unite for children the state of the worlds children 2009 maternal and newborn health
TRANSCRIPT
unite for children
THE STATE OF THE WORLD’S CHILDREN 2009
Maternal and Newborn Health
517
149
228
110134
195
445
172
517
379
162
178
371
358379
371490
194
2001-2003
Source: SRS
India: 301Kerala
110
Uttar Pradesh517
Maternal mortality ratio per 100,000 births
per 100,000 live births
Less than equal to 150
151 - 300
More than 300
Missing Data
Other Conditions
34%Haemorrhage
38%
Abortion 8%
Sepsis 11%Obstructed Labour 5% Hypertensive
Disorders 5%
Medical causes of maternal deaths in India
Source: SRS
45%
50%
54%
1992-93 1998-98 2005-06
Percentage of women aged 20-24 married before age 18
Age at marriage
Early marriage leads to early childbearing thereby enhancing maternal health risks
Source: NFHS
Nutrition among women
36%
56%
33%
52%
0
20
40
60
Any anemia BMI below normal
1998-98 2005-06
Percentage of ever-married women age 15-49 with any anaemia and Body Mass Index (BMI) below 18.5 kg/m2
High percentage of women with anaemia and low BMI results in higher risk of low birth weight and peri-natal deaths
Source: NFHS
65%59%
83%
66%
60%
87%
77%72%
91%
30
40
50
60
70
80
90
100
Urban Rural Total
1992-93 1998-98 2005-06
Antenatal carePercentage of ever-married women age 15-49 years having at least one ante-natal care
There has been a significant increase in ante-natal care in the last 7 years. Further increases are seen in the latest DLHS results
Source: NFHS
Institutional delivery
41
34
26
2005-061998-981992-93
Delivery assisted by health personnel
4942
35
2005-061998-991992-93
Deliveries at institutions / by skilled birth attendants
Institutional births have shown significant improvement in the DLHS results
Source: NFHS
Birth spacing
Intervals between 2 consecutive births in India have remained low, adversely affecting mothers’ health and children’s chances of survival
32 31 3139
54
3447
0
20
40
60
80
100
1992
-93
1998
-99
2005
-06
Bangla
desh
200
4
Indo
nesia
2002
/200
3
Nepal 2
006
Vietnam
200
3
Average (Median) number of months since preceding birth
Source: www.measuredhs.com
Post natal care for mothers
37.3
61.0
28.632.4
23.0
Total Urban Rural ScheduledCaste
ScheduledTribe
Percentage of women having at least one postnatal care within two days of delivery
Only 37% of women received postnatal check-ups within the recommended period of two days of delivery
Source: NFHS
Infant deaths within 7 days of birth
Infant deaths between7 days of birth and within 28 days
Infant deaths between 28 days and within one year of birth
Child deaths between oneyear and within five years of birth
40%
10%
26%
24%
Neonatal deaths50%
Infant deaths76%
Share of under-five mortality in India
Source : SRS 2007
Medical Causes of Neonatal Deaths
23%
3%
6%
24%
6%
2%
35%
Diarrhoea
Preterm
Congenital
Infection
Asphyxia
Other
Tetanus
Source: Lawn JE Cousen SN for CHERG (Nov 2006)
23%
21%
23% 23%
19%
22%
Total Urban Rural
1998-99 2005-06
Every year at least six million children in India are born with low birth weight which gives them a disadvantaged start in life
Based on reported birth weight data: 30% in NFHS 2 and 34% in NFHS 3
Birth weight
Percentage of children with reported birth weight less than 2.5 kg
Source: NFHS
Only one in four children in India are breastfed within 1 hour of birth
Initiation of breastfeeding within an hour
23%16%
10%
0
20
40
60
80
100
1992-93 1998-98 2005-06
Percentage of children born in the last three years who started breastfeeding within one hour of birth
Source: NFHS
Proposed action framework
Central premise “.. Essential services for mothers, newborns and children are most effective when delivered in an integrated package at critical points in life cycle, in a dynamic health system, in an environment supportive of women’s rights”
Continuum of care
Critical points for service delivery: Adolescence, Pre-pregnancy, Pregnancy, Birth, Post-partum, Neonatal, Infancy, Childhood
Essential Services: Basic health care, quality maternal-newborn care, adequate nutrition
Continuum of care
Key delivery modes: Household & Community, outreach, health facilities
Supportive environment: Quality education, women’s status, age at marriage and childbirth
Key actions
Create a supportive environment by promoting gender equality
– Enhance girl’s education
– Increase age at marriage & childbirth
Key actions Ensure continuum of care across time and locations
• Improve quality of reproductive health services
• Enhance nutrition of adolescent girls
• Ensure adequacy of antenatal care
• Ensure skilled assistance during pregnancy & childbirth
• Provide access to quality Basic and Comprehensive Emergency Obstetric & Newborn care when required
• Expand post-natal care for mothers & newborns
• Promote safe water & hygiene practices at households and in facilities
• Initiation of breastfeeding within one hour of birth
What will make it happen
• Building synergy and partnerships
• Generating and sustaining strong political leadership for health of women and children
• Mobilizing resources for maternal and newborn health
• Empowering families and communities for promoting health and accessing healthcare