Fulfilling the Health Agenda for Women and Children

Fulfilling the Health Agenda for Women and Children The 2014 Report ii. Acknowledgements. Countdown would like to thank the following: UNICEF/Data and Analytics Section for use of the global databases, preparation of country profiles, and inputs to and review of report text. Particular recognition goes to Danzhen You ...
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COUNTDOWN TO 2015

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Fulfilling the Health Agenda for Women and Children

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I N T E R N AT I O N A L

The 2014 Report

THE 2014 REPORT

FAMILY CARE

Fulfilling the Health Agenda for Women and Children

Contributors Lead writers: Jennifer Requejo (PMNCH), Jennifer Bryce (Johns Hopkins University), Cesar Victora (Federal University of Pelotas) Additional writing team: Adam Deixel (Family Care International), Aluisio Barros (Federal University of Pelotas), Zulfiqar Bhutta (Aga Khan University, SickKids Center for Global Child Health), Blerta Maliqi (WHO), Holly Newby (UNICEF), Joy Lawn (London School of Hygiene and Tropical Medicine, Save the Children) Profile development team: Tessa Wardlaw (UNICEF), Holly Newby (UNICEF), Archana Dwivedi (UNICEF), Colleen Murray (UNICEF) Countdown Coordinating Committee: Mickey Chopra (co-chair), Zulfiqar Bhutta (co-chair), Jennifer Bryce, Cesar Victora, Peter Berman, Joy Lawn, Elizabeth Mason, Ann Starrs, Carole Presern, Bernadette Daelmans, Tessa Wardlaw, Holly Newby, Ties Boerma, Andres de Francisco, Laura Laski, Jennifer Requejo, Archana Dwivedi, Nancy Terreri, Lori McDougall, Monica Fox Production team: Christopher Trott and Elaine Wilson (Communications Development Incorporated), Jennifer Requejo (PMNCH)

Technical Working Groups Coverage: Jennifer Bryce (co-chair), Holly Newby (co-chair), Archana Dwivedi, Jennifer Requejo, Allisyn Moran, Shams El Arifeen, Jocelyn DeJong, Monica Fox, Sennen Hounton, Doris Chou, Jamie Perin, James Tibanderana, Nancy Terreri, Lara Vaz Equity: Cesar Victora (co-chair), Ties Boerma (co-chair), Aluisio Barros, Carine Ronsmans, Wendy Graham, Betty Kirkwood, Edilberto Loiaza, Zulfiqar Bhutta, Kate Kerber , Ahmad Hosseinpoor, Alexander Manu, Xing Lin Feng Financing: Peter Berman (chair), Josephine Borghi, Lara Brearley, Rafael Cortes, Howard Friedman, Daniel Kraushaar, Gemini Mtei, Nebjosa Novcic, Ravi Rannan-Eliya, Nirmala Ravishankar Health systems and policies: Bernadette Daelmans (co-chair), Joy Lawn (co-chair), Blerta Maliqi, Neha Singh, Lara Brearley, Eleonora Cavagnero, Giorgio Cometto, Andres de Francisco, Kim Dixon, Sennen Hounton, Luis Huicho, Dan Kraushaar, Shyama Kuruvilla, Tiziana Leone, Zoe Matthews, Allisyn Moran, Susan Murray, Jennifer Requejo, Priyanka Saksena, Deb Sitrin, Amani Siyam, Nancy Terreri, Mark Young

ISBN: 978–92–806–4760–0 © Copyright UNICEF and World Health Organization, 2014. All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications - whether for sale or for noncommercial distribution - should be addressed to WHO Press through the WHO web site (http://www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. This publication has been prepared to facilitate the exchange of knowledge and to stimulate discussion. The logos that appear on the back cover represent the institutional affiliations of individual participants in report preparation and do not imply institutional endorsement of the contents or recommendations or approval of any specific intervention for which data are included. Implementation of specific intervention is dependent on the legal context in each country. While all reasonable precautions have been taken to verify the information contained in this publication, Countdown partners accept no responsibility for errors. Photo credits: cover, © 2010, UNICEF/NIGB2010-00307/Giacomo Pirozzi; page iii, © UNICEF/NYHQ2011-1601/Roger LeMoyne; page iv, © UNICEF/ NYHQ2006‑2848/Julie Pudlowski; page 2, © UNICEF/SLRA2013-0821/Olivier Asselin; page 4, © UNICEF/BANA2014-00767/Jannatul Mawa; page 5, © UNICEF/ MLIA2009‑00162/Giacomo Pirozzi; page 13, © UNICEF/UKLA2013-04096/Adam Vardy; page 21, © Graham Crouch/World Bank; Page 22, © Dominic Chavez/ World Bank; Page 24, © Arne Hoel/World Bank; Page 36, © UNICEF/UKLA2014-04749/Karin Schermbrucker; Page 40, © Chhor Sokunthea /World Bank; Page 42, © UNICEF/BANA2013-01079/Shafiqul Alam Kiron; Page 44, © UNICEF/SLRA2013-0148/Olivier Asselin; Page 222, © UNICEF/NYHQ2006-2477/Giacomo Pirozzi. Editing and layout by Communications Development Incorporated, Washington, DC USA.

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Fulfilling the Health Agenda for Women and Children

Acknowledgements

Countdown would like to thank the following: UNICEF/Data and Analytics Section for use of the global databases, preparation of country profiles, and inputs to and review of report text. Particular recognition goes to Danzhen You for help with the child mortality and demographic estimates, Agbessi Amouzou for help with the child and maternal health indicators, Julia Krasevec for help with the nutrition indicators, David Brown for help with immunization estimates, Robert Bain for help with the water and sanitation indicators, Priscilla Idele for help with the HIV/AIDS indicators and Colleen Murray for help with the databases. Siddha Development Research and Consultancy for its work in generating the profiles. Johns Hopkins University colleagues Lois Park and Elizabeth Hazel for their inputs to the coverage analyses. Federal University of Pelotas colleagues Maria Clara Restrepo, Giovanny Araújo França, Fernando Wehrmeister, Kerry Wong, Leonardo Ferreira and Luis Paulo Vidaletti for their inputs to the equity analyses. Jo Borghi from the London School of Hygiene and Tropical Medicine for her analysis of the official development assistance data. Ravindra P RannaEliya from the Institute for Health Policy, Sri Lanka, for his inputs to the catastrophic expenditure box. Priyanka Saksena from WHO for her inputs to the analysis of the financing data. Thierry Lambrechts, Dilip Thandassery and Matthews Mathai from WHO for providing health systems and policy data based on the MCA survey. Annabel Lim and Rufus Ferrabee from WHO for their inputs to the analysis of the health systems and policies data. The Partnership for Maternal, Newborn & Child Health for hosting the Countdown Secretariat

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Fulfilling the Health Agenda for Women and Children  The 2014 Report

and for convening meetings and teleconferences for Countdown. Particular recognition goes to Nacer Tarif and Nick Green for providing administrative support. American University of Beirut colleagues Hiam El Zein and Jocelyn DeJong for preparing a draft of the panel on conflict, including the material on Syria. Nadia Askeer and Zulfiqar Bhutta from the Centre for Global Child Health Hospital for Sick Children, Toronto, and the Aga Khan University and Taufiq Mashal from the Afghanistan Ministry of Public Health for their inputs to the Afghanistan text in the conflict panel. Matthew Matthais, Elizabeth Mason, Dilip Thandas­ sery, Thierry Lambrechts and Kathryn O’Neill from WHO for their inputs to the quality of care panel. Shams El Arifeen and Peter Kim Streatfield from ICDDR, B for their contributions to the Bangladesh example in the family planning panel. Robert Black and Li Liu at Johns Hopkins University for their inputs into the nutrition and cause of child death text. Lale Say and Doris Chou for their inputs to the maternal mortality section. Tiziana Leone from London School of Economics and Iqbal Shah for their inputs to the analysis of the legal status of abortion data. Luc de Bernis from UNFPA and Petra ten HoopeBender from Integrare for inputs to the human resources box focused on midwifery care. Family Care International for help with developing Countdown’s key advocacy messages. The Bill & Melinda Gates Foundation, the World Bank, and the governments of Australia, Canada, Norway, Sweden, the United States and the United Kingdom for their support for Countdown to 2015.

Contents

Countdown headlines for 2014

1

Introduction: unfinished business, achievable goals

3

Countdown: The 2014 Report

5

Progress towards Millennium Development Goals 4 and 5

6

Nutrition: a building block for progress

11

Coverage along the continuum of care

14

Equity: no women and children left behind 

22

Determinants of coverage and equity— policies, systems and financing

26

Data revolution and evolution: the foundation for accountability and progress

37

Annex A  About Countdown to 2015 for Maternal, Newborn and Child Survival

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Annex B  Summary of Countdown data sources and analysis methods

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Annex C  Country profile indicators and data sources, organized by order of presentation in the profile 202 Annex D  Definitions of Countdown coverage indicators

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Annex E  Definitions of health policies, systems and finance indicators

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Annex F  Technical annex for the Health Systems and Policies Technical Working Group and the Financing Technical Working Group 210 Annex G  Countdown countries prioritized for malaria intervention coverage analysis

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The Countdown process—what we have learned so far

41

Countdown speaks: priorities for the next 500 days and beyond

43

Annex H  Details on estimates produced by interagency groups used in the Countdown report—mortality, immunization, and water and sanitation

Country profiles

45

Notes

217

References

218

The Countdown country profile: a tool for action 46

Fulfilling the Health Agenda for Women and Children  The 2014 Report

iii

Countdown headlines for 2014

Real progress has been achieved.

But substantial business remains unfinished.

• The median annual rate of reduction in under-5 mortality in the Countdown countries doubled over 2000–2012 compared with 1990–2000, and child deaths have been almost halved since 1990.

• Fewer than half of Countdown countries will achieve Millennium Development Goal (MDG) 4, and very few will achieve MDG 5.

• Three-quarters of Countdown countries reduced maternal mortality faster in 2000–2013 than in the 1990s. • Median national coverage is 75% or higher for several key interventions (at least one antenatal care visit with skilled health personnel, vitamin A supplementation, immunizations and improved source for drinking water). • Rapid advances in coverage for malaria interventions show the impact of advocacy, investment and sustained effort and provide a model (and a challenge) for lagging interventions. • High coverage has been reached among the wealthy populations in many Countdown countries. Similar levels can be achieved across the whole population. Countries that have closed the equity gap provide a model of success. • Countdown countries continue to expand adoption of key policies that support improved coverage and quality of reproductive, maternal, newborn and child health interventions. • Total per capita health expenditure in the Countdown countries grew more than 10% between 2010 and 2012. • More than 75% of Countdown countries conducted a nationally representative household survey between 2008 and 2012. Before 2000 few countries had survey data available.

• Half of Countdown countries still have a high maternal mortality ratio (300–499 deaths per 100,000 live births), and 16 countries—all of them in Africa—have a very high maternal mortality ratio (500 or more deaths per 100,000 live births). • Progress in reducing preventable newborn deaths is much slower than progress in reducing deaths among children under age 5 in many Countdown countries. Most newborn deaths occur on the day of birth from intrapartum events, infections or preterm birth complications. • Preventable and treatable infectious diseases such as pneumonia and diarrhoea remain the leading causes of child deaths, and coverage of treatment interventions remains low in most Countdown countries. • Nearly half of child deaths are attributable to undernutrition. In 42 of the 62 Countdown countries with available data, more than 30% of children are stunted. Poor nutrition also harms women’s health and increases women’s risk of experiencing a stillbirth or delivering a lowbirthweight baby. • Severe health workforce shortages limit countries’ ability to provide high-quality care to women and children. Only seven Countdown countries report having enough skilled health professionals to achieve high coverage of essential interventions. • Not one Countdown country has adopted all 10 “tracer” policies that support delivery of proven

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interventions across the reproductive, maternal, newborn and child health continuum of care. • Official development assistance for maternal, newborn and child health in the Countdown countries decreased slightly between 2010 and 2011, driven by a 3% reduction in child health aid. Official development assistance for family planning grew substantially in 2011 but remains low. The amount of aid varies widely across countries and is not always proportional to need. • Only eight Countdown countries reported recent data on all coverage indicators recommended by the Commission on Information and Accountability for Women’s and Children’s Health. Half of Countdown countries reported new data from 2011–2012 on only one recommended indicator.

Inequities—between and within countries— mean that too many women and children are being left behind. • Even for interventions with high coverage in most Countdown countries, such as immunizations, some countries reach less than half of their population of women and children. • Across Countdown countries coverage for key interventions along the continuum of care is much higher for the wealthy than for the poor. Stunting is, on average, 2.5 times higher among poor children than among children from wealthier families.

Concerted, emphatic action is needed now to save lives and accelerate progress. • The next 18 months are critical for accelerating progress towards the MDG targets and for

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ensuring that work to achieve the next set of goals begins right now. • Sustainable development requires intensified support to countries that do not achieve the health MDGs and continued effort by and with countries that have. • Action on improving nutrition and coverage of effective interventions for all population groups in order to end preventable maternal and child deaths must not wait for the post-2015 targets to be finalized. These goals are crucial to any global agenda, and delays in pursuing them are unacceptable and unconscionable. • Increasing access to high-quality, skilled care around the time of birth will reduce maternal deaths, stillbirths and newborn deaths. Investment in water and sanitation programmes and strategies to increase coverage of treatment interventions for pneumonia and diarrhoea will help end the huge toll of deaths from these two leading killers of children. • Greater efforts are needed to help countries facing rapid population growth develop innovative approaches, including plans to increase health workforce production, deployment and retention, in order to reach all women and children with essential services. • We must all act to protect families, women and children from the destructive health impact of war and civil conflict and to help countries rebuild once conflict subsides. • Countries and their partners must invest in collecting and reporting health data that are fit for purpose, reliable, representative, timely and able to be disaggregated for subnational equity analyses.

Introduction: unfinished business, achievable goals

At the dawn of this new century, the countries of the world agreed on a set of Millennium Development Goals (MDGs)—ambitious and inspired statements of our global commitment to end extreme poverty and meet the needs of the world’s poorest. Improving women’s and children’s health and well-being—and in particular dramatically reducing millions of their preventable and needless deaths—stood at the centre of the framework, as the fourth and fifth of the eight MDGs. The deadline for achieving the goals was set for the end of 2015—exactly 18 months from today. When that deadline arrives, we will not have achieved the goals related to maternal and child health. Fewer than half of the 75 Countdown countries are likely to have succeeded in reducing child mortality by two-thirds from 1990 levels (MDG Target 4.A), only a small fraction will have cut maternal death by three-quarters (MDG Target 5.A), and we will still be far from ensuring universal access to reproductive health (MDG Target 5.B). This report highlights important progress in many countries and on many pressing health challenges. At the global level, over the 25-year measurement span of the MDGs, maternal and child deaths will have been almost halved. Dramatic progress on HIV interventions, vaccinations and distribution of insecticide-treated nets will have demonstrated the compelling power of high-level commitment, plentiful and consistent funding, and a focus on evidence-based programming to effect dramatic, life-saving change. The end of 2015 will inaugurate a new era in global health. We will enter that new era with unfinished business that can and must be addressed. As we move forward, setting new goals and establishing new accountability structures, we must renew and redouble our efforts in key areas where progress has been slowest:

• Meeting the vast unmet need for contraception, so that women and families can better control their fertility and their lives. • Ensuring that there are enough adequately trained health care workers equipped with the supplies needed to provide high-quality care before, during and after pregnancy to make pregnancy and childbirth safer for both mother and baby. • Improving maternal and newborn survival, including reducing preterm births and stillbirths, by investing in care on the day of birth when the risk of mortality is highest. • Addressing the infectious diseases, especially pneumonia and diarrhoea, that needlessly kill millions of children because they do not have access to effective treatments, appropriate nutrition, safe water and adequate sanitation facilities. • Confronting the huge burden of undernutrition that retards both the growth and the life opportunities of far too many children and adolescents in the majority of Countdown countries, where more than 30% of children are stunted. Underlying each of these issues is the harsh reality of many millions of women and children who are being left behind. Overcoming the huge inequities in access to high-quality health care is fundamental to success or failure in meeting the health targets—both pre- and post-2015—that we set for ourselves. Succeeding “on average” too often means failing to reach millions of poor and other disadvantaged women, children and families. Focused, evidence-based health policies and programmes must be targeted to the unreached. The task in front of us is not just about easy wins or low-hanging fruit. It is about the hard work of fulfilling every woman’s and child’s fundamental right to the highest attainable standard of health.

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Today, countries, their development partners and advocates are hard at work building consensus around a new set of objectives, with targets set a generation away. But we have not yet reached the end of 2015. Over the next 18 months we must use available data to drive emphatic, concerted action and sprint to the MDG finish line. A child dies every five seconds; a woman dies in pregnancy or childbirth every two minutes. Our efforts, right now, will save lives today and tomorrow, not just in 10 or 20 years. And a strong and determined run up to 2015 will put countries on a path to success in achieving the next set of goals and making life better for women and children everywhere. Economic development is a central focus of emerging accountability frameworks. But economic growth will not, on its own, result in lifesaving health care for all. It must be coupled with a core focus on health. Addressing pressing health challenges—in countries that often face a complex mix of climate change, population growth, civil conflict, gender discrimination, high HIV prevalence and other issues—is one of the most effective ways of building human capital and enabling equitable, sustainable economic development. We face a unique challenge, a compelling opportunity and a pressing obligation to end the heavy toll of millions of preventable women’s and children’s deaths. We can achieve this, but it will not happen on its own. We, as Countdown,

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challenge ourselves and the global reproductive, maternal, newborn and child health community to make the remaining days in the MDG era and the years beyond 2015 count for women and children. There must be continued, even increased, accelerations in coverage for lifesaving interventions and in improving nutrition and making family planning universally available. Coverage must be more equitable. And there must be greater commitment to data evolution that results in more and better data and data use for improving programmes. These targets do not need to wait for validation through the language of the sustainable development goals—they are a necessary part of any global agenda, and delays are unconscionable. Without consistent commitment and collaborative efforts, built on a strong foundation of evidence, the next generation of women and children will be saddled with the same crippling burden of illness and loss that we face today. Every country can improve women’s and children’s health and reduce preventable deaths. Countdown will continue to track progress towards these immutable targets at the country level and will hold fast to the principle of accountability by all for the health and development of women and children. With this report, Countdown begins the next stage of its work, enabling that progress by spotlighting the successes, the gaps, the programmatic innovations, the inequities and the lessons learned along the way.

Countdown: The 2014 Report

Countdown to 2015 is a global movement to track, stimulate and support country progress towards the health-related Millennium Development Goals, particularly goals 4 (reduce child mortality) and 5 (improve maternal health). Established in 2003 by the Bellagio Study Group on Child Survival,1 Countdown is supra-institutional and includes academics, governments, international agencies, professional associations, donors, nongovernmental organizations and other members of civil society, with The Lancet as a key partner. Countdown focuses specifically on tracking coverage of a set of evidencebased interventions proven to reduce maternal, newborn and child mortality in the 75 countries where more than 95% of maternal and child deaths occur. Countdown produces periodic publications, reports and other materials on key aspects of reproductive, maternal, newborn and child health, using data to hold stakeholders to account for global and national action. At the core of Countdown reporting are country profiles that present current evidence to assess country progress in improving reproductive, maternal, newborn and child health. The two-page profiles in this report are updated every two years and

include key demographic, nutritional status and mortality statistics; coverage levels and trends for proven reproductive, maternal, newborn and child health interventions; and policy, health system, financial and equity indicators. Countdown also prepares one-page versions of the profiles showcasing the priority indicators defined by the Commission on Information and Accountability for Women’s and Children’s Health and equity-specific profiles for each of the 75 priority countries. More information on Countdown data sources and methods are included in annexes B–H and at www. countdown2015mnch.org. This report begins with a summary of Countdown results for 2014 based on the data presented in the country profiles. Progress has been impressive in some areas, but unfinished business remains that must be prioritized in the post-2015 framework. The report then assesses the state of the data to support evidence-based decisions in women’s and children’s health. From there it goes on to describe elements of the Countdown process that might inform ongoing efforts to hold the world to account for progress. And finally the report lists concrete action steps that can be taken now to ensure continued progress for women and children in the years ahead.

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Progress towards Millennium Development Goals 4 and 5 Improving maternal, newborn and child survival in the Countdown countries depends on our ability to work together effectively to reach women and children with essential interventions. Trends in maternal, newborn and child mortality and undernutrition are the bottom line for assessing the impact of global and country efforts to increase equitable coverage of interventions across the reproductive, maternal, newborn and child health continuum of care. This section reviews progress in the 75 countries towards the mortality targets for Millennium Development Goals (MDGs) 4 and 5 and in addressing undernutrition.

Progress in reducing mortality is accelerating— but not fast enough! Child mortality in Countdown countries has declined substantially since 1990, paralleling a global drop from 12.6 million under-5 deaths in 1990 to 6.6 million in 2012.2 The median annual rate of reduction in under-5 mortality has increased in Countdown countries from 1.9% between 1990 and 1999 to 3.8% over 2000–2012 (table 1). But to achieve MDG 4, an annual rate of reduction of at least 4.4% over 1990–2015 was required, which few Countdown countries were able to reach and maintain. Only a minority of Countdown countries are on track to achieve MDG 4.3 However, 29 of the 75 Countdown countries achieved this high pace of progress over 2000–2012, an encouraging sign of what is possible.4 Approximately 18,000 children globally still die every day, the vast majority among disadvantaged population groups in Countdown countries.5 The leading causes of post-neonatal child deaths remain preventable infectious diseases—pneumonia, diarrhoea and malaria.6 Programmes that target these diseases need greater prioritization and sustained commitment. Slower progress has been achieved in reducing newborn mortality, so the percentage of child deaths that occur in the first four weeks of life is rising. The median share of newborn deaths

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among under-5 deaths in Countdown countries is 39%, with a low of 26% in Niger and a high of 64% in Brazil (see table 1). Countdown countries that have rapidly reduced child mortality, such as Brazil, tend to show a growing proportion of deaths in the newborn period. The three leading causes of newborn deaths are intrapartum events, complications of preterm birth and sepsis,7 all of which can be significantly reduced through increased investment in the quality of care around the time of birth. Such investments can also reduce the staggering number of stillbirths each year (around 2.6 million), more than 90% of which occur in the Countdown countries.8 Progress towards the maternal mortality target of MDG 5—reducing maternal mortality by threequarters between 1990 and 2015—has been slower and is harder to measure than progress towards MDG 4. Very few Countdown countries will achieve MDG 5.9 The median annual rate of reduction in the 75 Countdown countries over 2000–2013 is 3.1%, with a low of –0.5% in Côte d’Ivoire (where the maternal mortality ratio actually increased) and a high of 8.6% in Rwanda (table 2). It is very good news that 56 Countdown countries saw maternal mortality decline faster over 2000–2013 than in the 1990s and that over 2000–2013, 11 countries saw an annual rate of reduction of 5.5% or higher—the rate needed over 1990–2015 to meet the MDG target. However, the annual rate of reduction was less than 1% in four Countdown countries over the past decade, and 16 countries—all in Sub-­Saharan Africa—still have a very high maternal mortality ratio (500 or more deaths per 100,000 live births). The median lifetime risk of a maternal death is 1 in 66 in the Countdown countries, with a low of 1 in 1,800 in Azerbaijan and China and a high of 1 in 15 in Chad. In comparison, the likelihood that an adult woman will die from maternal causes is 1 in 3,400 in high-income countries.10 The majority of maternal deaths occur during the intrapartum and immediate postpartum periods from preventable causes such

TABLE 1

Trends in child mortality in the 75 Countdown countries, by average annual rate of reduction, 2000–2012 Under-five mortality rate Deaths per 1,000 live births

Share of under-5 deaths occurring in neonatal period (%)

Average annual rate of reduction (%)

Country

1990

2000

2012

1990–2012

1990–2000

2000–2012

2012

Rwanda

151

182

55

4.6

–1.9

10.0

39

Cambodia

116

111

40

4.9

0.5

8.5

47

54

37

14

6.1

3.8

8.1

61

244

174

71

5.6

3.4

7.5

34

China Malawi United Republic of Tanzania

166

132

54

5.1

2.3

7.4

40

Liberia

248

176

75

5.4

3.4

7.1

36

Senegal

142

139

60

3.9

0.2

7.1

42

62

33

14

6.6

6.2

6.9

64

Peru

79

40

18

6.7

6.9

6.5

51

Egypt

86

45

21

6.4

6.4

6.4

56

Brazil

Bangladesh

144

88

41

5.7

4.9

6.4

60

Ethiopia

204

146

68

5.0

3.4

6.3

43

Uganda

178

147

69

4.3

1.9

6.3

33

44

60

29

1.9

–3.2

6.1

54 43

Democratic People’s Republic of Korea

93

72

35

4.4

2.5

6.0

Niger

326

227

114

4.8

3.6

5.8

26

Nepal

142

82

42

5.6

5.5

5.7

57

Zambia

192

169

89

3.5

1.3

5.4

34

Bolivia (Plurinational State of)

123

78

41

5.0

4.6

5.3

46

Madagascar

159

109

58

4.6

3.8

5.2

38

Kyrgyzstan

71

50

27

4.4

3.5

5.2

54

Mozambique

233

166

90

4.3

3.4

5.1

34

Burkina Faso

202

186

102

3.1

0.8

5.0

27

South Sudan

251

181

104

4.0

3.3

4.6

35

Eritrea

150

89

52

4.8

5.2

4.5

36

Mali

253

220

128

3.1

1.4

4.5

33

84

52

31

4.5

4.7

4.4

48

Azerbaijan

Indonesia Guinea

241

171

101

3.9

3.4

4.4

34

Lao People’s Democratic Republic

163

120

72

3.7

3.1

4.3

38

Benin

181

147

90

3.2

2.0

4.2

31

61

74

45

1.4

–2.0

4.2

34

104

87

53

3.0

1.8

4.1

38

80

50

31

4.3

4.6

4.0

59

India

126

92

56

3.6

3.2

4.0

55

Yemen

125

97

60

3.3

2.5

4.0

45

Gambia

170

116

73

3.8

3.8

3.9

40

48

85

53

–0.5

–5.8

3.9

54 48

South Africa São Tomé and Príncipe Morocco

Botswana Guatemala

80

51

32

4.2

4.6

3.8

Cameroon

135

150

95

1.6

–1.1

3.8

30

46

25

16

4.8

6.0

3.7

44

Mexico Uzbekistan

74

61

40

2.8

1.8

3.7

34

Tajikistan

105

91

58

2.7

1.4

3.7

40

Nigeria

213

188

124

2.5

1.2

3.5

32

Kenya

98

110

73

1.4

–1.2

3.5

37

Swaziland

71

121

80

–0.5

–5.4

3.5

37

Myanmar

106

79

52

3.2

3.0

3.4

51

90

79

53

2.4

1.4

3.3

41

128

106

73

2.6

1.9

3.1

39

Turkmenistan Sudan Ghana

128

103

72

2.6

2.1

3.0

40

Burundi

164

150

104

2.1

0.9

3.0

35 (continued)

Fulfilling the Health Agenda for Women and Children  The 2014 Report

7

TABLE 1 (CONTINUED)

Trends in child mortality in the 75 Countdown countries, by average annual rate of reduction, 2000–2012 Under-five mortality rate Deaths per 1,000 live births

Share of under-5 deaths occurring in neonatal period (%)

Average annual rate of reduction (%)

Country

1990

2000

2012

1990–2012

1990–2000

2000–2012

Equatorial Guinea

182

143

100

2.7

2.4

2.9

34

Haiti

144

105

76

2.9

3.2

2.7

34

Gabon

92

86

62

1.8

0.7

2.7

41

Viet Nam

51

32

23

3.6

4.7

2.6

53

Afghanistan

176

134

99

2.6

2.7

2.6

36

Philippines

59

40

30

3.1

3.7

2.5

47

Guinea-Bissau

206

174

129

2.1

1.7

2.5

36 38

2012

Côte d’Ivoire

152

145

108

1.6

0.4

2.5

Djibouti

119

108

81

1.8

1.0

2.4

39

Mauritania

128

111

84

1.9

1.5

2.3

40

Pakistan

138

112

86

2.2

2.1

2.2

50

53

45

34

2.0

1.7

2.2

56

Sierra Leone

257

234

182

1.6

0.9

2.1

27

Comoros

124

99

78

2.1

2.2

2.0

40

Togo

143

122

96

1.8

1.6

2.0

35

Central African Republic

171

164

129

1.3

0.4

2.0

32

Iraq

89

79

63

1.6

1.3

1.9

39

209

189

150

1.5

1.0

1.9

27

Angola

213

203

164

1.2

0.5

1.8

28

Congo

100

118

96

0.2

–1.7

1.7

34

Democratic Republic of the Congo

171

171

146

0.7

0.0

1.3

30

Somalia

177

171

147

0.8

0.4

1.2

31

Lesotho

85

114

100

–0.7

–3.0

1.1

46

Zimbabwe

74

102

90

– 0.9

–3.2

1.1

44

Solomon Islands

39

35

31

1.0

1.0

0.9

44

Papua New Guinea Chad

Source: UN Inter-agency Group for Child Mortality Estimation 2013.

as haemorrhage, pre-eclampsia or eclampsia, and infection.11 Unsafe abortion also exacts a high toll of avoidable maternal deaths in the Countdown countries (box 1). Most maternal deaths can be averted by implementing programmes and policies

8

Fulfilling the Health Agenda for Women and Children  The 2014 Report

that support women’s access to affordable and high-quality family planning, antenatal, delivery and postnatal care. Progress and gaps in intervention coverage across the Countdown countries are reviewed in the next section.

TABLE 2

Trends in maternal mortality in the 75 Countdown countries, by average annual rate of reduction, 2000–2013 Maternal mortality ratio Deaths per 100,000 live births

Average annual rate of reduction (%)

Country

1990

2000

2013

1990–2013

1990–2000

Rwanda

1,400

1,000

320

6.1

2.8

8.6

Cambodia

1,200

540

170

8.1

7.7

8.4

Lao People's Democratic Republic

1,100

600

220

6.8

6.1

7.4

Equatorial Guinea

1,600

790

290

7.0

6.6

7.4

Afghanistan

1,200

1,100

400

4.7

1.4

7.2

2000–2013

Ethiopia

1,400

990

420

5.0

3.1

6.4

Angola

1,400

1,100

460

4.9

2.9

6.4

790

430

190

6.0

5.8

6.1

60

57

26

3.6

0.4

6.0

Botswana

360

390

170

3.1

–0.7

6.0

Zambia

580

610

280

3.1

–0.5

5.7

Bangladesh

550

340

170

5.0

4.6

5.4

Nepal Azerbaijan

2,300

2,200

1,100

3.3

0.7

5.3

Tajikistan

68

89

44

1.9

–2.6

5.3

China

97

63

32

4.7

4.2

5.1

910

770

410

3.5

1.7

4.8

Sierra Leone

United Republic of Tanzania India Mozambique

560

370

190

4.5

4.1

4.7

1,300

870

480

4.3

4.1

4.5

Myanmar

580

360

200

4.5

4.7

4.3

Uganda

780

650

360

3.2

1.9

4.3

1,700

670

380

6.2

8.7

4.2

250

160

89

4.4

4.6

4.2

Eritrea Peru Liberia

1,200

1,100

640

2.8

1.2

4.0

South Sudan

1,800

1,200

730

3.8

3.6

4.0

Nigeria

1,200

950

560

3.1

2.0

4.0

Viet Nam

140

82

49

4.4

4.9

3.9

Swaziland

550

520

310

2.5

0.6

3.9

Morocco

310

200

120

4.1

4.3

3.9

Egypt

120

75

45

4.1

4.4

3.8

Indonesia

430

310

190

3.5

3.2

3.8

Pakistan

400

280

170

3.6

3.3

3.7

Bolivia (Plurinational State of)

510

330

200

4.0

4.5

3.6

Solomon Islands

320

210

130

3.8

4.1

3.6

Djibouti

400

360

230

2.4

1.2

3.4

1,100

860

550

3.1

2.7

3.4

470

340

220

3.3

3.2

3.4

1,700

1,500

980

2.3

1.0

3.2

Sudan

720

540

360

3.0

2.8

3.1

Guinea-Bissau

930

840

560

2.2

1.0

3.1

Mauritania

630

480

320

2.9

2.6

3.1

Senegal

530

480

320

2.2

1.1

3.0 3.0

Mali Papua New Guinea Chad

1,000

1,100

730

1.5

–0.5

Ghana

Democratic Republic of the Congo

760

570

380

2.9

2.8

3.0

Congo

670

610

410

2.1

1.0

3.0

Guinea

1,100

950

650

2.2

1.2

2.9

770

580

400

2.9

2.8

2.9

1,100

750

510

3.2

3.7

2.8

Burkina Faso Malawi Zimbabwe

520

680

470

0.4

–2.7

2.8

Benin

600

490

340

2.4

2.0

2.7 (continued)

Fulfilling the Health Agenda for Women and Children  The 2014 Report

9

TABLE 2 (CONTINUED)

Trends in maternal mortality in the 75 Countdown countries, by average annual rate of reduction, 2000–2013 Maternal mortality ratio Deaths per 100,000 live births Country

Average annual rate of reduction (%)

1990

2000

2013

1990–2013

1990–2000

Kenya

490

570

400

0.8

–1.6

2.7

São Tomé and Príncipe

410

300

210

2.8

3.1

2.6

Democratic People's Republic of Korea Somalia

2000–2013

85

120

87

–0.1

–3.8

2.6

1,300

1,200

850

1.8

0.8

2.5

Lesotho

720

680

490

1.7

0.6

2.5

Comoros

630

480

350

2.6

2.6

2.5

Mexico

88

67

49

2.5

2.7

2.4

Gabon

380

330

240

2.0

1.4

2.4

1,300

1,000

740

2.3

2.1

2.4

460

370

270

2.3

2.2

2.3

1,000

850

630

2.0

1.6

2.3

85

100

75

0.5

–1.8

2.2

Burundi Yemen Niger Kyrgyzstan

66

48

36

2.6

3.0

2.2

1,200

1,200

880

1.3

0.2

2.2

Haiti

670

510

380

2.4

2.6

2.2

Gambia

710

580

430

2.1

2.1

2.2

66

81

61

0.3

–2.1

2.1

Togo

660

580

450

1.6

1.2

1.9

Uzbekistan Central African Republic

Turkmenistan Cameroon

720

740

590

0.9

–0.4

1.8

Madagascar

740

550

440

2.3

3.0

1.7

Brazil

120

85

69

2.4

3.3

1.7

Guatemala

270

160

140

2.8

4.8

1.3

South Africa

150

150

140

0.4

–0.2

0.9

Iraq

110

71

67

2.0

4.1

0.4

Philippines

110

120

120

–0.6

–1.2

–0.2

Côte d’Ivoire

740

670

720

0.1

1.0

–0.5

Source: Maternal Mortality Estimation Inter‑agency Group (World Health Organization, United Nations Children’s Fund, United Nations Population Fund, United Nations Population Division and World Bank) 2014.

BOX 1

Preventing unsafe abortion About 22 million unsafe abortions occur each year, resulting in thousands of preventable maternal deaths and numerous women left with permanent disabilities.1 Three-quarters of these unsafe abortions, the vast majority of which occur in developing countries, could be averted through improved access to family planning services. Provision of safe abortion services (to the extent allowed by law) and postabortion care in countries where safe abortion is legally restricted are also important measures for reducing unnecessary deaths and other complications. Of the 74 Countdown countries with data for 2013, 30 have legislation permitting abortion only to save a

woman’s life, 4 have legislation permitting abortion to preserve physical health, 26 have legislation permitting abortion to preserve mental or physical health, 2 have legislation permitting abortion for economic or social reasons as well as to preserve a woman’s health and survival and 12 have legislation permitting abortion on request. Four countries also have legislation allowing abortion in cases of rape or incest, 3 in cases of foetal impairment and 25 in cases of rape, incest or foetal impairment. Notes 1. WHO 2011.

Source: Countdown estimates based United Nations Population Division database (http://esa.un.org/poppolicy/about_database.aspx, accessed January 2014).

10

Fulfilling the Health Agenda for Women and Children  The 2014 Report

Nutrition: a building block for progress

Millennium Development Goal Target 1.C includes a focus on child undernutrition as an indicator for monitoring progress in eradicating poverty. The importance of ensuring good nutrition from adolescence through pregnancy and early childhood is being increasingly recognized as a priority for sustainable development.12 Poor nutrition status harms a woman’s own health and is a risk factor for intrauterine growth restriction and other poor obstetrical outcomes.13 Nearly half of all deaths among children under age 5—or about 3 million deaths a year—are attributable to undernutrition.14

FIGURE 1

In 42 of the 62 Countdown countries with available data, 30% or more of children are stunted Number of Countdown countries 25

20

Minimum: 9% (China) Median: 33% Maximum: 58%(Burundi)

15

10

Wasting (low weight for height) affects at least 52 million children globally.15 It indicates acute food shortage or disease, and it sharply increases a young child’s risk of death. The median prevalence of wasting in the 61 Countdown countries with available data is 7%, with a low of 1% in Peru and a high of 23% in South Sudan. Childhood wasting prevalence exceeds 5%—the threshold set by the World Health Assembly in 2013 for countries to achieve by 202516—in 41 of these countries.

5

0 Less than 9%

9%– 19%

20%– 29%

30%– 39%

40%– 49%

50% or more

Prevalence of stunting among children under age 5, 2008–2012 Source: United Nations Children’s Fund global databases, April 2014, based on Demographic and Health Surveys, Multiple Indicator Cluster Surveys and other national surveys.

Stunting (inadequate length and height for age) is the most sensitive indicator of the quality of a child’s life. Stunting reflects insufficient or low quality diets, poor child care or infection.17 In 42 of the 62 Countdown countries with available data, 30% or more of children are stunted (figure 1). Stunting is highly concentrated among the poor. On average across the Countdown countries, stunting prevalence is 2.5 times higher among the poorest wealth quintile than among the richest (figure 2). Stunting also tends to be more common in rural areas, in disadvantaged population groups and among boys.18 Addressing high prevalence of wasting and stunting requires a comprehensive approach

that includes nutrition-specific interventions for women and children, multisectoral efforts to combat food insecurity and improve women’s low social status, and increased access to safe water and sanitation facilities.19 Efforts to improve maternal and child nutrition, especially among those who are not now being reached, must be massively intensified to achieve the global target of reducing stunting prevalence 40% by 2025, set by the World Health Assembly in 2013. 20 Recognition of the crucial role nutrition plays in child health and development, long-term health outcomes, human capital development and economic productivity has seen a welcome expansion in recent years (box 2).

Fulfilling the Health Agenda for Women and Children  The 2014 Report

11

FIGURE 2

On average across the Countdown countries, stunting prevalence is 2.5 times higher among the poorest wealth quintile than among the richest Prevalence of stunting among children under age 5, wealthiest and poorest quintiles, various years (%) Madagascar (DHS 2008) Egypt (DHS 2008) Poorest quintile

Iraq (MICS 2011)

Wealthiest quintile

Zimbabwe (DHS 2010) Niger (DHS 2012) Uganda (DHS 2011) Tajikistan (DHS 2012) Sierra Leone (MICS 2010) Central African Rep. (MICS 2010) Ethiopia (DHS 2011) Afghanistan (MICS 2010) Congo, Dem. Rep. (MICS 2010) Tanzania (DHS 2010) Malawi (DHS 2010) Burkina Faso (DHS 2010) São Tomé and Príncipe (DHS 2008) Lesotho (DHS 2009) Kenya (DHS 2008) Senegal (DHS 2010) Ghana (MICS 2011) Gabon (DHS 2012) Haiti (DHS 2012) Burundi (DHS 2010) Mozambique (DHS 2011) Côte d’Ivoire (DHS 2011) Congo (DHS 2011) Swaziland (MICS 2010) Cambodia (DHS 2010) Rwanda (DHS 2010) Bangladesh (DHS 2011) Togo (MICS 2010) Nepal (DHS 2011) Viet Nam (MICS 2010) Cameroon (DHS 2011) Pakistan (DHS 2012) Peru (DHS 2012) Bolivia (DHS 2008) Lao PDR (MICS 2011) Nigeria (MICS 2011) 0

10

20

30

Source: Demographic and Health Surveys and Multiple Indicator Cluster Surveys.

12

Fulfilling the Health Agenda for Women and Children  The 2014 Report

40

50

60

70

80

BOX 2

The first 1,000 days: How interventions in early life can improve adult health and human capital Good nutrition during the “first 1,000 days”—from the beginning of pregnancy to a child’s second birthday—is essential for ensuring a healthy start in life and avoiding early morbidity and mortality.1 It has also been long recognized that insults and illnesses in early life can cause chronic conditions that last into adulthood. Examples include cerebral palsy as a result of birth hypoxia, paralysis as a consequence of polio, deformities from congenital syphilis and chronic obstructive pulmonary diseases caused by frequent lower respiratory infections in childhood. Recent evidence reveals that the long-term consequences of poor health and undernutrition in early life go well beyond the specific effects of particular conditions. The first 1,000 days play an important role in the development of several noncommunicable diseases among adults, including diabetes, obesity, hypertension and other cardiovascular diagnoses.2 They also represent a critical window for the acquisition of human capital, which includes adult height and lean body mass, performance on intelligence tests and school achievement, economic productivity and reproductive performance.3 Children who are undernourished are more likely to experience poor cognitive development and lower academic achievement. When combined with the shorter stature of adults who were malnourished in early life, poor cognitive development reduces earning potential after entry into the workforce. Girls who are undernourished are also at elevated risk of later entering pregnancy with short stature and low body mass index, increasing the likelihood they will

deliver a low-birthweight baby, perpetuating an insidious cycle that entrenches families in poverty.4 Suboptimal breastfeeding practices are a major contributor to the risk of infectious diseases and may influence adult health, nutrition status and intelligence.5 With the emerging evidence of the importance of preconception care and adolescent nutrition for reproductive health and outcomes, other windows of opportunity for intervention along the life course have become evident,6 but the importance of the first 1,000 days remains unparalleled. Countdown monitors intervention coverage during pregnancy, the perinatal period and the first years of the child’s life (see figure 3 in the main report). Access to these interventions is important not only for short-term survival, but also for reducing morbidity and ensuring optimal nutrition. The recognition of this crucial 1,000-day window of opportunity connects the short-term benefits of these interventions with their long-term effects on health and human capital, thus linking the child survival agenda with the broader agenda of economic and social development. Notes 1. Black and others 2013; UNICEF 2013a. 2. UNICEF 2013a. 3. Victora 2008. 4. Victora 2008. 5. Horta and Victora 2013. 6. Bhutta and others 2013a.

Fulfilling the Health Agenda for Women and Children  The 2014 Report

13

Coverage along the continuum of care

This section presents levels and trends in the Countdown coverage indicators, including measures of equity in coverage. Coverage refers to the proportion of a population in need of an intervention that actually receives it. Intervention coverage is closely related to maternal, newborn and child survival and nutrition. Increases in coverage suggest that countries are successfully implementing effective reproductive, maternal, newborn and child health policies and programmes; failure to increase coverage is a cause for urgent concern. Countries with high coverage of a basket of key interventions, as measured by the Composite Coverage Index,21 tend to have lower child mortality, and countries with low coverage tend to have higher child mortality (figure 3). There is a strong correlation between the Composite Coverage Index and child mortality that remains strong even after adjusting for country GDP. The correlation supports Countdown’s focus on tracking intervention coverage as central to accountability and counters suggestions that money can save lives directly.22 Financial well-being and maternal education are both of great importance to child health, but their impact is achieved primarily through more proximate interventions that address the causes of ill health and death. Figure 4 shows median national coverage for 21 interventions, using the most recent available data since 2008. It provides a snapshot of how well the Countdown countries are doing in reaching women and children with a core set of effective interventions that should be available to all (table 3 shows the number of countries with available data, medians and ranges for each indicator). A grey dot indicates the national coverage for each reporting country; there is a wide range of variability across countries. Updated results for the remaining Countdown coverage indicators (Caesarean section, prevention of mother-to-child transmission of HIV and eligible HIV-positive pregnant women receiving antiretroviral treatment for their own health) are available at www.countdown2015mnch.org.

