongsaly

Vientiane C

Phongsaly

Vientiane C

Attapeu

Borikhamxay

Source: LSIS 2012. Notes: Comparison of data is by residence (rural versus RR (rural with roads) versus RW (rural without roads) versus urban versus country total), wealth quintiles (poorest versus richest versus country total), ethno-linguistic groups and provinces (most affected versus least affected); U5MR: mortality for children younger than 5 years; IMR: infant mortality rate; BP/blood/urine: % of pregnant women who had their blood pressure (BP), blood and urine sample taken during an antenatal care (ANC) visit; ANC4: % of pregnant women receiving ANC 4 or more times during pregnancy (recommended # by WHO); SBA: % of pregnancies delivered by skilled birth attendant; birth registration: % of children younger than 5 years whose birth was registered with the State. Exclusively BF: % of children younger than 6 months who were exclusively breastfed; ORT/CONT. feeding: % of children with diarrhoea who received oral rehydration therapy or increased intake and at the same time was continuously fed; Tet Prot: % of women aged 15-49 with a live birth in the last two years who are protected against tetanus; Tx PNA: % of children younger than 5 years with suspected pneumonia who were taken to any appropriate provider; DPT3: % of children age 12-23 months who received the recommended 3 doses of DPT by 12 months; PNC 2d NB: % of newborns who received a postnatal check-up within 2 days of delivery; Vientiane C: Vientiane capital.


EQuITy fOCuS: Indicators by residence, wealth quintiles and provinces

Indicator

Residence Quintiles Most and least affected by ethno-linguistic group of household head


Rural urban Poorest wealthiest

U5MR (country avg: 54 per Levels & Trends 2011 report; LSIS 2012: 89)

Rural(R): 100Rural w/ road (RR): 94Rural w/o road (RW): 136

45 120 33 M: Chinese-Tibetan (160); L: Hmong-Mien (74)

Region: M: North (104); L: Central (73)Province:M:Phongsaly (151); Vientiane Capital (32**)

NMR (country avg: 21 per Levels & Trends 2011 report and 36 per LSIS 2012)

R: 39RR: 39RW: 39


Region: M: North (48); L: Central (26)Province:M:Phongsaly, Huaphanh, and Khammuane (62); Vientiane (10)

IMR (country avg: 42 per Levels & Trends 2011 report; LSIS 2012: 76)

R: 85RR: 82RW: 108


Region: M: South (88); L: Central (63)Province:M: Khammuane (131); Vientiane Capital (27**)

Pre-pregnancy

Contraceptive prevalence rate/met need (country avg: 49.8%)

R: 48.8RR: 50.2RW: 36.4

52.6 39.1 52.9 M: Hmong-Mien (31.7); L: Lao Tai (54.4)

Region: M: South (88); L: Central (63)Province:M: Khammuane (131); Vientiane Capital (27**)

Unmet need for family planning (% of women aged 15–49 currently married or in a union with an unmet family planning need) (country avg: 19.9%)

R: 20.2RR: 19.3RW: 27.6


Region: M: South (24.1); L: North (16.7)Province:M: Champasack (25.4); L: Xiengkhuang (10.4)

Antenatal

ANC1 (% of pregnant women receiving ANC 1 or more times from a skilled provider during pregnancy; country avg: 54.2%)

R: 45.9RR: 49.7RW: 19


Region: M: North (45); L: Central (63.3)Province:M: Phongsaly (25.2); L: Vientiane (74.1)

ANC4 (% of pregnant women receiving ANC from any provider 36.9)

R: 27.2RR: 29.7RW: 9.9

70.6 9.1 82.6 M: Chinese-Tibetan (6.1); L: Lao Tai (55.0)

Region: M: South (28.3); L: Central 46.5Province:M: Phongsaly (9.4); L: Vientiane Capital (82)

% pregnant women who received BP check, urine test, blood test before delivery (18.3%)

R: 11.1RR: 12.1RW: 4.0

43.6 3.5 52 M: Hmong-Mien (2.7); L: Lao Tai (27.7)

Region: M: South (12); L: Central 25.2Province:M: Huapanh (1.6); L: Vientiane Capital (62.6)

Blood pressure taken (country avg: 46.9%)

R: 38RR: 41RW: 17.4

77.9 18 87 M: Hmong-Mien (19.2); L: Lao Tai (62.4)

Region: M: South (39.9); L: North (52.5)Province:M: Phongsaly (24.9); L: Vientiane Capital (88.4)


