The State of Maternal Health,d Nutrition in Asia " World Vision data

7/27/2019 The State of Maternal Health,d Nutrition in Asia " World Vision data

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Asia Pacific facts and statistics

Together we can endpreventable deaths

www.wvasiapacific.org/maternalhealth

Maternal survival

How many deaths?

z In South and East Asia and the Pacific 232,000

women die a year from maternal deaths.1 This

equates to one mother dying every 2.3 minutes

from maternal related causes.

z 2007 figures show that in South Asia 50% of all births

were unregistered (as few as seven percent of births

are registered in Bangladesh).2 South Asia’s registered

maternal death total of 96,505 in 2007 is therefore

also likely to be much lower than the real toll.

Who?

z The highest maternal death rate in the Asia Pacificregion occurs in Cambodia, with 470 out of

100,000 mothers dying during pregnancy, birth,

or the first 42 days after delivery.3

z Massive discrepancies exist between countriesin the region. Cambodia loses 1,795 women

to maternal death each year, while neighbour

Thailand, with a population four times greater

than Cambodia, loses 12.4

Why?

The seven biggest maternal killers in Asia are:

haemorrhaging (31%), ectopic pregnancy, embolismor other complications (15%), anaemia (13%), sepsis,

infections (including AIDS-related deaths) (12%),

hypertensive disorders (9%), obstructed labour (9%),

and complications with abortions (6%).5

Underlying causes include:

z Under-nutrition in mothers, which makes themweak in withstanding neonatal infections. As a

result of under-nutr ition more than half the women

in reproductive age are anaemic in South and

Southeast Asia , and this number shows no sign

of declining.6

1 http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf 2 http://www.unicef.org/policyanalysis/files/FactsheetInvesting.pdf 3 http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf 4 http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf

5 Camilla6 http://www.adb.org/documents/periodicals/ADR/pdf/ADR-Vol17-

Mason-Hunt-Parker-Jonsson.pdf

z Access to medical care - in South Asia only 35% of

pregnant women give birth in a medical facility, andover half of all bir ths occur at home without any

skilled professional present.7

z High birth frequency, which through custom,

ignorance or powerlessness, puts women at greaterrisk statistically of dying from pregnancy-related

causes. Of all the people in the world who require

family planning services, but do not have access to

them, 55% live in Asia and the Pacif ic.8

z Low reproductive knowledge - countries with low

levels of gender inclusion in primary and secondary

education have the highest levels of maternal deaths.

Maternal death reduction strategies

Invest in facilities, training and education on maternal

health as a priority:

z Public health expenditure remains well below the

world average on 5.1 per cent, with South Asia

spending only 1.1 per cent of GDP and 1.9 per centbeing spent in the rest of Asia-Pacific.9

z Countries like Thailand, Malaysia and the Republic

of Korea (South Korea) experienced massive

economic growth in the last quar ter of last century.As these countries strengthened economically, they

invested in policies to improve services for both

mothers and children. The same cannot be said of

India, whose thriving economy is in stark contrast

to its public health spending, among the lowest in the world per capita. The public health care system,

which provides the only health care access for the

poor, has only two physicians and eight nurses per

10,000 population10 - very few of these medical staffhave training specific to midwifery.

z A country does not need to be wealthy to show

commitment to reducing maternal deaths. Over 40

years ago, Sri Lanka began to expand ante-natal and

7 http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.p8 http://www.adb.org/Documents/Brochures/Maternal-Child-

Health/Investing-Maternal-Child-Health.pdf 9 http://www.thaindian.com/newsportal/lifestyle/india-china-hold-

key-to-world-meetingmillenium-development-goals-unicef_10080148.html

10 http://www.searo.who.int/en/Section313/Section1519.htm



Asia Pacific f acts and s tatis tics

page 2


neo-natal services. Even though around one third of

its population lives under the poverty line, Sri Lanka

has now successfully decreased its maternal death

rate, from 340 per 100,000 bir ths in 1960 to just 43

in 2004. 98% of all births are now performed in a

medical facility.11

11 http://www.unicef.org/devpro/46000_48498.html

Child survival

How many deaths?

z Every year an estimated 3.8 million children in

South and South East Asia die before their fifth

birthday. (South Asia - 2.98 million / Eas t Asia -

799,000).12 This amounts to a child dying every

8.3 seconds, or the casualty equivalent of 1,264

September 11s.

z Of these 3.8 milllion children, around 2.1 die within

the f irs t 28 days. (East Asia – 535,914 / South Asia

1,557426)13

z In 2006, 2.5 million child deaths occurred in just two countr ies - India (2.1m) and China (415,000),

together accounting for nearly a third of all child

deaths worldwide.14

z Vaccination against childhood illness overall in the

Asia Pacific, at 78%, is slightly under the global

average of 80%. In some countries, however,

vaccination levels are decreasing; Myanmar’s has

fallen from 90% in 1990 to 78% in 2006, and India’s

has steadily decreased since 1996.15

Who?

z Myanmar has the highest child mortality rate in theAsia-Pacific region.16 At least one in ten children

will die before the age of five – three quarters of

them before the age of one. At the hear t of these

statistics is malnutrition.

z In India, where malnutrition in mothers causes

nearly one third of babies to be born with low

birth weight, around one in 12 die in their first five

years.17 One in five children who dies globally is an

Indian child.