14

Fulfilling the Health Agenda for Women and Children  The 2014 Report

These interventions are presented along the continuum of care from pre-pregnancy to early childhood, and include improved drinking water sources and sanitation facilities as cross-cutting interventions relevant to women’s and children’s health. Only Countdown countries with a considerable proportion of the population at risk of Plasmodium falciparum (the most lethal form of malaria) transmission are included in the analysis of coverage for the malaria indicators. These results clearly show the critical gaps that remain for care around the time of birth, when the risk of mortality is highest for mother and newborn, and for case management of childhood illnesses. By contrast, median coverage is at least 75% for antenatal care (at least one visit), vitamin A supplementation (two doses), immunization and improved drinking water sources. Yet, even for these high-performing interventions, some countries report coverage well below 50%. At the same time, for every intervention except intermittent preventive treatment of malaria for pregnant women (possibly due to this intervention’s relative newness or to changes in protocol and definition), there is at least one country with coverage that exceeds 75%. The results also show that the enormous lifesaving potential of appropriate infant and young child feeding is not being realized. Only a median of about 50% of mothers in Countdown countries reported early initiation of breastfeeding for their most recent child, and only 41% reported exclusive breastfeeding. Improvements in the coverage of exclusive breastfeeding remains one of the biggest missed opportunities to reduce child mortality. These cross-sectional results should be interpreted in light of changes in coverage over time. For countries with representative survey data from both 2000–2007 and 2008–2012, table 4 shows the percentage point change in coverage from the first to the second time period for each intervention and the proportion of the gap between the first

FIGURE 3

Countries with high coverage of key interventions tend to have lower child mortality Under-5 mortality rate (per 1,000 live births) 250

200

150

100

50

0 0

25

50 Score on Composite Coverage Index (%)

75

100

Source: Demographic and Health Surveys; UN Inter-agency Group for Child Mortality Estimation 2013.

FIGURE 4

Coverage of interventions varies across the continuum of care Median national coverage of selected Countdown interventions, most recent survey, 2008 or later (%) Prepregnancy

Pregnancy

Birth

Postnatal

Country reporting data for 2008 or later

Infancy

Water and sanitation

Childhood

100

75

50

Improved sanitation facilities

Improved drinking water sources

Oral rehydration salts

Malaria treatment (first-line antimalarial)a

Antibiotics for pneumonia

Careseeking for pneumonia

Children sleeping under insecticide-treated netsa

Vitamin A supplementation (two doses)b

Haemophilus influenzae type b immunization (three doses)b

Measles immunizationb

DTP3 immunizationb

Introduction of solid, semisolid or soft foods

Exclusive breasteeding (for first six months)

Postnatal visit for mother

Early initiation of breastfeeding

Skilled attendant at birth

Neonatal tetanus protectionb

Intermittent preventive treatment of malaria for pregnant womena

Antenatal care (at least four visits)

Antenatal care (at least one visit)

0

Demand for family planning satisfied

25

a. Analysis is based on countries with 75% or more of the population at risk of p. falciparum transmission and 50% or more cases of malaria caused by p. falciparum. b. Data are for 2012. Source: Immunization rates, WHO and UNICEF; postnatal visit for mother, Saving Newborn Lives analysis of Demographic and Health Surveys; improved water and sanitation, WHO and UNICEF Joint Monitoring Programme; all other indicators, UNICEF global databases, April 2014, based on Demographic and Health Surveys, Multiple Indicator Cluster Surveys and other national surveys.

Fulfilling the Health Agenda for Women and Children  The 2014 Report

15

TABLE 3

National coverage of Countdown interventions, most recent survey, 2008 or later Indicator

Number of countries with data

Median coverage (%)

Range (%)

53

64

13–95

Pre-pregnancy Demand for family planning satisfied Pregnancy Antenatal care (at least one visit)

58

90

40–100

Antenatal care (at least four visits)

48

53

15–94

Intermittent preventive treatment of malaria for pregnant womena

34

22

2–69

Neonatal tetanus protection

67

84

43–94

60

63

10–100 18–95

Birth Skilled attendant at birth Postnatal Early initiation of breastfeeding

47

50

Postnatal visit for mother

32

45

7–93

Postnatal visit for baby

17

30

5–83

Infancy Exclusive breastfeeding

51

41

3–85

Introduction of solid, semisolid or soft foods

47

66

20–92

Diphtheria-tetanus-pertussis (three doses)

75

85

33–99

Measles immunization

75

84

42–99

Haemophilus influenzae type b immunization (three doses)

66

86

10–99

Vitamin A supplementation (two doses)

55

78

0–99

Children sleeping under insecticide-treated netsa

36

38

10–77

Careseeking for symptoms of pneumonia

53

52

26–80

Antibiotic treatment for symptoms of pneumonia

40

46

7–88

Malaria treatment (first-line antimalarial) a

35

32

3–97

Oral rehydration therapy with continued feedingb

45

47

12–76

Oral rehydration salts

55

37

11–78

Childhood

Water and sanitation Improved drinking water sources (total)

72

75

30–99

Improved sanitation facilities (total)

72

38

9–100

a. Analysis is based on countries with 75% or more of the population at risk of p. falciparum transmission and 50% or more cases of malaria caused by p. falciparum. b. Indicator is not included in figure 4. Note: Bolded indicators are those recommended by the Commission on Information and Accountability for Women’s and Children’s Health. Source: United Nations Children’s Fund global databases, April 2014, based on Demographic and Health Surveys, Multiple Indicator Cluster Surveys and other national surveys.

measurement and 100% coverage that was closed by the time of the second measurement. The proportion of the gap closed metric is useful because it takes into account that coverage may have already been high during the first time period for some indicators (such as immunization and at least one antenatal care visit); looking only at percentage point change would mask any relative progress achieved by the second measurement. The data in table 4 reveal three primary coverage patterns: • For some interventions with high and sustained coverage at or over 80%, progress

16

Fulfilling the Health Agenda for Women and Children  The 2014 Report

has continued in closing the remaining gap to universal coverage. These interventions include antenatal care (at least one visit) and the three indicators of vaccination coverage. • For a second group of interventions, measurable progress has been made in absolute terms, but coverage remains low, and a large gap remains between current coverage and 100% coverage. These interventions include intermittent preventive treatment of malaria for pregnant women, children sleeping under insecticidetreated nets and treatment with recommended antimalarials—each of which showed absolute increases of around 20 percentage points

TABLE 4

Changes in national coverage of Countdown interventions from 2000–2007 to 2008–2012, by proportion of the coverage gap closed between the two periods Median coverage (%)

Number of countries with data

2000−07

Haemophilus influenzae type b immunization (three doses)

24

86

91

5

36

Malaria treatment (first-line antimalarial) a

19

5

37b

32

34 33

Indicator

2008−12

Change (percentage points)

Proportion of gap closed (%)

Antenatal care (at least one visit)

58

85

90

5

Children sleeping under insecticide-treated netsa

33

10

38

28

31

Antibiotic treatment for symptoms of pneumonia

21

26

47

21

28

Improved drinking water sources

71

66

75

9

26

Measles immunization

74

79

84

5

24

Skilled attendant at birth

60

54

63

9

20

Intermittent preventive treatment of malaria for pregnant womena

23

7

25 c

18

19

Demand for family planning satisfied

39

56

64 d

8

18

Diphtheria-tetanus-pertussis immunization (three doses)

74

82

85

3

17

Exclusive breastfeeding

47

34

41

7

11

Careseeking for symptoms of pneumonia

50

48

52

4

8

Oral rehydration salts treatment

52

29

35

6

8

Oral rehydration therapy with continued feeding

40

42

46

4

7

Improved sanitation facilities

71

36

40

4

6

a. Analysis is based on countries with 75% or more of the population at risk of p. falciparum transmission and 50% or more cases of malaria caused by p. falciparum. b. Includes 2013 Demographic and Health Survey data for Gambia and Liberia. c. Includes 2013 Demographic and Health Survey data for Gambia, Mali and Senegal. d. Includes 2013 Demographic and Health Survey data for Pakistan and 2013 Performance Monitoring and Accountability Family Planning Survey data for Ghana. Note: Table includes only indicators for which trend data are available in the data sets shared by the United Nations Children’s Fund to date. Source: UNICEF global databases, April 2014, based on Demographic and Health Surveys, Multiple Indicator Cluster Surveys and other national surveys.

between the two time periods. These examples show what can be accomplished with focused advocacy, sufficient resources and sustained effort.23 • The third group contains interventions for which coverage is inadequate and has not increased significantly since 2000. These interventions include demand for family planning satisfied, the presence of a skilled attendant at birth, exclusive breastfeeding among children under six months of age, use of improved sanitation facilities and appropriate careseeking and treatment for diarrhoea and pneumonia, the two most important infectious causes of death among children under age 5. We—the global reproductive, maternal, newborn and child health community—are accountable for the gap between the current, insufficient coverage and the universal coverage that we can and must achieve. Box 3 illustrates this challenge by comparing progress for one intervention from the rapid acceleration group (children sleeping under

insecticide-­treated nets) with one from the stagnant group (oral rehydration salts treatment). It shows that although coverage for insecticide-treated nets increased rapidly in Countdown countries from about 2006 to about 2011, coverage for the correct treatment of diarrhoea with oral rehydration salts has stagnated and even declined in some countries. Countdown has done similar analyses, and drawn similar conclusions, from a comparison of prevention of mother-to-child transmission of HIV (rapid acceleration) and careseeking for symptoms of pneumonia (stagnation). Both HIV and malaria are specifically named in Millennium Development Goal 6 and thus attracted resources for scaling up interventions, whereas diarrhoea and pneumonia interventions are lagging behind, perhaps because they have failed to attract sufficient attention from donors, even though they claim many more child lives than HIV or malaria do. Ensuring that all essential interventions benefit from focused advocacy and adequate financing is our responsibility, and discrepancies in attention and coverage must be redressed.

Fulfilling the Health Agenda for Women and Children  The 2014 Report

17

BOX 3

With adequate focus and financing, coverage can and should accelerate quickly for many proven interventions The figure below compares the annual percentage point change in coverage of insecticide-treated nets for the prevention of malaria with coverage of oral rehydration salt solution for the prevention of diarrhoea-related dehydration for Countdown countries with two data points since 2000. These two interventions, both targeted at leading killers of children, show divergent coverage trajectories, with considerable gains for insecticide-treated nets and small gains and even some reversals with oral rehydration salts solution. Recent gains in insecticide-treated net coverage in many malaria-endemic countries were achieved through a combination of political commitment, publicprivate partnerships, strong advocacy and considerable financial investment to support the integration of net delivery with maternal and child health programmes such as immunization.1 Lessons from the insecticide-treated nets success story should be applied to efforts to scale up oral rehydration salts and other preventive and treatment measures to combat childhood diarrhoea, as well as other leading killers of women and children. One step in this direction was the launch of the Global Action Plan for Pneumonia and Diarrhoea in 2013, which set targets to end preventable child deaths from the two diseases by 2025. 2 The plan calls for coordinating and integrating efforts to address the underlying environmental determinants of pneumonia and diarrhoea and to increase access to treatment. 3 Notes 1. Walker and others 2013. 2. WHO and UNICEF 2013. 3. Bhutta and others 2013b.

Rapid gains for insecticide-treated nets—why can’t we do the same for other interventions? Average annual percentage point change in coverage over the specified period Gambia 2006–2010 Guinea-Bissau 2006–2010 Swaziland 2007–2010 Lao PDR 2006–2012 Zimbabwe 2006–2011 Cameroon 2006–2011 Nigeria 2003–2011 Niger 2006–2012 Comoros 2000–2012 Congo 2005–2012 Ghana 2006–2011 São Tomé & Príncipe 2006–2009 Togo 2006–2010 Sierra Leone 2005–2010 Central African Rep. 2006–2010 Côte d’Ivoire 2006–2012 Uganda 2006–2011 Kenya 2003–2009 Burundi 2005–2010 Benin 2006–2012 Burkina Faso 2006–2010 Congo, Dem. Rep. 2007–2010 Mali 2006–2010 Rwanda 2005–2010 –10 –8 –6 –4 –2

Insecticide-treated nets Oral rehydration salts

0

2

4

6

8

10 12

Source: United Nations Children’s Fund global databases, April 2014, based on Demographic and Health Surveys, Multiple Indicator Cluster Surveys and other national surveys.

Assessing country efforts to increase access to services and coverage of interventions requires understanding context. Simple statistics showing the proportion of a population that received an intervention do not always tell the full story.

18

Fulfilling the Health Agenda for Women and Children  The 2014 Report

Box 4 explores how population dynamics can affect progress in intervention coverage, and box 5 describes the destructive impact of conflict. Other key contextual variables that influence coverage patterns and health outcomes include

BOX 4

Demographic change affects coverage change Expressed as proportions, coverage estimates can sometimes mask information on the number of people receiving care and thus must be interpreted in the context of population changes. A rising number of births translates into a parallel rise in the need for reproductive, maternal, newborn and child health services. In contrast, a falling number of births reduces service demand and makes it easier for countries to ensure health coverage for all. Projections show that in the absence of major changes, the highest levels of fertility will persist over the next generation in Countdown countries with the lowest per capita incomes and weakest health care infrastructures.2 Between 1990–1995 and 2005–2010 the absolute number of annual births increased around 36% in Sub-­Saharan Africa but around 6% in South America. Brazil and the Democratic Republic of Congo are two Countdown countries from these regions that show how population change affects a country’s ability to improve health coverage. In Brazil the absolute number of births increased slightly from 3.62 million in 1990 to 3.64 million in 2000 and then dropped steadily to 3.04 million in 2010 and is expected to further decrease to 2.96 million by 2015 (see figure). The proportion of births attended by skilled health personnel increased over a similar time period, from approximately 70% in 1991 to 97% in 2006, and is now near 100%. The decline in the number of births means that need for skilled birth attendants is less now than a decade ago, reducing the pressure on the health system to train, deploy and retain this cadre of health care workers and enabling a greater focus on improving the quality of care. In contrast, the Democratic Republic of Congo has seen steady increases in the number of births, from approximately 1.71 million in 1990 to 2.26 million in 2000 to 2.74 million in 2010—an increase of more than a million births a year over two decades. Meanwhile, the proportion of births attended by a skilled provider increased from 61% in 2001 to 80% in 2010. Had the number of births remained at 2001 levels, coverage of skilled birth attendants in 2010 would likely have been much higher.

Since 1990 the number of births has decreased in Brazil but steadily increased in the Democratic Republic of Congo, yielding different pressures on the health system to ensure access to a skilled provider Annual births 4,000

Brazil

3,000

2,000 Congo, Dem. Rep. 1,000

0 1990

1995

2000

2005

2010

2015

Source: UNDESA 2013.

Although the absolute number of annual live births is converging in Brazil and the Democratic Republic of Congo, the population trends in the two countries reflect opposite patterns. Brazil is experiencing fertility declines, while the Democratic Republic of Congo has had sustained high fertility rates. These contrary trends have placed differing pressures on the health system. The Democratic Republic of Congo’s laudable 20 percentage point increase in coverage was achieved in a context of massive increases in the number of women and children needing care, showing that progress is possible even in the face of population growth. However, the sustainability of coverage gains as the population continues to grow remains an open question. Brazil’s almost universal coverage in skilled delivery care is equally impressive, and the country’s continued downward fertility trajectory suggests that the number of women of childbearing age will pose less of a programmatic challenge over time for increasing access to reproductive, maternal, newborn and child health services.

Source: UNDESA 2013.

women’s social status, education levels and access to health services; natural disasters and other humanitarian crises; economic development; and environmental factors such as pathogen

burden (for example, HIV and tuberculosis prevalence, malaria endemicity, other parasite loads).

Fulfilling the Health Agenda for Women and Children  The 2014 Report

19

BOX 5

Conflict presents additional challenges for reproductive, maternal, newborn and child health Eight of the 10 Countdown countries with the highest under-5 mortality rates are currently affected by conflict (Afghanistan, Chad, Democratic Republic of Congo, Iraq, Somalia, Sudan, Pakistan and Yemen). Although the direct, short-term effects of armed violence usually receive considerable attention, the indirect and long-term impacts are often overlooked.1 For example, the collapse of health systems and poor access to health care by populations in conflict regions have significant harmful effects that are not directly related to battle injuries and death. Access to populations is challenging during humanitarian crises. Coverage rates of interventions are often unknown, particularly because the denominator of populations in need is difficult to determine or constantly changing. Children in countries affected by conflict are at increased risk of dying from preventable causes such as measles, malaria, diarrhoeal diseases, respiratory tract infections and malnutrition. 2 Disruptions in the health care infrastructure and increased exposure to stress, food shortages and infectious diseases under conflict conditions also increase women’s risk of experiencing a maternal death. 3 Adolescent pregnancy and violence against women are also common in conflict situations, with a negative impact on maternal and newborn health outcomes.4 The Syrian Arab Republic provides a troubling example of how conflict can turn back the clock on progress for women and children and strain health systems in neighbouring countries. Since the start of the crisis in 2011, nearly 7 million inhabitants have been displaced, almost half of them children.5 An estimated 2.5 million people, over two-thirds of them women and children, have taken refuge in neighbouring countries, and this number is expected to reach 4.1 million by the end of 2014 (see map). Population health indicators that were improving before the war 6 are now spiralling downward. The health system has deteriorated, even totally collapsing in some areas. More than 35% of hospitals have been destroyed, and many doctors and other skilled providers have been killed, imprisoned or tortured. Access to safe water has decreased by around two-thirds, increasing the risk of exposure to many infectious diseases. For families that leave Syria, living conditions and availability of health care are highly variable and depend on arrangements in each host country. Refugee women who need services for themselves and their children often face major

challenges, including high costs, a scarcity of female providers and lack of transport. The crisis in the Syrian Arab Republic shows how conflict can strain health systems in neighbouring countries

In Afghanistan decades of widespread conflict have ravaged the country. Although it is difficult to estimate with certainty, at least 400,000 people lost their lives due to the conflict. Many medical professionals fled in the 1980s and 1990s, and most medical training programmes ceased to operate. Smouldering and overt conflict, population displacement, the collapse of the health system and landmine injuries contributed to a desperate situation, with the brunt borne by women and children. But Afghanistan has made remarkable progress in women’s and children’s health since 2001. With increased donor support and national commitments, the country focused on innovations, task-shifting to outreach workers and engagement of civil society organizations for service delivery. The Basic Package of Health Services, introduced in 2003, expanded access to primary health care, and the community midwifery education programme, started in 2002, deployed large numbers of community midwives in target provinces. Coverage of skilled attendant at birth subsequently more than tripled to 47.4% in 2012, up from 14.0% in 2003 (see figure) and immunization coverage has exceeded 75%. (continued)

20

Fulfilling the Health Agenda for Women and Children  The 2014 Report

BOX 5 (CONTINUED)

Conflict presents additional challenges for reproductive, maternal, newborn and child health

Despite challenges posed by conflict, coverage of skilled attendant at birth in Afghanistan more than tripled over 2003–2012 Skilled attendant at birth (%) 50

40

30

20

10

0

2003– 2004

2005– 2006

2007– 2008

2009– 2010

2011– 2012

Experience in both the Syrian Arab Republic and Afghanistan underscores the importance of resilience and targeted strategies in conflict-affected populations. Continued efforts are needed to strengthen the basic health care infrastructure, promote innovation and ensure independent monitoring and accountability. Data collection on health needs and intervention coverage rates must improve, and greater efforts must be made to ensure that internally and externally displaced refugees are included in country statistics. Country governments and the international community must mount—and intensify—a strong and sustained response focused on protective strategies for families, women and children in conflict zones, especially in regions in the grip of chronic conflict across generations. Notes 1. UNICEF 2013b. 2. CRED 2013.

Source: Multiple Indicator Cluster Survey (2003–2004 and 2009–

3. Austin and others 2008.

2010), National Risk and Vulnerability Assessment (2005–2006,

4. WHO 2012.

2007–2008) and Afghanistan Health Survey (2005–2006, 2009–2010,

5. UN Office for the Coordination of Humanitarian Affairs website

2011–2012).

(http://syria.unocha.org, accessed 5 February 2014).

Fulfilling the Health Agenda for Women and Children  The 2014 Report

21

Equity: no women and children left behind

Focusing on coverage at the national level can mask large differences in access to services among different population groups within a country. A large part of the unfinished business in reproductive, maternal, newborn and child health is addressing pervasive inequity and ensuring that all women and children receive the services they need, regardless of differences in wealth, gender, ethnic group or geography. This section focuses on two summary metrics of socioeconomic inequity: the Composite Coverage Index and the co-coverage index. Details on how these indices are constructed are available at www. countdown2015mnch.org/reports-and-articles/ equity. Figure 5 shows the performance of Countdown countries with available data in achieving equitable coverage of eight preventive and curative interventions along the continuum of care, using the Composite Coverage Index. The message is clear: In virtually every country the coverage score among the richest—generally above 60%, and often above 80%—far exceeds coverage among the

22

Fulfilling the Health Agenda for Women and Children  The 2014 Report

poor. If such high coverage can be achieved among the wealthy, it should be possible to do the same across the whole population. And some countries have been able to do this. In Bolivia, Cambodia and Niger coverage has been increasing faster among the poor than among the rich (figure 6). In Nigeria, in contrast, inequality has remained unchanged over eight years. These examples indicate that rapid progress in reducing coverage inequality is possible in the Countdown countries, but that some countries are still lagging behind. A second set of equity analyses uses the cocoverage index to assess the extent of inequity in the proportions of individual mothers and their children who receive eight well established interventions that have been available in most if not all countries—even the poorest—for at least a decade. Focusing on mothers and children in the poorest 20% of the population, it is striking that in countries such as Somalia, Chad, Yemen, Nigeria, Afghanistan and Ethiopia more than half have received two or fewer of the eight evidence-based interventions (figure 7).

FIGURE 5

In virtually every Countdown country with available data, coverage of eight preventive and curative interventions is higher among the richest than among the poor Composite Coverage Index score for 31 Countdown countries with available data, by wealth quintile, 2008–2012 Richest quintile Quintile 4

Burundi

Quintile 3

Swaziland

Quintile 2 Poorest quintile

Malawi Peru Rwanda Egypt Gabon Indonesia Sierra Leone Iraq Cambodia Uganda Congo, Dem. Rep. Haiti Congo, Rep. Bangladesh Kenya Bolivia Philippines Tanzania Niger Côte d’Ivoire Burkina Faso Senegal Nepal Pakistan Central African Rep. Ethiopia Madagascar Cameroon Nigeria 0

25

50

75

100

Source: Demographic and Health Surveys and Multiple Indicator Cluster Surveys.

Fulfilling the Health Agenda for Women and Children  The 2014 Report

23

FIGURE 6

Some countries have been able to reduce inequality in coverage between rich and poor Composite Coverage Index score, by wealth quintile, various years Bolivia

Cambodia

1994

2000

1998 2005 2003

2010

2008 0

25

50

75

100

0

25

50

75

100

0

25

50

75

100

Nigeria

Niger

2003

1998

2007 2006 2008

2012

2011 0

25

50

75

100

Richest quintile

Quintile 3

Quintile 4

Quintile 2

Source: Demographic and Health Surveys and Multiple Indicator Cluster Surveys.

24

Fulfilling the Health Agenda for Women and Children  The 2014 Report

Poorest quintile

FIGURE 7

In some countries more than half the mothers and children in the poorest 20% of the population have received two or fewer essential interventions Share of mothers and children in the poorest 20% of the population who received none, one or two of eight essential preventive interventions, 2008–2012 (%) Egypt Zero interventions

Rwanda

One intervention

Malawi

Two interventions

Burundi Uganda Ghana Swaziland Peru Bolivia Tanzania Bangladesh São Tomé and Príncipe Senegal Gabon Lesotho Sierra Leone Nepal Burkina Faso Zimbabwe Congo Kenya Viet Nam Philippines Mozambique Haiti Indonesia Côte d’Ivoire Congo, Dem. Rep. Togo Niger Iraq Madagascar Cameroon Pakistan Lao PDR Central African Rep. Ethiopia Afghanistan Nigeria 0

10

20

30

40

50

60

70

80

Note: The length of the bar indicates the percentage of mothers and children who are receiving too few essential interventions. The ideal value is 0, which would indicate that all mothers and children in the poorest 20% of the population are receiving at least three of the eight interventions. Source: Demographic and Health Surveys and Multiple Indicator Cluster Surveys.

Fulfilling the Health Agenda for Women and Children  The 2014 Report

25

Determinants of coverage and equity—policies, systems and financing An understanding of intervention coverage is incomplete without attention to legislative frameworks and critical features of health systems, including health financing, human resources, supply chain and referral networks, the quality of service delivery, the acceptability of available services to the population and other factors driving service demand. Countdown works closely with those conducting research and programme evaluation in these areas. This section provides updates on country progress in improving determinants of coverage, including service quality (box 6). Countdown’s conceptual model (shown in annex A) illustrates how these key determinants of coverage can lead to improvements in health and nutrition outcomes.

Supportive policies and a strong health system A well functioning health system and a set of enabling policies provide a foundation for reaching all women and children with the interventions they need. Box 7 describes country progress in family planning to show how these factors influence coverage change and ultimately fertility and mortality outcomes. Countdown tracks adoption of 10 tracer policies that ensure access to family planning, provide protection for pregnant women from harmful environmental and labour conditions, authorize midwives to perform life-saving tasks, foster women’s ability to breastfeed immediately after birth and up to age 2, boost the delivery of key newborn interventions and stimulate increased uptake of treatment interventions for leading killers of children. Countdown also tracks a policy indicator on the legal status of abortion (see box 1). Some policies—such as low-osmolarity oral rehydration salts and zinc for management of diarrhoea, postnatal home visits in the first week of life and specific notification of maternal deaths—have high adoption rates (figure 8). But critical gaps remain, and fewer than half of Countdown countries report having policies that

26

Fulfilling the Health Agenda for Women and Children  The 2014 Report

allow adolescents access to contraception without parental or spousal consent, maternity protection in accordance with Convention 183 and regulation of the marketing of breastmilk substitutes. These tracer policies are of relevance to virtually all Countdown countries, yet no country has endorsed all 10 tracer indicators, and 22 have adopted five or fewer (figure 9). Understanding country progress in adopting key policy measures requires assessing changes in the number of countries that have endorsed policies over time. Over 2012–2014 the number of Countdown countries that have adopted five of the six key policies for which trend data are available has increased (figure 10). The number of Countdown countries that have adopted tracer policies related to maternal death notification and to postnatal home visits in the first week of life, for example, more than doubled between the two reporting years. These positive changes reflect important improvements in government prioritization of women’s and children’s health in recent years.24 The stagnation at a very low level in the number of countries that have adopted policies related to maternity protection is an alarm bell that should remind countries to focus more attention on this issue. However, policy adoption is not sufficient per se in the absence of ample resources and political will for ensuring successful policy and programme implementation. For example, the high adoption of policies on low-osmolarity oral rehydration salts and zinc treatment for diarrhoea (see figure 8) are in sharp contrast to the lack of improvement in oral rehydration salts coverage rates (see box 3). A major milestone on the pathway to sustainable programme and policy implementation is country development of costed plans for maternal, newborn and child health. Of the 57 Countdown countries with available data, 46 have costed plans for maternal health, 42 for newborn health and 36 for child health.

BOX 6

Coverage + Service Quality/Readiness = Impact Increases in intervention coverage will translate into reduced maternal, newborn and child mortality only if health care providers are able to deliver services at a high level of quality. Measuring and monitoring the quality of care is a complex process that ranges from time-consuming observations of the actual services provided during regular health care contacts to simpler, routine checks on the availability of equipment and supplies needed to deliver the standard of care. For example, Countdown tracks coverage of the presence of a skilled attendant at birth, which is an important measure of how well countries are doing in reaching women with skilled delivery care. But this indicator does not capture information on the specific life-saving services actually provided during and immediately after delivery. Quality assessments of the care around the time of birth conducted in Egypt showed that although 65% of births occurred in facilities, only 8% of babies were born with the assistance of a midwife trained in resuscitation techniques and only 17% were born in facilities with equipment for newborn respiratory support.1 These findings show the importance of combining estimates of coverage with estimates of service quality (sometimes referred to as “effective coverage”) to best monitor health system performance. An increasing number of Countdown countries are conducting assessments of quality and readiness for reproductive, maternal, newborn and child health services. Countries adapt standard tools to their own context, so cross-national interpretations must be made with care. The figures below show selected results collected since 2010 using one of these tools—the World Health Organization Service Availability Readiness Assessments—in eight Countdown countries in Sub-­Saharan Africa with available data.

Share of facilities surveyed with tracer commodities available on the day of the assessment visit Legend Benin (2013) Burkina Faso (2012) Kenya (2013)

Togo (2012) Uganda (2012)

Libya (2012) Mauritania (2013) Sierra Leone (2012)

Commodities for basic obstetric care Share of facilities surveyed (%) 100

80

60

40

20

0

Oxytocin

Magnesium sulphate

Antibiotics injectable

Commodities for child health services Share of facilities surveyed (%) 100

80

60

40

20

0

Oral rehydration salts

Zinc

Amoxcillin

(continued)

Fulfilling the Health Agenda for Women and Children  The 2014 Report

27

BOX 6 (CONTINUED)

Coverage + Service Quality/Readiness = Impact

Legend Benin (2013) Burkina Faso (2012) Kenya (2013)

Commodity for neonatal resuscitation Libya (2012) Mauritania (2013) Sierra Leone (2012)

Togo (2012) Uganda (2012)

Share of facilities surveyed (%) 100

80

The low availability of many of the commodities in the highlighted countries should be a red flag to decisionmakers. Targeted efforts are needed to strengthen supply chain management systems, so that providers are equipped with the supplies needed to deliver lifesaving reproductive, maternal, newborn and child health services. Tools enabling the regular collection of rigorous quality of care data need further development. In December 2013 the World Health Organization and the Partnership for Maternal, Newborn and Child Health convened a technical consultation to reach consensus on a core set of tracer indicators to monitor the quality of reproductive, maternal, newborn and child health services at the facility level. The next steps will focus on developing standardized definitions and data collection processes so that these indicators can be used to populate country and subnational scorecards that inform routine programme planning and monitoring. Note 1. Wall and others 2009.

60

40

20

0

Availability of bag and mask for neonatal resuscitation in facilities providing basic obstetric care services

Commodities related to water and sanitation Share of facilities surveyed (%) 100

80

60

40

20

0

Facility with improved water source within 500 metres

Soap and water or alcohol-based hand rub available

Source: Service Availability and Readiness Assessment Surveys.

An adequate and well trained health workforce and functioning referral and supply chain mechanisms are essential building blocks of a health system that can effectively and efficiently deliver services to all women and children. Many Countdown countries face severe health workforce shortages, including for midwives (box 8). These shortages negatively impact their ability to provide high-quality care. Only 7 of the 56 Countdown countries with available data (Botswana, Egypt, Gabon, India, the Philippines, the Solomon Islands and Viet Nam) meet or exceed the threshold of 23 skilled health professionals (doctors, nurses, midwives)

28

Fulfilling the Health Agenda for Women and Children  The 2014 Report

per 10,000 population needed to achieve high coverage of essential interventions. The good news is that most Countdown countries with available data are reporting increases in the absolute numbers of doctors, nurses and midwives. However, in some countries these net gains are not enough to keep pace with increased service demands resulting from population growth. Many countries are introducing various strategies to ameliorate their health workforce crises, such as delegating and sharing tasks across various categories of health care professionals and factoring in population dynamics when planning for human resource needs. 25

BOX 7

Family planning: addressing the unmet need Family planning is a cost-effective strategy for reducing maternal and newborn mortality by reducing the number of unintended and high-risk pregnancies and averting unsafe abortions (see box 1). Family planning services can also help delay women’s age at first pregnancy and lengthen the time interval between pregnancies, both of which improve maternal, newborn and child health and reduce the risk of low birth weight and stillbirth.1 Increasing access to and use of family planning services requires sustained political and financial support, accompanied by community-based approaches to improve awareness of and demand for modern contraceptive methods. Legislative frameworks are needed that support the availability of a full range of family planning services, including for adolescents, a rapidly expanding population group in many Countdown countries. The median annual birth rate among adolescent women in Countdown countries with available data is 89 births per 1,000 women ages 15–19, with a low of 0.7 in the Democratic People’s Republic of Korea and a high of 229 in the Central African Republic. In the 45 Countdown countries with data for 2008–2012, the median proportion of women ages 20–24 that had given birth before the age of 18 was 23%, with a low of 3% in Viet Nam and a high of 47% in Chad. It is important that laws and regulations to reduce adolescent pregnancy and prohibit child marriage are put into place and enforced to expand young women’s opportunities and improve their control over their own fertility. But only 15 of the 57 Countdown countries with policy data for 2013 have laws or regulations that allow adolescents to access contraception without parental or spousal consent. Family planning in Bangladesh: Community outreach as a pathway to success! Bangladesh identified family planning as a health priority more than five decades ago, even before the country’s independence from Pakistan. Early programmes in the 1970s–1990s involved recruiting thousands of married women as family welfare assistants to deliver basic family planning services— including oral pills, condoms, counselling and referrals for longer term methods on request—to the doorstep.

This intense community-based effort contributed to the steady increase in the country’s contraceptive prevalence rate, from 8% in the mid-1970s to around 50% by 1999, and to the drop in the total fertility rate, from around 7 children per woman to 3.3 over the same period. The rising expense of maintaining an extensive family welfare assistants programme due to a tripling in the population of women of childbearing age led to a new approach, adopted at the end of the 1990s, to delivering family planning services through community clinics and the private sector. This helped the country maintain its positive trends in contraceptive prevalence rate and total fertility rate, which continued through 2011 (see figure). The fertility decline in Bangladesh has also been attributed in part to the expansion of microcredit financing, girls’ improved access to education and growing employment opportunities in the textile sector, all of which increased legitimate alternatives to early motherhood. Delivering family planning services through community clinics and the private sector has helped Bangladesh maintain its positive trends in contraceptive prevalence rate and total fertility rate Contraceptive prevalence rate (modern and traditional) (%) 100

80

60

40

20

0

1989

1991

1993/ 1996/ 1999/ 1994 1997 2000

2004

2007

2011

Source: Bangladesh Fertility Survey (1989), Contraceptive Prevalence Survey (1991) and Demographic and Health Surveys (other years).

(continued)

Fulfilling the Health Agenda for Women and Children  The 2014 Report

29

BOX 7 (CONTINUED)

Family planning: addressing the unmet need women in this age group gave birth before age 18.2 Fertility has declined mostly among women older than age 30, which has been linked to increases in birth spacing intervals through the use of contraception.3 Geographic differences in fertility patterns that parallel economic development also persist, with higher fertility in the least developed eastern regions than in the west.

Total fertility rate (births per woman) 6

4

2

0

1989

1991

1994

1997

1999– 2000

2004

2007

The current national family planning programme targets adolescents and regions of the country where higher than average total fertility rates persist and aims to make a greater diversity of contraceptive methods (including long-term methods) more widely available.

2011

Source: Bangladesh Fertility Survey (1989), Contraceptive Prevalence Survey (1991) and Demographic and Health Surveys (other years).

Notes 1. Ahmed and others 2012; Cleland and others 2012; UNICEF, UNFPA

However, early marriage and early childbearing are still very prevalent: The median age at marriage among women ages 20–24 is 16.6, and 40% of

and UN Women 2012. 2. CPD 2003; Bangladesh Demographic and Health Survey 2011. 3. Arifeen and others forthcoming.

FIGURE 8

Some tracer policies have high adoption rates in Countdown countries, but critical gaps remain Share of 57 Countdown countries with tracer policy in place, 2013–2014 (%)

100

Prepregnancy

Pregnancy and birth

Postnatal

Infancy and childhood

75

50

25

a. Based on 33 countries. Source: World Health Organization Global Maternal Newborn Child and Adolescent Health Policy Indicator Survey.

30

Fulfilling the Health Agenda for Women and Children  The 2014 Report

Low-osmolarity oral rehydration salts and zinc for management of diarrhoea

Community treatment of pneumonia with antibiotics

International Code of Marketing of Breastmilk Substitutes

Postnatal home visits in first week of life

Kangaroo mother care for low-birthweight/ preterm newborns

Antenatal corticosteroids as part of management of preterm labour

Maternity protection in accordance with Convention 183

Specific notification of maternal deaths

Midwifery personnel authorized to administer core set of life-saving interventionsa

Laws or regulations allowing adolescents access to family planning without parental or spousal consent

0

FIGURE 9

FIGURE 10

No Countdown country with available data has endorsed all 10 tracer indicators, and 22 have adopted five or fewer

Over 2012–2014 the number of Countdown countries that have adopted five of the six key policies for which trend data are available has increased

Number of policies in place (out of 10), Countdown countries with available data, 2014 (n = 57)

Number of Countdown countries with available data that have adopted selected tracer reproductive, maternal, newborn and child health policies, 2012 and 2014 (n = 57)

Solomon Islands Somalia South Sudan Swaziland Bolivia (Plur. St. of) Chad Myanmar Angola Burundi Gabon Iraq Lesotho Morocco Sudan Afghanistan Comoros Congo, Dem. Rep. Djibouti Egypt Papua New Guinea Philippines Yemen Bangladesh Botswana Cameroon Congo Côte d'Ivoire Guinea India Indonesia Liberia Madagascar Nepal Pakistan Rwanda Sierra Leone Uganda Zambia Zimbabwe Equatorial Guinea Lao PDR Mali Tanzania (U. Rep.) Togo Viet Nam Cambodia Eritrea Ethiopia Guatemala Malawi Mozambique Niger Nigeria Senegal Benin Burkina Faso Gambia

Specific notification of maternal deaths 2012 2014

Maternity protection in accordance with Convention 183

Postnatal home visits in first week of life

International code of marketing of breastmilk substitutes Community treatment of pneumonia with antibiotics Low-osmolarity oral rehydration salts and zinc for management of diarrhoea 0

10

20

30

40

50

60

Source: World Health Organization Global Maternal Newborn Child and Adolescent Health Policy Indicator Survey.

BOX 8

Midwives matter

0

2

4

6

8

10

Almost all Countdown countries are facing major workforce challenges in delivering midwifery services, particularly in areas where the burden of maternal mortality and morbidity is highest. Although midwives can perform almost 90% of essential care for women and newborns if adequately trained on the latest evidencebased guidelines, countries have been slow to adopt policies enabling midwives to provide this care. There has been no increase among the 33 Countdown countries with available trend data since 2012 in adopting a policy authorizing midwives to administer a core set of life-saving interventions.

Source: World Health Organization Global Maternal Newborn Child and Adolescent Health Policy Indicator Survey.

Source: UNFPA 2014.

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31

Countdown tracks essential commodities across the continuum of care. The UN Commission on Life-Saving Commodities was established in 2012 to promote the availability and effective use of 13 life-saving commodities for women’s and children’s health.26 Including these commodities on the essential medicines list is a steppingstone to ensuring that these commodities are procured and widely distributed. Most Countdown countries with available data include the majority of these 13 commodities on their list, with the notable exception of the three prioritized reproductive health commodities, which are included on the list of fewer than half of countries with available data (figure 11).

positive trends in these indicators. Across the Countdown countries, the per capita total expenditure on health (in current purchasing power parity terms) increased from $200 in 2010 to $222 in 2012. Over the same period there was also a very slight increase in government expenditure on health as a share of total government expenditure, from 9.9% to 10%. Similarly, countries made marginal improvements in reducing the reliance on outof-pocket payments to finance health, from 43% of total expenditure on health in 2010 to 42% in 2012 (box 9). Increasing government expenditure on health is an important measure for improving access to health care and reducing poverty.

Financing women’s and children’s health

Tracking development partner disbursements to reproductive, maternal, newborn and child health is important for holding partners to account for commitments made and helps identify resource gaps or areas where further investment may be required.

Countdown tracks information on key indicators of domestic and external spending patterns for reproductive, maternal, newborn and child health. There is evidence of very modest FIGURE 11

Most Countdown countries with available data include the majority of the 13 essential commodities on their essential medicines list Number of Countdown countries with selected commodity, 2013 (n = 57) Prepregnancy

60

Pregnancy and birth

Postnatal

Infancy and childhood

40

Zinc

Oral rehydration salts

Paediatrict formulation of amoxicillin

Self-inflating bag and mask

7.1% chlorhexidine digluconateb

Dexamethasone injectiona

Gentamycin injection

Magnesium sulphate

Misoprostol tablets

Oxytocin

Emergency contraception

Implants

0

Female condoms

20

a. Refers mainly to other uses (such as for response to allergic reaction). Antenatal corticosteroids in preterm labour are recommended for use in all countries but were not added to the World Health Organization essential medicines list for preterm indication until 2013. b. Chlorhexidine has been recommended only since 2013, and World Health Organization guidelines suggest use only in high-mortality countries (with a neonatal mortality rate greater than 30 deaths per live births) and home births. Source: Female condoms, World Health Organization EML database (www.who.int/medicines/publications/essentialmedicines, accessed March 2014); implants and emergency contraception, U.S. Agency for International Development Deliver Project (http://deliver.jsi.com/dhome/whatwedo/ commsecurity/csmeasuring/csindicators/csindicatordashboards, accessed March 2014); maternal and newborn lifesaving commodities, World Health Organization Global Maternal Newborn Child and Adolescent Health Policy Indicator Survey 2013.

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Fulfilling the Health Agenda for Women and Children  The 2014 Report

BOX 9

Out-of-pocket financing—who pays for health care? In many Countdown countries the need to pay for health care out of pocket deters families from seeking care and depletes poor households of already scarce resources.1 Two types of indicators are commonly recommended to assess the effect of out-of-pocket spending on poverty2: • Impoverishment. The proportion of the population impoverished as a result of out-of-pocket payments (for example, the share of the population falling below the purchasing power parity (PPP) $2 poverty line as a result of out-of-pocket expenditures on health in the last month). • Catastrophic health expenditure. The proportion of the population incurring catastrophic health expenditures (for example, the share of the population spending more than a set proportion of nonfood expenditure, such as 25% or 40%, in a given month on direct healthcare payments). Countdown reviewed the limited published data available on these indicators for the Countdown countries (see annex F for data sources and definitions of indicators). Only two Countdown countries have data from 2008 or later on the percentage of the

Trend data on official development assistance (ODA) to the Countdown countries is available from 2003 for maternal, newborn and child health and from 2009 for reproductive health.27 This report presents ODA data up to 2011. Countdown expects to release ODA data for 2012 later in 2014. ODA for health was an estimated $19 billion in 2011, an increase of only 1% in real terms over 2010. This amount represents 12.4% of total ODA. In the 75 Countdown countries an estimated $8.7 billion went to reproductive, maternal, newborn and child health in 2011, a 1% increase over 2010, and accounted for 44% of ODA to health and 5% of total ODA. Of this amount, $3.9 billion (45%) went to child health, $3.1 billion (36%) went to reproductive health (which includes funding for family planning, sexual health and

population falling below the PPP$2 poverty line as a result of out-of-pocket health expenditure (Bangladesh, 2.7%, and Lao PDR 1.4%), and only seven Countdown countries have data on the percentage of households with out-of-pocket expenditure greater than 40% of nonfood spending (ranging from 0.1% in South Africa to 3.7% in Lao PDR). Most information on the impact of out-of-pocket spending is outdated and lacks comparability owing to variations in definitions. Greater investment is needed to gather reliable data on financial burdens to households resulting from out-ofpocket payments for health care and for reproductive, maternal, newborn and child health services specifically. Promising partnerships, including Equitap in Asia, ­L Anet‑EHS in Latin America and SHIELD in Africa, need to be strengthened and coordinated to ensure comparability of data collected. Work is also under way by the World Bank and the World Health Organization on monitoring financial risk protection. Notes 1. Brearley and others 2012. 2. WHO and World Bank 2013.

sexually transmitted infections including HIV) and $1.7 billion (19%) went to maternal and newborn health. 28 ODA to maternal, newborn and child health in the 75 Countdown countries decreased by 1% in real terms from 2010, due to a 3% reduction in funding to child health. 29 Funding to maternal and newborn health increased 4% over 2010, and funding to reproductive health increased 5%. The noted reduction in ODA to maternal, newborn and child health in Countdown countries in 2011 continues a slowdown detected between 2009 and 2010 relative to previous years.7 Assessing who benefits from ODA and whether resources are being allocated according to country need can improve resource allocation and efficiency (box 10).

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BOX 10

Official development assistance flows for reproductive, maternal, newborn and child health

From whom? In 2011 ODA from bilateral agencies accounted for more than half of ODA for maternal, newborn and child health in the 75 Countdown countries, just under a quarter came from multilateral agencies and another quarter from global health initiatives and foundations (comparable to proportions in 2009 and 2010) (box figure 1). A higher proportion of ODA for reproductive health comes from bilateral donors (76% of all ODA; box figure 2). Box figure 1. Official development assistance for maternal, newborn and child health in the 75 Countdown countries was $5.6 billion in 2011 (in 2012 dollars)

Box figure 3. In 2011 the United States continued to be the largest source of funding to reproductive, maternal, newborn and child health in the Countdown countries

Global health initiatives 22%

Multilateral agencies 23%

The United States continues to be the largest source of funding to reproductive, maternal, newborn and child health in the Countdown countries, followed by the Global Fund to Fight AIDS, Tuberculosis and Malaria (box figure 3). U.S. contributions to reproductive health including HIV exceeded $1.8 billion, nearly four times more than the next largest donor and nearly twice as much as U.S. contributions to maternal, newborn and child health. Across all donors, on average, higher amounts were disbursed to child health ($76 million) than to reproductive health ($60 million) and to maternal and newborn health ($32 million). This pattern is similar to previous years.