Indicator


Most and least affected provincesRural urban Poorest wealthiest

Blood sample (country avg: 23.2%)

R: 14.4RR: 15.8RW: 4.7

54.1 4.2 65 M: Hmong-Mien (4.1); L: Lao Tai (35.1)

Region: M: South (15.2); L: Central (29.4)Province:M: Huapanh (3.6); L: Vientiane Capital (68.5)

Urine sample taken at ANC, % (country level 22.6%)

R: 14.9RR: 16RW: 7.6


Region: M: South (15.3); L: Central (32.1)Province:M: Oudomxay (2.2); L: Vientiane Capital (72.8)

% of women aged 15–49 with a live birth in the last two years who are protected against tetanus (country avg: 77.5%)

R: 63.4RR: 64.8RW: 54.1


Region: M: South (62.7); L: North (71.8)Province:M: Phongsaly (43.7); L: Borikhamxay (80.4)

Intrapartum

Birth attended by any skilled attendant (country level: 41.5%)2

R: 30.7RR: 33.3RW: 12.4


Region: M: North (31); L: Central (52.8)Province:M: Phongsaly (18.7); L: Vientiane Capital (85.4)

Institutional delivery (37.5%)

R: 27RR: 29.2RW: 11.6


Region: M: South (25.4); L: North (50.0)Province:M: Phongsaly (18.1); L: Vientiane Capital (83.9)

Caesarean section (country level: 3.7%)

R: 1.9RR: 2.1RW: 0.0

10 0.1 13.1 M: Mon-Khmer (0.8); L: Lao Tai (5.8)

Region: M: North (2.3); L: Central (5.1)Province:M: Phongsaly (0.4); L: Vientiane Capital (15.4)

Postpartum

% no PNC for newborn (country avg: 87.8%)

R: 91.2RR: 90.7RW: 95.1


Region: M: North (90.7); L: Central (84.6)Province:M: Attapeu (97); L: Vientiane Capital (75.7)

PNC of the newborn within 2 days of delivery (country avg: 7.4%)

R: 5.9RR: 6.3RW: 3.3


Region: M: South (4.5); L: Central (9.9)Province:M: Attapeu (0.0); L: Borikhamxay (16.5)

% of women 15–49 who gave birth within past 2 years who received a PNC visit w/in 2 days (country avg: 3.1%)

R: 2.7RR: 2.9RW: 1.5

4.4 1.2 4.9 M: Chinese-Tibetan (0.8); L: Lao Tai (4.5)

Region: M: South (2.0); L: Central (4.1)Province:M: Oudomxay (0.0); L: Xayabury (6.0)

% no PNC for mothers (country avg: 92.8%)

R: 94.7RR: 94.4RW: 96.5


Region: M: North (28.2); L: Central (46.6)Province:M: Sekong and Oudomxay (99.7); L: Vientiane Capital (82.2)


Indicator



Rural urban Poorest wealthiest

% women aged 15–49 who along with their newborn received PNC or a health check within 2 days of delivery (both mother and newborn; country avg: 38.1%)

R: 29.5RR: 31.7RW: 14.4


Region: M: North (28.2); L: Central (46.6)Province:M: Huapanh (15.1); L: Vientiane Capital (78.7)

Birth registration (country avg: 76%)

- - - - - - -

% of children aged 0–5 months who are exclusively breastfed (country %: 40.4)

R: 41RR: 42.4RW: 30.1

38.2 46.6 34.1 M: Lao Tai (33); L: Hmong-Mien (68.0)

Region: M: South (29.7); L: North (60.5)Province:M: Champasack (20.1); L: Huaphanh (77.2)

Children younger than 5 years

% who received oral rehydration therapy (oral rehydration solution or recommended home fluids or increased fluids (country level %: 47.5)

R: 44.7RR: 46.3RW: 37.6


Region: M: South and Central (44.2); L: North (51)Province:M: Xiengkhuang (27); L: Vientiane Capital (88.2**)

% continued feeding and given ORT (country avg: 57.4%)

R: 55.6RR: 57.3RW: 50.3

71.2 54.6 69.7 M: Hmong-Mien (46.4); L: Mon-Khmer (62)

Region: M: Central (53.4); L: North (61.4)Province:M: Vientiane (33); L: Vientiane Capital (76.8**)

% of under-5 children with suspected pneumonia who were taken to any appropriate provider

(country avg: 54.4%)