Why?

The biggest killer of children under 5 in East Asia and the Pacif ic is inadequate bir thing conditions (45%),

including low birthweight as well as birth trauma

or asphyxiation. Other leading causes of death are

diarrhoea (17%), acute respiratory infections (16%),

accidents (8%), vaccine preventable diseases including

measles and TB (7%), and vector borne diseases e.g.

malaria. Malnutr ition is a contributory factor in more

than half of all deaths under 5.18

12 http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf 13 http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf 14 http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf

15 http://www.adb.org/Documents/Books/Key_Indicators/2008/pdf/ Goal-04.pdf 16 http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf 17 http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf 18 http://www.unicef.org/vietnam/media_983.html

Underlying causes include:

z Neonatal: Most deaths of under-fives occur in

the f irs t hours or days of a child’s life, mainly due

to deliveries at home with no access to sk illed

professionals who can identify illness or perform

emergency treatment. .

z Low birthweight or low immunity, due to maternal

malnutrition: Food shortages affect women more

than men, especially in countr ies with low gender

parity. In India, where around 350 million people

go short of food every day, resultant anaemia inpregnant women can be linked to around 20% of

infant deaths.19

z Insufcient breastfeeding denies a child natural

immunity, especially if the first vital colostorum ismissed. As well, exposure to gastric illness through

dirty water (including when mixed with baby

formula) is especially dangerous for a child under 6

months of age, and can wreak permanent damage

to infant intestinal tracts.

z Respiratory infections, usually linked to

malnutrition because of an infant’s low immunity

from birth , are one of the biggest causes of death

between 2 and 28 days. Effective post-natal

monitoring can recognise and treat respiratory

problems, but is underresourced in most Asian

countries.

z “Preventable causes”: for children under five,

especially children who are malnourished,

diarrhoea, malaria and other fevers quickly become

life threatening.

Child death reduction strategies

z Targeted health spending: In Malaysia both

maternal mortality and neonatal deaths have gonedown significantly since the government introduced

widespread access to skilled birth attendants.20

z Immunisation: DPT3, a three dosage immunisation

that protects against diphtheria , per tussis and

tetanus, is a country’s usual indicator of chi ld

routine immmunisation. Of the estimated 24 million

children globally that have not received DPT3, 9.7

million are Indian, 0.4 million are from Bangladesh,

1.1 million from Indonesia and 1.2 million in China.

India’s DPT3 vaccination rate peaked in 1995 andhas since declined to around 62%.21

19 http://www.wfp.org/countries/india20 http://www.unicef.org/vietnam/media_983.html21 http://www.adb.org/Documents/Books/Key_Indicators/2008/ pdf/Goal-04.pdf




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z Cleaner water, better sanitation: Children contract

diarrhoea from contaminated water or from

inadequate toilet hygiene. East and South-East Asia

have markedly improved both access to clean water

and to toilets over the last 20 years, but one in f ivepeople in the region still uses a toilet that does not

meet minimum hygiene standards of separatinghuman waste from the possibility of human

contact.22 In South Asia, two out of three people

do not use hygienic toilets.23

22 http://www.unicef.org/eapro/wes_revised_factsheet_2009.pdf 23 http://www.who.int/water_sanitation_health/monitoring/jmp 2008.pdf

z Protection from malaria, dengue and other

vector-borne diseases: Sleeping under a mosquito

net, removing stagnant water from near households,

and treating fever symptoms effectively, are

three impor tant solutions to reduce malaria anddengue deaths, but are dependent on community

knowledge and will. Public health campaigns areurgently needed to combat these preventable

deaths.

Maternal and child nutrition

How many affected?

z Around 30% of women in the Asia region areunderweight. 24

z A high rate of anaemia in pregnant and

breastfeeding mothers affects the nutrition of their

children. Anaemia in women, usually linked to diet,

ranges from 13.4% in Thailand to 87% in India.25

z An estimated 120 million children are malnourished

in South and Southeast Asia.26

z In East Asia and Pacific 11% of under-fives are

moderately to severely undernourished. In South

Asia the f igure is 41% (that’s over two out of f ive).27

z

Stunting in children under five as a result ofmalnourishment is almost equal between the two

sub-regions; 18% in South Asia , 16% in East Asia .28

Who?

z 2 million children are suffering from under-

nourishment in Bangladesh today. 500,000 of these

children have been diagnosed with severe acute

malnutrition.29

z Timor-Leste currently faces a massive 49%

malnutrition in its children, due in part to food

shortages and in part to lack of knowledge of

maternal and child health including birth spacing.30

Why?