Bilateral aid agencies 55%

2012 $ billions 5

4

3

Source: Organisation for Economic Co‑operation and Development’s Development Assistance Committee’s Creditor Reporting System Aid Activities Database.

Box figure 2. Official development assistance for reproductive health in the 75 Countdown countries was $3.1 billion in 2011 (in 2012 dollars)

Global health initiatives 16%

2

1

0

Reproductive health

Maternal and newborn health

United States Global Fund to Fights AIDS, Tuberculosis and Malaria United Kingdom International Development Association

Child health United Nations Population Fund EU institutions GAVI Alliance Canada Other

Source: Organisation for Economic Co‑operation and Development’s

Multilateral agencies 8%

Development Assistance Committee’s Creditor Reporting System and Activities Database. Bilateral aid agencies 76%

Source: Organisation for Economic Co‑operation and Development’s Development Assistance Committee’s Creditor Reporting System Aid Activities Database.

To whom? In 2011 approximately 79% of official development assistance for maternal, newborn and child health went to the 75 Countdown countries, with India and Ethiopia receiving the most (box figure 4). India also received the highest share of ODA for maternal, newborn and child health in 2009 and 2010. The (continued)

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Fulfilling the Health Agenda for Women and Children  The 2014 Report

BOX 10 (CONTINUED)

Official development assistance flows for reproductive, maternal, newborn and child health amount varies widely across countries and is not always in proportion to need.

Box figure 5. Seven Countdown countries received just over half of official development assistance to reproductive health in 2011

Seven Countdown countries received more than half of ODA to reproductive health, with the highest shares going to South Africa and Kenya (box figure 5). Nigeria, Ethiopia, Tanzania and Kenya received high shares of both ODA to maternal, newborn and child health and to reproductive health. Box figure 4. Ten Countdown countries received just under half of total official development assistance for maternal, newborn and child health in 2011 India 6.6%

South Africa 11.2% Kenya 9.3%

Other 48.6%

Tanzania 6.2% Uganda 6.2% Ethiopia Mozaqmbique 5.9% 4.8%

Ethiopia 6.1% Nigeria 5.6% Congo, Dem. Rep. 5.4%

Other 51.8%

Nigeria 7.8%

Pakistan 5.4% Afghanistan 5.0% Tanzania 4.6%

Kenya 3.5% Zambia Bangladesh 2.7% 3.0%

Source: Organisation for Economic Co‑operation and Development’s Development Assistance Committee’s Creditor Reporting System Aid Activities Database.

Official development assistance to maternal, newborn and child health in the context of target population size ODA for child and maternal and newborn health varies widely across Countdown countries, even after adjusting for the size of the target population. For example, in 2011 median ODA to child health per child ages 0–5 was $1.89 for the 10 countries receiving the least ODA and $47.58 for the 10 countries receiving the most (figure 6). Similarly, for maternal and newborn health, the median was $5.23 per live birth for the 10 countries receiving the least ODA and $115.92 per live birth for the 10 countries receiving the most (figure 7).

Source: Organisation for Economic Co‑operation and Development’s Development Assistance Committee’s Creditor Reporting System Aid Activities Database.

Box figure 6. In 2011 median official development assistance to child health per child ages 0–5 was $1.89 for the 10 countries receiving the least official development assistance and $47.58 for the 10 countries receiving the most Official development assistance to child health per child, 2012 ($) Solomon Islands São Tomé & Príncipe Liberia Haiti Lesotho Djibouti Zambia Sierra Leone Rwanda Papua New Guinea Mexico China Brazil Egypt India Turkmenistan Philippines Indonesia Korea, Dem. Rep. Peru

Top 10 median: $47.58

Bottom 10 median: $1.89

0

30

60

90

120

150

Source: Organisation for Economic Co‑operation and Development’s Development Assistance Committee’s Creditor Reporting System Aid Activities Database.

(continued)

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BOX 10 (CONTINUED)

Official development assistance flows for reproductive, maternal, newborn and child health More-populous Countdown countries receive more ODA for maternal, newborn and child health than less-populous ones. But adjusting for the size of the target population shows a different picture of aid flows to women’s and children’s health in the Countdown countries. For example, in 2011 Nigeria received the most ODA per country for child health in absolute terms, but the amount received per child ages 0–5 was $8.59 (the 51st highest). In contrast, Solomon Islands received the highest amount per child, $143.45, but much lower total funds (the 54th highest). For maternal and newborn health India received the most ODA overall, but only $6.05 per live birth, compared with $32.58 in Ethiopia, which received the second highest total ODA for maternal and newborn health, and $90.89 in Afghanistan, which received the third highest total ODA. Funding allocation by focus area The slight reduction in funding to child health is driven by a reduction in funding to immunization, earmarked malaria funding and basket funding, 40% of which is assumed to go to child health. The percentage of funding allocated to reproductive health remains driven by response to the HIV epidemic (78%). However, family planning accounts for a growing proportion (14%), a 42% increase over 2010 in real terms, compared with a 2% increase in funding related to HIV (which does not include prevention of mother‑to-

36

Fulfilling the Health Agenda for Women and Children  The 2014 Report

child transmission or childhood AIDS, which are captured in maternal, newborn and child health totals). Box figure 7. In 2011 median official development assistance to maternal and newborn health per live birth was $5.23 for the 10 countries receiving the least official development assistance and $115.92 for the 10 countries receiving the most Official development assistance to maternal and newborn health per live birth, 2012 ($) Solomon Islands Haiti São Tomé & Príncipe Swaziland Liberia Zambia Djibouti Afghanistan Lesotho Sierra Leone Mexico China Brazil Korea, Dem. Rep. Turkmenistan Egypt Philippines South Sudan India Angola Indonesia

Top 10 median: $115.92

Bottom 10 median: $5.23

0

100

200

300

400

Source: Organisation for Economic Co‑operation and Development’s Development Assistance Committee’s Creditor Reporting System Aid Activities Database.

Data revolution and evolution: the foundation for accountability and progress Without data there can be no accountability. Without accountability we risk making no progress for women and children. Countdown therefore puts a special focus on data availability, quality and use. Working closely with the independent Expert Review Group of the Commission on Information and Accountability for Women’s and Children’s Health, 31 Countdown advocates for efforts to ensure that all countries have adequate data to make informed decisions about programme priorities for women and children and to monitor the implementation of those programmes. These data include but are not limited to high-quality household surveys. Continued efforts are needed to strengthen civil registration and vital statistics, health management information systems and institutional capacity at the country level to

conduct independent evaluations of reproductive, maternal, newborn and child health programmes. Of the 75 Countdown countries, 28 (37%) conducted a nationally representative survey in 2011 or 2012, providing high-quality, recent data to support assessments of progress towards the Millennium Development Goals (map 1). Another 29 countries (39%) conducted such a survey between 2008 and 2010. This represents a major achievement, probably linked to the emphasis on global monitoring of the Millennium Development Goals. Prior to 2000 few of the 75 countries had nationally representative survey data on coverage of interventions for maternal, newborn and child health. Accurate and consistent data are crucial for governments and their partners to manage health

MAP 1

Of the 75 Countdown countries, 28 (37%) conducted a nationally representative survey in 2011 or 2012, providing high-quality, recent data to support assessments of progress towards the Millennium Development Goals

2011–2012 (n = 28) 2008–2010 (n = 29) 2000–2007 (n = 17) Administrative record

Note: Based on country reporting on the antenatal care (at least one visit) indicator. Source: United Nations Children’s Fund global databases, April 2014, based on Demographic and Health Surveys, Multiple Indicator Cluster Surveys and other national surveys.

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systems effectively, allocate resources according to need, and make and deliver on commitments where the impact will likely be greatest. These data must be: • Fit for purpose, designed to measure a set of standardized indicators that respond to accountability requirements. As new effective interventions are identified and consensus indicators agreed on, further work will be required to develop, validate and incorporate appropriate questions into the core surveys used by countries. The process through which indicators for postnatal care were defined and tested provides a good example of how this process can work (box 11).32 Similar efforts are needed to define standard coverage measures for other newborn-specific interventions and nutrition interventions that have been scaled up rapidly in the past decade but that lack standard methods for measurement. • Reliable, at least, and ideally also valid, so that they can be used over time and across countries to assess progress. There is an important research agenda on improving coverage measurement for reproductive, maternal,

newborn and child health that has already shown that at least one of the core indicators recommended by the commission—antibiotic treatment for childhood pneumonia—cannot be measured accurately through household surveys.33 Countdown has therefore added an indicator on careseeking for symptoms of childhood pneumonia to its reporting on commission indicators. This work on improving coverage measurement is continuing and is closely coordinated with Countdown. A particular focus is on unpacking service contact indicators such as antenatal care visits and skilled attendant at delivery to determine how best to generate valid measures of coverage for individual interventions provided through these service delivery platforms.34 • Timely, providing information on coverage that reflects recent progress and can be used in the short term to improve the performance of reproductive, maternal, newborn and child health programmes. • Able to be disaggregated, to assess inequity and to determine which women and children are not being reached, as a basis for action.35

BOX 11

Keeping coverage measurement current: an example from postnatal care Postnatal care visits for mothers and newborns offer an important opportunity to provide proven interventions that can save the lives of women and children. Despite the sparse and inconsistent data available at the time, Countdown began including postnatal care indicators for newborns in its reporting in 2005. This gap in data spurred efforts led by the Newborn Indicators Technical Working Group to refine the indicators and develop standard tools to measure coverage of key newborn interventions.1 These efforts informed the technical review process of Countdown, resulting in the addition over time of three newborn-related policy indicators on postnatal home visits in the first week of life on the Countdown 2012 country profiles and antenatal corticosteroids for preterm birth and kangaroo mother care on the Countdown 2014 country profiles. The visibility raised by including postnatal care indicators in Countdown reporting also sparked the two international household survey programmes that produce the majority of coverage data used in global monitoring, Demographic and Health Surveys and Multiple Indicator Cluster Surveys, to review their data

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Fulfilling the Health Agenda for Women and Children  The 2014 Report

collection efforts on postnatal care. The United Nations Children’s Fund, for example, developed a new module on postnatal care visits that was incorporated into the current round of Multiple Indicator Cluster Surveys and has increased the availability of country data on coverage of this service contact. This process has resulted in the development of global consensus on the definition of postnatal care visits and a surge of new data—the number of Countdown countries with recent available data on postnatal visit for the baby increased from zero in the 2005 report to six in the 2010 report to 17 in the 2014 report. Countdown currently tracks a systems indicator on emergency obstetric care and is actively working with partners on revising the list of signal functions that emergency obstetric care facilities must provide in order to include a comprehensive set of signal functions for newborn care. Notes 1. Moran and others 2013.

The Demographic and Health Surveys and Multiple Indicator Cluster Survey programmes remain the primary source of coverage data for most low- and middle-income countries and have worked hard to coordinate their protocols and target their support to the 75 Countdown countries.36 An important development is that a small but growing number of countries are fielding their own surveys, often using adaptations of the standard protocols, and this increase in national capacity must be supported and expanded while ensuring that indicator definitions reflect international consensus to enable comparisons across countries and over time. Success must be measured not only through the availability of high-quality, timely data, but also by the extent to which the process is implemented from start to finish by country-based research institutions, including special analyses to respond to questions from policymakers. Well designed and well implemented household surveys must remain a central pillar of government systems for programme monitoring and evaluation. But they alone are not enough. Measures of coverage for interventions needed by subsets of women and children, including women with obstetric complications and newborns or children who are ill, are also likely to benefit from efforts to link household surveys to assessments of service providers. Surveys can tell us about coverage, or the proportion of those who need an intervention who have actually received it. Health facility– based data, whether from information systems or facility surveys, can tell us about the quality of care received by those who accessed services. Efforts are under way to meet these challenges and to ensure that standard, fit for purpose indicators are defined, subjected to validation assessments and measured with adequate technical and financial support and institutional capacity building at the country level. Good examples of interdisciplinary groups that engage independent technical experts to address these issues include the Roll Back Malaria Monitoring and Evaluation Reference Group, the Newborn Indicators Technical Working Group and the various interagency working groups tackling measurement issues related to women and children. Countdown collaborates closely with these groups.

target implies measurement, and over the years Countdown has repeatedly pointed to the unfair demand that countries report on numerous indicators for which no measurement strategy is in place or supported. This message was echoed by the Commission on Information and Accountability for Women’s and Children’s Health, which defined 11 priority indicators—including 8 coverage measures—and recommended that countries report on them. However, uptake of this recommendation has been limited by the availability of data at the country level. Only 8 of the 75 Countdown countries had recent data on all of these coverage indicators in 2011–2012, and 37—half the Countdown countries—had data for only one of them (figure 12). The paltry number FIGURE 12

Half of Countdown countries had data for only 1 of 9 recommended coverage measures in 2011–2012 Number of 75 Countdown countries reporting updated data from 2011 or 2012 for one or more of nine coverage indicators recommended by the Commission on Information and Accountability for Women’s and Children’s Health 9 indicators 8 indicators 7 indicators 6 indicators 5 indicators 4 indicators 3 indicators 2 indicators 1 indicator 0

10

20

30

40

50

60

75

Note: Indicators include demand for family planning satisfied (including 2013 data for Ghana and Pakistan), antenatal care (four or more visits), skilled attendant at birth, postnatal care for mother, postnatal care for baby, exclusive breastfeeding, DTP3 vaccine coverage, careseeking for pneumonia and antibiotic treatment for pneumonia. This list does not include two indicators related to HIV, counts postnatal care for mother and baby separately and includes careseeking as well as treatment

Those who set global goals must be mindful of the technical demands of coverage measurement when defining indicators that will be used to track progress and assess accountability.37 Preliminary versions of the post-2015 sustainable development goals documentation included more than 20 targets for the health goal alone.38 Setting a

for pneumonia, so it differs from the list of 11 priority indicators (8 coverage and 3 impact) from the Commission on Information and Accountability for Women’s and Children’s Health. Source: United Nations Children’s Fund global databases, April 2014, based on Demographic and Health Surveys, Multiple Indicator Cluster Surveys and other national surveys.

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of countries able to report recent data on the full set of recommended coverage indicators is a distressing testament to data gaps in the countries where the burden of preventable maternal, newborn and child deaths is highest. Responsibility for filling those gaps, and for defining indicators based on what it is feasible to measure well, is shared by countries and the global reproductive, maternal, newborn and child health community. Gaps in data on the policy and health systems determinants of coverage also need to be addressed. Countdown reporting has drawn attention to some of these gaps and helped stimulate an effort led by the World Health Organization to work at the country level to obtain standardized reports on selected indicators in each area. Intensive efforts are also under way to generate evidence and develop guidance on policies and health systems factors that affect access to essential reproductive, maternal, newborn and child health interventions.39 There are critical gaps in resource tracking (see box 9). For the first time in 2014 Countdown country profiles include the Commission on

40

Fulfilling the Health Agenda for Women and Children  The 2014 Report

Information and Accountability for Women’s and Children’s Health–recommended resource indicator on reproductive, maternal, newborn and child health expenditures by source of funding, intended to track both domestic and external financial commitments to achieving the goals of the Global Strategy on Women’s and Children’s Health. More than two years have passed since the 2011 launch of the commission’s action agenda, and progress has been slow. According to the World Health Organization, only 4 of the 75 Countdown countries can report completely on the recommended financing indicator for recent years, and 2 countries can report partially. However, it is encouraging to note that 18 countries report that development of these indicators is in process and that 25 countries report being in the planning phase.40 Robust civil registration systems are still lacking in most Countdown countries, requiring the use of modelling to develop mortality and cause of death estimates (see annexes A and H). Most newborns and nearly all stillborn babies are born and die without ever being recorded, a situation that must be corrected in order to improve country capacity to plan for needed services and to monitor progress.

The Countdown process— what we have learned so far

In 2014, as Countdown’s original time horizon approaches, we must look both backwards and forwards to draw lessons that may inform the future landscape for women’s and children’s health. Many of the same challenges remain. Some—including the broadening of the goals to encompass a more holistic agenda and the explosion of tools and initiatives for monitoring— will be new. Countdown is fundamentally about accountability. It was conceived in a 2003 meeting at the Rockefeller Foundation’s Bellagio Center, resulting in the publication of a series on child survival in The Lancet in 2003.41 The original call was specific to child survival, but was later extended to include the full continuum of reproductive, maternal, newborn and child health: … we commit ourselves to ensuring that there is an overall mechanism for improving accountability, reenergising commitment, and recognising accomplishments… Participants will be those who support child survival, who monitor interventions and delivery strategies, and other concerned individuals and organisations. … regular opportunities for the world to take stock of progress … and to hold countries and their partners accountable. Countdown has grown in different dimensions since the first report in 2005. In addition to the shift from child survival to a broader reproductive, maternal, newborn and child health agenda, the number of countries has expanded from 60 to 75, and the number of interventions being monitored from 35 to 73. The 2005 report had 11 institutions’ logos on the back cover; the 2014 report has 43. Countdown now produces annual reports, with the full report (containing two-page country profiles) in even years and a shorter version (containing

one-page country profiles focused on the 11 commission indicators) in odd years. Countdown has become a key resource for the global health community. What are the strengths of Countdown that merit special consideration as the accountability and oversight structures are framed for the post-2015 period? First on the list is Countdown’s reliance on recent, replicable, relevant data on coverage and its determinants at the country level as the driving force, providing an unfiltered lens on progress and results. Second is the essential focus on disaggregating data to reveal inequities. Third, Countdown has maintained its commitment to bringing to the table scientists, policymakers, program leaders and advocates from both country and international institutions to review and act on these data. Finally, Countdown continues to search for more user-friendly ways to present countryspecific data to promote the translation of scientific findings into actions that will prolong and improve the lives of women and children. Conversely, it is precisely these strengths that have produced some of Countdown’s biggest challenges. One challenge has been maintaining the plurality of Countdown and its suprainstitutional governance, while remaining true to the evidence. Achieving evidence-based consensus across 43 institutions has transaction costs, particularly around issues related to selecting the subset of proven interventions to be tracked and upholding an appropriate balance across the reproductive, maternal, newborn and child health continuum of care. A related challenge is maintaining flexibility so that Countdown can change in response to new evidence and country needs while adhering to its core principles and processes of work. Another major challenge has been preserving the focus of Countdown. As Countdown has grown in visibility and influence, there has been continuous pressure to expand the areas of concern. For example, should Countdown also

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be reporting on child and maternal overweight or obesity? How much emphasis should be given to adolescent health, child development and human capital, maternal morbidity or stillbirths as elements of the continuum of care? How much collaboration is needed with other Millennium Development Goal and topic-specific monitoring initiatives so that each retains its added value yet is an integral part of the whole? Should Countdown retain its main focus on intervention coverage, or should it move more into social and environmental determinants of health or put a greater focus on health impact beyond mortality and nutrition? These debates are ongoing and are an important dialogue for ensuring that Countdown is responsive to the evidence and integrated into other accountability processes

42

Fulfilling the Health Agenda for Women and Children  The 2014 Report

while maintaining a manageable, well defined scope of work so that its messages are clear and actionable. Protecting the strengths of the Countdown process while addressing these challenges is the work of the future. We believe that there is no one optimal structural arrangement to protect the scientific integrity, programme relevance and independence of Countdown and that instead it represents a process of dedication, commitment, compromise and trust. One absolute necessity is to generate and sustain interest and commitment among young epidemiologists, program evaluators, health economists, communications specialists and programme leaders at the global level—particularly those living and working in Countdown countries.

Countdown speaks: priorities for the next 500 days and beyond What do the 2014 findings mean for women and children, both immediately for the 500 days that remain until the end of the Millennium Development Goal era and for the process of defining the post-2015 framework? What actions must be taken? The 2014 Countdown results continue to point to the agenda-setting role of the Millennium Development Goals. This power must be harnessed for women and children in the next set of goals as well. Looking forward to the post-2015 era, the Countdown experience and findings point to four absolute necessities related to accountability. • First, this is the time to be building a foundation of baseline data that can be used to track progress. This was a critical omission in the Millennium Development Goal framework. • Second, we must work to define an accountability mechanism that will serve women and children going forward. Countdown has tried to contribute to that conversation in this report. • Third, we must back up our accountability rhetoric with real resources that can be used by countries to generate the data they need to participate meaningfully in the process. Too many Countdown countries still cannot report annually on key indicators, even after more than a decade of Millennium Development Goal monitoring and more recent efforts around the Commission on Information and Accountability for Women’s and Children’s Health initiative. Addressing this gap means increasing support for and strengthening country institutional capacity to conduct high-quality household surveys at regular intervals of no more than three years, while working to strengthen vital statistics, tracking of financial resources and assessments of service provision. • Fourth, these data systems must be designed intentionally to permit disaggregation and

examination of equity trends, to identify the women and children who are being missed and to support effective programming to reach them. Our mandate is to use the coming 18 months to maintain and move forward on achieving high, sustained and equitable coverage with proven interventions that can save women’s and children’s lives and to strengthen country data systems so that they are able to respond to the future accountability agenda and build better programmes. There are opportunities to save lives now that must not be missed in the process of final assessments related to the Millennium Development Goals and in the current scrambling for places in the sun in the next set of goals. Experience from the Millennium Development Goals reflected in our results show that it took a long while for international agencies and country leaders to translate their global commitments into concrete action and for countries to accelerate coverage gains and mortality reduction. This must not happen on our watch over the coming two to three years. The essential foundation and processes for achieving the next set of goals begins today, with reinvigorated efforts to address the unfinished business of maternal, newborn and child survival. This includes continued recognition of the deep links between women’s and children’s health and the importance of improving service integration across the reproductive, maternal, newborn and child health continuum of care to maximize the impact, quality and efficiency of care provided. We, as Countdown, challenge ourselves and the global reproductive, maternal, newborn and child health community to make the remaining days in the Millennium Development Goal era and the years beyond 2015 count for women and children. There must be continued, and even increased, accelerations in coverage for life-saving interventions. There must be improvements in the equitable delivery of these interventions,

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providing essential services for all. There must be progress in ensuring that the necessary policy, health system and financial supports for these services are in place. And there must be greater commitment to data evolution that results in more and better data and data use for improving programmes. In addition, this transition period must see measureable progress in improving nutrition and in making family planning universally

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Fulfilling the Health Agenda for Women and Children  The 2014 Report

available. These targets do not need to wait for validation through the language of the sustainable development goals—they are a necessary part of any global agenda, and delays are unconscionable. Countdown will continue to track progress towards these immutable targets at the country level, and we will hold fast to the principle of accountability by all for the health and development of women and children.

Country profiles

The information summarized in the profiles is intended to help policymakers and their partners assess progress, prioritize actions and ensure accountability for commitments to reduce maternal, newborn, and child mortality. The following section contains profiles for the 75 Countdown countries: Afghanistan Angola Azerbaijan Bangladesh Benin Bolivia Botswana Brazil Burkina Faso Burundi Cambodia Cameroon Central African Republic Chad China Comoros Congo Congo, Democratic Republic of the Côte d’Ivoire Djibouti Egypt Equatorial Guinea Eritrea Ethiopia Gabon Gambia, The Ghana Guatemala Guinea Guinea-Bissau Haiti India Indonesia

Iraq Kenya Korea, Democratic People’s Republic of Kyrgyzstan Lao People’s Democratic Republic Lesotho Liberia Madagascar Malawi Mali Mauritania Mexico Morocco Mozambique Myanmar Nepal Niger Nigeria Pakistan Papua New Guinea Peru Philippines Rwanda São Tomé and Príncipe Senegal Sierra Leone Solomon Islands Somalia South Africa South Sudan Sudan Swaziland Tajikistan Tanzania, United Republic of Togo Turkmenistan Uganda Uzbekistan Viet Nam Yemen Zambia Zimbabwe

Fulfilling the Health Agenda for Women and Children  The 2014 Report

45

The Countdown country profile: a tool for action

The Countdown country profiles present in one place the latest evidence to assess country progress in improving reproductive, maternal, newborn and child health. The two-page profiles in this report are updated every two years with new data and analyses. Countdown has also committed to annually updating the core indicators selected by the Commission on Information and Accountability for Women’s and Children’s Health.

Reviewing the information The first step in using the country profiles is to explore the range of data presented: demographics, mortality, coverage of evidencebased interventions, nutritional status and socioeconomic equity in coverage, and information on policies, health systems and financing. Key questions in reviewing the data include: • Are trends in mortality and nutritional status moving in the right direction? Is the country on track to achieve the health-related Millennium Development Goals? • How high is coverage for each intervention? Are trends moving in the right direction towards universal coverage? Are there gaps in coverage for specific interventions? • How equitable is coverage? Are certain interventions particularly inaccessible for the poorest segment of the population? • Are key policies and systems measures and adequate funding in place to bring coverage of key interventions to scale?

Identifying areas to accelerate progress The second step in using the country profiles is to identify opportunities to address coverage gaps and accelerate progress in improving coverage and health outcomes across the continuum of care. Questions to ask include:

46

Fulfilling the Health Agenda for Women and Children  The 2014 Report

• Are the coverage data consistent with the epidemiological situation? For example: • If pneumonia deaths are high, are policies in place to support community case management of pneumonia? Are coverage levels low for careseeking and antibiotic treatment for pneumonia, and what can be done to reach universal coverage? Are the rates of deaths due to diarrhoea consistent with the coverage levels and trends of improved water sources and sanitation facilities? • In priority countries for eliminating motherto-child transmission of HIV, are sufficient resources being targeted to preventing mother-to-child transmission? • Does lagging progress on reducing maternal mortality or high newborn mortality reflect low coverage of family planning, antenatal care, skilled attendance at birth and postnatal care? • Do any patterns in the coverage data suggest clear action steps? For example, coverage for interventions involving treatment of an acute need (such as treatment of childhood diseases and childbirth services) is often lower than coverage for interventions delivered routinely through outreach or scheduled in advance (such as vaccinations). This gap suggests that health systems need to be strengthened, for example by training and deploying skilled health workers to increase access to care. • Do the gaps and inequities in coverage along the continuum of care suggest prioritizing specific interventions and increasing funding for reproductive, maternal, newborn and child health? For example, is universal access to labour, delivery and immediate postnatal care being prioritized in countries with gaps in interventions delivered around the time of birth?

Sample country profile Intervention coverage These charts show most recent coverage levels and trends for selected reproductive, maternal, newborn and child health interventions.

Key population characteristics These demographic indicators include the proportion of newborn deaths among all deaths of children under age 5, a Commission on Information and Accountability for Women’s and Children’s Health indicator.

Impact: under-5 mortality rate and maternal mortality ratio These charts display trends over time, reflecting progress towards reaching the Millennium Development Goal 4 and 5 targets.

Fulfilling the Health Agenda for Women and Children The 2014 Report

Fulfilling the Health Agenda for Women and Children The 2014 Report

Ghana

Ghana

DEMOGRAPHICS

DEMOGRAPHICS

Births (000) Birth registration (%) Total under-five deaths (000) Neonatal deaths: % of all under-5 deaths Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Stillbirth rate (per 1000 total births)

(2012)

3,640

(2012)

794

(2012)

63 56

(2011)

40

(2012)

28 49

(2012)

(2012)

(2012)

22

(2009)

3,100

(2013)

Lifetime risk of maternal death (1 in N)

66

(2013)

Total fertility rate (per woman)

3.9

(2012)

70

(2006)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

800

160 128

120

Pneumonia 11% 2%

72

MDG Target

0 1990

1995

2000

2005

380

2010

2015

Source: IGME 2013

2000

2005

2010

2015

Injuries 4%

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

83

Exclusive breastfeeding

46

Measles

Neonatal period

80

40

Infancy

47

44

40

57

50

20

88 0

0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

68

60

Percent

1988 DHS

1998 DHS

2003 DHS

2006 MICS

2008 DHS

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

2011 MICS

100 80 60 40 20 0

100

92

88

82

92

96

90

80 55

2011

CHILD HEALTH

Socioeconomic inequities in coverage

Immunization

Demand for family planning satisfied Antenatal care (1+ visit)

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine 92 92 88

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

49 43

40 20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months) ORT & continued feeding

(2011) (2011)

0 10 20 30 40 50 60 70 80 90 100

100

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

20 0

2616 1998 DHS

2003 DHS

34

41

33

24

2006 MICS

2008 DHS

56

2011 MICS

Postnatal visit for mother

83

(2011)

-

-

25

41 26

1988 DHS

1993 DHS

36

31

Vitamin A two dose coverage (%)

(2012)

(2011)

17

19

20

1998 DHS

2003 DHS

14

28

2006 MICS

13

23

2011 MICS

20 0

4

7

1988 DHS

1993 DHS

2003 DHS

5 8

63 46

40

2011 MICS

59

45 45

44

2008 DHS

35

35 (2011)

2

2012

1990 Urban

2012 1990

3

Rural

2012

Source: WHO/UNICEF JMP 2014

22

28

2006 MICS

2008 DHS

39

3 -

-

Newborn health (X of 4) Child health (X of 3)

2

(2013)

10.2

(2010)

37

(2011)

Density of doctors, nurses and midwives (per 10,000 population)

Per capita total expenditure on health (Int$)

4 2011 MICS

(2013)

-

100 22

19

80

8

10

7 1

31

60 42

72

40

59

106

(2012)

General government expenditure on health as % of total government expenditure (%)

10

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

29

(2012)

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

0

(2013)

Reproductive health (X of 3) Maternal health (X of 3)

National availability of Emergency Obstetric Care services

Improved sanitation coverage

20

34

19

Total

78

36

40 16

52

Yes

Life Saving Commodities in Essential Medicine List:

FINANCING

2003 DHS

9

Costed national implementation plan(s) for: maternal, newborn and child health available

(% of recommended minimum)

100 80 60 40 20 0

2011 MICS

10

10

38

1990

2008 DHS

2006 MICS

68

20

2003 DHS

29 29

0 7

8 8

44

60 10

0 1998 DHS

1998 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

100

31

40

40 39

29

29

80 36

53

Malaria prevention and treatment

Improved drinking water coverage Improved drinking water coverage

Percent of infants <6 months exclusively breastfed

60

Women with low body mass index (<18.5 kg/m2, %)

WATER AND SANITATION

(2011)

80 43

100 80 60 40 20 0

1993 DHS

100

60

40

24

1993 DHS

51

Early initiation of breastfeeding (within 1 hr of birth, %) 46 Introduction of solid, semi-solid/soft foods (%) 75

80

Percent

43

44

Exclusive breastfeeding

Percent of children <5 years who are moderately or severely: underweight stunted

Percent

Source: MICS 2011

6 11

Underweight and stunting prevalence

Careseeking for pneumonia

40 20 0

2012 2010

2005

Percent

Measles

2000

100 80 60

Yes

SYSTEMS

(within 2 days for home births, %)

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Yes Yes

(within 2 days for home births, %)

2011 MICS

-

International Code of Marketing of Breastmilk Substitutes

Low osmolarity ORS and zinc for management of diarrhoea

(2011)

2008 DHS

-

Antenatal corticosteroids as part of management of preterm labour

Community treatment of pneumonia with antibiotics

(2012)

2006 MICS

Yes

(2011)

83

2003 DHS

Postnatal home visits in the first week after birth Kangaroo Mother Care in facilities for low birthweight/preterm newborns

(2011)

88

1998 DHS

Yes

67

Postnatal visit for baby

1988 DHS

7 Partial

Maternal deaths notification

11, 17, 7

Malaria during pregnancy - intermittent preventive treatment (%)

Neonatal tetanus vaccine

Diarrhoeal disease treatment

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

Percent

Richest 20%

Percent

Poorest 20%

(2011)

CHILD HEALTH

Pneumonia treatment

Percent

EQUITY

87

40

0

2012

34

Antenatal care (4 or more visits, %)

60

20 2010

Source: UNICEF/UNAIDS/WHO 2013

Demand for family planning satisfied (%)

(2013)

(Minimum target is 5% and maximum target is 15%)

* See Annex/website for indicator definition

Household wealth quintile:

Source: WHO 2014

C-section rate (total, urban, rural; %)

80 95

Percent

*Postnatal care

Indirect 29%

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Antenatal care 76 (2012)

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

87 68

Maternity protection (Convention 183)

MATERNAL AND NEWBORN HEALTH

Skilled attendant at delivery

Percent

34

Midwives authorized for specific tasks

Hypertension 16%

0% 7% Diarrhoea

-

3 (R,F)

(X of 7 tasks)

Other direct 9%

Other 2%

Measles 1%

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care

Legal status of abortion (X of 5 circumstances)

Haemorrhage 25%

Sepsis** 8%

Malaria 19%

MDG Target

1995

Abortion 10%

Congenital 4%

190

0 1990

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Asphyxia* 12%

Neonatal death: 40%

HIV/AIDS 1%

200

Sepsis 10%

deaths are attributable to undernutrition

Other 17%

400 43

40

Globally nearly

Preterm 12% half of child

760

600

80

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012

Deaths per 100,000 live births

Percent

Total under-five population (000)

25,366

Percent

Total population (000)

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Policies These indicators show whether needed policies are in place to support the introduction and scale-up of proven interventions.

Cause of death These charts provide information useful for interpreting the coverage measures and identifying programmatic priorities.

29

External sources General government expenditure Out-of-pocket expenditure Other

33 15

47

Partially available

46

ODA to child health per child (US$)

24

(2011)

ODA to maternal and neonatal health

56

(2011)

per live birth (US$) Note: See annexes for additional information on the indicators above

44

29 14

7

1990

2012 Total

13

20

20 8

4

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

100

101

Equity in coverage Socioeconomic inequities in coverage highlight the need for concerted efforts to improve coverage among the poorest.

Nutrition Undernutrition contributes to at least a third of all deaths among children under age 5 globally.

Water and sanitation Water and sanitation from improved sources are essential for reducing transmission of infectious disease.

Health systems and financing These indicators provide information on health system strength and available financing for scaling up interventions.

Continuum of care Gaps in coverage along the continuum of care from pre-pregnancy and childbirth through childhood up to age 5 should serve as a call to action for a country to prioritize these interventions.

Fulfilling the Health Agenda for Women and Children  The 2014 Report

47

Fulfilling the Health Agenda for Women and Children The 2014 Report

Afghanistan DEMOGRAPHICS Total population (000)

29,825

(2012)

Total under-five population (000)

4,964

(2012)

Births (000)

1,053

(2012)

37

(2010-2011)

103

(2012)

Neonatal deaths: % of all under-5 deaths

36

(2012)

Neonatal mortality rate (per 1000 live births)

36

(2012)

Infant mortality rate (per 1000 live births)

71

(2012)

Stillbirth rate (per 1000 total births)

29

(2009)

Birth registration (%) Total under-five deaths (000)

Total maternal deaths

4,200

(2013)

Lifetime risk of maternal death (1 in N)

49

(2013)

Total fertility rate (per woman)

5.1

(2012)

90

(2008)

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

1600

176

150

1200

1200

99

800

100 59

50 0 1990

MDG Target

1995

2000

2005

2010

400

400

300

0 1990

2015

Source: IGME 2013

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Skilled attendant at delivery

Coverage along the continuum of care

39

*Postnatal care

Birth

23

Neonatal period

Exclusive breastfeeding

Infancy

Measles

0

60

20 40 60 80 100

24

14

0

2003 MICS

Percent

20

39

34

40 20

68

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Percent

15

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

2008 Other NS

2010 DHS

15 10

5 0

2010-2011 MICS

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

100 80

Skilled attendant at delivery

80

71 71 68

60

Percent

Percent

Antenatal care (4+ visits)

40

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

2010-2011 MICS

2012 2010

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

64

40 0

0

Measles

61

60 20

20

Early initiation of breastfeeding

9

(2004)

-

-

Early initiation of breastfeeding (within 1 hr of birth, %)

54

(2010-2011)

Introduction of solid, semi-solid/soft foods (%)

20

(2010-2011)

-

-

Vitamin A two dose coverage (%)

ORT & continued feeding

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia

Percent of infants <6 months exclusively breastfed

80 Percent

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Exclusive breastfeeding

100

0 10 20 30 40 50 60 70 80 90 100

Source: MICS 2010-2011

60 40

45

59

53 33

20 0

48

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

1997 MICS

2004 Other NS

No Data

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Afghanistan DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

Preterm 11%

2%

18%

Neonatal death: 36%

Asphyxia* 10%

Globally nearly half of child deaths are attributable to undernutrition

Sepsis 14%

Embolism 2%

1%

13%

Injuries 7%

Hypertension 10%

Indirect 29%

Diarrhoea

Source: WHO 2014

Measles 3% Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Demand for family planning satisfied (%)

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

Percent

(Minimum target is 5% and maximum target is 15%)

48

36

40

0

-

15

(2011)

-

-

4, 9, 2

(2010-2011)

60

(2012)

-

-

Antenatal care (4 or more visits, %)

C-section rate (total, urban, rural; %)

60

60

20

-

Malaria during pregnancy - intermittent preventive treatment (%)

100

80

Neonatal tetanus vaccine

Postnatal visit for baby

(within 2 days for home births, %)

16

Postnatal visit for mother

(within 2 days for home births, %)

2003 MICS

2008 Other NS

2010 DHS

2010-2011 MICS

Women with low body mass index (<18.5 kg/m2, %)

23

(2010)

-

-

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Percent

100 80 48

60 40 20

2003 MICS

-

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

40

0

100

11

62

20

Percent of population by type of sanitation facility, 1995-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

52

60

Source: WHO/UNICEF JMP 2014

4

Urban

Antenatal corticosteroids as part of management No of preterm labour International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

2

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

7.3

(2011)

-

-

47

(2012)

7

(2012)

74

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

20

Rural

0

16

45

46

8

21

29

1995

2012 Total

Out-of-pocket expenditure

37

49

36 11

General government expenditure 20

21

38

26

2012 Urban

38

(2011)

ODA to maternal and neonatal health per live birth (US$)

91

(2011)

8

7

23

20

1995

Other

ODA to child health per child (US$)

Note: See annexes for additional information on the indicators above

12 47

No Data

External sources

0 32

40

28 10

Total

33

15

33

54

No

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Percent

60

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

General government expenditure on health as % of total government expenditure (%)

80

27

Yes

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 2012 Piped on premises Other improved Surface water Unimproved

80

Yes

Postnatal home visits in the first week after birth

Per capita total expenditure on health (Int$)

Very limited risk

2010-2011 MICS

3 7

Maternal deaths notification

FINANCING

53

Improved drinking water coverage

9

No

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Maternity protection (Convention 183)

(% of recommended minimum)

30

0

-

(X of 7 tasks) Other direct 8%

Congenital 2%

Malaria 0%

1

Midwives authorized for specific tasks

Sepsis** 8% HIV/AIDS 0%

-

Legal status of abortion (X of 5 circumstances)

Haemorrhage 30%

Abortion 6%

Other 2%

Other 23%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Southern Asia, 2013

1995

2012 Rural

Source: WHO/UNICEF JMP 2014

49

Fulfilling the Health Agenda for Women and Children The 2014 Report

Angola DEMOGRAPHICS Total population (000)

20,821

(2012)

3,966

(2012)

Births (000)

934

(2012)

Birth registration (%) Total under-five deaths (000)

36 148

(2001)

28

(2012)

45 100

(2012)

150

(2012)

100

25

(2009)

4,400

(2013)

Lifetime risk of maternal death (1 in N)

35

(2013)

Total fertility rate (per woman)

6.0

(2012)

Adolescent birth rate (per 1000 girls)

188

(2008)

Total under-five population (000)

Neonatal deaths: % of all under-5 deaths Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Stillbirth rate (per 1000 total births) Total maternal deaths

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

250

1500

213

200

1400

1200

164

900 71

50

0 1990

2000

2005

2010

0 1990

2015

Source: IGME 2013

350

300

MDG Target

1995

460

600

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Birth

Exclusive breastfeeding

Neonatal period

11

60

Measles

0

20 40 60 80 100

Source: DHS, MICS, Other NS

30

23

20

97 0

40

47

40

Infancy

<1 (2012)

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80 Percent

47

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

*Postnatal care

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Coverage along the continuum of care

1996 MICS

Percent

17

17

10

0

2006-2007 Other NS

21

20

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine 97 100

80

Skilled attendant at delivery

No Data

20 0

No Data

Measles

1990

1995

Source: WHO/UNICEF 2013

2012 2010

2005

NUTRITION Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months) ORT & continued feeding

8

(2007)

12

(2000)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Vitamin A two dose coverage (%)

(2012)

44

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80

37

29 16

20 0

(2007)

62

60

40

Early initiation of breastfeeding (within 1 hr of birth, %) 55 Introduction of solid, semi-solid/soft foods (%) 77

100

80

Percent

50

2000

1996 MICS

2007 Other NS

Percent

DTP3

91

40

Early initiation of breastfeeding ITN use among children <5 yrs

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

91

60

Percent

Antenatal care (4+ visits)

Pneumonia treatment

60 40 20 0

11 2001 MICS

(2001)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Angola DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

15%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 8%

2%

Asphyxia* 8%

Neonatal death: 28%

Other 2%

Sepsis 10%

Congenital 1% Other 24%

Embolism 2%

Abortion 10%

Haemorrhage 25%

0%

14%

Hypertension 16%

Diarrhoea

Malaria 13%

Injuries 5%

Indirect 29%

Measles 1%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Demand for family planning satisfied (%)

-

-

Antenatal care (4 or more visits, %)

-

-

18

(2011)

-

-

72

(2012)

Malaria during pregnancy - intermittent preventive treatment (%)

80

80

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

2006-2007 Other NS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Percent

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

No Data

100 80 60 40 20 0

77 (2011)

Percent

80

22

24

60 34

30

18

33

26

2011 Other NS

0

1990

28 15

27

21

Total

2012

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

51

41

20 36 6

Improved sanitation coverage

30

44 34

40

16

1990 Urban

Maternity protection (Convention 183)

No

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

No

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

No

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

0

(2013)

2

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

18.3

(2009)

25

(2006)

212

(2012)

6

(2012)

27

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

Per capita total expenditure on health (Int$) General government expenditure on health as % of total government expenditure (%)

No Data

Reproductive, maternal, newborn and child health expenditure by source

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

6

(2011)

ODA to maternal and neonatal health per live birth (US$)

7

(2011)

Note: See annexes for additional information on the indicators above

33

34

1

2012 1990

-

FINANCING

2

13

Midwives authorized for specific tasks

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 24

1

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

2006-2007 Other NS

Improved drinking water coverage

No

(X of 7 tasks)

Other direct 9%

Sepsis** 6%

HIV/AIDS 1%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

1

Rural

2012

Source: WHO/UNICEF JMP 2014

51

Fulfilling the Health Agenda for Women and Children The 2014 Report

Azerbaijan DEMOGRAPHICS Total population (000)

9,309

(2012)

Total under-five population (000)

768

(2012)

Births (000)

168

(2012)

Birth registration (%) Total under-five deaths (000)

94 6

(2006)

Neonatal deaths: % of all under-5 deaths

43

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

15 31

Stillbirth rate (per 1000 total births)

12

(2009)

Total maternal deaths

43

(2013)

1,800

(2013)

1.9

(2012)

47

(2010)

Lifetime risk of maternal death (1 in N) Total fertility rate (per woman) Adolescent birth rate (per 1000 girls)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

100

100

93

80

80

(2012)

60

60

(2012)

40

35

31

20

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

60

40

26

20

15

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 77

99

*Postnatal care

66

Exclusive breastfeeding

100

Pre-pregnancy Pregnancy

45

12

Birth

Neonatal period

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

20 0

Percent

1990 Other NS

1998 Other NS

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

99

88

84

40

20 40 60 80 100

Source: DHS, MICS, Other NS

100

60

66 0

97

80

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2000 MICS

2006 DHS

2010 Other NS

100 80 60 40 20 0

2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

100 60

Percent

Skilled attendant at delivery

40 20

Early initiation of breastfeeding

0 1990

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

7

(2006) (2006)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Early initiation of breastfeeding (within 1 hr of birth, %) 32 Introduction of solid, semi-solid/soft foods (%) 83

(2006)

Vitamin A two dose coverage (%)

(2012)

Percent of infants <6 months exclusively breastfed

100 80

60

40 20 0

90

Exclusive breastfeeding

80

Percent

36

40 20 0

2000 MICS

10

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

28 9 1996 Other NS

14

24

2000 MICS

18 6 2001 Other NS

27

8 2006 DHS

Percent

Measles Vitamin A (past 6 months)

52

1995

ITN use among children <5 yrs

Source: DHS 2006

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics 91 75 66

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

EQUITY

60 40 20 0

7

12

2000 MICS

2006 DHS

(2006)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Azerbaijan DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