R: 50.6RR: 52.3RW: 37.8**

79 42.1 85.5** M: Mon-Khmer (54.3); L: Lao-Tai (56.8) and other values ***

Region: M: South (46.4); L: Central (59.5)Province: M: Saravane (38.9); L: Sekong (54.9) and other values ***

% of children aged 0–59 months with suspected pneumonia who received antibiotics in the last two weeks (57.4%)

R: 54.8RR: 56.9RW: 39.1**

74.3 47.4 71.9** M: Mon-Khmer (54.3); L: Lao-Tai (60.1) and other values ***

Region: M: South (45.6); L: Central (65.3)Province: M: Saravane (35.8); L: Bokeo (64.1**) and other values ***

DPT3 (country avg: 55.5%) with HepB-Hib

R: 51.7RR: 53.8RW: 35.5


Region: M: Central (52.6); L: South (60.6)Province:M: Phongsaly (23.8); L: Xayabury (91.8)

Source: All data from LSIS 2012 unless specified; UN Inter-agency Group for Child Mortality Estimation, Levels & Trends in Child Mortality, 2011.** Certain figures are based on 25–49 unweighted cases;*** Denominators of 24 unweighted cases and less, thus the information was suppressed.


Sp

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t o

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NIC

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rk

Giving newborns a better chance

backgroundDramatic increases over the past decade in child health services and outreach have been turning the negative trajectory of mortality rates of children younger than 5 years – even in countries heavily hindered by poverty and a preponderance of remote communities. Lao PDR, for instance, has one of the fastest declines in under-5 mortality globally, from nearly 107 deaths per 100,000 live births in 2000 to only 75 in 2010.

Although more children now live beyond their fifth birthday, a disproportionate number do not survive their first month of life. In Lao PDR, 39 per cent of all under-5 deaths occur in the first 28 days of life. The neonatal period has emerged as the most critical period for making a difference in child survival rates.

In looking at why neonatal deaths remain high in prevalence in the country, the Lao Ministry of Health and UNICEF conducted a 2012 comprehensive assessment of the newborn care situation. A large proportion of home births without a skilled birth attendant, low coverage of early essential newborn care and postnatal services, and prevalent cultural practices of discarding the colostrum and early bathing are some of the challenges. Local beliefs and myths hinder access to care seeking from health facilities, even when a newborn is experiencing health problems.

According to the assessment, poverty, geography, ethnicity and education level are important determinants of disparity not only for neonatal mortality but also for coverage of maternal and newborn health services along the continuum of care. The assessment’s mapping of gaps showed that basic emergency obstetric and newborn care is available at district, provincial and central hospitals, while comprehensive care is largely limited to provincial and central hospitals. This has implications for out-of-pocket expenses required for transportation and the need for the mother to obtain permission from her husband.

Due to a lack of knowledge on having the assistance of a specially qualified health workers during childbirth, distrust in the competency of medical staff and facilities, preference for traditional healers, an inability to pay for transport to a facility or the services once there, or the inability to reach the services, more than 58 per cent of births in 2011 took place with no skilled birth attendant; but that was significant improvement from 2005 when it was 82 per cent of births, according to government data.

The Ministry of Health has been working with UNICEF and other agencies to improve health facilities and women’s confidence in them. Basic health providers and midwives have been trained and given protocols and checklists to work with as well as newborn resuscitation equipment. Refresher courses on early essential newborn care are required. Perhaps the biggest stride in wooing women to facilities is the lure of free care, even for emergency obstetric surgeries – the Government has been piloting free mother and child health services that will be scaled up across the country.

To increase demand for facility care, UNICEF and partners are helping the Government revitalize village health committees and increase the number of midwives and village health volunteers who can encourage pregnant women and their husbands to seek out prenatal care and assisted births. The expanded cadre of midwives now make regular visits to communities to provide free contraceptives, vaccinations, antenatal care and, if need be, delivery assistance in remote villages.

To break through the grip of myths and traditional beliefs, the Government and UNICEF, along with other partners, heavily promote outreach by the health centre staff to build villagers’ trust in them and in optimal care practices during pregnancy, at delivery and during the postnatal period. “We hope that all maternal and child health issues will benefit with a greater attention to the quality of village

volunteer training, improving community engagement and ensuring accessible basic health services in the under-served areas,” says Viorica Berdaga, Chief, Child Survival and Development.

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maternal and newborn health country profiles lao … · 2 maternal and newborn health country...

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