z In remote or protected areas like outlying

Indonesia, rural Myanmar or most of DPRK,

malnutrition is linked to food shortages, caused by

24 http://www.searo.who.int/LinkFiles/FCH_SEA-CHD-7.pdf p.1325 http://www.searo.who.int/LinkFiles/FCH_SEA-CHD-7.pdf p.1326 http://www.adb.org/documents/periodicals/ADR/pdf/ADR-Vol17- Mason-Hunt-Parker-Jonsson.pdf 27 http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf 28 http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf

29 http://www.un.org/apps/news/story.asp?NewsID=30329&Cr= bangladesh&Cr130 http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf

inadequate harvests, natural disasters or unequal

food access. Last year, a survey of children in the

Indonesian province of West Timor found up to

60% of children were malnourished.31

z In urban areas, malnutrition can be dr iven by

food costs, where household income in poor

communities does not increase in line with the

cost of living. In the last two years, r ising food costs

in megacities like Manila, Jakarta and Dhaka have

almost certainly led to increased malnutrition in

millions of children under f ive.32

z Knowledge and availability of nutritious food

poses a challenge to children’s health, especially in

communities where mothers have not attended

school or had other exposure to the concept ofnutrition. What is traditionally grown and cooked

by communities may not contain a full spectrum of

nutritional requirements.

z Insufcient breastfeeding – when babies are movedfrom breast milk to low nutrition rice porridges

their weight and health drops dramatically. In

Vietnam only 17% of children are breast fed to six

months; as a result, one quarter of children are

underweight, despite the relative food security of

this prospering nation.33

z Intestinal parasites affect up to 90% of children in

poor communities across the Asia Pacific region,

including hookworms or roundworms. Infected

children are nearly four times more likely to be

stunted and to suffer learning disabilities and

underperform academically.34

31 http://www.alertnet.org/thenews/fromthefield/284081/ 121146418139.htm32 http://www.reuters.com/article/homepageCrisis/idUSDEL457287. _CH_.2400

33 http://www.wpro.who.int/vietnam/sites/dhp/nutrition/34 http://www.wpro.who.int/media_centre/press_releases/pr_ 20020912.htm




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Maternal and child malnutritionreduction strategies

z Improving family nutrition need not be expensive.

The PD (or “Positive Deviance) Hearth modelstar ts by teaching mothers the basics of family

healthcare with a strong emphasis on nutrition.

After this, mothers whose children show good

nutritional results take on the responsibility of

training others , by sharing their own good practice.

World Vision’s PD Hear th programmes have

shown good results in diverse contexts and cultures

across Asia and the Pacif ic and have proven to be

sustainable without the need for ongoing funding.35

35 http://www.positivedeviance.org/about_pd/impact.html

z In 2005 a concerted effor t in Cambodia saw the

Ministry of Health partner with WHO and UNICEF

to deliver deworming treatment to nearly 3 million

children. Health workers targeted 24 provinces

through schools with deworming pills , educationposters and pamphlets for teachers as well as

games and pictures for children. The campaign cost6 US cents per child.36

36 http://whqlibdoc.who.int/hq/2005/WHO_CDS_CPE_PVC_ 2005.14.pdf

Terms and definitions

Child mortality usually refers to deaths in the under-

five age group. Within this group lies:

z Infant mortality or deaths in children before the

age of one year; and

z Neonatal mortality or deaths in children during the

first 28 days after birth

Maternal deaths are deaths occurring to women

during pregnancy, childbirth or within 42 days of

delivery.

Malnutrition can occur to both adults and children.

At any age, malnutrition will reduce immunity and

resilience to other health conditions. In children,

especially under the age of five, malnutr ition can

lead to permanent and devastating damage. Stunting,

reduced brain size, sk in conditions, bone diseases (for

instance rickets) are all caused by malnutrition. As well,

children are more susceptible to diseases.

Stunting measures height against age: usually caused

by long-term insufficient nutrient intake or frequent

infections. Stunting generally occurs before the age of two; effects are largely irreversible.

Wasting measures weight against height in all ages:usually an indicator of acute food shortage and/or

disease. A high prevalence of wasting usually correlates

with a high under-five mortality rate.

Underweight measures weight against age: the

indicator used to determine malnutrition in children

under five. Usually reversible, as opposed to stunted

growth caused by being underweight.

Recommended further references

For country comparative statistics on maternaland child health:

The State of the World’s Children 2009: Maternal

and Newborn Health, UNICEF 2009http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf

For country comparative statistics on water

and sanitation:

Progress on Drink ing-Water and Sanitation, WHO/

UNICEF Joint Monitoring Project 2008http://www.who.int/water_sanitation_health/monitoring/jmp2008/en/index.html

For funding and policy briefing statistics:Investing in Maternal, Newborn and Child Health;

the Case for Asia and the Pacific,

Asian Development Bank and partners 2007

http://www.adb.org/Documents/Brochures/Maternal-Child-Health/Investing-Maternal-Child-Health.pdf