1%

16%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 17%

Other 25%

Sepsis 9%

Embolism 11%

Abortion 5%

Asphyxia* 8%

Neonatal death: 43%

Other direct 17%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Caucasus and Central Asia, 2013

Legal status of abortion (X of 5 circumstances)

Sepsis** 5%

Measles 0%

Hypertension 15%

Indirect 22%

0% 8% Diarrhoea

Injuries 8%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100 80 Percent

Demand for family planning satisfied (%)

77

(2006)

Antenatal care (4 or more visits, %)

45

(2006)

-

-

5, 5, 4

(2006)

Malaria during pregnancy - intermittent preventive treatment (%)

98 77

70

66

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

-

-

40

Postnatal visit for baby

-

-

66

(2006)

-

-

(within 2 days for home births, %)

20 0

Postnatal visit for mother

(within 2 days for home births, %)

1997 MoH

2000 MICS

1996-2001 Other NS

2006 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

40

31

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

21

10 2000 MICS

-

Percent

80 21

21

2

18

16

51

40

67

78

32

51

20 44

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

-

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

-

Low osmolarity ORS and zinc for management of diarrhoea

-

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Rural

-

-

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

-

-

Newborn health (X of 4) Child health (X of 3)

-

-

101.2

(2012)

-

-

572

(2012)

4

(2012)

69

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1995-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100 0 80

0 11

38

7

0

21

0 3 11

9

0

1 18

55

3

-

40

82 57

86

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$) ODA to maternal and neonatal health per live birth (US$)

60 5

20 17

0

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

General government expenditure on health as % of total government expenditure (%)

Improved sanitation coverage

13

33

29

60 26

1990

10 10

No

Out of pocket expenditure as % of total expenditure on health(%)

Percent

12

11

Yes

Postnatal home visits in the first week after birth

Per capita total expenditure on health (Int$)

1 2000 MICS

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 1

Maternal deaths notification

FINANCING

2006 DHS

Improved drinking water coverage

8

Yes

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100 9

Maternity protection (Convention 183)

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

-

(X of 7 tasks)

Other 5%

Malaria 0%

5 (R,F)

Midwives authorized for specific tasks

Haemorrhage 23%

Congenital 6%

HIV/AIDS 0%

-

9

(2011)

18

(2011)

Note: See annexes for additional information on the indicators above

2 78

70 43

20

0 2012

1995

2012 Total

1995

2012 Urban

1995

2012 Rural

Source: WHO/UNICEF JMP 2014

53

Fulfilling the Health Agenda for Women and Children The 2014 Report

Bangladesh DEMOGRAPHICS Total population (000)

154,695

(2012)

15,074

(2012)

3,150

(2012)

31 127

(2011)

Neonatal deaths: % of all under-5 deaths

60

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

24 33

(2012)

Stillbirth rate (per 1000 total births)

36

(2009)

5,200

(2013)

250

(2013)

Total fertility rate (per woman)

2.2

(2012)

Adolescent birth rate (per 1000 girls)

128

(2009)

Total under-five population (000) Births (000) Birth registration (%) Total under-five deaths (000)

Total maternal deaths Lifetime risk of maternal death (1 in N)

(2012)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

600 144

150

550

450

100

300

48

41

50

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

170 140

150

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

26

*Postnatal care

27

82

Birth

Exclusive breastfeeding

Neonatal period

64

Measles

60

30

32

20

18

14

10

12

1993-94 DHS

1999-00 DHS

0

20 40 60 80 100

Source: DHS, MICS, Other NS

40

40

96 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

32

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2003 MICS

2007 DHS

20 10

0

2011 DHS

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine 96 100

Percent

60

Percent

Skilled attendant at delivery

40 20

Early initiation of breastfeeding

40 20

1995

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

16

(2011)

22

(2006)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

80

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Percent

Percent

60

40

33

27

20

30 22

35

2004 DHS

2006 MICS

2011 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 47 Introduction of solid, semi-solid/soft foods (%) 62

(2011)

Vitamin A two dose coverage (%)

(2012)

(2011)

99

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100 62 63

53

80

60 42

51

43 51 41 43 37 41

20 0

28

1993-94 1996-97 1999-00 DHS DHS DHS

2012 2010

2005

Percent

Measles

71

0 1990

Vitamin A (past 6 months)

54

100 80 60

0

ITN use among children <5 yrs

Source: DHS 2011

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

96 96

80

Antenatal care (4+ visits)

Pneumonia treatment

60 40

64 46

45

46

42

43

2004 DHS

2007 DHS

20 1989-90 1996-97 1999-00 Other NS DHS DHS

2004 DHS

2007 DHS

2011 DHS

0

1993-94 1996-97 1999-00 DHS DHS DHS

2011 DHS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Bangladesh DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 2% 11%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 19%

Other 16%

Neonatal death: 60%

HIV/AIDS 0%

Malaria 0%

Sepsis 14%

Regional estimates for Southern Asia, 2013

Embolism 2%

Haemorrhage 30%

Abortion 6%

Asphyxia* 13%

Measles 2%

Sepsis** 11%

0%

Diarrhoea

Hypertension 10%

Indirect 29%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

82

Antenatal care (4 or more visits, %)

26

(2011)

-

-

17, 29, 14

(2011)

Neonatal tetanus vaccine

94

(2012)

Postnatal visit for baby

30

(2011)

Postnatal visit for mother

27

(2011)

Women with low body mass index

28

(2011)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(2011)

Malaria during pregnancy - intermittent preventive treatment (%)

100

60 40

33

26

55

52

40

0

(Minimum target is 5% and maximum target is 15%)

(within 2 days for home births, %)

20

(within 2 days for home births, %)

1993-94 DHS

1999-00 DHS

2003 MICS

2007 DHS

2011 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

61

52

50

67

68

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

-

1999-00 DHS

2004 DHS

2007 DHS

60 75

40

10

5

1990

83

Total

2012

Source: WHO/UNICEF JMP 2014

0

1990 Urban

2012 1990

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100

1

Rural

2012

3 12

34

28

60 16 40

20

32

23

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

2 3

(2013)

5.7

(2011)

54

(2007)

68

(2012)

8

(2012)

63

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

80

65

63

20

0

0 16

7 28

54

58

Yes

General government expenditure on health as % of total government expenditure (%)

Percent

Percent

80 26

0 14

2 17

No

Postnatal home visits in the first week after birth

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 0

No

Maternal deaths notification

Per capita total expenditure on health (Int$)

2011 DHS

Improved drinking water coverage

15

6

(2013)

FINANCING

WATER AND SANITATION

100 6

Midwives authorized for specific tasks

(% of recommended minimum)

Very limited risk

1993-94 DHS

1

National availability of Emergency Obstetric Care services

76 78

77

Legal status of abortion (X of 5 circumstances)

Maternity protection (Convention 183)

Congenital 7% 6%

-

(X of 7 tasks)

Other direct 8%

Other 7%

Injuries 6%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

10

19

0 15

3 11

40

25

28 15

17 57

0

1990

2012 Total

46

ODA to maternal and neonatal health per live birth (US$)

7

(2011)

17

(2011)

Note: See annexes for additional information on the indicators above

15

33

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

30

No Data

55

58 30

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

55

2011 Report

Fulfilling the Health Agenda for Women and Children The 2014 Report

Benin DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

10,051

(2012)

1,631

(2012)

371

(2012)

Birth registration (%) Total under-five deaths (000)

80 32

(2011-2012)

Neonatal deaths: % of all under-5 deaths

31

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

28 59

(2012)

Stillbirth rate (per 1000 total births)

(2012)

(2012)

24

(2009)

1,300

(2013)

Lifetime risk of maternal death (1 in N)

59

(2013)

Total fertility rate (per woman)

4.9

(2012)

98

(2009)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

800

181

600

600

150

90

100

60

50

MDG Target

0 1990

1995

2000

2005

340

400

2010

2015

Source: IGME 2013

200

150

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 28

84

*Postnatal care Exclusive breastfeeding

100

Pre-pregnancy Pregnancy

61

Birth

Neonatal period

33

60

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

80

40

72 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

66

60

60

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

84

74

80

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1996 DHS

Percent

2001 DHS

2006 DHS

2011-2012 DHS

40

0

40

32

22

20 2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

85 85 85 72

80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

40 0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

100 80 60 40 20 0

2012 2010

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

16

(2011-2012)

15

(2006)

32

35

1996 DHS

2001 DHS

36

31

2006 DHS

2011-2012 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 50 Introduction of solid, semi-solid/soft foods (%) 76 Vitamin A two dose coverage (%)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

80 39 26

20 0

(2012)

100

60

40

99

(2008)

Percent of infants <6 months exclusively breastfed

80

Percent

(2011-2012)

Exclusive breastfeeding

1996 DHS

45

39

22

2001 DHS

20

2006 DHS

Percent

ORT & continued feeding

56

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

20

Early initiation of breastfeeding

Source: DHS 2006

Pneumonia treatment

Percent

EQUITY

60 38

40 20 0

43

33

10 1996 DHS

2001 DHS

2006 DHS

2011-2012 DHS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Benin DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

Preterm 10%

2%

13%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 9% Other 1%

Neonatal death: 32%

Other 18%

Sepsis 10%

Malaria 21%

* Intrapartum-related events

Midwives authorized for specific tasks

Hypertension 16%

Diarrhoea Injuries 5%

Indirect 29%

Measles 1% Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

81

80

80

86

84

Demand for family planning satisfied (%)

28

(2012)

Antenatal care (4 or more visits, %)

61

(2006)

Malaria during pregnancy - intermittent preventive treatment (%)

23

(2011-2012)

4, 6, 2

(2006)

93

(2012)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1996 DHS

2001 DHS

2006 DHS

2011-2012 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

42

50

42 23

26

1996 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

23

2001 DHS

2006 DHS

32 (2011-2012)

20

7 2001 DHS

2006 DHS

2011-2012 DHS

4 22

20

Percent

80 60

2 13

9 19

21

53 60

40

6 25

80

22

56

65

20 5

1990

16

16

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

4

0

2012 1990

Rural

2012

52

9

40

0

8 7

23

5

14

1990

2012 Total

76

11

60 80

20

32

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

-

-

2

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

8.3

(2008)

34

(2011)

Per capita total expenditure on health (Int$)

70

(2012)

General government expenditure on health as % of total government expenditure (%)

10

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

44

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

96

14 20 14

1990

2012 Urban

(2012)

20

%

52

22

ODA to child health per child (US$)

26

(2011)

ODA to maternal and neonatal health per live birth (US$)

43

(2011)

Note: See annexes for additional information on the indicators above

37

25

Available 6

External sources General government expenditure Out-of-pocket expenditure Other

27 54

49

52

0

29

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100

Maternal deaths notification

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

100

Yes

FINANCING

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

Maternity protection (Convention 183)

National availability of Emergency Obstetric Care services 71

2011-2012 DHS

Improved drinking water coverage

7

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

3 (R,F)

(X of 7 tasks)

0%

9%

Partial

Legal status of abortion (X of 5 circumstances)

Haemorrhage 25%

Other direct 9%

Sepsis** 6%

HIV/AIDS 1%

Embolism 2%

Abortion 10%

Congenital 3%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

7

3 1 0

12 5

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

Countdown to 2015 2011 Report

57

Fulfilling the Health Agenda for Women and Children The 2014 Report

Bolivia DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

10,496

(2012)

1,264

(2012)

Under-five mortality rate

273

(2012)

Birth registration (%) Total under-five deaths (000)

76 11

(2008)

Neonatal deaths: % of all under-5 deaths

46

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

19 33

(2012)

90

(2012)

Stillbirth rate (per 1000 total births)

60

17

(2009)

550

(2013)

Lifetime risk of maternal death (1 in N)

140

(2013)

Total fertility rate (per woman)

3.3

(2012)

89

(2005)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

Maternal mortality ratio

Deaths per 1000 live births

150

Deaths per 100,000 live births

600

123

120

510

480 360 41

41

30

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

240

200 130

120 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 75 72 71

*Postnatal care

77

Exclusive breastfeeding

60

Measles

Neonatal period

80

Infancy

100 75 50 25

0

20 40 60 80 100

Source: DHS, MICS, Other NS

61

47

20

84 0

43

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

71

69

59

60 40

1989 DHS

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1994 DHS

1998 DHS

2000 MICS

2003 DHS

0

2008 DHS

2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

100

76

60

Percent

Skilled attendant at delivery

80 80

20 0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

1

(2008)

6

(2008)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

43

1998 DHS

2000 MICS

2003 DHS

64

2008 DHS

(2008)

Vitamin A two dose coverage (%)

(2012)

(2008)

41

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80

44

8 1989 DHS

33

37

40

0

51

100

60

20

40

52

Early initiation of breastfeeding (within 1 hr of birth, %) 64 Introduction of solid, semi-solid/soft foods (%) 83

80

Percent

40 20 0

54

1994 DHS

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

2005

11 1994 DHS

33

27

6

6

5

1998 DHS

2003 DHS

2008 DHS

Percent

Measles Vitamin A (past 6 months)

Source: DHS 2008

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

40

Early initiation of breastfeeding

58

84

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

EQUITY

60

51

40

50 39

43

54

60

20 0

1989 DHS

1994 DHS

1998 DHS

2000 MICS

2003 DHS

2008 DHS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Bolivia DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 15%

2%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 13%

Other 23%

Sepsis 8%

Regional estimates for Latin America, 2013

Embolism 3%

Abortion 10%

Haemorrhage 23%

Asphyxia* 13%

Neonatal death: 46%

Injuries 7%

Measles 0%

* Intrapartum-related events

0%

Hypertension 22%

Indirect 19%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

83

Percent

60

86

79

69

80

Demand for family planning satisfied (%)

75

(2008)

Antenatal care (4 or more visits, %)

72

(2008)

-

-

19, 28, 8

(2008)

Neonatal tetanus vaccine

76

(2012)

Postnatal visit for baby

77

(2008)

Postnatal visit for mother

77

(2008)

-

-

Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

53

46

40

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1989 DHS

1994 DHS

1998 DHS

2000 MICS

2003 DHS

2008 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

59

30

33

1994 DHS

1998 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

-

2000 MICS

29

2003 DHS

60

79

49

95 29

57

12

0

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

Rural

19

25

14

14

21

20

80 46

5 15

19 83

1990

23

40

20

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100

4

12

40 20

0 1

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

No

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

3

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

14.8

(2011)

48

(2003)

305

(2012)

General government expenditure on health as % of total government expenditure (%)

10

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

23

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

60

14

(2013)

5 10

28

49 72

20

22 57 46

28

1990

2012 Total

41

1990

2012 Urban

No Data

External sources General government expenditure Out-of-pocket expenditure Other

40 12

0 2012

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Percent

80

1 8 12

No

Per capita total expenditure on health (Int$)

Very limited risk

2008 DHS

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 8 4 5

Yes

Postnatal home visits in the first week after birth

FINANCING 29 35

Improved drinking water coverage

19

Partial

(% of recommended minimum)

WATER AND SANITATION

100

-

Maternal deaths notification

National availability of Emergency Obstetric Care services

54

25

3 (R)

Maternity protection (Convention 183)

Sepsis** 8%

8%

Legal status of abortion (X of 5 circumstances) (X of 7 tasks)

Congenital 7%

Malaria 0%

Partial

Midwives authorized for specific tasks

Other direct 15%

Other 4%

HIV/AIDS 0%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

13

5

3 12

24

1990

ODA to child health per child (US$)

18

(2011)

ODA to maternal and neonatal health per live birth (US$)

34

(2011)

Note: See annexes for additional information on the indicators above

2012 Rural

Source: WHO/UNICEF JMP 2014

59

Fulfilling the Health Agenda for Women and Children The 2014 Report

Botswana DEMOGRAPHICS Total population (000)

2,004

(2012)

232

(2012)

Births (000)

48

(2012)

Birth registration (%) Total under-five deaths (000)

72 3

(2007)

Neonatal deaths: % of all under-5 deaths

54

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

29 41

(2012)

60

(2012)

Stillbirth rate (per 1000 total births)

40

16

(2009)

Total maternal deaths

Total under-five population (000)

(2012)

83

(2013)

Lifetime risk of maternal death (1 in N)

200

(2013)

Total fertility rate (per woman)

2.7

(2012)

51

(2006)

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

100

500

80

400 48

360

300

53

200

20

16 MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

170

100

90

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

95

*Postnatal care Exclusive breastfeeding

100

Pre-pregnancy Pregnancy

73

Birth

Neonatal period

20

0

60 40

0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

20

94

1988 DHS

Percent

95 (2012)

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

95

94

87

78

80

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1996 Other NS

2000 MICS

2007 Other NS

100 80 60 40 20 0

>95

>95

2010

Source: UNICEF/UNAIDS/WHO 2013

>95

2011

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Percent

Skilled attendant at delivery

60

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics 96 94 52

40 20

No Data

0 1990

1995

Source: WHO/UNICEF 2013

2000

100 80 60 40 20 0

14 2000 MICS

2012 2010

2005

NUTRITION

DTP3 Measles

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

7

(2007)

13

(2007)

Early initiation of breastfeeding (within 1 hr of birth, %) 40 Introduction of solid, semi-solid/soft foods (%) 46 Vitamin A two dose coverage (%)

ORT & continued feeding

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia

100

0 10 20 30 40 50 60 70 80 90 100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Percent of infants <6 months exclusively breastfed

100 80

60 35

40 20 0

-

Exclusive breastfeeding

80

Percent

60

Pneumonia treatment

15 1996 Other NS

31

29 11 2000 MICS

11 2007 Other NS

Percent

ITN use among children <5 yrs

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine 96 100

80

Antenatal care (4+ visits)

Early initiation of breastfeeding

Immunization

Percent

EQUITY

60 40

34 20

20 0

2000 MICS

2007 Other NS

(2007) (2007) -

Impr

Fulfilling the Health Agenda for Women and Children The 2014 Report

Botswana DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

2%

11%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 21%

Other 18%

Sepsis 10%

Embolism 2%

Abortion 10%

Neonatal death: 54%

Haemorrhage 25%

Injuries 5%

Hypertension 16%

Congenital 6%

Measles 1%

7% 0% Diarrhoea

* Intrapartum-related events

Indirect 29%

Sepsis** 9%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

97

92

100

73

(2007)

Malaria during pregnancy - intermittent preventive treatment (%)

-

-

C-section rate (total, urban, rural; %)

-

-

92

(2012)

Antenatal care (4 or more visits, %)

94

80 Percent

-

-

Demand for family planning satisfied (%)

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1988 Other NS

2000 MICS

2007 Other NS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

-

Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 27

80

4 3

8 6

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100

55 76

90

40

70

20

39

38

22

10

0

1990

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

13

80 35

61

60 70

No

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

No

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

2

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

31.8

(2006)

-

-

872

(2012)

General government expenditure on health as % of total government expenditure (%)

8

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

6

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

Rural

60 21 40

11

15

23

8

5

5

0 16 6

64

20 39

35 52 12

78

61

11

20 6

(2013)

1990

2012 Total

1990

2012 Urban

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

10

(2011)

ODA to maternal and neonatal health per live birth (US$)

26

(2011)

Note: See annexes for additional information on the indicators above

42

22

0 2012

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Percent

0 1 9

Maternity protection (Convention 183)

Per capita total expenditure on health (Int$)

Sub-national risk

WATER AND SANITATION

0 0

5

FINANCING

2000 Other NS

1

3 (R,F)

National availability of Emergency Obstetric Care services

7

2

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

49

100 5 3

Yes

(X of 7 tasks)

Other 3%

Malaria 0%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent Midwives authorized for specific tasks

Other direct 9%

Asphyxia* 13%

HIV/AIDS 5%

Regional estimates for Sub-Saharan Africa, 2013

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

61

Fulfilling the Health Agenda for Women and Children The 2014 Report

Brazil DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

198,656

(2012)

14,563

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

3,009

(2012)

Birth registration (%) Total under-five deaths (000)

93 42

(2010)

Neonatal deaths: % of all under-5 deaths

64

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

9 13

(2012)

45

90

(2012)

30

60

Stillbirth rate (per 1000 total births)

(2012)

10

(2009)

2,100

(2013)

Lifetime risk of maternal death (1 in N)

780

(2013)

Total fertility rate (per woman)

1.8

(2012)

65

(2011)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

75

150

62

60

120

120

21

14

15

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

69

30

30

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014

Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 93 91 97

*Postnatal care Exclusive breastfeeding

Neonatal period

41

Infancy

Measles

0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

70

60

100 80

40 20

99

60 40 20

0

20 40 60 80 100

Source: DHS, MICS, Other NS

88

80

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

97

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1991 DHS

Percent

1996 DHS

0

2006 MoH

2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

80 Percent

Skilled attendant at delivery

60 40

100

80 60 40

0 1990

1995

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

15

0

ITN use among children <5 yrs

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

50

46

20

20

Early initiation of breastfeeding

1996 DHS

2012 2010

2

(2006-2007)

8

(2010)

2006 MoH

Early initiation of breastfeeding (within 1 hr of birth, %) 68 Introduction of solid, semi-solid/soft foods (%) 70 Vitamin A two dose coverage (%)

ORT & continued feeding

Percent of children <5 years who are moderately or severely: underweight stunted

100

80

80

60

60

Percent

Percent

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Percent of infants <6 months exclusively breastfed

100

0 10 20 30 40 50 60 70 80 90 100

Source: DHS 2006-2007

40 20

0

-

Exclusive breastfeeding

Underweight and stunting prevalence

Careseeking for pneumonia

62

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

99 95 94 89 86

100

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: with 3 doses DTP against measles with rotavirus vaccine with 3 doses Hib with 3 doses pneumococcal conjugate vaccine

Percent

EQUITY

19 5 1989 Other NS

5

14 1996 DHS

4 2002-2003 Other NS

2

7

2006-2007 DHS

40

40

41

2006 MoH

2008 MoH

20 0

(2008) (2006) -

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Brazil DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 6%

1%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 21%

Other 24%

Neonatal death: 64%

HIV/AIDS 0%

Sepsis 8%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Latin America, 2013

Embolism 3%

Abortion 10%

Legal status of abortion (X of 5 circumstances)

Haemorrhage 23%

Other 10%

Maternity protection (Convention 183)

Injuries 5%

0%

Diarrhoea

Hypertension 22%

Indirect 19%

Congenital 12%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Sepsis** 9%

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100 74

80 Percent

86

98

98

97

Demand for family planning satisfied (%)

93

(2006)

Antenatal care (4 or more visits, %)

91

(2009)

-

-

50 , - , -

(2009)

93

(2012)

Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

6

(1996)

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1986 DHS

1996 DHS

2003 MoH

2006 MoH

2009 MoH

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

-

60

14 18

92

92

18

80

67

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

17

3 15

15 1

1

-

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

-

-

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

0

(2013)

-

-

Newborn health (X of 4) Child health (X of 3)

-

-

94.9

(2013)

-

-

1,109

(2012)

8

(2012)

31

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

-

1 11 1

40

2012

General government expenditure Out-of-pocket expenditure 17

48

60 81

67

79

87

20

1

2012 Total

Other

ODA to child health per child (US$)

1

(2011)

ODA to maternal and neonatal health per live birth (US$)

1

(2011)

Note: See annexes for additional information on the indicators above

1 49

31

1990

No Data

External sources

33

0 Rural

6 14 1

20

39

0

1990

100

97

20

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

3 12

29

40 78

Antenatal corticosteroids as part of management of preterm labour

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Percent

80

-

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 0 3 0

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

General government expenditure on health as % of total government expenditure (%)

1996 DHS

04 4

Yes

Per capita total expenditure on health (Int$)

Very limited risk

Improved drinking water coverage 02 6

Yes

Postnatal home visits in the first week after birth

National availability of Emergency Obstetric Care services

WATER AND SANITATION

8 10

Maternal deaths notification

FINANCING

27

100 4

Partial

(% of recommended minimum)

44

1991 DHS

-

(X of 7 tasks) Other direct 15%

Measles 0% 2%

1 (R)

Midwives authorized for specific tasks

Asphyxia* 10%

Malaria 0%

-

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

63

Fulfilling the Health Agenda for Women and Children The 2014 Report

Burkina Faso DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

16,460

(2012)

2,932

(2012)

Under-five mortality rate

Deaths per 100,000 live births

250

1000

683

(2012)

Birth registration (%) Total under-five deaths (000)

77 66

(2010)

Neonatal deaths: % of all under-5 deaths

27

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

28 66

(2012)

150

(2012)

Stillbirth rate (per 1000 total births)

100

26

(2009)

2,800

(2013)

44

(2013)

Total fertility rate (per woman)

5.7

(2012)

Adolescent birth rate (per 1000 girls)

136

(2008)

Total maternal deaths Lifetime risk of maternal death (1 in N)

(2012)

Maternal mortality ratio

Deaths per 1000 live births

202

200

770

800 600

102 67

50

400

MDG Target

0 1990

1995

2000

2005

2010

190 MDG Target

0 1990

2015

Source: IGME 2013

400

200 1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 40

66

*Postnatal care

Birth

72

Exclusive breastfeeding

Neonatal period

38

80

Measles

0

20 40 60 80 100

Source: DHS, MICS, Other NS

75

31

20

87 0

100

38

42

40

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

66

54

60

Infancy

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

34

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1993 DHS

1998-1999 DHS

2003 DHS

2006 MICS

25

0

2010 DHS

66

56

50

50

2010

2011

Source: UNICEF/UNAIDS/WHO 2013

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

40 0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

11

(2012)

14

(2010)

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

15

1998-1999 DHS

2003 DHS

2006 MICS

2010 DHS

(2010)

Vitamin A two dose coverage (%)

(2012)

(2012)

99

Percent of infants <6 months exclusively breastfed

100 80

60

40

22

Early initiation of breastfeeding (within 1 hr of birth, %) 42 Introduction of solid, semi-solid/soft foods (%) 57

80

Percent

19 12

56 47

39

36

Exclusive breastfeeding

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

40 20 0

1993 DHS

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

2005

41

30

34

46

35

43

38 42

26

35

24

33

Percent

Measles Vitamin A (past 6 months)

Source: DHS 2010

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

20

Early initiation of breastfeeding

64

90 90 87

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

60

20

20

0

0

1993 1998-1999 2003 DHS DHS DHS

2006 MICS

2009 2012 Other NS Other NS

38

40

25

19 3

6

1993 1998-1999 2003 DHS DHS DHS

7 2006 MICS

2010 DHS

2012 Other NS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Burkina Faso DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 14% 2%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 9%

Asphyxia* 8% Other 20%

Other 1%

Neonatal death: 27%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Congenital 2%

Haemorrhage 25%

Diarrhoea

Hypertension 16% Indirect 29%

Injuries 5%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

85

73

80

Demand for family planning satisfied (%)

40

(2010)

Antenatal care (4 or more visits, %)

34

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

11

(2010)

2, 6, 1

(2010)

Neonatal tetanus vaccine

88

(2012)

Postnatal visit for baby

26

(2010)

Postnatal visit for mother

72

(2010)

Women with low body mass index

14

(2010)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

61

59

60

94

40

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1993 DHS

1998-1999 DHS

2003 DHS

2006 MICS

2010 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

47 19

15

12 1993 DHS

42

1998-1999 DHS

2003 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

33

21

17

2006 MICS

25 (2010)

10

2 2003 DHS

2006 MICS

2010 DHS

Percent

80 60

4

1

14

24

0 3

70 75

76 39 11

7

2

1990

Total

2012

Source: WHO/UNICEF JMP 2014

100

1990 Urban

0

2012 1990

0

Rural

2012

57

60 78 40

20

27

11

0

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

No

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

2

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

6.1

(2010)

16

(2011)

Per capita total expenditure on health (Int$)

90

(2012)

General government expenditure on health as % of total government expenditure (%)

12

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

36

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

External sources General government expenditure Out-of-pocket expenditure Other

9 5

13

80

51

64

20 42

0

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

19

48

40

5

10

No

Postnatal home visits in the first week after birth

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

100 8

Maternal deaths notification

(2013)

FINANCING

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

Yes

National availability of Emergency Obstetric Care services

47

2010 DHS

Improved drinking water coverage

7

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

3 (R,F)

Maternity protection (Convention 183)

0%

Measles 1% Malaria 23%

Legal status of abortion (X of 5 circumstances) (X of 7 tasks)

HIV/AIDS 1% 10%

Yes

Midwives authorized for specific tasks

Other direct 9%

Sepsis** 6%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

36

32

89

75

17

8

19

1990

2012 Total

(2012)

2 30

%

40

28

ODA to child health per child (US$)

14

(2011)

ODA to maternal and neonatal health per live birth (US$)

31

(2011)

Note: See annexes for additional information on the indicators above

7 7 7

Available

44

50

1990

2012 Urban

8

6 3 2

10 7

1990

2012

Rural

Source: WHO/UNICEF JMP 2014

65

Fulfilling the Health Agenda for Women and Children The 2014 Report

Burundi DEMOGRAPHICS Total population (000)

9,850

(2012)

Total under-five population (000)

1,839

(2012)

Births (000)

443

(2012)

Birth registration (%) Total under-five deaths (000)

75 43

(2010)

Neonatal deaths: % of all under-5 deaths

35

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

36 67

(2012)

Stillbirth rate (per 1000 total births)

(2012)

(2012)

28

(2009)

3,400

(2013)

Lifetime risk of maternal death (1 in N)

22

(2013)

Total fertility rate (per woman)

6.1

(2012)

65

(2008)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

1600

164

1300

1200

150 104

100

55

50

400

MDG Target

0 1990

1995

2000

2005

740

800

2010

0 1990

2015

Source: IGME 2013

330 MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 40

60

*Postnatal care

Birth

30

Exclusive breastfeeding

Neonatal period

69

Measles

80

60

34

40

25

19

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

60

60

93 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

47 (2012)

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

33

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1987 DHS

Percent

Percent

Coverage along the continuum of care

2000 MICS

2005 MICS

20

0

2010 DHS

54

51

49

40

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine 96 96 100 96 93 80

60

Percent

Antenatal care (4+ visits)

Immunization

Skilled attendant at delivery

40 0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

100 80 60 40 20 0

55 40

38 26

2000 MICS

2012 2010

6

(2010)

13

(2010)

2005 MICS

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Early initiation of breastfeeding (within 1 hr of birth, %) 74 Introduction of solid, semi-solid/soft foods (%) 70

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

63

56

60

40

34

39

58 35

58 29

20 0

Percent of infants <6 months exclusively breastfed

100

80

Percent

-

Exclusive breastfeeding

80 Percent

Careseeking for pneumonia

43

2010 DHS

Vitamin A two dose coverage (%)

ORT & continued feeding

66

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

20

Early initiation of breastfeeding

Source: DHS 2010

Pneumonia treatment

Percent

EQUITY

77

69 62

60

45

40 20

1987 DHS

2000 MICS

2005 Other NS

2010 DHS

0

1987 DHS

2000 MICS

2005 Other NS

2010 DHS

(2010) (2010) -

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Burundi DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

2%

17%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 11%

Embolism 2%

Abortion 10%

Haemorrhage 25%

Asphyxia* 10%

Neonatal death: 35%

Other 22%

Sepsis 10%

Other 2%

Indirect 29%

Diarrhoea

Measles 0%

* Intrapartum-related events

Hypertension 16%

0%

13%

Injuries 6%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

79

Percent

80

Demand for family planning satisfied (%)

40

(2010)

Antenatal care (4 or more visits, %)

33

(2010)

-

-

4, 12, 3

(2010)

85

(2012)

8

(2010)

Postnatal visit for mother

30

(2010)

Women with low body mass index

12

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

99

92

100

78

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1987 DHS

2000 MICS

2005 MICS

2010 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

23

16 11

2000 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

43 38

35

2005 MICS

70 (2010)

2005 MICS

2010 DHS

WATER AND SANITATION

80

12

10

2 2

5 3

13

21

44

Percent

64

10

13

69

66

20

0

48

32 6

3

1990

Total

2012

Source: WHO/UNICEF JMP 2014

72

66

Urban

3 40

40

2012 1990

1

Rural

2012

2

1 41

3

3

50

43

18

37

60

10

7

20 42 1

1990

3

80 48

14

23

60

40

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100

No

Maternal deaths notification

No

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

No

Antenatal corticosteroids as part of management of preterm labour

No

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

3

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

2.2

(2004)

27

(2010)

Per capita total expenditure on health (Int$)

45

(2012)

General government expenditure on health as % of total government expenditure (%)

14

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

28

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

100

-

(2013)

FINANCING

8

1 2000 MICS

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

Midwives authorized for specific tasks

National availability of Emergency Obstetric Care services

45

2010 DHS

Improved drinking water coverage

3

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Legal status of abortion (X of 5 circumstances)

Maternity protection (Convention 183)

Sepsis** 7%

Malaria 5%

No

(X of 7 tasks)

Other direct 9%

Congenital 2%

HIV/AIDS 1%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

47

0

1990

2012 Total

27

6

5 43

31

1990

2012 Urban

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

21

(2011)

ODA to maternal and neonatal health per live birth (US$)

30

(2011)

Note: See annexes for additional information on the indicators above

48

42

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

67

Fulfilling the Health Agenda for Women and Children The 2014 Report

Cambodia DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

14,865

(2012)

1,669

(2012)

386

(2012)

Birth registration (%) Total under-five deaths (000)

62 14

(2010)

Neonatal deaths: % of all under-5 deaths

47

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

18 34

(2012)

Stillbirth rate (per 1000 total births)

(2012)

(2012)

18

(2009)

Total maternal deaths

670

(2013)

Lifetime risk of maternal death (1 in N)

180

(2013)

Total fertility rate (per woman)

2.9

(2012)

30

(2012)

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

140

1200

116

1200

900

105 70

600

40

35

39

300

MDG Target

0 1990

1995

2000

2005

2010

0 1990

2015

Source: IGME 2013

300

170

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 75

72

*Postnatal care

70

Exclusive breastfeeding

74

Measles

Birth

Neonatal period

80

34

80

32

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

100

44

40

93 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

72

71

60

Infancy

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

59

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

60 40 20

1998 MoH

2000 DHS

2005 DHS

2010 DHS

2011 Other NS

0

2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

80 60

Percent

Skilled attendant at delivery

40 20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

11

(2010)

11

(2010)

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

60

40

68

2005 DHS

2010 DHS

(2010)

Vitamin A two dose coverage (%)

(2012)

98

Percent of infants <6 months exclusively breastfed

100 80

59 43

40

49

44 28

29

40

29

41

20 0

39

Early initiation of breastfeeding (within 1 hr of birth, %) 66 Introduction of solid, semi-solid/soft foods (%) 88

80

Percent

37

Exclusive breastfeeding

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

40 20 0

64

48

2000 DHS

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

2005

Percent

Measles Vitamin A (past 6 months)

Source: DHS 2010

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

95 95 93

100

Antenatal care (4+ visits)

Pneumonia treatment

2000 DHS

2005 DHS

2008 Other NS

2010 DHS

74

60

60 40 20

1996 Other NS

66

0

12 2000 DHS

2005 DHS

2008 Other NS

2010 DHS

(2010)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Cambodia DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

Preterm 14%

2%

15%

Abortion 7%

Sepsis 6%

Embolism 12%

Haemorrhage 30%

Sepsis** 8%

Measles 0%

* Intrapartum-related events

Indirect 17% Hypertension 15%

0%

8% Diarrhoea

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

89

100

Percent

60 40

75

Antenatal care (4 or more visits, %)

59

(2010)

-

-

3, - , -

(2011)

91

(2012)

-

-

70

(2010)

-

-

Malaria during pregnancy - intermittent preventive treatment (%) (Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

38

34

Demand for family planning satisfied (%)

(2010)

C-section rate (total, urban, rural; %)

69

80

Postnatal visit for baby

(within 2 days for home births, %)

20

Postnatal visit for mother

0

(within 2 days for home births, %)

1998 MoH

2000 DHS

2005 DHS

2010 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

50

48 21

18

2000 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2005 DHS

34

-

15

60

40

53

42

100 37

20 2

43

1990

18

Total

2012

Source: WHO/UNICEF JMP 2014

15

1990 Urban

80

17

61

67

17

7 0 11

5

0

Rural

2012

54

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

93

2 7

40

0

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

10.1

(2008)

33

(2008)

135

(2012)

7

(2012)

62

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

37

9 03

1990

2012 Total

No Data

External sources General government expenditure Out-of-pocket expenditure Other 66

66

60 88

20

20

2012 1990

Yes

Postnatal home visits in the first week after birth

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

17

41

20

0

27

Maternal deaths notification

General government expenditure on health as % of total government expenditure (%)

Improved sanitation coverage

Percent

Percent

80 36

No

Out of pocket expenditure as % of total expenditure on health(%)

2 4

27

Maternity protection (Convention 183)

Per capita total expenditure on health (Int$)

4 2005 DHS

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

7

FINANCING

2010 DHS

Improved drinking water coverage

14

5 (R,F)

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Yes

(X of 7 tasks)

Congenital 7%

Malaria 0% Injuries 8%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent Midwives authorized for specific tasks

Other 4%

HIV/AIDS 0%

Regional estimates for South-eastern Asia, 2013

Other direct 14%

Asphyxia* 12%

Neonatal death: 48%

Other 21%

Globally nearly half of child deaths are attributable to undernutrition

ODA to child health per child (US$)

27

(2011)

ODA to maternal and neonatal health per live birth (US$)

64

(2011)

Note: See annexes for additional information on the indicators above

82 3 6

14 2 18

1990

2012 Urban

7 0 0

25

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

69

Fulfilling the Health Agenda for Women and Children The 2014 Report

Cameroon DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

21,700

(2012)

3,572

(2012)

820

(2012)

Birth registration (%) Total under-five deaths (000)

61 74

(2011)

Neonatal deaths: % of all under-5 deaths

30

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

28 61

(2012)

Stillbirth rate (per 1000 total births)

(2012)

(2012)

26

(2009)

4,900

(2013)

Lifetime risk of maternal death (1 in N)

34

(2013)

Total fertility rate (per woman)

4.9

(2012)

Adolescent birth rate (per 1000 girls)

128

(2008)

Total maternal deaths

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

800

135

150

720 590

600 95

100

400 45

50

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

200

180 MDG Target

0 1990

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 50

64

*Postnatal care

Birth

37

Exclusive breastfeeding

Neonatal period

20

80 60

0

20 40 60 80 100

Source: DHS, MICS, Other NS

62

60

58

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

64

63

80

60

20

82 0

64

40

Infancy

Measles

Percent

44 (2012)

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

62

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1991 DHS

1998 DHS

2000 MICS

2004 DHS

2006 MICS

2011 DHS

64

56

55

40 20

0

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

40 0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

6

(2011)

11

(2006)

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

1998 DHS

2000 MICS

2004 DHS

35 38 30

2006 MICS

45

2011 DHS

(2006)

Vitamin A two dose coverage (%)

(2012)

(2006)

88

Percent of infants <6 months exclusively breastfed

80

36

40

0

40

25

100

60

20

34

Early initiation of breastfeeding (within 1 hr of birth, %) 20 Introduction of solid, semi-solid/soft foods (%) 63

80

Percent

44

Exclusive breastfeeding

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

40 20 0

1991 DHS

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

2005

18 1991 DHS

35

38 17 1998 DHS

15 2004 DHS

36 17

2006 MICS

33

15

2011 DHS

Percent

Measles Vitamin A (past 6 months)

Source: DHS 2011

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

20

Early initiation of breastfeeding

70

85 85 84 82

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

60 40 20 0

7

12

1991 DHS

1998 DHS

24

21

2004 DHS

2006 MICS

20

2011 DHS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Cameroon DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 15%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 8%

2%

Asphyxia* 10%

Neonatal death: 30%

Other 22%

Sepsis 10%

Embolism 2%

Abortion 10%

Sepsis** 6%

Maternity protection (Convention 183) Hypertension 16%

0% Indirect 29%

Measles 1%

Injuries 6%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

79

Percent

80

79

75

83

85

82

Demand for family planning satisfied (%)

50

(2011)

Antenatal care (4 or more visits, %)

62

(2011)

Malaria during pregnancy - intermittent preventive treatment (%)

26

(2011)

4, 7, 2

(2011)

85

(2012)

-

-

37

(2011)

8

(2011)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

(within 2 days for home births, %)

20

Postnatal visit for mother

0

(within 2 days for home births, %)

1991 DHS

1998 DHS

2000 MICS

2004 DHS

2006 MICS

2011 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

22

18 1991 DHS

47

43

32

17

14

1998 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2000 MICS

2004 DHS

22

17

13

2006 MICS

2011 DHS

26 (2011)

8

14

18

Percent

80 60

1 5

2 20

35

66

53

40

1

1

2000 MICS

2004 DHS

16

11

1990

Total

2012

44

2006 MICS

Source: WHO/UNICEF JMP 2014

Urban

2012 1990

6

2 16

1 14

34

22

23

2011 DHS

No

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

13

Rural

2012

12

17

(2013)

Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

5.2

(2009)

60

(2010)

120

(2012)

9

(2012)

63

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

(2013)

54

60

1990

2012 Total

ODA to maternal and neonatal health per live birth (US$)

1,819

(2011)

23

(2011)

Note: See annexes for additional information on the indicators above

62

45

0

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

15

40

20 40 4

Yes

Life Saving Commodities in Essential Medicine List:

Reproductive, maternal, newborn and child health expenditure by source

49

60

48

2

1990

100 11

32

28

25

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Per capita total expenditure on health (Int$)

21

13

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

80 36

32

20

0

16

22

58

40

No

FINANCING

Improved sanitation coverage

Percent

100

Yes

Postnatal home visits in the first week after birth

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

Partial

Maternal deaths notification

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

7

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

3 (R)

(X of 7 tasks)

HIV/AIDS 3%

Malaria 12%

-

Midwives authorized for specific tasks

Other direct 9%

Congenital 2%

Diarrhoea

Legal status of abortion (X of 5 circumstances)

Haemorrhage 25%

Other 1%

11%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

1990

2012 Urban

7

7

27

27

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

71

Fulfilling the Health Agenda for Women and Children The 2014 Report

Central African Republic DEMOGRAPHICS Total population (000)

4,525

(2012)

Total under-five population (000)

662

(2012)

Births (000)

156

(2012)

Birth registration (%) Total under-five deaths (000)

61 19

(2010)

Neonatal deaths: % of all under-5 deaths

32

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

41 91

(2012)

Stillbirth rate (per 1000 total births)

24

(2009)

1,400

(2013)

Lifetime risk of maternal death (1 in N)

27

(2013)

Total fertility rate (per woman)

4.5

(2012)

Adolescent birth rate (per 1000 girls)

229

(2009)

Total maternal deaths

(2012)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

1600

171

150

1200

1200

129

100

880

800 57

50 0 1990

1995

2000

2005

2010

0 1990

2015

Source: IGME 2013

300

400

MDG Target

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 36

54

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

34

Measles

60

0

46

40

53

44

54

44

No Data

20

49

0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

38

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1994-1995 DHS

2000 MICS

2006 MICS

2009 Other NS

2010 MICS

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

49 47

Percent

60

47 47

40 20

Early initiation of breastfeeding

Percent

80

Skilled attendant at delivery

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

7

(2010) (2010)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

Percent

20 0

24

1994-1995 DHS

45

45 22

2000 MICS

28

24

41

2010 MICS

2006 MICS

30 31

2010 MICS

83

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

60 40 20

2006 MICS

39

(2012)

80 42

2000 MICS

32

Vitamin A two dose coverage (%)

100

40

32

(2010)

80 60

41

Early initiation of breastfeeding (within 1 hr of birth, %) 44 Introduction of solid, semi-solid/soft foods (%) 60

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

40 20 0

1994-1995 DHS

14

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

Percent

Measles Vitamin A (past 6 months)

72

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

Source: MICS 2010

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

0

23

3 1994-1995 DHS

34

17 2000 MICS

2006 MICS

2010 MICS

(2010)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Central African Republic DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 2% 12%

Other 15%

Neonatal death: 32%

Globally nearly half of child Preterm 10% deaths are Asphyxia* 10% attributable to undernutrition

Sepsis 10% Abortion 10%

Congenital 1%

9%

Diarrhoea

Indirect 29%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

80

67

69

62

Demand for family planning satisfied (%)

36

(2010)

Antenatal care (4 or more visits, %)

38

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

38

(2010)

5, 8, 2

(2010)

66

(2012)

C-section rate (total, urban, rural; %)

68

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

15

(1994-1995)

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1994-1995 DHS

2000 MICS

2006 MICS

2010 MICS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

47

47

28

1994-1995 DHS

17

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

38

16

13

2000 MICS

2006 MICS

9 (2010)

