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