100

15

2 2000 MICS

2006 MICS

2010 MICS

29

28

0 10

2 18

5

19

60 72

40

86

66

56

0

3

1990

54

46

20 8

2

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100 80

41

35

4

2012 1990

0

0

Rural

2012

8 32

23

Partial

Maternal deaths notification

No

Postnatal home visits in the first week after birth

No

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

-

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

No

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

-

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

-

-

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

2

(2013)

-

-

Newborn health (X of 4) Child health (X of 3)

-

-

3.1

(2009)

-

-

Per capita total expenditure on health (Int$)

32

(2012)

General government expenditure on health as % of total government expenditure (%)

11

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

46

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

-

28

42

45

34

46

40

37 13

20 8

22

15

1990

2012 Total

13

44

20

56

5

2012 Urban

ODA to child health per child (US$)

22

(2011)

ODA to maternal and neonatal health per live birth (US$)

31

(2011)

Note: See annexes for additional information on the indicators above

3 7

12

1990

No Data

External sources General government expenditure Out-of-pocket expenditure Other

4

24 59

60

0

7

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Percent

80

3

13

Midwives authorized for specific tasks

FINANCING

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

1

National availability of Emergency Obstetric Care services

36

2010 MICS

Improved drinking water coverage

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

-

Maternity protection (Convention 183) Hypertension 16%

Antenatal care

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

(X of 7 tasks)

0%

Measles 1%

Injuries 4%

Haemorrhage 25%

Other direct 9%

Sepsis** 6%

* Intrapartum-related events

Embolism 2%

Other 1%

HIV/AIDS 3%

Malaria 25%

Regional estimates for Sub-Saharan Africa, 2013

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

73

Fulfilling the Health Agenda for Women and Children The 2014 Report

Chad DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

12,448

(2012)

2,406

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

250

2000

579

(2012)

Birth registration (%) Total under-five deaths (000)

16 82

(2010)

Neonatal deaths: % of all under-5 deaths

27

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

40 89

(2012)

150

1200

(2012)

Stillbirth rate (per 1000 total births)

100

800

29

(2009)

5,800

(2013)

Lifetime risk of maternal death (1 in N)

15

(2013)

Total fertility rate (per woman)

6.4

(2012)

Adolescent birth rate (per 1000 girls)

203

(2009)

Total maternal deaths

(2012)

209

200

70

50

MDG Target

0 1990

1995

2000

2005

2010

1700

1600

150

430

400 0 1990

2015

Source: IGME 2013

980

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 15

23

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

3

60

0

15

0

Percent

23

15

16

14

1996-1997 DHS

2000 MICS

2004 DHS

20

20 40 60 80 100

Source: DHS, MICS, Other NS

20

40

64

32 (2012)

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

Measles

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

23

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

8

5

0

2010 MICS

14

13

10

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

64 45 45

Percent

60

40

Percent

80

Skilled attendant at delivery

20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

(2010)

20

(2010)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

2004 DHS

26 31

2010 MICS

Vitamin A two dose coverage (%)

(2012)

(2010)

0

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

20

45 34

29

39

45 34

30 39

20 0

2000 MICS

12

25

60

40

22

(2010)

80 Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

19

Early initiation of breastfeeding (within 1 hr of birth, %) 29 Introduction of solid, semi-solid/soft foods (%) 46

100

Percent

40 20 0

1996-1997 DHS

16

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

Percent

Measles Vitamin A (past 6 months)

74

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

Source: DHS 2004

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

15

5 1996-1997 DHS

2000 MICS

2004 DHS

2010 MICS

10

10

0

2

2 1996-1997 DHS

2000 MICS

2004 DHS

3 2010 MICS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Chad DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 2% 15%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 9% Asphyxia* 7%

Neonatal death: 27%

Other 21%

Sepsis 10%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Legal status of abortion (X of 5 circumstances)

Haemorrhage 25%

Other 2% Congenital 1%

12%

0%

Hypertension 16%

* Intrapartum-related events

Indirect 29%

Measles 0%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Demand for family planning satisfied (%)

15

(2010)

Antenatal care (4 or more visits, %)

23

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

22

(2010)

2, 4, 1

(2010)

43

(2012)

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

23

(2004)

C-section rate (total, urban, rural; %)

80

(Minimum target is 5% and maximum target is 15%)

60

53

42

40

39

23

0

Neonatal tetanus vaccine (within 2 days for home births, %)

20

(within 2 days for home births, %)

1996-1997 DHS

2000 MICS

2004 DHS

2010 MICS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

44 23

1996-1997 DHS

27

16 2000 MICS

23

15

2004 DHS

13

3 (2010)

46

28

48

2000 MICS

45

2

1990

Total

2012

Source: WHO/UNICEF JMP 2014

44

37 7

6

1990 Urban

100

25

60 79

65

International Code of Marketing of Breastmilk Substitutes

No

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

0

1

Rural

2012

42

37

79

93

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

2

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

2.3

(2006)

20

(2011)

53

(2012)

6

(2012)

53

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

18 5 12

8

1990

2012 Total

No Data

ODA to child health per child (US$)

11

(2011)

ODA to maternal and neonatal health per live birth (US$)

16

(2011)

Note: See annexes for additional information on the indicators above

18

20 10 0

Yes

External sources General government expenditure Out-of-pocket expenditure Other

14

40 3

25

2012 1990

-

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

52

42

20 38

Antenatal corticosteroids as part of management of preterm labour

General government expenditure on health as % of total government expenditure (%)

2010 MICS

80

47

40

0

3

16 47

60 46

No

Per capita total expenditure on health (Int$)

10

1

Improved sanitation coverage

Percent

Percent

80

0

3

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 3

Yes

FINANCING

2010 MICS

Improved drinking water coverage

14

No

Postnatal home visits in the first week after birth

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Maternal deaths notification

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

No

Maternity protection (Convention 183)

Diarrhoea Injuries 4%

7

(X of 7 tasks)

HIV/AIDS 2% Malaria 19%

2 (F)

Midwives authorized for specific tasks

Other direct 9%

Sepsis** 5%

No

12 21

31

1990

2012 Urban

14

2 1 4

1 6

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

75

Fulfilling the Health Agenda for Women and Children The 2014 Report

China DEMOGRAPHICS Total population (000)

1,377,065

(2012)

Total under-five population (000)

88,934

(2012)

Births (000)

18,455

(2012)

258

(2012)

Neonatal deaths: % of all under-5 deaths

61

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

9 12

(2012)

Stillbirth rate (per 1000 total births)

10

(2009)

5,900

(2013)

1,800

(2013)

1.7

(2012)

6

(2009)

Birth registration (%) Total under-five deaths (000)

Total maternal deaths Lifetime risk of maternal death (1 in N) Total fertility rate (per woman) Adolescent birth rate (per 1000 girls)

-

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

120

80 60

97

90

54

40

60

20

18

14

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

32

30

24

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 97

Exclusive breastfeeding

Birth

Neonatal period

28

100

Pre-pregnancy Pregnancy

100

*Postnatal care

0

100

99

98

97

89

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

60 40

No Data

20

99

0

20 40 60 80 100

Source: DHS, MICS, Other NS

94

80

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

1990 MoH

1995 MoH

2000 MoH

2005 MoH

2008 MoH

2011 MoH

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine 99 100 99

60

Percent

Skilled attendant at delivery

No Data

40 20

Early initiation of breastfeeding

0 1990

ITN use among children <5 yrs

1995

2000

Source: WHO/UNICEF 2013

No Data

Measles

2012 2010

2005

NUTRITION Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

2

(2010)

3

(2008)

Early initiation of breastfeeding (within 1 hr of birth, %) 41 Introduction of solid, semi-solid/soft foods (%) 43 Vitamin A two dose coverage (%)

ORT & continued feeding

Percent of children <5 years who are moderately or severely: underweight stunted

100

100

80 Percent

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Percent of infants <6 months exclusively breastfed

80

60 32

40 20 0

31

13

11

1990 Other NS

1995 Other NS

Percent

0 10 20 30 40 50 60 70 80 90 100

-

Exclusive breastfeeding

Underweight and stunting prevalence

Careseeking for pneumonia

76

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

80

Antenatal care (4+ visits)

DTP3

Pneumonia treatment

18

7 2000 Other NS

5

12

2005 Other NS

3

9

2010 Other NS

60 40

28

20 0

2008 Other NS

(2008) (2008) -

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

China DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 4% 10%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 14%

Other 16%

HIV/AIDS 0%

Neonatal death: 61%

Malaria 0%

Abortion 1% Other direct 14%

1%

Diarrhoea

Sepsis** 2%

* Intrapartum-related events

Legal status of abortion (X of 5 circumstances)

Congenital 9%

Haemorrhage 36%

Hypertension 10%

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH

100

Percent

80

89

79

70

97

(2001)

Antenatal care (4 or more visits, %)

-

-

Malaria during pregnancy - intermittent preventive treatment (%)

-

-

36, 47, 33

(2011)

Demand for family planning satisfied (%)

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

90

94

91

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

-

-

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1992 MoH

1995 MoH

2000 MoH

2005 MoH

2008 MoH

2011 MoH

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

5 (R,F)

-

(X of 7 tasks)

Indirect 25%

Antenatal care

-

Midwives authorized for specific tasks

Other 15%

3%

Embolism 12%

Asphyxia* 15%

Injuries 10% Measles 0%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Eastern Asia, 2013

Sepsis 3%

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

-

Maternity protection (Convention 183)

No

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

-

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

-

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

-

-

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

0

(2013)

-

-

Newborn health (X of 4) Child health (X of 3)

-

-

29.7

(2010)

-

-

480

(2012)

General government expenditure on health as % of total government expenditure (%)

13

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

34

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

National availability of Emergency Obstetric Care services

-

(% of recommended minimum)

FINANCING

No Data

Per capita total expenditure on health (Int$)

Very limited risk

WATER AND SANITATION Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 1

100 7

7

02 3

1 5

21

80 26

100 7

40 34

95

92

44

71

45

20 33 1990

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

60 40

3

0

2 24

34

Rural

28 72

15

14

65

20

48

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

0

(2011)

ODA to maternal and neonatal health per live birth (US$)

0

(2011)

Note: See annexes for additional information on the indicators above

74

7

56

4 15

0 2012

2

9

19

62

24

12

0

1 15

80

34

60

40

2 13

10

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

Percent

Percent

2

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

1990

2012 Total

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

77

Fulfilling the Health Agenda for Women and Children The 2014 Report

Comoros DEMOGRAPHICS Total population (000)

718

(2012)

Total under-five population (000)

115

(2012)

Births (000)

26

(2012)

Birth registration (%) Total under-five deaths (000)

88 2

(2000)

Neonatal deaths: % of all under-5 deaths

40

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

31 58

(2012)

90

(2012)

Stillbirth rate (per 1000 total births)

60

27

(2009)

Total maternal deaths

90

(2013)

Lifetime risk of maternal death (1 in N)

58

(2013)

Total fertility rate (per woman)

4.8

(2012)

70

(2011)

Adolescent birth rate (per 1000 girls)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

150

Deaths per 100,000 live births

750

124

120

630

600 450

78

350

300 41

30

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

160

150 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 37

82

Exclusive breastfeeding

100

Pre-pregnancy Pregnancy

*Postnatal care

Birth

Neonatal period

21

60

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

40

40

85 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

62

52

1996 DHS

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

82

80

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2000 MICS

30 20 10 0

2012 pDHS

2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

40 20

Early initiation of breastfeeding

1995

DTP3

NUTRITION

Measles

53

56

1996 DHS

2000 MICS

38

40 20

0 1990

Source: WHO/UNICEF 2013

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

2012 2010

11

(2012)

25

(2000)

2012 pDHS

Early initiation of breastfeeding (within 1 hr of birth, %) 25 Introduction of solid, semi-solid/soft foods (%) 34 Vitamin A two dose coverage (%)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Percent of infants <6 months exclusively breastfed

100

80

Percent

80

60

0

47

39

40 20

-

Exclusive breastfeeding

15 1991-1992 Other NS

40

21

1996 DHS

25

2000 MICS

15

30

2012 pDHS

Percent

ORT & continued feeding

Source: DHS 1996

100 80 60

0

ITN use among children <5 yrs

Vitamin A (past 6 months)

78

Percent

60

Percent

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

86 86 85

80

Antenatal care (4+ visits)

Pneumonia treatment

60 40 20 0

21 3 1996 DHS

2000 MICS

(1996) (2000) -

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Comoros DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 2% 13%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 13%

Other 17%

Neonatal death: 40%

Embolism 2%

Haemorrhage 25%

Abortion 10%

Asphyxia* 12%

Congenital 3%

Sepsis** 8%

Malaria 15%

Hypertension 16%

0% 9% Diarrhoea Measles 0%

* Intrapartum-related events

Indirect 29%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

100

92

85

75

74

80 Percent

37

(1996)

-

-

28

(2012)

5, 9, 4

(1996)

85

(2012)

Demand for family planning satisfied (%)

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

Antenatal care (4 or more visits, %) Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

10

(1996)

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1996 DHS

2000 MICS

2004 Other NS

2012 pDHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

29

1996 DHS

31

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

38 19

2000 MICS

2012 pDHS

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

16 (2012)

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

No Data

No

Legal status of abortion (X of 5 circumstances)

3

Midwives authorized for specific tasks

7

Maternity protection (Convention 183)

-

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

No

International Code of Marketing of Breastmilk Substitutes

-

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

-

-

3

(2013)

Newborn health (X of 4) Child health (X of 3)

2 2

(2013)

8.9

(2004)

33

(2005)

Per capita total expenditure on health (Int$)

56

(2012)

General government expenditure on health as % of total government expenditure (%)

10

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

44

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

National availability of Emergency Obstetric Care services

(2013)

(% of recommended minimum)

FINANCING 41 9 2000 MICS

2012 pDHS

WATER AND SANITATION Improved drinking water coverage

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

(X of 7 tasks)

Other direct 9%

Other 2%

HIV/AIDS 1%

Injuries 5%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Improved sanitation coverage

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

No Data

Reproductive, maternal, newborn and child health expenditure by source

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

21

(2011)

ODA to maternal and neonatal health per live birth (US$)

52

(2011)

Note: See annexes for additional information on the indicators above

79

Fulfilling the Health Agenda for Women and Children The 2014 Report

Congo DEMOGRAPHICS Total population (000)

4,337

(2012)

Total under-five population (000)

722

(2012)

Births (000)

165

(2012)

Birth registration (%) Total under-five deaths (000)

91 15

(2011-2012)

Neonatal deaths: % of all under-5 deaths

34

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

32 62

(2012)

Stillbirth rate (per 1000 total births)

(2012)

(2012)

26

(2009)

690

(2013)

Lifetime risk of maternal death (1 in N)

48

(2013)

Total fertility rate (per woman)

5.0

(2012)

Adolescent birth rate (per 1000 girls)

147

(2009)

Total maternal deaths

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

160

800

120

600

100

96

80

670 410

400

40

33 MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

200

170

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 71

94

*Postnatal care

64

Exclusive breastfeeding

100

Pre-pregnancy Pregnancy

75

Birth

Neonatal period

19

0

60

40

40

30

0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

20

80

2005 DHS

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

94

83

80

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

20

0

2011-2012 DHS

19

19

10

7

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

100 60

Percent

Skilled attendant at delivery

40 20

Early initiation of breastfeeding

1990

1995

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

100 80 60 40 20 0

2012 2010

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

6

(2011-2012)

13

(2005)

48

52

2005 DHS

2011-2012 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 39 Introduction of solid, semi-solid/soft foods (%) 78 Vitamin A two dose coverage (%)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Percent of infants <6 months exclusively breastfed

100

80

Percent

Percent

Source: DHS 2011-2012

80

60

40 20 0

-

Exclusive breastfeeding

30 16 1987 Other NS

31 12 2005 DHS

24 12 2011-2012 DHS

Percent

ORT & continued feeding

80

10

0

ITN use among children <5 yrs

Vitamin A (past 6 months)

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics 85 85 80

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

EQUITY

60 40 20 0

19

2005 DHS

(2005) (2005) -

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Congo DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

Preterm 12%

2%

10%

Globally nearly half of child deaths are attributable to undernutrition

Other 16%

Neonatal death: 33%

Sepsis 10%

Embolism 2%

Abortion 10%

Haemorrhage 25%

Asphyxia* 9% Other 1%

Sepsis** 6% 8%

Malaria 25%

Hypertension 16%

0% Diarrhoea Indirect 29%

Measles 0%

Injuries 4%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

93

86

Percent

Demand for family planning satisfied (%)

71

(2011-2012)

Antenatal care (4 or more visits, %)

75

(2005)

Malaria during pregnancy - intermittent preventive treatment (%)

22

(2011-2012)

3, 4, 2

(2005)

83

(2012)

-

-

Postnatal visit for mother

64

(2011-2012)

Women with low body mass index

13

(2005)

C-section rate (total, urban, rural; %)

80

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

2005 DHS

2011-2012 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

35

39 18 2005 DHS

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

57 (2012)

2011-2012 DHS

100

36

50

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

No

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

40

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

2

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

9.2

(2007)

25

(2010)

140

(2012)

6

(2012)

25

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 2012 Improved facilities Shared facilities Open defecation Unimproved facilities

25 58

60

No

Per capita total expenditure on health (Int$)

26 6

Improved sanitation coverage

0 4

16

Maternity protection (Convention 183)

(2013)

FINANCING

2005 DHS

8

80 Percent

Percent

80

-

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 2012 Piped on premises Other improved Surface water Unimproved 9

1

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks

(% of recommended minimum)

100 80 60 40 20 0

2011-2012 DHS

Improved drinking water coverage

No

(X of 7 tasks)

Other direct 9%

Congenital 3%

HIV/AIDS 3%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

External sources General government expenditure Out-of-pocket expenditure Other

2 20 37

47

60 41

40

No Data

65

ODA to child health per child (US$)

15

(2011)

ODA to maternal and neonatal health per live birth (US$)

20

(2011)

Note: See annexes for additional information on the indicators above

30

20 0

25

Total

Source: WHO/UNICEF JMP 2014

38

Urban

37

20

2

0

Rural

15

20

9 6

Total

Urban

Rural

Source: WHO/UNICEF JMP 2014

81

Fulfilling the Health Agenda for Women and Children The 2014 Report

Congo,

Democratic Republic of the

DEMOGRAPHICS Total population (000)

65,705

(2012)

Total under-five population (000)

11,691

(2012)

2,839

(2012)

28 391

(2010)

30

(2012)

44 100

(2012)

29

(2009)

21,000

(2013)

Lifetime risk of maternal death (1 in N)

23

(2013)

Total fertility rate (per woman)

6.0

(2012)

Adolescent birth rate (per 1000 girls)

135

(2009)

Births (000) Birth registration (%) Total under-five deaths (000) Neonatal deaths: % of all under-5 deaths Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Stillbirth rate (per 1000 total births) Total maternal deaths

(2012)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

200

Deaths per 100,000 live births

1200

171

146

150

900

100

600 57

50 1995

2000

2005

2010

250

0 1990

2015

Source: IGME 2013

730

300

MDG Target

0 1990

1000

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 42

80

*Postnatal care Exclusive breastfeeding

100

Pre-pregnancy Pregnancy

45

Birth

Neonatal period

37

80

Source: DHS, MICS, Other NS

61

20

15

20 0

20 40 60 80 100

18 (2012)

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

40

73 0

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

80

74

60

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2001 MICS

Percent

2007 DHS

6

5

0

2010 MICS

13

10 1

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent

60

40

26

20

Early initiation of breastfeeding

Percent

73 72 72

80

Skilled attendant at delivery

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

9

(2010) (2010)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

2010 MICS

(2010)

Vitamin A two dose coverage (%)

(2012)

84

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80 51 31

34

46

44 28

44 24

20 0

2007 DHS

100

60

40

40 42

42

36

Early initiation of breastfeeding (within 1 hr of birth, %) 43 Introduction of solid, semi-solid/soft foods (%) 52

80

Percent

40 20 0

2001 MICS

10

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

Percent

Measles Vitamin A (past 6 months)

82

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

Source: MICS 2010

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

60 40 20

1995 Other NS

2001 MICS

2007 DHS

2010 MICS

0

24

24

1995 MICS

2001 MICS

36

37

2007 DHS

2010 MICS

(2010)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Congo,

Democratic Republic of the

DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 14% 2%

Other 19%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 10% Asphyxia* 8%

Neonatal death: 30%

Sepsis 10%

Regional estimates for Sub Saharan Africa, 2013

Embolism 2%

Abortion 10%

Other 2%

Haemorrhage 25%

12%

Malaria 16% Injuries 4%

* Intrapartum-related events

Diarrhoea

Hypertension 16%

0% Indirect 29%

Measles 4%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

85

80 Percent

89

Demand for family planning satisfied (%)

42

(2010)

Antenatal care (4 or more visits, %)

45

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

21

(2010)

7, 10, 6

(2010)

70

(2012)

C-section rate (total, urban, rural; %)

68

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

2001 MICS

2007 DHS

2010 MICS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

42

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

39

31

17 17 2001 MICS

2007 DHS

27

4 (2010)

100

1

6

2001 MICS

2007 DHS

2010 MICS

60

16

24

18

23

33

38

33

59

41

48

0

38

29

14

1990

49

2012

Source: WHO/UNICEF JMP 2014

28

20

8

Total

25

1

1990 Urban

2012 1990

1

Rural

2012

9

18

43

60 54

0

1 23

13

45

41 27

40

20

5 36

80

39

40 20

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100

3

Maternal deaths notification

No

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

No

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

3

(2013)

2

(2013)

Newborn health (X of 4) Child health (X of 3)

4 3

(2013)

6.4

(2004)

-

-

Per capita total expenditure on health (Int$)

24

(2012)

General government expenditure on health as % of total government expenditure (%)

13

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

32

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Percent

80

1 11

No

(2013)

FINANCING

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

-

National availability of Emergency Obstetric Care services

38

2010 MICS

Improved drinking water coverage

1

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks Maternity protection (Convention 183)

Sepsis** 6%

HIV/AIDS 1%

No

(X of 7 tasks)

Other direct 9%

Congenital 1%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

25

17

61

External sources General government expenditure Out-of-pocket expenditure Other

Available

(2011)

53

%

47

ODA to child health per child (US$)

21

(2011)

ODA to maternal and neonatal health per live birth (US$)

23

(2011)

Note: See annexes for additional information on the indicators above

13

11 31

17

1990

2012 Total

32

29

5

33

11

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

83

Fulfilling the Health Agenda for Women and Children The 2014 Report

Côte d’Ivoire DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

19,840

(2012)

3,088

(2012)

731

(2012)

Birth registration (%) Total under-five deaths (000)

65 75

(2011-2012)

Neonatal deaths: % of all under-5 deaths

38

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

40 76

(2012)

Stillbirth rate (per 1000 total births)

(2012)

(2012)

27

(2009)

5,300

(2013)

Lifetime risk of maternal death (1 in N)

29

(2013)

Total fertility rate (per woman)

4.9

(2012)

Adolescent birth rate (per 1000 girls)

125

(2009)

Total maternal deaths

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

800 152

150

740

720

600

108

100

400 51

50

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

200

190 MDG Target

0 1990

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 45

59

*Postnatal care

Birth

70

Exclusive breastfeeding

Neonatal period

12

40

Infancy

Measles

55

57

47

45

59

0

20 40 60 80 100

Source: DHS, MICS, Other NS

63

20

85 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80 60

1994 DHS

Percent

34 (2012)

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

44

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1998-99 DHS

2000 MICS

2005 Other NS

2006 MICS

2011-12 DHS

100 80 60 40 20 0

55

68

53

2010

2011

Source: UNICEF/UNAIDS/WHO 2013

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

100 60

Percent

Skilled attendant at delivery

40 20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

100 80 60 40 20 0

39

1994 DHS

2010 2012

7

(2011-2012)

17

(2006)

38

35

35

38 19

1998-99 DHS

2000 MICS

2006 MICS

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

(2012)

80 40

34

40

0

99

100

60

20

(2011-2012)

Percent of infants <6 months exclusively breastfed

80

Percent

Percent

Source: DHS 2011-2012

(2011-2012)

Exclusive breastfeeding

20

1994 DHS

32 18

1998-99 DHS

17

2006 MICS

14

28

2011-12 DHS

Percent

Careseeking for pneumonia

2011-12 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 31 Introduction of solid, semi-solid/soft foods (%) 64 Vitamin A two dose coverage (%)

ORT & continued feeding

84

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

94 94 85

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

EQUITY

60 40 20 0

10

3

4

1994 DHS

1998-99 DHS

2000 MICS

5 2003-04 Other NS

4 2006 MICS

12 2011-12 DHS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Côte d’Ivoire DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

Globally nearly Preterm 12% half of child deaths are Asphyxia* 11% attributable to undernutrition

2%

12% Other 18%

Neonatal death: 38%

Embolism 2%

Sepsis 10% Abortion 10%

Other 2% Congenital 2%

HIV/AIDS 2%

Regional estimates for Sub-Saharan Africa, 2013

Haemorrhage 25%

Injuries 4%

Indirect 29%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Measles 0%

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

88

84

83

87

91

85

Percent

Demand for family planning satisfied (%)

45

(2011-2012)

Antenatal care (4 or more visits, %)

44

(2011-2012)

Malaria during pregnancy - intermittent preventive treatment (%)

18

(2011-2012)

3, 5, 1

(2011-2012)

C-section rate (total, urban, rural; %)

80

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

82

(2012)

40

Postnatal visit for baby

34

(2011-2012)

Postnatal visit for mother

70

(2011-2012)

6

(2011-2012)

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1994 DHS

1998-99 DHS

2000 MICS

2005 Other NS

2006 MICS

2011-12 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

24

16

11 1994 DHS

45

34

1998-99 DHS

2000 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

36 17

10 2006 MICS

17 (2011-2012)

1 2000 MICS

4

3

14

20

28

40

6

16

2003-04 Other NS

2006 MICS

2011-12 DHS

53 64 40

Total

2012

Source: WHO/UNICEF JMP 2014

100 80

60

1990 Urban

2012 1990

Rural

2012

36

28

0

6

6

30

18

Antenatal corticosteroids as part of management of preterm labour

No

International Code of Marketing of Breastmilk Substitutes

No

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

2

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

6.3

(2008)

7

(2010)

144

(2012)

8

(2012)

56

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

General government expenditure on health as % of total government expenditure (%)

21

29

36

43

22

15

1990

2012 Total

15

(2011)

ODA to maternal and neonatal health per live birth (US$)

23

(2011)

24

27

28

ODA to child health per child (US$)

Note: See annexes for additional information on the indicators above

29

20

No Data

External sources General government expenditure Out-of-pocket expenditure Other 51

56

40

20 14

5

0

1990

54

62

50

23

Yes

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

26

17

40

60

40

1 7

0 10

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Per capita total expenditure on health (Int$)

Improved sanitation coverage

Percent

Percent

80

3 17

Yes

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 10

Yes

Postnatal home visits in the first week after birth

FINANCING 37

2011-12 DHS

Improved drinking water coverage

Partial

Maternal deaths notification

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

1

7

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks Maternity protection (Convention 183)

Hypertension 16%

0% 10% Diarrhoea

Yes

(X of 7 tasks)

Other direct 9%

Sepsis** 8%

Malaria 16%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

33

1990

2012 Urban

15 10

10 7

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

85

Fulfilling the Health Agenda for Women and Children The 2014 Report

Djibouti DEMOGRAPHICS Total population (000)

860

(2012)

Total under-five population (000)

108

(2012)

Births (000)

24

(2012)

Birth registration (%) Total under-five deaths (000)

92 2

(2006)

Neonatal deaths: % of all under-5 deaths

39

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

31 66

(2012)

90

(2012)

Stillbirth rate (per 1000 total births)

60

34

(2009)

Total maternal deaths

55

(2013)

Lifetime risk of maternal death (1 in N)

130

(2013)

Total fertility rate (per woman)

3.5

(2012)

21

(2010)

Adolescent birth rate (per 1000 girls)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

500

150 119

120

81

300 40

30

MDG Target

0 1990

1995

2000

2005

2010

400

400

2015

Source: IGME 2013

230

200 100

100

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

93

*Postnatal care Exclusive breastfeeding

100

Pre-pregnancy Pregnancy

7

Birth

Neonatal period

1

30

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

40

40

83 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

61

60

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

93

80

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2003 MoH

Percent

20

0

2006 MICS

20

10

13

10

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

40 0

Measles

1990

1995

2000

Source: WHO/UNICEF 2013

2005

ORT & continued feeding

22

(2012)

10

(2006)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

43

40 20 0 2006 MICS

Early initiation of breastfeeding (within 1 hr of birth, %) 55 Introduction of solid, semi-solid/soft foods (%) 35

(2006)

Vitamin A two dose coverage (%)

(2012)

Percent of infants <6 months exclusively breastfed

20

80 Percent

15

60

40 20 0

88

Exclusive breastfeeding

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

62

2002 Other NS

Underweight and stunting prevalence

Careseeking for pneumonia

62

NUTRITION Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

100 80 60

2012 2010

20

32

28

1989 Other NS

16 1996 Other NS

25 27

2002 Other NS

30 33

30 34

Percent

No Data

DTP3

86

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

20

Early initiation of breastfeeding ITN use among children <5 yrs

83 81 81

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

10 5

2006 MICS

2012 (p)Other NS

0

1 2006 MICS

(2006)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Djibouti DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 13%

Preterm 12%

2%

Other 20%

Globally nearly half of child deaths are attributable to undernutrition

Sepsis 10%

Embolism 2%

Abortion 10%

Asphyxia* 9% Neonatal death: 33% Other 2%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

Haemorrhage 25%

Sepsis** 6%

HIV/AIDS 2% 9%

Malaria 1% Injuries 5%

Hypertension 16%

0%

Diarrhoea

Indirect 29%

Measles 16%

* Intrapartum-related events

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

92

100

Percent

80

Demand for family planning satisfied (%)

-

-

Antenatal care (4 or more visits, %)

7

(2002)

Malaria during pregnancy - intermittent preventive treatment (%)

-

-

12, - , -

(2008)

79

(2012)

C-section rate (total, urban, rural; %)

67

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

2003 MoH

2006 MICS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

62 33

22 (2009)

1 2009 Other NS

Percent

80 60

29

0 0 21

15

1

6 34

63

54

100

47

56

19

14

80 14

20

60

5

10

2

16

19

5

6

13

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

9

Rural

2012

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

No

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 2

(2013)

10.3

(2008)

50

(2004)

231

(2012)

General government expenditure on health as % of total government expenditure (%)

14

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

40

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

50

40 62

61

69

73

54

6 5

No Data

External sources General government expenditure Out-of-pocket expenditure Other

5

20

0

1990

79

67

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

34

23

40 20

0 18

No

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

0 8

21

Maternity protection (Convention 183)

Per capita total expenditure on health (Int$)

WATER AND SANITATION

100 2

7

National availability of Emergency Obstetric Care services

20 2006 MICS

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

Midwives authorized for specific tasks

FINANCING

2006 MICS

Improved drinking water coverage

1

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Legal status of abortion (X of 5 circumstances) (X of 7 tasks)

Other direct 9%

Congenital 3%

Partial

21

ODA to child health per child (US$)

42

(2011)

ODA to maternal and neonatal health per live birth (US$)

99

(2011)

Note: See annexes for additional information on the indicators above

3

39

22

0

1990

2012 Total

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

87

Fulfilling the Health Agenda for Women and Children The 2014 Report

Egypt DEMOGRAPHICS Total population (000)

80,722

(2012)

Total under-five population (000)

9,237

(2012)

Births (000)

Under-five mortality rate

1,898

(2012)

Birth registration (%) Total under-five deaths (000)

99 40

(2005)

Neonatal deaths: % of all under-5 deaths

56

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

12 18

(2012)

60

(2012)

Stillbirth rate (per 1000 total births)

40

13

(2009)

860

(2013)

Lifetime risk of maternal death (1 in N)

710

(2013)

Total fertility rate (per woman)

2.8

(2012)

50

(2005)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

Maternal mortality ratio

Deaths per 1000 live births

100

Deaths per 100,000 live births

150

86

80

120

120 90 29

21

20

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

60

45 30

30 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

66

*Postnatal care

65

84

79

Exclusive breastfeeding

Neonatal period

53

Measles

100

Pre-pregnancy Pregnancy Birth

80 60 40

Infancy

0

20 40 60 80 100

Source: DHS, MICS, Other NS

35

46

41

55

69

61

79

74

Percent

1988 DHS

1992 DHS

1995 DHS

1998 DHS

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

20

20

93 0

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2000 DHS

2003 DHS

2005 DHS

2008 DHS

15 10 5 0

2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

40 20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION 8

(2008)

13

(2008)

100

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Percent

Percent

73

58

25

1995 DHS

2000 DHS

2003 DHS

2008 DHS

(2005)

Vitamin A two dose coverage (%)

(2012)

(2008)

62

Percent of infants <6 months exclusively breastfed

100 80

60

60

40

0

70 73

Early initiation of breastfeeding (within 1 hr of birth, %) 43 Introduction of solid, semi-solid/soft foods (%) 70

80

20

75

Exclusive breastfeeding

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

40 20 0

66

62

59

1992 DHS

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

Source: DHS 2008

2000

35

31 8 1992 DHS

25 9

11 1995 DHS

2000 DHS

20

2003 DHS

31

24 5

7

2005 DHS

2008 DHS

Percent

Measles Vitamin A (past 6 months)

88

Percent

60

Percent

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

93 93

80

Antenatal care (4+ visits)

Pneumonia treatment

46

56

57

40

53

30

38

2003 DHS

2005 DHS

20 0

1992 DHS

1995 DHS

2000 DHS

2008 DHS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Egypt DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 2% 8%

Globally nearly half of child Preterm 23% deaths are attributable to undernutrition

Other 27%

Abortion 2% Other direct 17%

Haemorrhage 37%

Neonatal death: 56%

Other 4%

Malaria 0% Injuries 3%

Sepsis** 4%

5% 0% Diarrhoea

Indirect 18%

Congenital 12%

Hypertension 17%

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

Percent

53

53

60 40

53

47

39

74

70

69

80

84

Antenatal care (4 or more visits, %)

66

(2008)

-

-

28, 37, 22

(2008)

86

(2012)

8

(2008)

65

(2008)

-

-

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby

(within 2 days for home births, %)

20 0

Demand for family planning satisfied (%)

(2008)

Malaria during pregnancy - intermittent preventive treatment (%)

100

Postnatal visit for mother

(within 2 days for home births, %)

1988 1992 1995 1998 2000 2003 2005 2008 DHS DHS DHS DHS DHS DHS DHS DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

-

Legal status of abortion (X of 5 circumstances)

1

Midwives authorized for specific tasks

-

Maternity protection (Convention 183)

No

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

No

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

0

(2013)

2

(2013)

Newborn health (X of 4) Child health (X of 3)

2 3

(2013)

63.5

(2009)

-

-

323

(2012)

6

(2012)

60

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

National availability of Emergency Obstetric Care services

(2013)

(% of recommended minimum)

FINANCING 40 29

1992 DHS

1995 DHS

29 34

26 28

27

2000 DHS

2003 DHS

2005 DHS

34

19

Per capita total expenditure on health (Int$)

Very limited risk

28

General government expenditure on health as % of total government expenditure (%)

2008 DHS

Out of pocket expenditure as % of total expenditure on health(%)

WATER AND SANITATION Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

100 25

1

3

0

0 64

0 0 0

80 32

3 7

1 6

0

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

96

40

90

100

93

14

1990

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

02 0

ODA to child health per child (US$)

2

(2011)

60

4

ODA to maternal and neonatal health per live birth (US$)

5

(2011)

40

96

91

98

72

Rural

94

Note: See annexes for additional information on the indicators above

57

0 2012

00 6

17

External sources General government expenditure Out-of-pocket expenditure Other

22

20

39

0

1 5 3

No Data

80 4

61

20

0 0 4

100 10

51

60

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Percent

Partial

(X of 7 tasks)

Asphyxia* 12%

HIV/AIDS 0%

Measles 0%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Northern Africa, 2013

Sepsis 6% Embolism 3%

1990

2012 Total

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

89

Fulfilling the Health Agenda for Women and Children The 2014 Report

Equatorial Guinea DEMOGRAPHICS Total population (000)

736

(2012)

Total under-five population (000)

113

(2012)

Births (000)

26

(2012)

Birth registration (%) Total under-five deaths (000)

37 3

(2000)

Neonatal deaths: % of all under-5 deaths

34

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

34 72

(2012)

Stillbirth rate (per 1000 total births)

17

(2009)

Total maternal deaths

79

(2013)

Lifetime risk of maternal death (1 in N)

72

(2013)

Total fertility rate (per woman)

4.9

(2012)

Adolescent birth rate (per 1000 girls)

128

(2001)

(2012)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

1600

182

1600

1200

150 100

100

800 61

50

400

MDG Target

0 1990

1995

2000

2005

2010

0 1990

2015

Source: IGME 2013

400

290

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 27

65

Exclusive breastfeeding

Neonatal period

24

Measles

Birth

0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80 65

60 40

Infancy

20

51

No Data

5

0

20 40 60 80 100

Source: DHS, MICS, Other NS

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

*Postnatal care

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1994 Other NS

Percent

2000 MICS

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

80 60

Percent

Skilled attendant at delivery

No Data

33

20 0 1990

Measles

1995

Source: WHO/UNICEF 2013

2000

2012 2010

2005

NUTRITION Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

3

(2004)

Early initiation of breastfeeding (within 1 hr of birth, %)

-

-

13

(2000)

Introduction of solid, semi-solid/soft foods (%)

-

-

Vitamin A two dose coverage (%)

-

-

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent of infants <6 months exclusively breastfed

100

80 Percent

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Exclusive breastfeeding

80

60

20 0

43

39

40 14

1997 Other NS

16 2000 MICS

35 11 2004 Other NS

Percent

No Data

Vitamin A (past 6 months)

90

51

40

Early initiation of breastfeeding

DTP3

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

ITN use among children <5 yrs

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

60 40 20 0

24

2000 MICS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Equatorial Guinea DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

Preterm 11%

2%

13%

Neonatal death: 33%

Other 17%

Globally nearly half of child deaths are attributable to undernutrition

Embolism 2%

Sepsis 10%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

Abortion 10%

Haemorrhage 25%

Asphyxia* 10%

Sepsis** 6%

Malaria 15%

8%

Injuries 4%

* Intrapartum-related events

Hypertension 16%

0% Diarrhoea

Indirect 29%

Source: WHO 2014

Measles 4% Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

100

86

Percent

80 60 40

Antenatal care (4 or more visits, %)

-

-

Malaria during pregnancy - intermittent preventive treatment (%)

-

-

C-section rate (total, urban, rural; %)

-

-

75

(2012)

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

37

(within 2 days for home births, %)

20 0

27

(2011)

Demand for family planning satisfied (%)

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

(within 2 days for home births, %)

1994 Other NS

2000 MICS

(<18.5 kg/m2, %)

CHILD HEALTH

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

36

29

2000 MICS

Malaria prevention and treatment Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Percent

Diarrhoeal disease treatment

100 80 60 40 20 0

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

No Data

Midwives authorized for specific tasks

7

-

Partial

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

No

Community treatment of pneumonia with antibiotics

-

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

-

-

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

8.4

(2004)

-

-

1,432

(2012)

7

(2012)

44

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

National availability of Emergency Obstetric Care services

(2013)

(% of recommended minimum)

FINANCING Per capita total expenditure on health (Int$) 1 2000 MICS

General government expenditure on health as % of total government expenditure (%) Out of pocket expenditure as % of total expenditure on health(%)

WATER AND SANITATION Improved drinking water coverage

3

Maternity protection (Convention 183)

Congenital 2%

HIV/AIDS 7%

Legal status of abortion (X of 5 circumstances) (X of 7 tasks)

Other direct 9%

Other 2%

Yes

Improved sanitation coverage

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

No Data

Reproductive, maternal, newborn and child health expenditure by source

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

16

(2011)

ODA to maternal and neonatal health per live birth (US$)

48

(2011)

Note: See annexes for additional information on the indicators above

91

Fulfilling the Health Agenda for Women and Children The 2014 Report

Eritrea DEMOGRAPHICS Total population (000)

6,131

(2012)

Total under-five population (000)

1,034

(2012)

Births (000)

230

(2012)

Birth registration (%) Total under-five deaths (000)

11

(2012)

Neonatal deaths: % of all under-5 deaths

36

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

18 37

(2012)

Stillbirth rate (per 1000 total births)

21

(2009)

Total maternal deaths

-

(2012)

880

(2013)

Lifetime risk of maternal death (1 in N)

52

(2013)

Total fertility rate (per woman)

4.8

(2012)

85

(1999)

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

2000 150

150

1700

1500

100

1000

52

50

50

MDG Target

0 1990

1995

2000

2005

2010

0 1990

2015

Source: IGME 2013

380

500

430

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 22

28

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

52

Measles

60

0

1995 DHS

Percent

60

28

21

20

20 40 60 80 100

Source: DHS, MICS, Other NS

80

40

99 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

41

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

20

0

2002 DHS

46

40 0

5

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

60

40 20

Early initiation of breastfeeding

DTP3

No Data

Measles

ORT & continued feeding

1995

Source: WHO/UNICEF 2013

2000

NUTRITION 15

(2002)

14

(2002)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Vitamin A two dose coverage (%)

(2012)

38

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80

37

40

48

35

44

20 0

(2002)

70

60

40

Early initiation of breastfeeding (within 1 hr of birth, %) 78 Introduction of solid, semi-solid/soft foods (%) 43

100

80

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

2002 DHS

2012 2010

2005

Underweight and stunting prevalence

Careseeking for pneumonia

44

40 20

0 1990

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

92

100 80 60

0

Percent

ITN use among children <5 yrs

Percent

80

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

99 99 99

100

Antenatal care (4+ visits)

Pneumonia treatment

60

59

52

40 20

1993 Other NS

1995 DHS

2002 DHS

0

1995 DHS

2002 DHS

(2002)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Eritrea DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 17% 2%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 7%

Neonatal death: 34%

Sepsis 10%

Embolism 2%

Abortion 10%

Haemorrhage 25%

Asphyxia* 11%

Other 23%

Regional estimates for Sub-Saharan Africa, 2013

Sepsis** 7%

Malaria 0% Injuries 8%

10% Diarrhoea

Hypertension 16%

0% Indirect 29%

Source: WHO 2014

Measles 6%

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

Percent

41

(2002)

-

-

3, 7, 1

(2002)

94

(2012)

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

38

(2002)

(Minimum target is 5% and maximum target is 15%)

49

Neonatal tetanus vaccine

40

(within 2 days for home births, %)

20 0

22

Antenatal care (4 or more visits, %)

C-section rate (total, urban, rural; %)

70

80 60

Demand for family planning satisfied (%)

(2002)

Malaria during pregnancy - intermittent preventive treatment (%)

100

(within 2 days for home births, %)

1995 DHS

2002 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

54

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

45

33

1995 DHS

2002 DHS

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

5 (2008)

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

3 (R,F)

No

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

No

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

2

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

6.3

(2004)

-

-

17

(2012)

4

(2012)

53

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

(% of recommended minimum)

FINANCING 49 4 2002 DHS

2008 Other NS

Per capita total expenditure on health (Int$) General government expenditure on health as % of total government expenditure (%) Out of pocket expenditure as % of total expenditure on health(%)

Improved sanitation coverage

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

Reproductive, maternal, newborn and child health expenditure by source

No Data

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

No Data

7

Maternity protection (Convention 183)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Legal status of abortion (X of 5 circumstances) (X of 7 tasks)

Congenital 5% HIV/AIDS 1%

Yes

Midwives authorized for specific tasks

Other direct 9%

Other 2%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

ODA to maternal and neonatal health per live birth (US$)

8

(2011)

21

(2011)

Note: See annexes for additional information on the indicators above

93

Fulfilling the Health Agenda for Women and Children The 2014 Report

Ethiopia DEMOGRAPHICS Total population (000)

91,729

(2012)

Total under-five population (000)

14,095

(2012)

3,084

(2012)

7 205

(2005)

Neonatal deaths: % of all under-5 deaths

43

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

29 47

(2012)

150

(2012)

Stillbirth rate (per 1000 total births)

100

26

(2009)

13,000

(2013)

Lifetime risk of maternal death (1 in N)

52

(2013)

Total fertility rate (per woman)

4.6

(2012)

87

(2008)

Births (000) Birth registration (%) Total under-five deaths (000)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

250

1500

204

200

1400

1200 900 68

68

50

600

MDG Target

0 1990

1995

2000

2005

2010

350

0 1990

2015

Source: IGME 2013

420

300

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 52

10

*Postnatal care

Birth

7

Exclusive breastfeeding

Neonatal period

52

Measles

80

40

60

0

20 40 60 80 100

Source: DHS, MICS, Other NS

60

20

66 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

38 (2012)

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

19

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

6

6

2000 DHS

2005 DHS

Percent

Coverage along the continuum of care

10

40

0

2011 DHS

41

20

24

16

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

66 61 61

40 20

Early initiation of breastfeeding

12

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months) ORT & continued feeding

(2011)

20

(2005)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

60

40

19 5 2005 DHS

27 7 2011 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 52 Introduction of solid, semi-solid/soft foods (%) 49

(2011)

Vitamin A two dose coverage (%)

(2012)

31

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80

67 57 42

42

51 35

29

44

20 0

16

100

80

Percent

40 20 0

2000 DHS

10

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

Percent

Percent

60

Percent

80

Skilled attendant at delivery

94

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

Source: DHS 2011

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

60

54

49

52

40 20

1992 Other NS

2000 DHS

2005 DHS

2011 DHS

0

2000 DHS

2005 DHS

2011 DHS

(2011)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Ethiopia DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 16% 2%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 11%

Other 19%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10% Haemorrhage 25%

Asphyxia* 14%

Neonatal death: 43%

Hypertension 16%

Sepsis** 9%

Injuries 6% Measles 2%

* Intrapartum-related events

Indirect 29%

0%

9%

Source: WHO 2014

Diarrhoea Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

52

Antenatal care (4 or more visits, %)

19

(2011)

-

-

2, 8, 1

(2011)

68

(2012)

Postnatal visit for baby

-

-

Postnatal visit for mother

7

(2011)

24

(2011)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(2011)

Malaria during pregnancy - intermittent preventive treatment (%)

100

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

43

40

28

27

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

2000 DHS

2005 DHS

2011 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

25 26

15 20

13

2000 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2005 DHS

28 (2011)

33

30

2007 Other NS

2011 Other NS

2 2005 DHS

17

Percent

80 49

46 31

60

40

42

51

12 1

1990

10

10

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

42 3

2012 1990

41 0

1

Rural

2012

60

0

40

23

12

92

26

40

20

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

3

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

2.8

(2009)

11

(2008)

Per capita total expenditure on health (Int$)

44

(2012)

General government expenditure on health as % of total government expenditure (%)

11

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

41

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

42

43

100

27

29 13 2 4 2

24

1990

2012 Total

No Data

External sources General government expenditure Out-of-pocket expenditure Other

8 37

80

55 38

20

0

20

71 38

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100

0 3

9 10

No

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

100

Maternity protection (Convention 183)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

7

FINANCING

2011 DHS

Improved drinking water coverage

3 (R,F)

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Legal status of abortion (X of 5 circumstances) (X of 7 tasks)

Congenital 4%

Malaria 3%

Yes

Midwives authorized for specific tasks

Other direct 9%

Other 2%

HIV/AIDS 2%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

ODA to child health per child (US$)

17

(2011)

ODA to maternal and neonatal health per live birth (US$)

33

(2011)

Note: See annexes for additional information on the indicators above

7 19

27

1990

2012 Urban

0 00

23

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

95

Fulfilling the Health Agenda for Women and Children The 2014 Report

Gabon DEMOGRAPHICS Total population (000)

1,633

(2012)

238

(2012)

Births (000)

53

(2012)

Birth registration (%) Total under-five deaths (000)

90 3

(2012)

Neonatal deaths: % of all under-5 deaths

41

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

25 42

(2012)

60

300

(2012)

40

200

Total under-five population (000)

Stillbirth rate (per 1000 total births)

(2012)

17

(2009)

130

(2013)

94

(2013)

Total fertility rate (per woman)

4.1

(2012)

Adolescent birth rate (per 1000 girls)

115

(2009)

Total maternal deaths Lifetime risk of maternal death (1 in N)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

100

Deaths per 100,000 live births

500

92

80

62

31

20

0 1990

MDG Target

1995

2000

2005

2010

380

400

2015

Source: IGME 2013

240

100

95

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 54

89

*Postnatal care

59

Exclusive breastfeeding

100

Pre-pregnancy Pregnancy

78

6

Birth

Neonatal period

0

60

100

40

75

0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

20

71

2000 DHS

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

89

86

80

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

50

48

25

0

2012 DHS

70

50

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

100 60

Percent

Skilled attendant at delivery

40 20

Early initiation of breastfeeding

0 1990

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

ORT & continued feeding

3

(2012) (2000)

Percent of children <5 years who are moderately or severely: underweight stunted

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Vitamin A two dose coverage (%)

(2012)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80

40

0

2

100

60

20

2012 DHS

(2012)

80

Percent

50

Early initiation of breastfeeding (within 1 hr of birth, %) 32 Introduction of solid, semi-solid/soft foods (%) 62

Percent

0 10 20 30 40 50 60 70 80 90 100

40 20 0

68

48

2000 DHS

14

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

96

1995

ITN use among children <5 yrs

Source: DHS 2012

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics 82 82 71

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

EQUITY

26 9 2000-2001 Other NS

6

17

2012 DHS

60 40 20 0

6

6

2000 DHS

2012 DHS

(2000)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Gabon DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

2%

10%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 15%

Other 17%

Neonatal death: 41%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10% Haemorrhage 25%

Asphyxia* 11%

HIV/AIDS 2%

Hypertension 16%

Sepsis** 8% 0% 7% Diarrhoea

Injuries 4%

Indirect 29%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Measles 1%

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

54

Antenatal care (4 or more visits, %)

78

(2012)

3

(2012)

10, 11, 6

(2012)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(2012)

Malaria during pregnancy - intermittent preventive treatment (%)

95

94

100

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

75

(2012)

40

Postnatal visit for baby

25

(2012)

Postnatal visit for mother

59

(2012)

5

(2012)

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

2000 DHS

2012 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

52

44

26

25

2000 DHS

34 (2012)

39

2008 Other NS

31

3 3

2

1

29 51

68

61

20 35

43

44

49

29

Total

2012

Source: WHO/UNICEF JMP 2014

1995 Urban

2012 1995

80

2

2 30

23

34

60 30

Rural

2012

2

2 26

19

Antenatal corticosteroids as part of management of preterm labour

No

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

-

-

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

53.1

(2004)

123

(2001)

558

(2012)

7

(2012)

41

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

3

4

41

45

36

33

21

40

20 38 14

8

0

1995

100

19

40

No

General government expenditure on health as % of total government expenditure (%)

2012 DHS

Percent of population by type of sanitation facility, 1995-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

30 7

60 45

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Per capita total expenditure on health (Int$)

Improved sanitation coverage

Percent

Percent

80

5 3

Yes

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1995-2012 Piped on premises Other improved Surface water Unimproved 13 7

Yes

Postnatal home visits in the first week after birth

(2013)

FINANCING

55

2012 DHS

Improved drinking water coverage

Partial

Maternal deaths notification

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

1

4

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks Maternity protection (Convention 183)

Congenital 4% Malaria 19%

No

(X of 7 tasks)

Other direct 9%

Other 2%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

41

0

1995

2012 Total

39

43

1995

2012 Urban

19

35

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$) ODA to maternal and neonatal health per live birth (US$)

6

(2011)

28

(2011)

Note: See annexes for additional information on the indicators above

32

1995

2012 Rural

Source: WHO/UNICEF JMP 2014

97

Fulfilling the Health Agenda for Women and Children The 2014 Report

Gambia DEMOGRAPHICS Total population (000)

1,791

(2012)

328

(2012)

Births (000)

77

(2012)

Birth registration (%) Total under-five deaths (000)

53 5

(2010)

Neonatal deaths: % of all under-5 deaths

40

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

28 49

(2012)

Stillbirth rate (per 1000 total births)

26

(2009)

340

(2013)

Lifetime risk of maternal death (1 in N)

39

(2013)

Total fertility rate (per woman)

5.8

(2012)

88

(2011)

Total under-five population (000)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

800

170

710

600

150 100

57

50

MDG Target

0 1990

1995

2000

2005

430

400

73

2010

2015

Source: IGME 2013

200

180

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 38

57

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

34

60

57

57

100

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

55

44

40

95 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

Measles

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

72

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1990 Other NS

2000 MICS

2005-2006 MICS

75 50 25 0

2010 MICS

2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine 98 98 100 98 95 80

60

Percent

Antenatal care (4+ visits)

Immunization

Skilled attendant at delivery

40

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

(2010)

10

(2010)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

20 0

69 70

40 20 0 2005-2006 MICS

2010 MICS

(2010)

Vitamin A two dose coverage (%)

(2012)

46

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100 80

60

40

69 61

Early initiation of breastfeeding (within 1 hr of birth, %) 52 Introduction of solid, semi-solid/soft foods (%) 34

80

Percent

Percent

Source: MICS 2005-2006

75

2000 MICS

10

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

36 23

1996 MICS

15

24

2000 MICS

28

16 2005-2006 MICS

17 23

2010 MICS

Percent

Measles Vitamin A (past 6 months)

98

Pneumonia treatment

Percent

EQUITY

60 40

26

41

34

2005-2006 MICS

2010 MICS

20 0

2000 MICS

(2010)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Gambia DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 2% 11%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 11%

Other 17%

Neonatal death: 40%

Sepsis 10%

Embolism 2%

Abortion 10% Haemorrhage 25%

Asphyxia* 12% Other direct 9%

Other 2%

HIV/AIDS 1%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

Sepsis** 8% 7% Diarrhoea

Injuries 4%

Hypertension 16%

0% Indirect 29%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Measles 0%

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

98

98

91

100

Percent

Demand for family planning satisfied (%)

38

(2010)

Antenatal care (4 or more visits, %)

72

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

62

(2013)

3, 5, 1

(2010)

92

(2012)

C-section rate (total, urban, rural; %)

80

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

2000 MICS

2005-2006 MICS

2010 MICS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

67 39

38 39

38 33

2000 MICS

2005-2006 MICS

37 (2013)

0 10

100 0

33

15 2000 MICS

2005-2006 MICS

2010 MICS

0 16

30

Percent of population by type of sanitation facility, 1995-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100 6

58

80

59

40 65

79

69 52

20

32

11

1990

5

1

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

Rural

2012

2 9

0 8

4

10 13

28

27

21

No

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

9.7

(2008)

50

(2012)

Per capita total expenditure on health (Int$)

98

(2012)

General government expenditure on health as % of total government expenditure (%)

11

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

16

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

No Data

External sources General government expenditure Out-of-pocket expenditure Other

27

ODA to child health per child (US$)

27

(2011)

14

ODA to maternal and neonatal health per live birth (US$)

31

(2011)

16

22

60

Note: See annexes for additional information on the indicators above

40

20

27

2 16

12

42

60

0

0

Maternity protection (Convention 183)

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Percent

80

24

0 6

0 14

7

FINANCING

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

Midwives authorized for specific tasks

National availability of Emergency Obstetric Care services

49

2010 MICS

Improved drinking water coverage

3

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Legal status of abortion (X of 5 circumstances) (X of 7 tasks)

Congenital 4% Malaria 20%

Yes

61

60

0

1995

2012 Total

62

64

1995

2012 Urban

61

55

1995

2012 Rural

Source: WHO/UNICEF JMP 2014

99

Fulfilling the Health Agenda for Women and Children The 2014 Report

Ghana DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

25,366

(2012)

3,640

(2012)

794

(2012)

Birth registration (%) Total under-five deaths (000)

63 56

(2011)

Neonatal deaths: % of all under-5 deaths

40

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

28 49

(2012)

Stillbirth rate (per 1000 total births)

(2012)

(2012)

22

(2009)

3,100

(2013)

Lifetime risk of maternal death (1 in N)

66

(2013)

Total fertility rate (per woman)

3.9

(2012)

70

(2006)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

160

800

128

120

760

600 72

80

43

40

MDG Target

0 1990

1995

2000

2005

380

400

2010

2015

Source: IGME 2013

200

190 MDG Target

0 1990

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 34 87 68

*Postnatal care

83

Exclusive breastfeeding

46

Measles

Neonatal period

80

Infancy

0

20 40 60 80 100

Source: DHS, MICS, Other NS

40

47

44

57

50

20

88 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

68

60 40

Percent

76 (2012)

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1988 DHS

1998 DHS

2003 DHS

2006 MICS

2008 DHS

2011 MICS

100 80 60 40 20 0

95

80 55

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

80 60

Percent

Skilled attendant at delivery

20 0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

6

(2011)

11

(2011)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

20 0

24

2616

1993 DHS

1998 DHS

2003 DHS

34

51

41

33

24

2006 MICS

2008 DHS

56

2011 MICS

(2011)

Vitamin A two dose coverage (%)

(2012)

(2011)

17

Percent of infants <6 months exclusively breastfed

100 80

60

40

44

Early initiation of breastfeeding (within 1 hr of birth, %) 46 Introduction of solid, semi-solid/soft foods (%) 75

80

Percent

40 20 0

43

Exclusive breastfeeding

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

2005

43 25

1988 DHS

41 26

1993 DHS

36

31 20

1998 DHS

19

2003 DHS

14

28

2006 MICS

13

23

2011 MICS

Percent

Measles Vitamin A (past 6 months)

100

49 43

40

Early initiation of breastfeeding

Source: MICS 2011

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

92 92 88

100

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

53

60

0

46

31

40 20

63

4

7

1988 DHS

1993 DHS

1998 DHS

2003 DHS

2008 DHS

2011 MICS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Ghana DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 11% 2%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 12%

Other 17%

Embolism 2%

Abortion 10%

Legal status of abortion (X of 5 circumstances)

Haemorrhage 25%

Asphyxia* 12%

Neonatal death: 40%

HIV/AIDS 1%

Sepsis 10%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

Maternity protection (Convention 183)

Sepsis** 8%

Injuries 4%

Hypertension 16%

0%

7% Diarrhoea

Indirect 29%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Measles 1%

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

92

88

82

92

96

90

Percent

Demand for family planning satisfied (%)

34

(2013)

Antenatal care (4 or more visits, %)

87

(2011)

Malaria during pregnancy - intermittent preventive treatment (%)

67

(2011)

11, 17, 7

(2011)

C-section rate (total, urban, rural; %)

80

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

88

(2012)

40

Postnatal visit for baby

83

(2011)

Postnatal visit for mother

83

(2011)

-

-

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1988 DHS

1998 DHS

2003 DHS

2006 MICS

2008 DHS

2011 MICS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

29

29

1993 DHS

1998 DHS

40 39

2003 DHS

29 29

2006 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

45 45

44

2008 DHS

35

35 (2011)

22

28

2006 MICS

2008 DHS

39

5 8

Percent

80 36

44

60 10

40

59

68

2011 MICS

1990

Total

Source: WHO/UNICEF JMP 2014

2

1990 Urban

2012 1990

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100 22

3

Rural

2012

19

80

8

10

7 1

31

60 42

72

40

20

34

19

2012

78

0

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

-

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

3

(2013)

-

-

Newborn health (X of 4) Child health (X of 3)

2

(2013)

10.2

(2010)

37

(2011)

106

(2012)

General government expenditure on health as % of total government expenditure (%)

10

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

29

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

9

52

36

40 16

10

10

38

20

0

0 7

8 8

Yes

Per capita total expenditure on health (Int$)

4 2003 DHS

Percent

100

Yes

Postnatal home visits in the first week after birth

National availability of Emergency Obstetric Care services

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

Maternal deaths notification

-

FINANCING

2011 MICS

Improved drinking water coverage

Partial

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

7

(X of 7 tasks)

Congenital 4% Malaria 19%

3 (R,F)

Midwives authorized for specific tasks

Other direct 9%

Other 2%

-

59

29

External sources General government expenditure Out-of-pocket expenditure Other

33 15

47

Partially available

ODA to child health per child (US$)

24

(2011)

ODA to maternal and neonatal health per live birth (US$)

56

(2011)

Note: See annexes for additional information on the indicators above

46 44

29 14

7

1990

2012 Total

13

20

20 8

4

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

101

Fulfilling the Health Agenda for Women and Children The 2014 Report

Guatemala DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

15,083

(2012)

2,215

(2012)

Under-five mortality rate

474

(2012)

Birth registration (%) Total under-five deaths (000)

97 15

(2008-2009)

Neonatal deaths: % of all under-5 deaths

48

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

15 27

(2012)

60

(2012)

40

Stillbirth rate (per 1000 total births)

(2012)

10

(2009)

660

(2013)

Lifetime risk of maternal death (1 in N)

170

(2013)

Total fertility rate (per woman)

3.8

(2012)

92

(2011)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

300

100 80

80

270

240 180 32 27

20

MDG Target

0 1990

1995

2000

2005

140

120

2010

2015

Source: IGME 2013

68

60 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 72

52

Birth

Exclusive breastfeeding

Neonatal period

50

Measles

40

0

20 40 60 80 100

Source: DHS, MICS, Other NS

60

35

29

41

Percent

1987 DHS

1995 DHS

40

52

41

20

93 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

*Postnatal care

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1998-1999 2002 2008-2009 DHS Other NS Other NS

30 20 10 0

2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine 96 96 100 93 80 81

Percent

Antenatal care (4+ visits)

Immunization

Skilled attendant at delivery

60

40

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

100 80 60 40 20 0

2012 2010

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

1

(2008-2009)

11

(2008-2009)

64 41

37

1995 DHS

1998-1999 DHS

Percent of children <5 years who are moderately or severely: underweight stunted

66

40

28

20 0

1987 DHS

22

1995 DHS

80

53

55

60

20

54 18

48 13

1998-1999 2002 2008-2009 DHS Other NS Other NS

Percent

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

14

100

80

Percent

(2008-2009)

Percent of infants <6 months exclusively breastfed

100

0 10 20 30 40 50 60 70 80 90 100

Source: DHS 1998-1999

(2008-2009)

Exclusive breastfeeding

Underweight and stunting prevalence

Careseeking for pneumonia

2002 Other NS

Early initiation of breastfeeding (within 1 hr of birth, %) 56 Introduction of solid, semi-solid/soft foods (%) 71 Vitamin A two dose coverage (%)

ORT & continued feeding

102

Pneumonia treatment

Percent

EQUITY

60

46

51

1995 DHS

2002 Other NS

50

40 20 0

2008-2009 Other NS

(2012)

Imp

Fulfilling the Health Agenda for Women and Children The 2014 Report

Guatemala DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 15% 2%

Other 20%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 11%

Neonatal death: 48%

Sepsis 8%

Embolism 3%

Abortion 10%

Haemorrhage 23%

Asphyxia* 14%

Sepsis** 9%

Injuries 8% Measles 0%

Hypertension 22%

Indirect 19%

0% 8% Diarrhoea

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

80 Percent

93

84

-

-

Malaria during pregnancy - intermittent preventive treatment (%)

-

-

16, 26, 11

(2008-2009)

85

(2012)

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

35

40

Antenatal care (4 or more visits, %)

C-section rate (total, urban, rural; %)

60

53

60

72

(2008-2009)

Demand for family planning satisfied (%)

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1987 DHS

1995 DHS

1998-1999 2002 2008-2009 DHS Other NS Other NS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

1995 DHS

1998-1999 DHS

37

34

30

22

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2002 Other NS

-

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

60

0 11

7 23

32

6 5

18 8

98

86

73

68

49

1990

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

100 22

6 6

80 10

8

Rural

2 0 10

10 12

34

6

13 4 80

62

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

2

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

18.3

(2009)

-

-

368

(2012)

General government expenditure on health as % of total government expenditure (%)

19

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

50

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

81

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$) ODA to maternal and neonatal health per live birth (US$)

6

(2011)

24

(2011)

Note: See annexes for additional information on the indicators above

88

72 49

0 2012

5 5 9

6

40

20

35

0

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

60

Yes

Postnatal home visits in the first week after birth

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

16

39

40 20

2

Maternal deaths notification

Per capita total expenditure on health (Int$)

1 1999 Other NS

Percent

Percent

80

3 3 8

Partial

FINANCING

2008-2009 Other NS

Improved drinking water coverage

12 7

-

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

1

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks Maternity protection (Convention 183)

Congenital 10%

Malaria 0%

Yes

(X of 7 tasks) Other direct 15%

Other 3%

HIV/AIDS 1%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Latin America, 2013

1990

2012 Total

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

103

Fulfilling the Health Agenda for Women and Children The 2014 Report

Guinea DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

11,451

(2012)

1,856

(2012)

Under-five mortality rate

Deaths per 100,000 live births

250

1250

428

(2012)

Birth registration (%) Total under-five deaths (000)

43 41

(2005)

Neonatal deaths: % of all under-5 deaths

34

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

34 65

(2012)

150

(2012)

100

Stillbirth rate (per 1000 total births)

(2012)

24

(2009)

2,800

(2013)

30

(2013)

Total fertility rate (per woman)

5.0

(2012)

Adolescent birth rate (per 1000 girls)

154

(2009)

Total maternal deaths Lifetime risk of maternal death (1 in N)

Maternal mortality ratio

Deaths per 1000 live births

241

1100

1000

200

750

101

650

500 80

50

MDG Target

0 1990

1995

2000

2005

2010

250

2015

Source: IGME 2013

280

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 29

45

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

48

Measles

Infancy

31

35

80

45

46

38

60

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

56

60

58 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

40

1992 DHS

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

50

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1999 DHS

2003 MICS

2005 DHS

2007 Other NS

2012 DHS

44

40 20

0

31

17 2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

59 59 58

Percent

60

40

Percent

80

Skilled attendant at delivery

20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

6

(2011-2012)

12

(2005)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

37

2003 MICS

2005 DHS

2012 DHS

(2005)

Vitamin A two dose coverage (%)

(2012)

99

(2008)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80 35

40

0

42 33

100

60

20

39

Early initiation of breastfeeding (within 1 hr of birth, %) 40 Introduction of solid, semi-solid/soft foods (%) 32

80

Percent

40 20 0

1999 DHS

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

2005

21

1994-1995 Other NS

34

21

1999 DHS

39 23

2005 DHS

40 21

36 16

2008 2011-2012 Other NS Other NS

Percent

Measles Vitamin A (past 6 months)

104

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

Source: DHS 2005

Pneumonia treatment

60

48

40 20 0

11 1999 DHS

23

2003 MICS

27

2005 DHS

2008 Other NS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Guinea DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 11% 2%

Preterm 10%

Other 14%

Neonatal death: 34%

HIV/AIDS 2%

Globally nearly half of child deaths are attributable to undernutrition

Sepsis 10%

Embolism 2%

Abortion 10%

Asphyxia* 11%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

Legal status of abortion (X of 5 circumstances)

Haemorrhage 25%

Maternity protection (Convention 183)

Sepsis** 7%

Injuries 4%

* Intrapartum-related events

Hypertension 16%

0% 8% Diarrhoea

Indirect 29%

Measles 2%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

84

Percent

82

71

80

88

85

Demand for family planning satisfied (%)

29

(2005)

Antenatal care (4 or more visits, %)

50

(2007)

Malaria during pregnancy - intermittent preventive treatment (%)

18

(2012)

2, 5, 2

(2007)

80

(2012)

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

11

(2012)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

58

60

Neonatal tetanus vaccine

40

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1992 DHS

1999 DHS

2003 MICS

2005 DHS

2007 Other NS

2012 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

44 40

35

25

1992 DHS

1999 DHS

2003 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

38 33

2005 DHS

34

5 (2012)

Percent

60

8

67

0

1

5

2005 DHS

2007 Other NS

13

5

Total

2012

Source: WHO/UNICEF JMP 2014

35

19

39

Urban

2012 1990

5

100

17

80 41

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

0

Rural

2012

1 26

(2013)

Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

6.1

(2005)

13

(2013)

67

(2012)

7

(2012)

67

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

43 55

40 42 21

23

1990

2012 Total

ODA to maternal and neonatal health per live birth (US$)

5

(2011)

17

(2011)

Note: See annexes for additional information on the indicators above

37 33

19

8

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

55

43

60

0

Partial

Life Saving Commodities in Essential Medicine List:

Reproductive, maternal, newborn and child health expenditure by source

23 54

20 9

0

1990

Yes

General government expenditure on health as % of total government expenditure (%)

2012 DHS

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

24

53

65

47

1990

11

8

62

40 20

57

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Per capita total expenditure on health (Int$)

26

Improved sanitation coverage

Percent

18

80 40

0 8

7 7

Yes

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 7

No

Postnatal home visits in the first week after birth

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Maternal deaths notification

FINANCING

2012 DHS

Improved drinking water coverage

Partial

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

7

(X of 7 tasks)

Congenital 2% Malaria 27%

3 (R,F)

Midwives authorized for specific tasks

Other direct 9%

Other 2%

Partial

18

1990

2012 Urban

8

3 5

11

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

105

Fulfilling the Health Agenda for Women and Children The 2014 Report

Guinea-Bissau DEMOGRAPHICS Total population (000)

1,664

(2012)

265

(2012)

Births (000)

63

(2012)

Birth registration (%) Total under-five deaths (000)

24 8

(2010)

Neonatal deaths: % of all under-5 deaths

36

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

46 81

(2012)

150

(2012)

Stillbirth rate (per 1000 total births)

100

30

(2009)

360

(2013)

Lifetime risk of maternal death (1 in N)

36

(2013)

Total fertility rate (per woman)

5.0

(2012)

Adolescent birth rate (per 1000 girls)

137

(2009)

Total under-five population (000)

Total maternal deaths

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

250

1000

206

200

930

800 129

600 69

50

1995

2000

2005

2010

0 1990

2015

Source: IGME 2013

230

200

MDG Target

0 1990

560

400 MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 70 68 43

Exclusive breastfeeding

Neonatal period

38

60 40

39

80

43

60

0

20 40 60 80 100

Source: DHS, MICS, Other NS

35

25

20

69 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

Measles

1990-1995 Other NS

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy Birth

*Postnatal care

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2000 MICS

2006 MICS

40 20

0

2010 MICS

2010

Source: UNICEF/UNAIDS/WHO 2013

33

22

15

2011

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

60

40

Percent

80 76 69

80

Skilled attendant at delivery

20

Early initiation of breastfeeding

100 80 60

1995

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

6

(2010)

11

(2010)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

20 0

52

35

2006 MICS

2010 MICS

(2010)

Vitamin A two dose coverage (%)

(2012)

95

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100 80

60

40

42

Early initiation of breastfeeding (within 1 hr of birth, %) 55 Introduction of solid, semi-solid/soft foods (%) 43

80

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

2000 MICS

2012 2010

48

36

22

2000 MICS

28 17 2006 MICS

17

2008 Other NS

18

32

2010 MICS

Percent

ORT & continued feeding

57

0 1990

Measles

64

40 20

0

ITN use among children <5 yrs

Vitamin A (past 6 months)

106

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

Source: MICS 2006

Pneumonia treatment

60 40

16

20 0

38

37

2000 MICS

2006 MICS

2010 MICS

(2010)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Guinea-Bissau DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

Preterm 9%

3%

12% Other 17%

Globally nearly half of child deaths are attributable to undernutrition

Neonatal death: 36%

Sepsis 10%

Embolism 2%

Abortion 10%

Haemorrhage 25%

Asphyxia* 12% Other 2%

Regional estimates for Sub-Saharan Africa, 2013

HIV/AIDS 3%

Sepsis** 8% Hypertension 16%

0% 10% Diarrhoea

Malaria 18% Injuries 4%

* Intrapartum-related events

Indirect 29%

Measles 1%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

93

100

78

Percent

80

Demand for family planning satisfied (%)

70

(2010)

Antenatal care (4 or more visits, %)

68

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

14

(2010)

2, 5, 1

(2010)

80

(2012)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

62

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

2000 MICS

2006 MICS

2010 MICS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

53

39

25 23

23

2000 MICS

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

19

2006 MICS

-

36

2006 MICS

2010 MICS

7 2000 MICS

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

24

60

1 3

85 69

31

56 32

20 32 4

1990

14

5

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

Percent of population by type of sanitation facility, 2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100 80

41

63

40

0

3

5

55

60

11

2012 1990

-

Maternity protection (Convention 183)

No

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

-

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

-

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

60

0

0

Rural

2012

-

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

-

-

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

-

-

-

-

Newborn health (X of 4) Child health (X of 3)

-

-

Density of doctors, nurses and midwives (per 10,000 population)

6.6

(2009)

National availability of Emergency Obstetric Care services

127

(2002)

66

(2012)

8

(2012)

43

(2012)

-

Per capita total expenditure on health (Int$) General government expenditure on health as % of total government expenditure (%)

40

36

ODA to child health per child (US$)

18

(2011)

ODA to maternal and neonatal health per live birth (US$)

47

(2011)

Note: See annexes for additional information on the indicators above

45 34

0

Total

43

28

15 20

No Data

External sources General government expenditure Out-of-pocket expenditure Other

2 25

40 20

No

Low osmolarity ORS and zinc for management of diarrhoea

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Percent

80

0

Midwives authorized for specific tasks

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage 2

1

FINANCING 39

WATER AND SANITATION

100 4

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

100 80 60 40 20 0

2010 MICS

-

(X of 7 tasks)

Other direct 9%

Congenital 2%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Urban

4 8

Rural

Source: WHO/UNICEF JMP 2014

107

Fulfilling the Health Agenda for Women and Children The 2014 Report

Haiti DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

10,174

(2012)

1,250

(2012)

265

(2012)

Birth registration (%) Total under-five deaths (000)

80 20

(2012)

Neonatal deaths: % of all under-5 deaths

34

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

25 57

(2012)

Stillbirth rate (per 1000 total births)

15

(2009)

1,000

(2013)

Lifetime risk of maternal death (1 in N)

80

(2013)

Total fertility rate (per woman)

3.2

(2012)

65

(2009)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

800 144

150

670

600

100

400

76

50

48 MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

380

200

170

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 49 67 37

*Postnatal care Exclusive breastfeeding

Neonatal period

40

Measles

60 40

0

20 40 60 80 100

Source: DHS, MICS, Other NS

23

20

58 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy Birth

32

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

21

1989 1994-1995 Other NS DHS

24

2000 DHS

37

26

2005-2006 DHS

Percent

Coverage along the continuum of care

2012 DHS

100 80 60 40 20 0

>95 71 40

2010

2011

Source: UNICEF/UNAIDS/WHO 2013

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

60 58

Percent

60

40

Percent

80

Skilled attendant at delivery

20

Early initiation of breastfeeding

100 80 60 40 20

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

1994-1995 DHS

2012 2010

2005

5

(2012)

23

(2012)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

20 0

2005-2006 DHS

2012 DHS

Vitamin A two dose coverage (%)

(2012)

54

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100 80

60

40

2000 DHS

(2012)

80

Percent

3

Early initiation of breastfeeding (within 1 hr of birth, %) 47 Introduction of solid, semi-solid/soft foods (%) 87

40 24

37 24

1990 1994-1995 Other NS DHS

28

14 2000 DHS

19

30

2005-2006 DHS

11

22

2012 DHS

Percent

Measles

17

38 46

31

26

0

0

Vitamin A (past 6 months)

108

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

Source: DHS 2012

Pneumonia treatment

60 40 20 0

41

40

24

2000 DHS

2005-2006 DHS

2012 DHS

(2012)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Haiti DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 2%

20%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 11%

Neonatal death: 34%

Sepsis 8%

Regional estimates for Caribbean, 2013

Embolism 3%

Abortion 10%

Haemorrhage 23%

Asphyxia* 9% Other direct 15%

Congenital 2% Sepsis** 6%

HIV/AIDS 1% Malaria 1%

Measles 0%

Injuries 7%

11% Diarrhoea

0%

Hypertension 22%

Indirect 19%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100 71

Percent

80

79

68

90

85

Demand for family planning satisfied (%)

49

(2012)

Antenatal care (4 or more visits, %)

67

(2012)

-

-

6, 10, 3

(2012)

Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

76

(2012)

40

Postnatal visit for baby

19

(2012)

Postnatal visit for mother

32

(2012)

9

(2012)

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1984-1989 1994-1995 Other NS DHS

2000 DHS

2005-2006 DHS

2012 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

26

1994-1995 DHS

2000 DHS

57 53

43 40

41 35

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2005-2006 DHS

-

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

22

48 26

9

8

1990

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100 21

80 48

12

2012 1990

43

2

4

Rural

2012

31

60 40

16 17

24

19

24

20 0

Maternity protection (Convention 183)

No

Maternal deaths notification

No

Postnatal home visits in the first week after birth

-

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

-

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

-

-

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

3

(2013)

-

-

Newborn health (X of 4) Child health (X of 3)

-

-

3.6

(1998)

12

(2008)

84

(2012)

General government expenditure on health as % of total government expenditure (%)

5

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

3

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

45

63

53

53

8

22 28

61

20

0

24

34

60

40

1

5 8

-

Per capita total expenditure on health (Int$)

12 2012 DHS

Percent

Percent

80

4

Midwives authorized for specific tasks

-

FINANCING

2012 DHS

Improved drinking water coverage

17

1

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

-

(X of 7 tasks)

Other 3%

Other 27%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2012 Total

8

13 14

38

62 39

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

26

ODA to maternal and neonatal health per live birth (US$)

35

35

No Data

74

(2011)

283

(2011)

Note: See annexes for additional information on the indicators above

16 34

31

1990

2012 Urban

9

11

13

16

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

109

Fulfilling the Health Agenda for Women and Children The 2014 Report

India DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

1,236,687

(2012)

120,581

(2012)

25,642

(2012)

41 1,414

(2005-2006)

Neonatal deaths: % of all under-5 deaths

55

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

31 44

(2012)

Stillbirth rate (per 1000 total births)

22

(2009)

50,000

(2013)

Lifetime risk of maternal death (1 in N)

190

(2013)

Total fertility rate (per woman)

2.5

(2012)

39

(2009)

Birth registration (%) Total under-five deaths (000)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

160

600 126

120

560

450 56

80

300 42

40

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

190

150

140

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care

37

*Postnatal care

37

73

52

Exclusive breastfeeding

Neonatal period

46

Measles

0

60 40

34

52

47

43

42

No Data

20

74

0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1992-1993 1998-1999 NFHS NFHS

2000 MICS

2005-2006 2007-2008 NFHS Other NS

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

80 Percent

Skilled attendant at delivery

74 72

60

40

Percent

100

Antenatal care (4+ visits)

20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

100 80 60

20

(2005-2006)

28

(2005-2006)

69

69

67 33

40 20 0

13

1992-1993 NFHS

2012 2010

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

1998-1999 NFHS

2005-2006 NFHS

Early initiation of breastfeeding (within 1 hr of birth, %) 41 Introduction of solid, semi-solid/soft foods (%) 56 Vitamin A two dose coverage (%)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

60

51

(2012)

80

58 46

54

44

48

40 20 0

59

100

80

Percent

(2005-2006)

Percent of infants <6 months exclusively breastfed

100

0 10 20 30 40 50 60 70 80 90 100

Source: NFHS 2005-2006

(2007-2008)

Exclusive breastfeeding

Percent

ORT & continued feeding

110

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

60 40

44

46

37

1992-1993 NFHS

1998-1999 NFHS

2000 MICS

46

20 1992-1993 NFHS

1998-1999 NFHS

2005-2006 NFHS

0

2005-2006 NFHS

Imp

Fulfilling the Health Agenda for Women and Children The 2014 Report

India DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia Other 16%

Globally nearly half of child deaths are attributable to undernutrition

2%

12%

Preterm 25%

Neonatal death: 55%

HIV/AIDS 0% Malaria 0%

Embolism 2%

Sepsis 14%

Haemorrhage 30%

Abortion 6%

Congenital 4%

Hypertension 10%

Indirect 29%

Sepsis** 9%

10% 0% Diarrhoea

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

80 Percent

Demand for family planning satisfied (%)

73

(2008)

Antenatal care (4 or more visits, %)

37

(2005-2006)

-

-

9, 17, 6

(2005-2006)

87

(2012)

-

-

37

(2005-2006)

-

-

Malaria during pregnancy - intermittent preventive treatment (%)

100 65

62

C-section rate (total, urban, rural; %)

74

62

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

(within 2 days for home births, %)

20

Postnatal visit for mother

0

(within 2 days for home births, %)

1992-1993 NFHS

1998-1999 NFHS

2000 MICS

2005-2006 NFHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

-

-

Maternity protection (Convention 183)

No

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

No

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

2

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

24.1

(2012)

-

-

157

(2012)

9

(2012)

58

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

(% of recommended minimum)

33

27

18

1998-1999 NFHS

Per capita total expenditure on health (Int$)

No Data

26

General government expenditure on health as % of total government expenditure (%)

2005-2006 NFHS

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 1 6

1 10

0 3

1

4

8

32

27

77

40 53

57 48

20

1990

51 14

7

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

60

28

Rural

2012

48

74

0

8

5

20

50

1990

2012 Total

2

(2011)

ODA to maternal and neonatal health per live birth (US$)

6

(2011)

5 5

60 2 1 7

36

18

ODA to child health per child (US$)

Note: See annexes for additional information on the indicators above

9

3 5

65 90

7

No Data

External sources General government expenditure Out-of-pocket expenditure Other

12

17

40

20

26

17

100 80

67

60

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

46

41

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

100 3

Percent

4 (R,F)

National availability of Emergency Obstetric Care services

WATER AND SANITATION

0

Legal status of abortion (X of 5 circumstances)

FINANCING

1992-1993 NFHS

80

No

(X of 7 tasks)

Other 5%

Measles 2%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent Midwives authorized for specific tasks

Other direct 8%

Asphyxia* 11%

Injuries 3%

Regional estimates for Southern Asia, 2013

1990

2012 Urban

25

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

111

Fulfilling the Health Agenda for Women and Children The 2014 Report

Indonesia DEMOGRAPHICS Total population (000)

246,864

(2012)

24,622

(2012)

4,736

(2012)

67 152

(2012)

Neonatal deaths: % of all under-5 deaths

48

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

15 26

(2012)

60

(2012)

Stillbirth rate (per 1000 total births)

40

15

(2009)

8,800

(2013)

Lifetime risk of maternal death (1 in N)

220

(2013)

Total fertility rate (per woman)

2.4

(2012)

47

(2009)

Total under-five population (000) Births (000) Birth registration (%) Total under-five deaths (000)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

100

Deaths per 100,000 live births

500

84

80

430

400 300 31

28

20

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

190

200

110

100

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 84

*Postnatal care

80

88 83

Exclusive breastfeeding

42

100

Pre-pregnancy Pregnancy Birth

Neonatal period

80

40

0

20 40 60 80 100

Source: DHS, MICS, Other NS

20

43

20

80 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

37

32

Percent

1991 DHS

1994 DHS

1997 DHS

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

83

79

66

60

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2002-2003 DHS

2007 DHS

15 10 5 0

2012 DHS

2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

80 64

Percent

60

40

Percent

80

Skilled attendant at delivery

20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

12

(2010)

9

(2007)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

1991 DHS

1994 DHS

69

61

75

66

39

40 20 0 1997 2002-2003 2007 DHS DHS DHS

2012 DHS

(2010)

Vitamin A two dose coverage (%)

(2012)

73

(2007)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80 48

30

20 0

63

100

60

40

64

Early initiation of breastfeeding (within 1 hr of birth, %) 29 Introduction of solid, semi-solid/soft foods (%) 85

80

Percent

100 80 60

2012 2010

1995 MICS

40

42

39

23

20

19

2001 Other NS

2007 Other NS

2010 Other NS

Percent

Measles Vitamin A (past 6 months)

112

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

Source: DHS 2012

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

60

63

40

45

37

1991 DHS

1994 DHS

42

40

32

42

20 0

1987 DHS

1997 2002-2003 2007 DHS DHS DHS

2012 DHS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Indonesia DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

1%

15%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 18%

Other 18%

Neonatal death: 48%

Abortion 7%

Embolism 12%

Other direct 14%

Asphyxia* 10% Other 5%

Malaria 2%

Congenital 7%

Indirect 17%

Sepsis** 6%

Measles 4%

Hypertension 15%

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

76

80 Percent

82

96

93

92

89

Demand for family planning satisfied (%)

84

(2012)

Antenatal care (4 or more visits, %)

88

(2012)

-

-

12, 17, 8

(2012)

Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

85

(2012)

40

Postnatal visit for baby

48

(2012)

Postnatal visit for mother

80

(2012)

-

-

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1991 DHS

1994 DHS

1997 DHS

2002-2003 DHS

2007 DHS

2012 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

61

56

43

43

1991 DHS

2000 MICS

61

54

36

2002-2003 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

39

35

2007 DHS

-

24

60

64

65

25

21

9

1990

4

31

20

68

59

20

0

8

61

40 61

3

Total

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

No

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

8

Rural

2012

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

2

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

15.9

(2012)

-

-

150

(2012)

7

(2012)

45

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100 80 40

22 9

60 18

10

19

14

12

6 9

8

31

49 12 11

21

40 7

20

32

2

2012

No

Per capita total expenditure on health (Int$) 2007 DHS

Percent

Percent

80

0 7

1 9

Maternity protection (Convention 183)

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

-

(2013)

FINANCING

2012 DHS

Improved drinking water coverage 2 13

1 (R,F)

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100 6

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

No

(X of 7 tasks)

0% 6% Diarrhoea

* Intrapartum-related events

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent Midwives authorized for specific tasks

Haemorrhage 30%

HIV/AIDS 1%

Injuries 7%

Sepsis 6%

Regional estimates for South-eastern Asia, 2013

59

61

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

3

(2011)

ODA to maternal and neonatal health per live birth (US$)

7

(2011)

Note: See annexes for additional information on the indicators above

71

6

35

46

24

0

1990

2012 Total

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

113

Fulfilling the Health Agenda for Women and Children The 2014 Report

Iraq DEMOGRAPHICS Total population (000)

32,778

(2012)

Total under-five population (000)

4,824

(2012)

Births (000)

1,037

(2012)

Birth registration (%) Total under-five deaths (000)

99 35

(2011)

Neonatal deaths: % of all under-5 deaths

56

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

19 28

(2012)

9

(2009)

710

(2013)

Lifetime risk of maternal death (1 in N)

340

(2013)

Total fertility rate (per woman)

4.1

(2012)

68

(2006)

Stillbirth rate (per 1000 total births) Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

60

Deaths per 100,000 live births

120

53

45

110

90

34

30

67

60 18

15

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

30

28

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 87 50 91

*Postnatal care Exclusive breastfeeding

Neonatal period

20

100

Pre-pregnancy Pregnancy Birth

0

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

91

80

72

60

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

54

40

No Data

20

69

0

20 40 60 80 100

Source: DHS, MICS, Other NS

89

80

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

1989 Other NS

2000 MICS

2006 MICS

2006-2007 Other NS

2011 MICS

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

69 69

Percent

60

46 31

40 20

Early initiation of breastfeeding

Percent

80

Skilled attendant at delivery

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

100 80 60

76

2000 MICS

7

(2011)

13

(2011)

82

82

2006 MICS

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

100 80

60

40 20 0

-

Percent of infants <6 months exclusively breastfed

80

Percent

2011 MICS

Exclusive breastfeeding

28 10 1991 Other NS

34

28 13 2000 MICS

10 2003 Other NS

28

23

7

9

2006 MICS

2011 MICS

Percent

Careseeking for pneumonia

67

Early initiation of breastfeeding (within 1 hr of birth, %) 43 Introduction of solid, semi-solid/soft foods (%) 36 Vitamin A two dose coverage (%)

ORT & continued feeding

74

40 20 0

2012 2010

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

114

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

Source: MICS 2011

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

60 40 20 0

12 2000 MICS

25

20

2006 MICS

2011 MICS

(2011) (2011) -

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Iraq DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 13%

2%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 18%

Other 18%

Neonatal death: 56%

HIV/AIDS 0%

Sepsis 5% Abortion 3%

Embolism 9%

Other direct 16%

Asphyxia* 14%

Malaria 0%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Western Asia, 2013

Injuries 6%

Indirect 23%

Congenital 10% 6% 0% Diarrhoea

* Intrapartum-related events

Hypertension 13%

Sepsis** 10% Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

80

78

84

77

78

Demand for family planning satisfied (%)

87

(2011)

Antenatal care (4 or more visits, %)

50

(2011)

-

-

22, 25, 16

(2011)

85

(2012)

Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1996 Other NS

2000 MICS

2006 MICS

2011 MICS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

-

31

Very limited risk

26 23

2006 MICS

95 74

15 84

13

60

56

Total

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

100 6 80

29

2012

Percent of population by type of sanitation facility, 1995-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

22

10

20

1990

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

No

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

6.1

(2010)

-

-

149

(2012)

4

(2012)

46

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

40

0 5 10

13 9

Rural

0

30 11

7 11

0 10

19

8 29

5 85

72

82

(2013)

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

6

(2011)

ODA to maternal and neonatal health per live birth (US$)

7

(2011)

Note: See annexes for additional information on the indicators above

86

82 47

20 0

2012

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Percent

9 46

60

0

Yes

Postnatal home visits in the first week after birth

Out of pocket expenditure as % of total expenditure on health(%)

1 5 10

2 03

11

40 75

Maternal deaths notification

General government expenditure on health as % of total government expenditure (%)

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 4 11

No

Per capita total expenditure on health (Int$)

2011 MICS

Improved drinking water coverage

15 7 80 3

Maternity protection (Convention 183)

FINANCING

WATER AND SANITATION

100

-

National availability of Emergency Obstetric Care services

64

2000 MICS

1

(% of recommended minimum)

54 27

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks (X of 7 tasks)

Haemorrhage 31%

Other 3%

Measles 0%

Partial

1995

2012 Total

1995

2012 Urban

1995

2012 Rural

Source: WHO/UNICEF JMP 2014

115

Fulfilling the Health Agenda for Women and Children The 2014 Report

Kenya DEMOGRAPHICS Total population (000)

43,178

(2012)

Total under-five population (000)

6,956

(2012)

Births (000)

1,535

(2012)

60 108

(2008-2009)

Neonatal deaths: % of all under-5 deaths

37

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

27 49

(2012)

Birth registration (%) Total under-five deaths (000)

Stillbirth rate (per 1000 total births)

(2012)

(2012)

22

(2009)

6,300

(2013)

Lifetime risk of maternal death (1 in N)

53

(2013)

Total fertility rate (per woman)

4.5

(2012)

Adolescent birth rate (per 1000 girls)

106

(2006)

Total maternal deaths

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

120

600

98

90

490 400

450

73

60

300

33

30

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

150

120

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 64

44

*Postnatal care

Birth

42

Exclusive breastfeeding

Neonatal period

32

Measles

50

45

40

0

20 40 60 80 100

Source: DHS, MICS, Other NS

60

44

42

Percent

80

44

20

93 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

58 (2012)

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

47

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1989 DHS

1993 DHS

1998 DHS

2003 DHS

2008-2009 DHS

66

60 Percent

Coverage along the continuum of care

53

42

40 20

0

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 Percent

Skilled attendant at delivery

60

40

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

100 80 60

7

(2008-2009)

8

(2008-2009)

56

49

57

52

40 20 0

1998 DHS

2003 DHS

Percent of children <5 years who are moderately or severely: underweight stunted

40

40 20 0

(2012)

80

60 20

1993 DHS

41

37 18 1998 DHS

18

2000 MICS

36 17

2003 DHS

35

16

2008-2009 DHS

Percent

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

66

100

80

Percent

(2008-2009)

Percent of infants <6 months exclusively breastfed

100

0 10 20 30 40 50 60 70 80 90 100

Source: DHS 2008-2009

(2008-2009)

Exclusive breastfeeding

Underweight and stunting prevalence

Careseeking for pneumonia

2008-2009 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 58 Introduction of solid, semi-solid/soft foods (%) 85 Vitamin A two dose coverage (%)

ORT & continued feeding

50

22 1993 DHS

2012 2010

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

116

93 83 82 83

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

60 40 20 0

32

23 12 1989 DHS

1993 DHS

12

13

1998 DHS

2003 DHS

2008-2009 DHS

Imp

Fulfilling the Health Agenda for Women and Children The 2014 Report

Kenya DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

Preterm 10%

2%

15%

Other 22%

Globally nearly half of child deaths are attributable to undernutrition

Neonatal death: 37%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Asphyxia* 12%

Haemorrhage 25%

Congenital 3%

HIV/AIDS 4%

Sepsis** 7%

Malaria 4%

Hypertension 16%

0% 10% Diarrhoea

Injuries 6% Measles 0%

Indirect 29%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

95

100

77

80 Percent

92

92

88

76

Demand for family planning satisfied (%)

64

(2008-2009)

Antenatal care (4 or more visits, %)

47

(2008-2009)

Malaria during pregnancy - intermittent preventive treatment (%)

15

(2008-2009)

6, 11, 5

(2008-2009)

73

(2012)

-

-

42

(2008-2009)

-

-

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

(within 2 days for home births, %)

20

Postnatal visit for mother

0

(within 2 days for home births, %) 1989 DHS

1993 DHS

1998 DHS

2000 MICS

2003 DHS

2008-2009 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

39

37

32

15

1993 DHS

1998 DHS

2000 MICS

33 29

2003 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

43 39

34 (2008-2009)

3

2003 DHS

2008-2009 DHS

60

15

20

0

25

1990

42 44

20

Total

2012

Source: WHO/UNICEF JMP 2014

16

18 56

18

29

38

42

40

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

23

Urban

2012 1990

13

36

31

60

3

3

31

18

13

Rural

2012

48

40

40 20

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

-

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

-

-

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

3 -

-

Newborn health (X of 4) Child health (X of 3)

1 -

(2013)

9.7

(2011)

-

-

84

(2012)

6

(2012)

48

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

-

General government expenditure on health as % of total government expenditure (%)

30

25

0

1990

2012 Total

22

17

38

35

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

23

(2011)

ODA to maternal and neonatal health per live birth (US$)

27

(2011)

19

16 26

No Data

Note: See annexes for additional information on the indicators above

26

20

10

1990

19

80

49

16

Maternal deaths notification

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage 100

5 13

36

No

Per capita total expenditure on health (Int$)

5

2000 MICS

Percent

Percent

80 41

Maternity protection (Convention 183)

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 4 4

7

FINANCING

47

2008-2009 DHS

Improved drinking water coverage

23

3

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

-

(X of 7 tasks)

Other direct 9%

Other 2%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

31

1990

2012 Urban

29

24

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

117

Fulfilling the Health Agenda for Women and Children The 2014 Report

Korea,

Democratic People’s Republic of

DEMOGRAPHICS Total population (000)

24,763

(2012)

1,690

(2012)

Births (000)

356

(2012)

Birth registration (%) Total under-five deaths (000)

100 10

(2009)

Neonatal deaths: % of all under-5 deaths

54

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

16 23

(2012)

60

(2012)

Stillbirth rate (per 1000 total births)

40

13

(2009)

310

(2013)

Lifetime risk of maternal death (1 in N)

630

(2013)

Total fertility rate (per woman)

2.0

(2012)

1

(2008)

Total under-five population (000)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

100

125

80

100

85

87

75

44 29

50

20

15

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

25

21

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 83 94

Exclusive breastfeeding Measles

Birth

Neonatal period

65

100

Pre-pregnancy Pregnancy

100

*Postnatal care

0

97

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

97

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80 60 40

Infancy

No Data

20

99

0

20 40 60 80 100

Source: DHS, MICS, Other NS

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

2000 MICS

Percent

2004 Other NS

2009 MICS

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Percent

60

40

32

20 0

No Data

1990

1995

100 80 60

80

88

40 20 0 2004 Other NS

2012 2010

2005

93

2009 MICS

NUTRITION

DTP3 Measles

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months) ORT & continued feeding

4

(2012)

6

(2009)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

60

56

Vitamin A two dose coverage (%)

(2012)

99

Percent of infants <6 months exclusively breastfed

80

64

40

51 25

20 0

(2009)

100

80

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 18 Introduction of solid, semi-solid/soft foods (%) 31

Exclusive breastfeeding

Underweight and stunting prevalence

Careseeking for pneumonia

118

2000

1998 Other NS

2000 MICS

43 21

2004 Other NS

19

32

2009 MICS

15

28

2012 Other NS

Percent

ITN use among children <5 yrs

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

99 96

80

Skilled attendant at delivery

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

Antenatal care (4+ visits)

Early initiation of breastfeeding

Immunization

Percent

EQUITY

65

60 40 20 0

2004 Other NS

(2004)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Korea,

Democratic People’s Republic of

DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 1% 15%

Preterm 20%

Other 18%

Other direct 14%

Embolism 12%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Eastern Asia, 2013

Legal status of abortion (X of 5 circumstances)

HIV/AIDS 0%

Malaria 0%

Sepsis** 6%

0%

Diarrhoea

* Intrapartum-related events

Maternal deaths notification

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

83

Antenatal care (4 or more visits, %)

94

(2009)

-

-

13, 15, 9

(2009)

93

(2012)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

100

97

100

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

2000 MICS

2009 MICS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

-

WATER AND SANITATION Improved drinking water coverage

Percent of population by type of drinking water source, 2012 Piped on premises Other improved Surface water Unimproved 51

Percent

80

3 17

89

94

80

Percent of population by type of sanitation facility, 1995-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100 0 80

0 13

44

5

Source: WHO/UNICEF JMP 2014

Urban

Rural

39

06 6

0

0 24

50

3

2

International Code of Marketing of Breastmilk Substitutes

No

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

-

-

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

-

-

-

-

Newborn health (X of 4) Child health (X of 3)

-

-

74.1

(2003)

-

-

Per capita total expenditure on health (Int$)

-

-

General government expenditure on health as % of total government expenditure (%)

-

-

Out of pocket expenditure as % of total expenditure on health(%)

-

-

Density of doctors, nurses and midwives (per 10,000 population)

-

57

53

1995

2012

Total

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

3

(2011)

ODA to maternal and neonatal health per live birth (US$)

5

(2011)

Note: See annexes for additional information on the indicators above

88

82

0

Total

0

4

40 20

20 0

-

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

60 3

60 40

Antenatal corticosteroids as part of management of preterm labour

FINANCING Very limited risk

2 9

-

(% of recommended minimum)

2009 MICS

100

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

National availability of Emergency Obstetric Care services

74

67

No

Postnatal home visits in the first week after birth

Hypertension 10%

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Antenatal care

-

Maternity protection (Convention 183)

Haemorrhage 36%

Indirect 25%

Congenital 9%

6%

5 (R,F)

(X of 7 tasks)

Other 7%

Injuries 7%

-

Midwives authorized for specific tasks

Asphyxia* 10%

Neonatal death: 54%

Measles 0%

Sepsis 3% Abortion 1%

Globally nearly half of child deaths are attributable to undernutrition

73 48

1995

2012 Urban

1995

2012 Rural

Source: WHO/UNICEF JMP 2014

119

Fulfilling the Health Agenda for Women and Children The 2014 Report

Kyrgyzstan DEMOGRAPHICS Total population (000)

5,474

(2012)

Total under-five population (000)

659

(2012)

Births (000)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

148

(2012)

Birth registration (%) Total under-five deaths (000)

96 4

(2006)

Neonatal deaths: % of all under-5 deaths

54

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

14 24

(2012)

60

90

(2012)

Stillbirth rate (per 1000 total births)

40

60

10

(2009)

110

(2013)

Lifetime risk of maternal death (1 in N)

390

(2013)

Total fertility rate (per woman)

3.1

(2012)

41

(2011)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

100

150

80

120

71

27

24

20

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

85 75

30

21

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 67

99

Exclusive breastfeeding

Birth

Neonatal period

32

0

100 80

40

20

60 40 20

0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

60

98

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

99

98

80

Infancy

Measles

98

100

Pre-pregnancy Pregnancy

*Postnatal care

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1997 DHS

Percent

2006 MICS

0

2012 DHS

2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine 98 100 96 96

Percent

60

Percent

Skilled attendant at delivery

40 20

Early initiation of breastfeeding

100 80 60 40 20

1990

1995

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

48

62

45

0

0

ITN use among children <5 yrs

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

1997 DHS

2012 2010

3

(2012)

5

(2006)

2006 MICS

Early initiation of breastfeeding (within 1 hr of birth, %) 65 Introduction of solid, semi-solid/soft foods (%) 60 Vitamin A two dose coverage (%)

ORT & continued feeding

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Percent of infants <6 months exclusively breastfed

100

80

Percent

80

60

36

40 20 0

-

Exclusive breastfeeding

10 1997 DHS

18 3 2006 MICS

Percent

Careseeking for pneumonia

120

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

80

Antenatal care (4+ visits)

Source: MICS 2006

Pneumonia treatment

23 5 2009 Other NS

3

18

2012 DHS

60 40 20 0

24

1997 DHS

32

2006 MICS

(2006) (2006) -

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Kyrgyzstan DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 2% 12%

Preterm 16%

Other 21%

Neonatal death: 54%

Globally nearly half of child deaths are attributable to undernutrition

Sepsis 9%

Embolism 11%

Abortion 5%

Other direct 17%

Asphyxia* 12%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Caucasus and Central Asia, 2013

Legal status of abortion (X of 5 circumstances)

Maternity protection (Convention 183)

Other 4%

6% 0% Diarrhoea

* Intrapartum-related events

Sepsis** 8%

Congenital 13%

Hypertension 15%

Indirect 22%

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care 97

100

97

97

Antenatal care (4 or more visits, %)

-

-

Malaria during pregnancy - intermittent preventive treatment (%)

-

-

6, 7, 6

(1997)

C-section rate (total, urban, rural; %)

80 Percent

67

(2012)

Demand for family planning satisfied (%)

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

-

-

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

6

(2012)

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1997 DHS

2006 MICS

2012 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

-

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

-

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

-

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

-

-

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

-

-

-

-

Newborn health (X of 4) Child health (X of 3)

-

-

80.9

(2012)

-

-

175

(2012)

General government expenditure on health as % of total government expenditure (%)

12

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

35

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

National availability of Emergency Obstetric Care services

-

(% of recommended minimum)

35

22 20

2006 MICS

Per capita total expenditure on health (Int$)

Very limited risk

2012 DHS

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

100

9 3

20 7

2 2

0 3 10

17

34

87

79

46

36

54

20 44

36

23

0

1990

30 11

60 29

40

15 3

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities 0 35

100 4 0 5

Rural

10 7

0 1 7

1 5 3

3

5

0

80

60

92

91

92

92

92

91

40

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

22

(2011)

ODA to maternal and neonatal health per live birth (US$)

38

(2011)

Note: See annexes for additional information on the indicators above

20 0

2012

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Improved drinking water coverage

Percent

Partial

FINANCING 40

1997 DHS

80

-

(X of 7 tasks)

Injuries 7% Measles 0%

5 (R,F)

Midwives authorized for specific tasks

Haemorrhage 23%

HIV/AIDS 0% Malaria 0%

-

1990

2012 Total

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

121

Fulfilling the Health Agenda for Women and Children The 2014 Report

Lao

People’s Democratic Republic

DEMOGRAPHICS Total population (000)

6,646

(2012)

Total under-five population (000)

889

(2012)

Births (000)

181

(2012)

Birth registration (%) Total under-five deaths (000)

75 14

(2011-2012)

Neonatal deaths: % of all under-5 deaths

38

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

27 54

(2012)

Stillbirth rate (per 1000 total births)

(2012)

(2012)

14

(2009)

Total maternal deaths

400

(2013)

Lifetime risk of maternal death (1 in N)

130

(2013)

Total fertility rate (per woman)

3.1

(2012)

94

(2010)

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

1200

163

1100

900

150 100

600

72

50

54

300

MDG Target

0 1990

1995

2000

2005

2010

0 1990

2015

Source: IGME 2013

220

280

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

37

*Postnatal care

40

71

42

Exclusive breastfeeding

Neonatal period

26

Measles

60

Source: DHS, MICS, Other NS

19

20 0

20 40 60 80 100

30

42

40

72 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

15

2000 MICS

Percent

2005 Other NS

Percent

Coverage along the continuum of care

20

2006 MICS

2011-2012 MICS

20 10 0

2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

79 79 72

80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

40

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

7

(2006) (2011-2012)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

2006 MICS

2011-2012 MICS

(2006)

Vitamin A two dose coverage (%)

(2012)

47

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80

54 40

48

53

36

36

32

48

20 0

32

100

60

40

36

Early initiation of breastfeeding (within 1 hr of birth, %) 30 Introduction of solid, semi-solid/soft foods (%) 41

80

Percent

Percent

Source: MICS 2011-2012

40 20 0

54 57

52

2000 MICS

15

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

Percent

Measles Vitamin A (past 6 months)

122

Pneumonia treatment

Percent

EQUITY

60 40 20

1993 Other NS

1994 Other NS

2000 Other NS

2006 MICS

0

23

26

2000 MICS

2006 MICS

(2006)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Lao

People’s Democratic Republic

DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

Preterm 10%

2%

18%

Asphyxia* 12%

Neonatal death: 38%

Other 24%

Globally nearly half of child deaths are attributable to undernutrition

Abortion 7%

Sepsis 6%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for South-eastern Asia, 2013

Embolism 12%

Other direct 14%

Other 3%

Haemorrhage 30%

Sepsis** 7% Indirect 17%

Malaria 1% Injuries 7% Measles 0%

0% 12% Diarrhoea

Hypertension 15%

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

71

Antenatal care (4 or more visits, %)

37

(2011-2012)

1

(2006)

4, 10, 2

(2011-2012)

C-section rate (total, urban, rural; %)

80 54

60

Percent

Demand for family planning satisfied (%)

(2011-2012)

Malaria during pregnancy - intermittent preventive treatment (%)

100

40

35

29

27

0

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

80

(2012)

Postnatal visit for baby

41

(2011-2012)

Postnatal visit for mother

40

(2011-2012)

-

-

(within 2 days for home births, %)

20

(within 2 days for home births, %)

2000 MICS

2005 Other NS

2006 MICS

2011-2012 MICS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

57

49 46 37 32

2000 MICS

2006 MICS

42

11 (2011-2012)

2000 MICS

43

21

Percent

24

10

2006 MICS

2011-2012 MICS

47 60

20

0

59

6

Source: WHO/UNICEF JMP 2014

100

Urban

Rural

29

80

60 40

20

25

Total

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

0

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

-

-

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

10.6

(2012)

46

(2011)

84

(2012)

6

(2012)

38

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1995-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

25

60 40

Maternal deaths notification

Per capita total expenditure on health (Int$)

Improved sanitation coverage

Percent

80

No

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 2012 Piped on premises Other improved Surface water Unimproved 1 15

Maternity protection (Convention 183)

(2013)

FINANCING

41 18

2011-2012 MICS

Improved drinking water coverage

7

7

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

2

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks (X of 7 tasks)

Congenital 3%

HIV/AIDS 0%

Partial

4 2

69

26

4 2 4

9 3

42

78

7 1

90

10 1

65

62

1995

2012 Total

1995

2012 Urban

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

21

(2011)

ODA to maternal and neonatal health per live birth (US$)

36

(2011)

Note: See annexes for additional information on the indicators above

50

10 0 12

20

No Data

1995

2012 Rural

Source: WHO/UNICEF JMP 2014

123

Fulfilling the Health Agenda for Women and Children The 2014 Report

Lesotho DEMOGRAPHICS Total population (000)

2,052

(2012)

260

(2012)

Births (000)

57

(2012)

Birth registration (%) Total under-five deaths (000)

45 6

(2009)

Neonatal deaths: % of all under-5 deaths

46

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

45 74

(2012)

90

(2012)

Stillbirth rate (per 1000 total births)

60

25

(2009)

280

(2013)

Lifetime risk of maternal death (1 in N)

64

(2013)

Total fertility rate (per woman)

3.1

(2012)

92

(2007)

Total under-five population (000)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

150

750

120

600

100

85

720 490

450 300 28

30

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

180

150 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 67

62

*Postnatal care

48

Exclusive breastfeeding

54

Measles

Birth

Neonatal period

80

Infancy

55

60

40

0

20 40 60 80 100

Source: DHS, MICS, Other NS

61

60

1993 MoH

Percent

2000 MICS

2004 DHS

50 (2012)

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

62

20

85 0

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

70

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2009 DHS

100 80 60 40 20 0

77

64

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

58

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

100 Percent

Skilled attendant at delivery

60

40 20

Early initiation of breastfeeding

0 1990

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

100 80 60

2000 MICS

4

(2009)

11

(2009)

66

59

49

40 20 0

2012 2010

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

2004 DHS

2009 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 53 Introduction of solid, semi-solid/soft foods (%) 68 Vitamin A two dose coverage (%)

Percent of children <5 years who are moderately or severely: underweight stunted

100

80 Percent

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Percent of infants <6 months exclusively breastfed

100

0 10 20 30 40 50 60 70 80 90 100

80

53

60 39

40 20 0

-

Exclusive breastfeeding

Underweight and stunting prevalence

Careseeking for pneumonia

14 1992 Other NS

45

38 19

1993 Other NS

15 2000 MICS

17

2004 DHS

39 14 2009 DHS

Percent

ORT & continued feeding

124

1995

ITN use among children <5 yrs

Source: DHS 2009

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

85 83 83

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

EQUITY

54

60

36

40 20 0

16

15

1996 MICS

2000 MICS

2004 DHS

2009 DHS

(2009) (2009) -

Impr

Fulfilling the Health Agenda for Women and Children The 2014 Report

Lesotho DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

10%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 15%

3%

Other 14%

Neonatal death: 46%

Sepsis 10%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Haemorrhage 25%

Other 2%

HIV/AIDS 19%

Hypertension 16%

Congenital 3% Malaria 0%

Sepsis** 9%

Indirect 29%

0% 7% Diarrhoea

Injuries 4% Measles 1%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

91

100

88

85

67

Antenatal care (4 or more visits, %)

70

(2009)

-

-

7, 11, 5

(2009)

83

(2012)

-

-

48

(2009)

4

(2009)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(2009)

Malaria during pregnancy - intermittent preventive treatment (%)

92

90

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

(within 2 days for home births, %)

20

Postnatal visit for mother

0

(within 2 days for home births, %)

1993 Other NS

1995 Other NS

2000 MICS

2004 DHS

2009 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

53

54

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

-

2004 DHS

2009 DHS

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 20

0 7

7

27

2

1

Percent of population by type of sanitation facility, 1995-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100

22

23

80 49

67

60

59 73

40 72

22

6

1990

73

66

20

0

0

2012

Source: WHO/UNICEF JMP 2014

34

60 40

1990 Urban

2012 1990

4

Rural

2012

12

5

21

24

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

No

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

2

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

6.7

(2003)

29

(2004)

227

(2012)

General government expenditure on health as % of total government expenditure (%)

14

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

15

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

23

20 8

13

23

30

0

1995

2012 Total

34

32

24

21 35

37

2012 Urban

ODA to child health per child (US$)

52

(2011)

ODA to maternal and neonatal health per live birth (US$)

89

(2011)

Note: See annexes for additional information on the indicators above

4

3

27

20

1995

No Data

External sources General government expenditure Out-of-pocket expenditure Other 45

56

20

26

2

Total

No

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Percent

80

18

Maternity protection (Convention 183)

Per capita total expenditure on health (Int$)

Very limited risk

Improved drinking water coverage 1

4

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100 2

Midwives authorized for specific tasks

FINANCING

29

2000 MICS

1

(% of recommended minimum)

48 51

42

Legal status of abortion (X of 5 circumstances) (X of 7 tasks)

Other direct 9%

Asphyxia* 14%

Partial

1995

2012 Rural

Source: WHO/UNICEF JMP 2014

125

Fulfilling the Health Agenda for Women and Children The 2014 Report

Liberia DEMOGRAPHICS Total population (000)

4,190

(2012)

Total under-five population (000)

678

(2012)

Births (000)

150

(2012)

Birth registration (%) Total under-five deaths (000)

4 11

(2007)

Neonatal deaths: % of all under-5 deaths

36

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Stillbirth rate (per 1000 total births)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

248

250

2000

200

1600

27 56

(2012)

150

1200

(2012)

100

27

(2009)

980

(2013)

31

(2013)

Total fertility rate (per woman)

4.9

(2012)

Adolescent birth rate (per 1000 girls)

149

(2011)

Total maternal deaths Lifetime risk of maternal death (1 in N)

83

75

50 MDG Target

0 1990

1995

2000

2005

2010

800

640

400

300

0 1990

2015

Source: IGME 2013

1200

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 24 66 46

*Postnatal care

60

Exclusive breastfeeding

Neonatal period

34

0

58

60

51

46

40

No Data

20

80

0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

Measles

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1986 DHS

Percent

1999-2000 DHS

2007 DHS

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

40 0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

3

(2010) (2007)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

(2007)

Vitamin A two dose coverage (%)

(2012)

20 0

13

-

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100 80

60

40

40 20 0

Early initiation of breastfeeding (within 1 hr of birth, %) 67 Introduction of solid, semi-solid/soft foods (%) -

80

Percent

62

2007 DHS

14

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

2005

45 23

1999-2000 Other NS

42

39

20

2007 DHS

15 2010 Other NS

Percent

Measles Vitamin A (past 6 months)

Source: DHS 2007

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

20

Early initiation of breastfeeding

126

80 77 77

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

60 40 20 0

35

29

34

1999-2000 Other NS

2007 DHS

2010 Other NS

12 1986 DHS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Liberia DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

Preterm 9%

2%

12%

Globally nearly half of child deaths are attributable to undernutrition

Other 16%

Neonatal death: 35%

Sepsis 10%

Embolism 2%

Abortion 10%

HIV/AIDS 1%

Legal status of abortion (X of 5 circumstances)

Haemorrhage 25%

Asphyxia* 12% Other 2%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

Hypertension 16%

0% 8% Diarrhoea

Injuries 5%

Indirect 29%

Source: WHO 2014

Measles 1%

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

84

83

79

Percent

80

Demand for family planning satisfied (%)

24

(2007)

Antenatal care (4 or more visits, %)

66

(2007)

Malaria during pregnancy - intermittent preventive treatment (%)

48

(2013)

4, 5, 3

(2007)

91

(2012)

-

-

60

(2007)

-

-

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

(within 2 days for home births, %)

20 0

Postnatal visit for mother

(within 2 days for home births, %)

1986 DHS

1999-2000 DHS

2007 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

53

47

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

7 1986 DHS

43 (2013)

Percent of population by type of drinking water source, 2012 Piped on premises Other improved Surface water Unimproved

100 80

13

1 12

12

37

2009 Other NS

2011 Other NS

40

71

81 62

40

4

6

1

Total

Urban

Rural

Source: WHO/UNICEF JMP 2014

26 17 13

Yes

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

No

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

2

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

2 3

(2013)

2.9

(2008)

27

(2011)

102

(2012)

General government expenditure on health as % of total government expenditure (%)

19

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

21

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

Total

Partially available

ODA to child health per child (US$) 67

ODA to maternal and neonatal health per live birth (US$)

98

(2011)

118

(2011)

Note: See annexes for additional information on the indicators above

29 8

23

17

0

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

External sources General government expenditure Out-of-pocket expenditure Other

47

60

20

20 0

Percent

Percent

13

Yes

Reproductive, maternal, newborn and child health expenditure by source

100

60

Yes

Postnatal home visits in the first week after birth

Per capita total expenditure on health (Int$)

26

Percent of population by type of sanitation facility, 2012 Improved facilities Shared facilities Open defecation Unimproved facilities

80

Maternal deaths notification

FINANCING

Improved sanitation coverage

24

No

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Maternity protection (Convention 183)

(% of recommended minimum)

100 80 60 40 20 0

2007 DHS

7

(X of 7 tasks)

Sepsis** 7%

Malaria 21%

3 (R,F)

Midwives authorized for specific tasks

Other direct 9%

Congenital 3%

Partial

28

19

Urban

Rural

6

Source: WHO/UNICEF JMP 2014

127

Fulfilling the Health Agenda for Women and Children The 2014 Report

Madagascar DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

22,294

(2012)

3,529

(2012)

781

(2012)

Birth registration (%) Total under-five deaths (000)

80 44

(2008-2009)

Neonatal deaths: % of all under-5 deaths

38

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

22 41

(2012)

Stillbirth rate (per 1000 total births)

21

(2009)

3,500

(2013)

Lifetime risk of maternal death (1 in N)

47

(2013)

Total fertility rate (per woman)

4.5

(2012)

Adolescent birth rate (per 1000 girls)

147

(2006)

Total maternal deaths

(2012)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

800 159

150

740

600

100

440

400 58

50

53

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

200

190 MDG Target

0 1990

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

44

*Postnatal care

46

Exclusive breastfeeding

51

68 49

Measles

Neonatal period

47

46

51

10

44

40

8

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

57

60

69 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

6 4 2

1992 DHS

1997 DHS

2000 MICS

2003-2004 2008-2009 DHS DHS

0

2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

86 86 69

80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

40

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100 80 60

20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

40 20 0

2012 2010

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

15

(2003-2004)

16

(2008-2009)

47

42 20 1992 DHS

48

37

1997 DHS

2000 MICS

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Early initiation of breastfeeding (within 1 hr of birth, %) 72 Introduction of solid, semi-solid/soft foods (%) 86

0 10 20 30 40 50 60 70 80 90 100

100

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

61

60

40

88

(2012)

Percent of infants <6 months exclusively breastfed

36

30

80

58

55

38

37

53

49

20 0

(2008-2009)

100

80

Percent

Percent

Source: DHS 2008-2009

(2008-2009)

Exclusive breastfeeding

Percent

Careseeking for pneumonia

42

2003-2004 2008-2009 DHS DHS

Vitamin A two dose coverage (%)

ORT & continued feeding

128

Pneumonia treatment

Percent

EQUITY

67

60 40

38

48

41

1997 DHS

2000 MICS

51

20 1992 DHS

1995 MICS

1997 DHS

2003-2004 2008-2009 DHS DHS

0

1992 DHS

2003-2004 2008-2009 DHS DHS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Madagascar DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 2%

16%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 10% Asphyxia* 12%

Other 20%

Neonatal death: 38%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Haemorrhage 25%

Sepsis** 7%

Malaria 7% 10%

Injuries 7%

Measles 1%

Hypertension 16%

0% Diarrhoea

Indirect 29%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

78

Percent

80

77

86

80

71

Demand for family planning satisfied (%)

68

(2008-2009)

Antenatal care (4 or more visits, %)

49

(2008-2009)

Malaria during pregnancy - intermittent preventive treatment (%)

20

(2011)

2, 6, 1

(2008-2009)

78

(2012)

-

-

46

(2008-2009)

-

-

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

(within 2 days for home births, %)

20

Postnatal visit for mother

0

(within 2 days for home births, %)

1992 DHS

1997 DHS

2000 MICS

2003-2004 2008-2009 DHS DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

47 23

14

1992 DHS

1997 DHS

49

47 10

2000 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

17

12

19 (2011)

0 2000 MICS

2008-2009 DHS

2011 Other NS

29

Percent

80 41

15

21

50

20 22

0

23

7

1990

7

Total

2012

Source: WHO/UNICEF JMP 2014

27 35

43

1990 Urban

15

33

14

2

1

2012 1990

80

38

63

30

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100

11 11 50

60

40

12

Rural

2012

23 54

19

48

39 41

60

32

63

26

40 26

20 12

21

8

14

0

Maternal deaths notification

No

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

No

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

2

(2013)

2

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

4.8

(2007)

11

(2010)

Per capita total expenditure on health (Int$)

40

(2012)

General government expenditure on health as % of total government expenditure (%)

13

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

31

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

100

No

(2013)

FINANCING

46

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

-

National availability of Emergency Obstetric Care services 77

2003-2004 2008-2009 DHS DHS

Improved drinking water coverage

1

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks Maternity protection (Convention 183)

Congenital 4% HIV/AIDS 1%

-

(X of 7 tasks)

Other direct 9%

Other 2%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2012 Total

30

22 14

19

1990

2012 Urban

25

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

13

(2011)

ODA to maternal and neonatal health per live birth (US$)

19

(2011)

Note: See annexes for additional information on the indicators above

23 16

8 6

11

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

129

Fulfilling the Health Agenda for Women and Children The 2014 Report

Malawi DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

15,906

(2012)

2,859

(2012)

639

(2012)

Birth registration (%) Total under-five deaths (000)

43

(2012)

Neonatal deaths: % of all under-5 deaths

34

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

24 46

(2012)

Stillbirth rate (per 1000 total births)

-

(2012)

24

(2009)

3,400

(2013)

Lifetime risk of maternal death (1 in N)

34

(2013)

Total fertility rate (per woman)

5.5

(2012)

Adolescent birth rate (per 1000 girls)

157

(2008)

Total maternal deaths

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

300

1200 244

1100

900

225 150

510

600 71

75

81

300

MDG Target

0 1990

1995

2000

2005

2010

0 1990

2015

Source: IGME 2013

280 MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

46

*Postnatal care

43

64

Exclusive breastfeeding

Birth

Neonatal period

71

Measles

80

0

56

56

55

80

54

60

40

Infancy

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

71

60

90 Percent

86 (2012)

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

71

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1992 DHS

2000 DHS

2004 DHS

2006 MICS

26

20

0

2010 DHS

60

49

40

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent

60

40 20

Early initiation of breastfeeding

7

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

ORT & continued feeding

4

(2010)

14

(2010)

20 0

64

56

60

40

24

30

27

2000 DHS

70

52

2004 DHS

2006 MICS

2010 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 95 Introduction of solid, semi-solid/soft foods (%) 86

(2010)

Vitamin A two dose coverage (%)

(2012)

60

Percent of infants <6 months exclusively breastfed

100

80 Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

37

Exclusive breastfeeding

100

Percent

40 20 0

54

1992 DHS

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100 80 60

2012 2010

2005

Underweight and stunting prevalence

Careseeking for pneumonia

Source: DHS 2010

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

130

Percent

80

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

99 96 90 96

100

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

24

26

22

1992 1997-1998 2000 DHS Other NS DHS

71

80

55

53

53 18

2004 DHS

16

2006 MICS

48 14 2010 DHS

Percent

EQUITY

60 40

44

53

57

20 0

2000 DHS

2004 DHS

2006 MICS

2010 DHS

(2010)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Malawi DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 2% 11% Other 15%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 10%

Neonatal death: 34%

Embolism 2%

Sepsis 10% Abortion 10%

Haemorrhage 25%

Asphyxia* 10% Other 2%

Sepsis** 7%

8% Malaria 15%

Injuries 5%

* Intrapartum-related events

Diarrhoea

Hypertension 16%

0% Indirect 29%

Measles 1%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

92

91

90

100

95

92

Percent

Demand for family planning satisfied (%)

64

(2010)

Antenatal care (4 or more visits, %)

46

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

53

(2012)

5, 8, 4

(2010)

89

(2012)

-

-

43

(2010)

-

-

C-section rate (total, urban, rural; %)

80

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

(within 2 days for home births, %)

20

Postnatal visit for mother

0

(within 2 days for home births, %)

1992 DHS

2000 DHS

2004 DHS

2006 MICS

2010 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

54

51 48

61

55

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

69 48

27

32

1992 DHS

2000 DHS

2004 DHS

2006 MICS

91 (2012)

25

15

3 2000 DHS

39

2004 DHS

2006 MICS

2010 DHS

2012 Other NS

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 3 12

17

Percent

55

41

0

3 14

19

62

45

77

40

80

20 36

0

5

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100 80

80 60

3 5

37

35

8

6

1990

33

Total

2012

Source: WHO/UNICEF JMP 2014

Urban

2012 1990

3

Rural

2012

0

4

2

8 33

47 58 77

55

80

56

22

7

Maternity protection (Convention 183)

No

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

2

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

3.6

(2009)

32

(2010)

Per capita total expenditure on health (Int$)

83

(2012)

General government expenditure on health as % of total government expenditure (%)

18

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

13

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

FINANCING

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

37

(2011)

ODA to maternal and neonatal health per live birth (US$)

52

(2011)

Note: See annexes for additional information on the indicators above

18

20 6

1

1990

7

29

60 40

Midwives authorized for specific tasks

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

100

1

National availability of Emergency Obstetric Care services

56

2010 DHS

Improved drinking water coverage

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Partial

(X of 7 tasks)

Other direct 9%

Congenital 3%

HIV/AIDS 12%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

6 10

10

1990

2012 Total

27

22

1990

2012 Urban

4 8

4 7

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

131

Fulfilling the Health Agenda for Women and Children The 2014 Report

Mali DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

14,854

(2012)

2,865

(2012)

705

(2012)

Birth registration (%) Total under-five deaths (000)

81 83

(2010)

Neonatal deaths: % of all under-5 deaths

33

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

42 80

(2012)

Stillbirth rate (per 1000 total births)

23

(2009)

4,000

(2013)

Lifetime risk of maternal death (1 in N)

26

(2013)

Total fertility rate (per woman)

6.9

(2012)

Adolescent birth rate (per 1000 girls)

172

(2011)

Total maternal deaths

(2012)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

300

1200

253

1100

900

225

128

150

600

84

75

MDG Target

0 1990

1995

2000

2005

2010

280 MDG Target

0 1990

2015

Source: IGME 2013

550

300

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 23

56

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

20

Measles

60 40

0

20 40 60 80 100

Source: DHS, MICS, Other NS

40

32

56

49

41

40

20

59 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

35

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1987 DHS

1995-1996 DHS

2001 DHS

2006 DHS

30 20 10 0

2010 MICS

2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine 74 74 74 59

Percent

60

40

Percent

80

Skilled attendant at delivery

20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

9

(2010)

18

(2010)

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

2010 MICS

(2010)

Vitamin A two dose coverage (%)

(2012)

(2010)

93

Percent of infants <6 months exclusively breastfed

80

29

36

38 40

43

30

28

39

20 0

2006 DHS

100

60

40

2001 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 57 Introduction of solid, semi-solid/soft foods (%) 27

80

Percent

42 44

38

36

22

Exclusive breastfeeding

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

40 20 0

1995-1996 DHS

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

2005

1987 DHS

1995-1996 DHS

2001 DHS

2006 DHS

19

28

2010 MICS

Percent

Measles Vitamin A (past 6 months)

132

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

Source: DHS 2006

Pneumonia treatment

60 40 20 0

25 9

8

1987 DHS

1995-1996 DHS

2001 DHS

38 20

2006 DHS

2010 MICS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Mali DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

Preterm 11%

2%

14%

Asphyxia* 9%

Neonatal death: 34%

Other 20%

Globally nearly half of child deaths are attributable to undernutrition

Sepsis 10%

Embolism 2%

Legal status of abortion (X of 5 circumstances)

Abortion 10% Haemorrhage 25%

Other 3%

11%

Injuries 5%

Hypertension 16% Indirect 29%

Measles 1%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

75

70

80 60

57

47

40

Demand for family planning satisfied (%)

23

(2006)

Antenatal care (4 or more visits, %)

35

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

20

(2012-2013)

4, 8, 2

(2010)

89

(2012)

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

31

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1987 DHS

1995-1996 DHS

2001 DHS

2006 DHS

2010 MICS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

45

38

1995-1996 DHS

32 14

12

16

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2001 DHS

11

2006 DHS

19 (2012-2013)

27

2006 DHS

2010 Other NS

32

Percent

80 60

0 9

2 45

63

53

70

36 53

20

0

36

24 4

1990

17

14

Total

2012

Source: WHO/UNICEF JMP 2014

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100 80

44

55

40

2

10

1990 Urban

20 0

2012 1990

1

Rural

2012

60

29

13

5

4

26

23

46

0

37

18

38

36

43

58

47

40

20

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

No

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

3

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

5.1

(2010)

-

-

Per capita total expenditure on health (Int$)

74

(2012)

General government expenditure on health as % of total government expenditure (%)

13

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

61

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

1

100 9

No

Postnatal home visits in the first week after birth

(2013)

FINANCING

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

Maternal deaths notification

National availability of Emergency Obstetric Care services 70

2010 MICS

Improved drinking water coverage

Yes

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

7

Maternity protection (Convention 183)

0% Diarrhoea

1 (R)

(X of 7 tasks)

Sepsis** 7%

Malaria 14%

Yes

Midwives authorized for specific tasks

Other direct 9%

Congenital 2% HIV/AIDS 1%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

13

19

15

22

1990

2012 Total

33

35

1990

2012 Urban

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

29

(2011)

ODA to maternal and neonatal health per live birth (US$)

61

(2011)

Note: See annexes for additional information on the indicators above

9

6 10

15

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

133

Fulfilling the Health Agenda for Women and Children The 2014 Report

Mauritania DEMOGRAPHICS Total population (000)

3,796

(2012)

Total under-five population (000)

575

(2012)

Births (000)

Under-five mortality rate

131

(2012)

Birth registration (%) Total under-five deaths (000)

59 11

(2011)

Neonatal deaths: % of all under-5 deaths

40

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

34 65

(2012)

90

(2012)

Stillbirth rate (per 1000 total births)

60

27

(2009)

430

(2013)

Lifetime risk of maternal death (1 in N)

66

(2013)

Total fertility rate (per woman)

4.7

(2012)

88

(2001)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

Maternal mortality ratio

Deaths per 1000 live births

150

Deaths per 100,000 live births

750

128

120

630

600 84

450 43

30

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

320

300

160

150 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 20

65

*Postnatal care Exclusive breastfeeding

Neonatal period

46

Measles

Birth

80

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

20

40

40

75 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

65

61

57

60

Infancy

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

48

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1990-1991 Other NS

2000-2001 DHS

2007 MICS

15 10 5 0

2011 pMICS

2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

60

40

Percent

80 80 75

80

Skilled attendant at delivery

20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

12

(2012)

35

(2011)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

60

40 20 0

45

41

43 24

2007 MICS

30

2011 pMICS

Early initiation of breastfeeding (within 1 hr of birth, %) 81 Introduction of solid, semi-solid/soft foods (%) 61

(2010)

Vitamin A two dose coverage (%)

(2012)

99

(2010)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100

80

Percent

40 20 0

2000-2001 DHS

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

80 55

50

43

30

40

20

1990 1995-1996 2000-2001 Other NS MICS DHS

23 29

2007 MICS

20 22

2012 Other NS

Percent

Measles Vitamin A (past 6 months)

134

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

Source: MICS 2007

Pneumonia treatment

60 35

40 20 0

11

16

2007 MICS

2008 Other NS

2009 Other NS

46

2010 Other NS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Mauritania DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 2%

14%

Other 21%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 15%

Neonatal death: 41%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Haemorrhage 25%

Asphyxia* 10%

Sepsis** 9%

Malaria 10% 9%

Injuries 5%

Measles 1%

* Intrapartum-related events

Diarrhoea

Hypertension 16%

0%

Indirect 29%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

80

75

64

60

84

Demand for family planning satisfied (%)

20

(2001)

Antenatal care (4 or more visits, %)

48

(2011)

Malaria during pregnancy - intermittent preventive treatment (%)

19

(2011)

10, 18, 4

(2011)

80

(2012)

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

9

(2000-2001)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

48

Neonatal tetanus vaccine

40

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1990-1991 Other NS

2000-2001 DHS

2007 MICS

2011 pMICS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

32

23

9

2000-2001 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

34

20

2007 MICS

19

7 (2011)

3

2011 pMICS

60

47 64

6

23

17 34

6

Total

2012

Source: WHO/UNICEF JMP 2014

35 15

14

Urban

2012 1990

Rural

2012

23

15

38 12

40 27

0

-

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

-

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

No

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

-

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

-

-

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

-

-

Newborn health (X of 4) Child health (X of 3)

-

-

8.0

(2009)

31

(2004)

122

(2012)

General government expenditure on health as % of total government expenditure (%)

10

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

34

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

-

10 27

1990

2012 Total

76

ODA to child health per child (US$)

12

(2011)

ODA to maternal and neonatal health per live birth (US$)

42

(2011)

Note: See annexes for additional information on the indicators above

10

51

6 16

18

69

No Data

External sources General government expenditure Out-of-pocket expenditure Other

16

51

51

60

20

26 0

1990

100

46

21

20 24

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

80

48

63

27

1990

9

65

40

0

0

-

Postnatal home visits in the first week after birth

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Percent

80

1

Partial

Maternal deaths notification

Per capita total expenditure on health (Int$)

19

WATER AND SANITATION

100 6

-

National availability of Emergency Obstetric Care services

2 2003-2004 Other NS

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

Midwives authorized for specific tasks

FINANCING

2011 pMICS

Improved drinking water coverage

1

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Legal status of abortion (X of 5 circumstances)

Maternity protection (Convention 183)

Congenital 3%

HIV/AIDS 0%

-

(X of 7 tasks)

Other direct 9%

Other 1%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

29

20

11 4 9

3 8

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

135

Fulfilling the Health Agenda for Women and Children The 2014 Report

Mexico DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

120,847

(2012)

11,405

(2012)

Under-five mortality rate

2,269

(2012)

Birth registration (%) Total under-five deaths (000)

93 37

(2009)

Neonatal deaths: % of all under-5 deaths

44

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

7 14

(2012)

30

(2012)

20

Stillbirth rate (per 1000 total births)

(2012)

5

(2009)

1,100

(2013)

Lifetime risk of maternal death (1 in N)

900

(2013)

Total fertility rate (per woman)

2.2

(2012)

85

(2012)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Maternal mortality ratio

Deaths per 1000 live births

50

Deaths per 100,000 live births

100

46

88

80

40

60 16

15

10

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

49

40 22

20 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 88 86

Exclusive breastfeeding

Birth

Neonatal period

19

Measles

0

60

60

40

40

0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

20

99 Percent

1990 Other NS

1997 Other NS

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

96

86

84

80

Infancy

95

93

100

Pre-pregnancy Pregnancy

96

*Postnatal care

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2006 2004-2009 2012 Other NS Other NS Other NS

20 0

2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

80 60

Percent

Skilled attendant at delivery

20 0 1990

No Data

Measles

2000

2012 2010

2005

NUTRITION Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

2

(2011-2012)

9

(2012)

Early initiation of breastfeeding (within 1 hr of birth, %) 18 Introduction of solid, semi-solid/soft foods (%) 27 Vitamin A two dose coverage (%)

ORT & continued feeding

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Percent of infants <6 months exclusively breastfed

100

80

Percent

80

60

40 20 0

-

Exclusive breastfeeding

Underweight and stunting prevalence

Careseeking for pneumonia

136

1995

Source: WHO/UNICEF 2013

29

Percent

DTP3

No Data

40

Early initiation of breastfeeding ITN use among children <5 yrs

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

99 99 99 99 99

100

Antenatal care (4+ visits)

Pneumonia treatment

22

26

16

14

12

10

1988 Other NS

1996 1998-1999 2006 2011-2012 Other NS Other NS Other NS Other NS

6

3

3

60 40

38 20

20 0

1987 DHS

1999 Other NS

19

2009 Other NS

(2009) (2009) -

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Mexico DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

9%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 16%

2%

Other 36%

Neonatal death: 44%

Sepsis 8%

Embolism 3%

Abortion 10%

Legal status of abortion (X of 5 circumstances)

Haemorrhage 23%

Asphyxia* 6%

Malaria 0%

0%

3%

Maternity protection (Convention 183)

Hypertension 22%

Indirect 19%

Diarrhoea

Measles 0%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

80

86

78

98

96

Demand for family planning satisfied (%)

88

(2009)

Antenatal care (4 or more visits, %)

86

(2009)

-

-

46, 49, 36

(2012)

88

(2012)

Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1987 Other NS

1995 Other NS

2004-2009 Other NS

2006 Other NS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

-

2012 Other NS

Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

91

86

95 77 49

20

0

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100 22 80 4 8

14

6 10

40 75

1990

0 9

35

60

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

-

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

-

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

-

-

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

-

-

-

-

Newborn health (X of 4) Child health (X of 3)

-

-

46.2

(2011)

-

-

1,062

(2012)

General government expenditure on health as % of total government expenditure (%)

16

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

44

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

1 3 11

3 51

8

10

60 40

85

66

-

78

87

9 5

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

0

(2011)

ODA to maternal and neonatal health per live birth (US$)

0

(2011)

Note: See annexes for additional information on the indicators above

79

35

0 Rural

0 2 11

10 2 10

20

2012

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Percent

0 1 4

4 4 6

No

Per capita total expenditure on health (Int$)

WATER AND SANITATION

0 5 4

Yes

Postnatal home visits in the first week after birth

FINANCING Very limited risk

13 5 80 7

Partial

(% of recommended minimum)

52

100

-

Maternal deaths notification

National availability of Emergency Obstetric Care services

81

1996-1997 Other NS

5 (R,F)

Midwives authorized for specific tasks

Other direct 15%

Sepsis** 6%

HIV/AIDS 0%

-

(X of 7 tasks)

Other 3% Congenital 11%

Injuries 7%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Latin America, 2013

1990

2012 Total

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

137

Fulfilling the Health Agenda for Women and Children The 2014 Report

Morocco DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

32,521

(2012)

3,234

(2012)

Under-five mortality rate

Deaths per 100,000 live births

100

350

739

(2012)

Birth registration (%) Total under-five deaths (000)

94 23

(2010-2011)

Neonatal deaths: % of all under-5 deaths

59

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

18 27

(2012)

60

(2012)

Stillbirth rate (per 1000 total births)

40

20

(2009)

880

(2013)

Lifetime risk of maternal death (1 in N)

300

(2013)

Total fertility rate (per woman)

2.7

(2012)

32

(2008)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

Maternal mortality ratio

Deaths per 1000 live births

80

80

310

280 210 31

27

20

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

140

120 78

70 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 86

74

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

31

80

Infancy

Measles

0

60

40

40

0

20 40 60 80 100

Source: DHS, MICS, Other NS

60

Percent

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

74

63

31

26

20

99

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

31

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1987 DHS

1992 DHS

Percent

Coverage along the continuum of care

1995 DHS

2003-2004 2010-2011 DHS Other NS

40 20 0

2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

80 Percent

Skilled attendant at delivery

72

60

40 20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

100 80 60 40 20 0

70

38 17

28 7

1992 DHS

2012 2010

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

2

(2010-2011)

15

(2003-2004)

1997 Other NS

2003-2004 DHS

Percent of children <5 years who are moderately or severely: underweight stunted

35

40 20 0

-

80

60

13 1987 DHS

29

30 8 1992 DHS

8

10

Percent

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

-

100

80

Percent

(2003-2004)

Percent of infants <6 months exclusively breastfed

100

0 10 20 30 40 50 60 70 80 90 100

Source: DHS 2003-2004

(2003-2004)

Exclusive breastfeeding

Underweight and stunting prevalence

Careseeking for pneumonia

2010-2011 Other NS

Early initiation of breastfeeding (within 1 hr of birth, %) 52 Introduction of solid, semi-solid/soft foods (%) 52 Vitamin A two dose coverage (%)

ORT & continued feeding

138

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

99 99 99 88

100

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

EQUITY

23 3

15

1996-1997 2003-2004 2010-2011 Other NS DHS Other NS

60 40

37

50 25

31

20 0

1987 DHS

1992 DHS

1995 DHS

2003-2004 DHS

Imp

Fulfilling the Health Agenda for Women and Children The 2014 Report

Morocco DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 11% 2%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 20%

Other 19%

Regional estimates for Northern Africa, 2013

Other direct 17%

Haemorrhage 37%

Asphyxia* 12%

Neonatal death: 58%

HIV/AIDS 0%

Sepsis 6% Abortion 2%

Embolism 3%

Congenital 9%

Measles 0% 0% 6% Diarrhoea

* Intrapartum-related events

Indirect 18%

Sepsis** 9%

Hypertension 17%

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

80 Percent

Demand for family planning satisfied (%)

86

(2011)

Antenatal care (4 or more visits, %)

31

(2003-2004)

-

-

16, 19, 11

(2007-2010)

89

(2012)

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

4

(2003-2004)

Malaria during pregnancy - intermittent preventive treatment (%)

100

77

68

60 40

45

32

25

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

42

(within 2 days for home births, %)

20 0

C-section rate (total, urban, rural; %)

(within 2 days for home births, %)

1987 DHS

1992 DHS

1995 DHS

1997 2003-2004 2010-2011 Other NS DHS Other NS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

28

-

60

20 8

19

23

5

6

42

30

35

40

75

61

42

90 49

1990

Total

Source: WHO/UNICEF JMP 2014

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100 80 38

60

13 1 11

00 15

5 0 14

2 8

40

75

1990 Urban

2012 1990

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

-

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

No

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

0

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 1

(2013)

15.1

(2009)

69

(2000)

340

(2012)

6

(2012)

59

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

81

85

Rural

1 7

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

4

(2011)

ODA to maternal and neonatal health per live birth (US$)

7

(2011)

Note: See annexes for additional information on the indicators above

2 3

63

26

0 2012

29 69

22

4

2012

Yes

Postnatal home visits in the first week after birth

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

20 52

20 38

0

Maternal deaths notification

General government expenditure on health as % of total government expenditure (%)

Percent

Percent

80

24

0 6

Yes

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 2

Maternity protection (Convention 183)

Per capita total expenditure on health (Int$)

Very limited risk

2003-2004 DHS

Improved drinking water coverage

14

-

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100 3

3

FINANCING 23

14

1995 DHS

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks

(% of recommended minimum)

46

1992 DHS

No

(X of 7 tasks)

Other 5%

Malaria 0% Injuries 6%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2012 Total

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

139

Fulfilling the Health Agenda for Women and Children The 2014 Report

Mozambique DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

25,203

(2012)

4,332

(2012)

Under-five mortality rate

995

(2012)

Birth registration (%) Total under-five deaths (000)

48 84

(2011)

Neonatal deaths: % of all under-5 deaths

34

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

30 63

(2012)

150

(2012)

Stillbirth rate (per 1000 total births)

100

28

(2009)

4,800

(2013)

41

(2013)

Total fertility rate (per woman)

5.3

(2012)

Adolescent birth rate (per 1000 girls)

166

(2009)

Total maternal deaths Lifetime risk of maternal death (1 in N)

(2012)

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

1500

233

250

1300

1200

200

900 90

78

50

600

MDG Target

0 1990

1995

2000

2005

2010

330

0 1990

2015

Source: IGME 2013

480

300

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 29

54

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

43

Measles

54

48

44

40

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

55

60

82 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

40 (2012)

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

51

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1997 DHS

Percent

2003 DHS

2008 MICS

2011 DHS

100 80 60 40 20 0

86 54

53

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

60

40

Percent

82 76 76

80

Skilled attendant at delivery

20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

6

(2011)

17

(2011)

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

20 0

2003 DHS

2008 MICS

12 2011 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 77 Introduction of solid, semi-solid/soft foods (%) 90

(2011)

Vitamin A two dose coverage (%)

(2012)

20

Percent of infants <6 months exclusively breastfed

80

60

60

40

50 22

100

80

Percent

39

55

Exclusive breastfeeding

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

40 20 0

65

1997 DHS

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

2005

50

49 24

1995 MICS

26

23

47 21

1997 2000-2001 2003 DHS Other NS DHS

43

44 18

2008 MICS

16

2011 DHS

Percent

Measles Vitamin A (past 6 months)

140

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

Source: DHS 2011

Pneumonia treatment

60 40

37

30

30

1997 DHS

2003 DHS

43

20 0

2008 MICS

2011 DHS

(2011)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Mozambique DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 2%

12%

Globally nearly half of child deaths are Asphyxia* 10% attributable to undernutrition

Preterm 11%

Other 16%

Neonatal death: 34%

Sepsis 10%

Embolism 2%

Abortion 10% Haemorrhage 25%

Other 2%

Sepsis** 7%

0%

9%

Hypertension 16%

Diarrhoea

Malaria 18%

Indirect 29%

Measles 0%

Injuries 5%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

85

76

71

80

92

91

Demand for family planning satisfied (%)

29

(2011)

Antenatal care (4 or more visits, %)

51

(2011)

Malaria during pregnancy - intermittent preventive treatment (%)

19

(2011)

4, 9, 2

(2011)

83

(2012)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

7

(2011)

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1997 DHS

2000 Other NS

2003 DHS

2008 MICS

2011 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

42

1997 DHS

47 49

56 55

47 46

2003 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2008 MICS

60 (2011)

36

23

7 2007 Other NS

Percent

80 60

11 26

4 24

15

32

2008 MICS

2011 DHS

40

55

52

50

45

100

60

20 29 8

5

1990

20

Total

2012

Source: WHO/UNICEF JMP 2014

25

34

22

1

1990 Urban

2012 1990

1

Rural

2012

40

20 0

31

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

3

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

4.5

(2012)

-

-

66

(2012)

General government expenditure on health as % of total government expenditure (%)

9

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

5

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

66

52

29 35

24

4

2 8

1990

2012 Total

76

8

34

44

1990

2012 Urban

ODA to child health per child (US$)

24

(2011)

ODA to maternal and neonatal health per live birth (US$)

60

(2011)

Note: See annexes for additional information on the indicators above

6

21

No Data

External sources General government expenditure Out-of-pocket expenditure Other

12 36

40

41

Maternal deaths notification

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

80

40

40

0

4 16

No

Per capita total expenditure on health (Int$)

Improved sanitation coverage

Percent

100

Maternity protection (Convention 183)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

3

7

FINANCING

2011 DHS

Improved drinking water coverage

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

No

(X of 7 tasks)

Other direct 9%

Congenital 2% HIV/AIDS 6%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

35 22

2 11

02

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

141

Fulfilling the Health Agenda for Women and Children The 2014 Report

Myanmar DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

52,797

(2012)

4,434

(2012)

922

(2012)

Birth registration (%) Total under-five deaths (000)

72 48

(2009-2010)

Neonatal deaths: % of all under-5 deaths

51

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

26 41

(2012)

Stillbirth rate (per 1000 total births)

20

(2009)

Total maternal deaths

(2012)

(2012)

1,900

(2013)

Lifetime risk of maternal death (1 in N)

250

(2013)

Total fertility rate (per woman)

2.0

(2012)

17

(2006)

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

120

800

106

580

600

90

52

60

400

35

30

MDG Target

0

1990

1995

2000

2005

2010

2015

Source: IGME 2013

200

200

150 MDG Target

0

1990

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 66 73

Exclusive breastfeeding

Birth

Neonatal period

24

80

Infancy

Measles

0

57

56

46

40

0

20 40 60 80 100

Source: DHS, MICS, Other NS

60

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

71

64

20

84 Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

71

*Postnatal care

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1991 1997 2001 2007 2009-2010 Other NS Other NS Other NS Other NS MICS

100 80 60 40 20 0

2010

2011

2012

Source: UNICEF/UNAIDS/WHO 2013

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

100 Percent

Skilled attendant at delivery

40 0 1990

No Data

Measles

1995

2000

Source: WHO/UNICEF 2013

48

34

2000 MICS

2003 MICS

2009-2010 MICS

8

(2009-2010)

9

(2009-2010)

Early initiation of breastfeeding (within 1 hr of birth, %) 76 Introduction of solid, semi-solid/soft foods (%) 76 Vitamin A two dose coverage (%)

ORT & continued feeding

Percent of children <5 years who are moderately or severely: underweight stunted

100 80

80 Percent

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Percent of infants <6 months exclusively breastfed

100

0 10 20 30 40 50 60 70 80 90 100

54

60

40

37

55 28

41 30

30

41 23

35

60

40 20

20 0

86

Exclusive breastfeeding

Underweight and stunting prevalence

Careseeking for pneumonia

142

40 20 0

69

66

NUTRITION Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

100 80 60

2012 2010

2005

Percent

DTP3

60

20

Early initiation of breastfeeding ITN use among children <5 yrs

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics 85 84

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

EQUITY

1991 Other NS

1997 Other NS

2000 MICS

2003 MICS

2009-2010 MICS

0

15 2003 MICS

24

2009-2010 MICS

(2009-2010) (2009-2010) (2012)

Imp

Fulfilling the Health Agenda for Women and Children The 2014 Report

Myanmar DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

Preterm 18%

2%

15%

Neonatal death: 50%

Other 17%

Globally nearly half of child deaths are attributable to undernutrition

Abortion 7%

Sepsis 6%

Embolism 12%

Other direct 14%

Asphyxia* 11%

Malaria 2%

Congenital 4%

Injuries 5%

Indirect 17%

Sepsis** 7%

Measles 4% 0%

7%

Diarrhoea

* Intrapartum-related events

Hypertension 15%

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100 76

Percent

80

83

80

76

Demand for family planning satisfied (%)

66

(2001)

Antenatal care (4 or more visits, %)

73

(2007)

Malaria during pregnancy - intermittent preventive treatment (%)

-

-

C-section rate (total, urban, rural; %)

-

-

93

(2012)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1997 Other NS

2001 Other NS

2007 Other NS

2009-2010 MICS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

65 48 45

2000 MICS

53

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

50

2003 MICS

61

-

60

0 5

78

5 14

32

17

76

63

20 78

40 20

0

8

5

1990

Total

2012

Source: WHO/UNICEF JMP 2014

19

1990 Urban

2012 1990

-

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

-

Antenatal corticosteroids as part of management of preterm labour

No

International Code of Marketing of Breastmilk Substitutes

No

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

100

1

3

Rural

2012

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

2

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

2 3

(2013)

16.2

(2012)

-

-

25

(2012)

2

(2012)

71

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1995-2012 Improved facilities Shared facilities Open defecation Unimproved facilities 15

5 5

80 23

13

1 2 13

2 10 11

7 5

20

14

27

(2013)

40

77

77

84

8

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$) ODA to maternal and neonatal health per live birth (US$)

60 9

20 17

Yes

Postnatal home visits in the first week after birth

General government expenditure on health as % of total government expenditure (%)

Improved sanitation coverage

47

51

Maternal deaths notification

Per capita total expenditure on health (Int$)

11 2009-2010 Other NS

Percent

Percent

80

11

27

No

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 12 8

Maternity protection (Convention 183)

FINANCING

2009-2010 MICS

Improved drinking water coverage

3

1

-

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Partial

(X of 7 tasks) Haemorrhage 30%

Other 8%

HIV/AIDS 0%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for South-eastern Asia, 2013

6

(2011)

13

(2011)

Note: See annexes for additional information on the indicators above

74

53

45

0

1995

2012 Total

1995

2012 Urban

1995

2012 Rural

Source: WHO/UNICEF JMP 2014

143

Fulfilling the Health Agenda for Women and Children The 2014 Report

Nepal DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

27,474

(2012)

2,984

(2012)

593

(2012)

Birth registration (%) Total under-five deaths (000)

42 24

(2011)

Neonatal deaths: % of all under-5 deaths

57

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

24 34

(2012)

Stillbirth rate (per 1000 total births)

23

(2009)

1,100

(2013)

Lifetime risk of maternal death (1 in N)

200

(2013)

Total fertility rate (per woman)

2.4

(2012)

87

(2008)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

160

1000

142

790

750

120 80

500 42

40

47

MDG Target

0 1990

1995

2000

2005

2010

0 1990

2015

Source: IGME 2013

190

250

200

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 64

36

*Postnatal care

Birth

45

Exclusive breastfeeding

Neonatal period

70

Measles

60

20

7

9

1991 Other NS

1996 DHS

19

16

11

15

0

20 40 60 80 100

Source: DHS, MICS, Other NS

20 36

40

86 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

50

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2001 DHS

2003-04 Other NS

2006 DHS

2011 DHS

10 5

0

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

90 90 86

80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

40 0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

11

(2011)

18

(2011)

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

60

66 47

40

26

7 2001 DHS

2006 DHS

2011 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 45 Introduction of solid, semi-solid/soft foods (%) 66

(2011)

Vitamin A two dose coverage (%)

(2012)

95

Percent of infants <6 months exclusively breastfed

38

80

57

61 43

39

49 29

41

20 0

18

25

100

80

Percent

50

43

Exclusive breastfeeding

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

40 20 0

1996 DHS

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

2005

Percent

Measles Vitamin A (past 6 months)

144

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

20

Early initiation of breastfeeding

Source: DHS 2011

Pneumonia treatment

Percent

EQUITY

74

68

60

70 53

40 20

1996 DHS

1997-1998 Other NS

2001 DHS

2006 DHS

2011 DHS

0

1996 DHS

2001 DHS

2006 DHS

2011 DHS

(2011)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Nepal DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

Preterm 16%

2%

12%

Globally nearly half of child deaths are attributable to undernutrition

Other 15%

Neonatal death: 52%

HIV/AIDS 0%

Sepsis 14%

Legal status of abortion (X of 5 circumstances)

Hypertension 10%

Indirect 29%

0%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Diarrhoea

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

64

Antenatal care (4 or more visits, %)

50

(2011)

-

-

5, 15, 4

(2011)

Neonatal tetanus vaccine

82

(2012)

Postnatal visit for baby

30

(2011)

Postnatal visit for mother

45

(2011)

Women with low body mass index

20

(2011)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(2011)

Malaria during pregnancy - intermittent preventive treatment (%)

100 58

60

44

40 15

20

28

24

(Minimum target is 5% and maximum target is 15%)

(within 2 days for home births, %)

0

(within 2 days for home births, %)

1991 Other NS

1996 DHS

2001 DHS

2006 DHS

2011 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

32

26

1996 DHS

37

2001 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

-

29

Very limited risk

2011 DHS

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

27

72 61 46

1990

49 16

2

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

Rural

2012

40

60 86

6

40

17

20

21

Total

100

41

60

6

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

80

67

20

0

3 9

7 30

51

60

40

8

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

2

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

4 3

(2013)

6.7

(2004)

46

(2007)

Per capita total expenditure on health (Int$)

80

(2012)

General government expenditure on health as % of total government expenditure (%)

10

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

49

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Percent

80

2

1 2

No

Postnatal home visits in the first week after birth

(2013)

FINANCING 39

Improved drinking water coverage 3 9

Maternal deaths notification

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100 7

No

(% of recommended minimum)

47

2006 DHS

-

Maternity protection (Convention 183)

Sepsis** 10%

6%

5 (R,F)

(X of 7 tasks)

Congenital 6%

Measles 9%

Partial

Midwives authorized for specific tasks

Haemorrhage 30%

Other direct 8%

Other 5%

Injuries 6%

Embolism 2%

Abortion 6%

Asphyxia* 12%

Malaria 0%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Southern Asia, 2013

0

33

9 3

8

37

47

91

25

6

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

13

(2011)

ODA to maternal and neonatal health per live birth (US$)

31

(2011)

Note: See annexes for additional information on the indicators above

13

51 5 3

37

34

6

1990

2012 Total

1990

2012 Urban

34

5 1 3

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

145

Fulfilling the Health Agenda for Women and Children The 2014 Report

Niger DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

17,157

(2012)

3,557

(2012)

858

(2012)

Birth registration (%) Total under-five deaths (000)

32 91

(2006)

Neonatal deaths: % of all under-5 deaths

26

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

28 63

(2012)

Stillbirth rate (per 1000 total births)

23

(2009)

5,600

(2013)

Lifetime risk of maternal death (1 in N)

20

(2013)

Total fertility rate (per woman)

7.6

(2012)

Adolescent birth rate (per 1000 girls)

206

(2010)

Total maternal deaths

(2012)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

400

1200 326

300

900

200

600

114

100

109

1995

2000

2005

2010

250 MDG Target

0 1990

2015

Source: IGME 2013

630

300

MDG Target

0 1990

1000

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 47

29

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

23

60

15

18

16

1992 DHS

1998 DHS

2000 MICS

20

60

29

18

0

20 40 60 80 100

Source: DHS, MICS, Other NS

80

40

73 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

Measles

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

15

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2006 DHS

40 20

0

2012 DHS

2010

2011

Source: UNICEF/UNAIDS/WHO 2013

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

60

40

Percent

74 74 73

80

Skilled attendant at delivery

20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

18

(2012)

27

(2006)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

27

26 1998 DHS

2000 MICS

2006 DHS

2012 DHS

(2010)

Vitamin A two dose coverage (%)

(2012)

(2010)

98

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100

60

40

14 9

Early initiation of breastfeeding (within 1 hr of birth, %) 42 Introduction of solid, semi-solid/soft foods (%) 65

80

Percent

40 20 0

58

47

1992 DHS

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

2005

41

48

47 51

80

54 44

40

55

36 44

Percent

Measles Vitamin A (past 6 months)

146

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

Source: DHS 2012

Pneumonia treatment

60 40

20

20

0

0

1992 DHS

1998 DHS

2000 MICS

2006 DHS

2012 DHS

14 3 1992 DHS

1 2000 MICS

2006 DHS

27

23

4 2008 2010 Other NS Other NS

2012 DHS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Niger DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 1% 16%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 9% Asphyxia* 6%

Neonatal death: 26%

Embolism 2%

Sepsis 10% Abortion 10%

Congenital 1%

HIV/AIDS 0%

Hypertension 16% Indirect 29%

Measles 0%

Injuries 5%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

83

Percent

Demand for family planning satisfied (%)

47

(2012)

Antenatal care (4 or more visits, %)

15

(2006)

Malaria during pregnancy - intermittent preventive treatment (%)

35

(2012)

1, 5, 0

(2006)

84

(2012)

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

13

(2012)

C-section rate (total, urban, rural; %)

80

(Minimum target is 5% and maximum target is 15%)

60 40

Neonatal tetanus vaccine

46

41

39

30

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1992 DHS

1998 DHS

2000 MICS

2006 DHS

2012 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

43 20

10 1992 DHS

44

34 14

1998 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2000 MICS

18

2006 DHS

83 (2012)

100 2

3

20

1

7

2000 MICS

2006 DHS

2009 Other NS

2010 Other NS

2012 DHS

3

4

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100

60

67

27

54

39 44

20 30 8

4

1990

22

Total

2012

Source: WHO/UNICEF JMP 2014

39

41

30

0

1990 Urban

2012 1990

1

Rural

2012

60 85

76

17

0

36

29

21

40

20

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

-

-

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

1.6

(2008)

29

(2010)

Per capita total expenditure on health (Int$)

44

(2012)

General government expenditure on health as % of total government expenditure (%)

10

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

53

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

External sources General government expenditure Out-of-pocket expenditure Other

80 Percent

Percent

45

64

40

0

1

0

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

38

80 60

1

Yes

(2013)

FINANCING

64

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

No

Postnatal home visits in the first week after birth

National availability of Emergency Obstetric Care services

43

2012 DHS

Improved drinking water coverage

Maternal deaths notification

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Partial

Maternity protection (Convention 183)

Diarrhoea Malaria 19%

7

(X of 7 tasks)

0%

12%

3 (F)

Midwives authorized for specific tasks

Other direct 9%

Sepsis** 5%

Yes

Legal status of abortion (X of 5 circumstances)

Haemorrhage 25%

Other 2%

Other 20%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

89 95

Available

(2011)

7 13 %

20

ODA to child health per child (US$)

14

(2011)

ODA to maternal and neonatal health per live birth (US$)

27

(2011)

61

Note: See annexes for additional information on the indicators above

15

10

7 3 5

5 9

1990

2012 Total

22

33

1990

2012 Urban

2 1 2

5 2 4

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

147

Fulfilling the Health Agenda for Women and Children The 2014 Report

Nigeria DEMOGRAPHICS Total population (000)

168,834

(2012)

29,697

(2012)

7,028

(2012)

42 827

(2011)

Neonatal deaths: % of all under-5 deaths

32

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

39 78

(2012)

150

(2012)

Stillbirth rate (per 1000 total births)

100

42

(2009)

40,000

(2013)

Lifetime risk of maternal death (1 in N)

31

(2013)

Total fertility rate (per woman)

6.0

(2012)

Adolescent birth rate (per 1000 girls)

122

(2011)

Total under-five population (000) Births (000) Birth registration (%) Total under-five deaths (000)

Total maternal deaths

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

250

1500

213

200

1200

1200 124

900 71

50

600

MDG Target

0 1990

1995

2000

2005

2010

300 MDG Target

0 1990

2015

Source: IGME 2013

560

300 1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 43

*Postnatal care

38

49

Exclusive breastfeeding

Birth

Neonatal period

15

Measles

60 40

0

20 40 60 80 100

Source: DHS, MICS, Other NS

42

31

40

49

39

35

30

20

42 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

Percent

18 (2012)

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

57

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1990 DHS

1999 DHS

2003 DHS

2008 DHS

20

20

0

2011 MICS

17

10

10 2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent

60

42 41

40 20

Early initiation of breastfeeding

10

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

10

(2011)

15

(2011)

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

23

2003 DHS

2008 DHS

40 45

2011 MICS

(2011)

Vitamin A two dose coverage (%)

(2012)

(2011)

78

Percent of infants <6 months exclusively breastfed

80 51 35

35

43

44 27

27

41

24

36

20 0

23

100

60

40

33

Early initiation of breastfeeding (within 1 hr of birth, %) 23 Introduction of solid, semi-solid/soft foods (%) 33

80

Percent

45

37

Exclusive breastfeeding

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

40 20 0

1990 DHS

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

2005

Percent

Measles Vitamin A (past 6 months)

Percent

80

Skilled attendant at delivery

148

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

Source: MICS 2011

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

60 40 20

1990 DHS

1993 Other NS

2003 DHS

2008 DHS

2011 MICS

0

17

17

13

15

2008 DHS

2011 MICS

1 1990 DHS

1999 DHS

2003 DHS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Nigeria DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 2%

14%

Other 17%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 10%

Neonatal death: 32%

Sepsis 10%

Embolism 2%

Abortion 10%

Haemorrhage 25%

Asphyxia* 10%

Sepsis** 6%

Injuries 4%

* Intrapartum-related events

Hypertension 16%

0%

9%

Malaria 20%

Diarrhoea

Measles 1%

Indirect 29%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

79

Percent

80

64

57

60

58

66

58

Demand for family planning satisfied (%)

43

(2011)

Antenatal care (4 or more visits, %)

57

(2011)

Malaria during pregnancy - intermittent preventive treatment (%)

13

(2010)

5, 9, 3

(2011)

60

(2012)

-

-

38

(2008)

-

-

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

40

Postnatal visit for baby

(within 2 days for home births, %)

20

Postnatal visit for mother

0

(within 2 days for home births, %)

1986 DHS

1990 DHS

1999 DHS

2003 DHS

2008 DHS

2011 MICS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

34

28

12 1990 DHS

1999 DHS

18

2003 DHS

25 26

2008 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

28 26

12 (2010)

29 1

6

2003 DHS

2008 DHS

2010 Other NS

2011 MICS

60

20

0

30

14

6

4

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

48

25

33

1990

23

60

32

80 11

49

73

40

24

21

45

20

2012 1990

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

3

1

Rural

2012

60

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

2

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

4.1

(2009)

-

-

161

(2012)

7

(2012)

66

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100

4 17

23

Maternal deaths notification

Per capita total expenditure on health (Int$)

16

Improved sanitation coverage

Percent

Percent

80 34

No

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 6 16

Maternity protection (Convention 183)

(2013)

FINANCING

2011 MICS

Improved drinking water coverage

13

3

7

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Partial

(X of 7 tasks)

Other direct 9%

Other 2%

Congenital 1%

HIV/AIDS 3%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

23

7 11

15

14 23

28

12

46 40

40

External sources General government expenditure Out-of-pocket expenditure Other 31

33

26

32

18

No Data

ODA to child health per child (US$) ODA to maternal and neonatal health per live birth (US$)

9

(2011)

10

(2011)

Note: See annexes for additional information on the indicators above

12

20 37

28

0

1990

2012 Total

36

31

1990

2012 Urban

37

25

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

149

Fulfilling the Health Agenda for Women and Children The 2014 Report

Pakistan DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

179,160

(2012)

21,996

(2012)

4,604

(2012)

27 409

(2006-2007)

Neonatal deaths: % of all under-5 deaths

50

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

42 69

(2012)

Stillbirth rate (per 1000 total births)

47

(2009)

7,900

(2013)

Lifetime risk of maternal death (1 in N)

170

(2013)

Total fertility rate (per woman)

3.3

(2012)

48

(2010)

Birth registration (%) Total under-five deaths (000)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

600 138

150

450

100

50

46 MDG Target

0 1990

1995

2000

2005

2010

400

300

86

2015

Source: IGME 2013

170

150

100

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 64

43

*Postnatal care

Birth

39

Exclusive breastfeeding

Neonatal period

37

40

0

20 40 60 80 100

Source: DHS, MICS, Other NS

60

20

83 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

Measles

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

28

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

19

31

23

18

20

43

39

15 Percent

Coverage along the continuum of care

1990-91 1996-97 2001-02 2004-05 2006-07 2010-11 DHS Other NS Other NS Other NS DHS Other NS

10 5

0

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

100 Percent

Skilled attendant at delivery

81 81

60

40 20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

69

66

40 20 0

16 1990-91 DHS

15

(2011)

32

(2006-2007)

50

2006-07 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 29 Introduction of solid, semi-solid/soft foods (%) 36 Vitamin A two dose coverage (%)

Percent of children <5 years who are moderately or severely: underweight stunted

100

80 Percent

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Percent of infants <6 months exclusively breastfed

100

0 10 20 30 40 50 60 70 80 90 100

60

40

80

63

44

55 39

34

31

42

31

43

20 0

99

Exclusive breastfeeding

Underweight and stunting prevalence

Careseeking for pneumonia

Percent

ORT & continued feeding

150

100 80 60

2012 2010

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

Source: DHS 2012

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

83

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

EQUITY

60

20 1985-87 Other NS

1990-91 DHS

1995 MICS

2001 Other NS

2011 Other NS

37

40

0

16 1995 MICS

2006-07 DHS

(2006-2007) (2006-2007) (2012)

Imp

Fulfilling the Health Agenda for Women and Children The 2014 Report

Pakistan DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 3% 14%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 17%

Other 19%

Sepsis 14%

Haemorrhage 30%

Injuries 6%

Sepsis** 11%

Hypertension 10%

Measles 1% Indirect 29%

0%

10%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Diarrhoea

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

64

Antenatal care (4 or more visits, %)

28

(2006-2007)

-

-

7, 13, 5

(2006-2007)

75

(2012)

-

-

Postnatal visit for mother

39

(2006-2007)

Women with low body mass index

17

(2012-2013)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(2013)

Malaria during pregnancy - intermittent preventive treatment (%)

100 61

60

43

40

Neonatal tetanus vaccine

36

26

26

Postnatal visit for baby

(within 2 days for home births, %)

20 0

(Minimum target is 5% and maximum target is 15%)

(within 2 days for home births, %)

1990-91 DHS

1996-97 Other NS

2001 Other NS

2004-05 Other NS

2006-07 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

-

-

Maternity protection (Convention 183)

No

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

No

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

3

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

2 3

(2013)

14.0

(2010)

-

-

91

(2012)

5

(2012)

62

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

FINANCING Per capita total expenditure on health (Int$)

Very limited risk

General government expenditure on health as % of total government expenditure (%)

2006-07 DHS

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 3

6

0 4

1 4 39

38

4 7

11 8

62

66

73

40 56

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

100 23

40

20

2012

6

34 72 26

6

18

72

3

72

2012 Total

12

(2011)

ODA to maternal and neonatal health per live birth (US$)

13

(2011)

Note: See annexes for additional information on the indicators above

6 34

1 7

1990

ODA to child health per child (US$)

20

48

27

No Data

External sources General government expenditure Out-of-pocket expenditure Other

4 18

23

0 Rural

8 14 6

52

60

23

8

0

1990

58

36

23

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

80

55

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

100 8 7 80 Percent

3

National availability of Emergency Obstetric Care services

WATER AND SANITATION

20

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

41

37

39

1990-91 DHS

60

No

(X of 7 tasks)

Congenital 3%

Malaria 0%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent Midwives authorized for specific tasks

Other direct 8%

Other 3%

HIV/AIDS 0%

Embolism 2%

Abortion 6%

Asphyxia* 12%

Neonatal death: 50%

Regional estimates for Southern Asia, 2013

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

151

Fulfilling the Health Agenda for Women and Children The 2014 Report

Papua New Guinea DEMOGRAPHICS Total population (000)

7,167

(2012)

Total under-five population (000)

982

(2012)

Births (000)

Under-five mortality rate

210

(2012)

Birth registration (%) Total under-five deaths (000)

13

(2012)

Neonatal deaths: % of all under-5 deaths

39

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

24 48

(2012)

60

(2012)

40

Stillbirth rate (per 1000 total births)

-

15

(2009)

460

(2013)

Lifetime risk of maternal death (1 in N)

120

(2013)

Total fertility rate (per woman)

3.8

(2012)

65

(2004)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Maternal mortality ratio

Deaths per 1000 live births

100

Deaths per 100,000 live births 470

500

89

80

400

63

300 30

20

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

220

200

120

100 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 54

53

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

56

Measles

0

60

53

60

53

40

Infancy

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

67

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

55

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1996 DHS

Percent

22

20 0

2006 DHS

39

40

2010

Source: UNICEF/UNAIDS/WHO 2013

23

2011

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

40 20

Early initiation of breastfeeding

0 1990

1995

Source: WHO/UNICEF 2013

Measles

2000

(2009-2011)

11

(2005)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

2006 DHS

Early initiation of breastfeeding (within 1 hr of birth, %)

-

-

Introduction of solid, semi-solid/soft foods (%)

76

(2006)

Vitamin A two dose coverage (%)

15

(2012)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100

100

80

80

Percent

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

63

40 20 0 1996 DHS

16

Underweight and stunting prevalence

Careseeking for pneumonia

75

NUTRITION Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

100 80 60

2012 2010

2005

60

40 20 0

46 23

1982-1983 Other NS

48

44 18 2005 Other NS

27

Percent

No Data

Vitamin A (past 6 months)

152

67 63 63

60

Percent

80

Skilled attendant at delivery

DTP3

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

ITN use among children <5 yrs

Pneumonia treatment

60

59

56

40 20

2009-2011 Other NS

0

1996 DHS

2006 DHS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Papua New Guinea DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

Preterm 11%

2%

15%

Other 19%

Globally nearly half of child deaths are attributable to undernutrition

Abortion 7%

Embolism 15%

Other direct 12%

Asphyxia* 12%

Neonatal death: 38%

Sepsis 5%

Congenital 4%

Injuries 6%

0% Diarrhoea

Measles 1%

Hypertension 14%

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

79

77

80

Demand for family planning satisfied (%)

54

(2006)

Antenatal care (4 or more visits, %)

55

(2006)

Malaria during pregnancy - intermittent preventive treatment (%)

-

-

C-section rate (total, urban, rural; %)

-

-

70

(2012)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(within 2 days for home births, %)

20

(within 2 days for home births, %)

0

1996 DHS

Legal status of abortion (X of 5 circumstances)

1

Midwives authorized for specific tasks

-

Maternity protection (Convention 183)

Haemorrhage 30%

Indirect 17%

Sepsis** 7% 9%

Yes

(X of 7 tasks)

Other 3%

HIV/AIDS 1% Malaria 11%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Oceania, 2013

2006 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

-

Partial

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

No

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

0

(2013)

2

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

5.1

(2008)

-

-

151

(2012)

14

(2012)

9

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

National availability of Emergency Obstetric Care services

(2013)

(% of recommended minimum)

FINANCING Per capita total expenditure on health (Int$)

No Data

No Data

General government expenditure on health as % of total government expenditure (%) Out of pocket expenditure as % of total expenditure on health(%)

WATER AND SANITATION Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

80 43

42

100

3 9

6 7 26

33

49

Percent

18

23

31

20 22

0

12

1990

27 61

55

9

Total

2012

Source: WHO/UNICEF JMP 2014

19 30

20

4

1990 Urban

2012 1990

3

Rural

2012

16

12

3 25

80

48

60

40

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

Percent

100

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

4

13

18

31 10

60 60

9

66

71

66

20 4 0

3

20

2012 Total

ODA to child health per child (US$)

40

(2011)

ODA to maternal and neonatal health per live birth (US$)

62

(2011)

56

3 13

3 13

19

1990

External sources General government expenditure Out-of-pocket expenditure Other

Note: See annexes for additional information on the indicators above

40 62

No Data

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

153

Fulfilling the Health Agenda for Women and Children The 2014 Report

Peru DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

29,988

(2012)

2,925

(2012)

Under-five mortality rate

600

(2012)

Birth registration (%) Total under-five deaths (000)

96 11

(2012)

Neonatal deaths: % of all under-5 deaths

51

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

9 14

(2012)

60

(2012)

Stillbirth rate (per 1000 total births)

40

10

(2009)

530

(2013)

Lifetime risk of maternal death (1 in N)

440

(2013)

Total fertility rate (per woman)

2.5

(2012)

67

(2010)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

300

100 79

80

250

240 180 120

18

20

26

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

89

60

63 MDG Target

0 1990

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 90 94 87

*Postnatal care

93

Exclusive breastfeeding

71

Measles

100

Pre-pregnancy Pregnancy Birth

Neonatal period

80 60

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

56

53

71

59

Percent

1992 DHS

1996 DHS

2000 DHS

2004 DHS

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

87

83

40

Infancy

94 0

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

100 80 60 40 20 0

Percent

Coverage along the continuum of care

2009 DHS

2012 DHS

2010

2011

Source: UNICEF/UNAIDS/WHO 2013

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

80 60

Percent

Skilled attendant at delivery

40 0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

100 80 60 40 20 0

1

(2012)

8

(2007)

67

58

33

1992 DHS

2012 2010

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

72

46

1996 DHS

2000 2004-2006 2009 DHS DHS DHS

Percent of children <5 years who are moderately or severely: underweight stunted

80

60

37

40 20 0

-

-

100

80 Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

(2010) (2004-2008)

Percent of infants <6 months exclusively breastfed

100

Percent

2012 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 51 Introduction of solid, semi-solid/soft foods (%) 82

31

32

30

24

18

9

6

5

5

4

3

1992 DHS

1996 DHS

2000 DHS

2005 DHS

2009 DHS

2012 DHS

Percent

0 10 20 30 40 50 60 70 80 90 100

48

Exclusive breastfeeding

Underweight and stunting prevalence

Careseeking for pneumonia

59

55

Vitamin A two dose coverage (%)

ORT & continued feeding

Source: DHS 2009

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

20

Early initiation of breastfeeding

154

95 95 94 91 89

100

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

67 53

60 40

28

33

1986 DHS

1992 DHS

61

66

71

20 0

1996 DHS

2000 DHS

2004 DHS

2008 DHS

2011 DHS

Imp

Fulfilling the Health Agenda for Women and Children The 2014 Report

Peru DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 8% 2%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 19%

Other 30%

Neonatal death: 51%

Sepsis 8%

Regional estimates for Latin America, 2013

Embolism 3%

Abortion 10%

Haemorrhage 23%

Asphyxia* 7%

Sepsis** 6%

Injuries 6% Measles 0%

Hypertension 22%

Indirect 19%

4% 0% Diarrhoea

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

84

80 Percent

91

96

94

Demand for family planning satisfied (%)

90

(2012)

Antenatal care (4 or more visits, %)

94

(2012)

-

-

25, 33, 11

(2012)

85

(2012)

-

-

93

(2012)

1

(2007-2008)

Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

67

64

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

(within 2 days for home births, %)

20

Postnatal visit for mother

0

(within 2 days for home births, %)

1992 DHS

1996 DHS

2000 DHS

2004 DHS

2009 DHS

2012 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

26

20 1992 DHS

1996 DHS

2000 DHS

2004-2006 DHS

-

32

2010 DHS

2012 DHS

17

15

40 20

82

73

54

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100 80

12 9

87 33

60

11

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

Rural

6 13

33

8

7 6

73

54

23

71

28 4

81

9

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

-

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

-

-

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

0

(2013)

-

-

Newborn health (X of 4) Child health (X of 3)

-

-

26.5

(2012)

-

-

555

(2012)

General government expenditure on health as % of total government expenditure (%)

18

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

36

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

-

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$) ODA to maternal and neonatal health per live birth (US$)

4

(2011)

13

(2011)

Note: See annexes for additional information on the indicators above

45

1 16

0 2012

1 9 9

15 6 8

74

40

63

20

0

1990

16

27

29

60 20

Yes

Postnatal home visits in the first week after birth

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Percent

80

1 8 4

Maternal deaths notification

Per capita total expenditure on health (Int$)

Very limited risk

31

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved 1 11

Partial

FINANCING

Improved drinking water coverage

4 9 5

-

(% of recommended minimum)

WATER AND SANITATION

100 9

3

National availability of Emergency Obstetric Care services

64

25

22

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

64

60

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks Maternity protection (Convention 183)

Congenital 12%

Malaria 0%

-

(X of 7 tasks) Other direct 15%

Other 5%

HIV/AIDS 1%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2012 Total

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

155

Fulfilling the Health Agenda for Women and Children The 2014 Report

Philippines DEMOGRAPHICS Total population (000)

96,707

(2012)

Total under-five population (000)

11,165

(2012)

Births (000)

Under-five mortality rate

2,383

(2012)

Birth registration (%) Total under-five deaths (000)

90 69

(2010)

Neonatal deaths: % of all under-5 deaths

47

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

14 24

(2012)

60

(2012)

Stillbirth rate (per 1000 total births)

40

16

(2009)

3,000

(2013)

Lifetime risk of maternal death (1 in N)

250

(2013)

Total fertility rate (per woman)

3.1

(2012)

53

(2006)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

100

150

80

120 59

110

120

90 30

60 20

20

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

30

28

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 72 78 62

*Postnatal care Exclusive breastfeeding

34

Neonatal period

60

20

15

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

56

53

62

60

58

40

85 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

Measles

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy Birth

77

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1993 DHS

1998 DHS

2000 MICS

2003 DHS

10 5

0

2008 DHS

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

100

40 23

20

Early initiation of breastfeeding

5

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

ORT & continued feeding

7

(2011)

21

(2008)

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

20 0

55

36

1998 DHS

2003 DHS

50

42

2008 DHS

(2008)

Vitamin A two dose coverage (%)

(2012)

90

Percent of infants <6 months exclusively breastfed

100 80

60

40

1993 DHS

58

Early initiation of breastfeeding (within 1 hr of birth, %) 54 Introduction of solid, semi-solid/soft foods (%) 90

80

Percent

40 20 0

51 44

Exclusive breastfeeding

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100 80 60

2012 2010

2005

Underweight and stunting prevalence

Careseeking for pneumonia

Source: DHS 2008

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

156

Percent

60

Percent

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

86 85

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with Rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

45 29

26

39

38 28

21

34

21

32

34 20

Percent

EQUITY

60 40

26

37

34

34

1998 DHS

2003 DHS

2008 DHS

20 1987 1993 1998 2003 2008 2011 Other NS Other NS Other NS Other NS Other NS Other NS

0

1993 DHS

(2008)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Philippines DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia

2%

17%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 15%

Other 21%

Abortion 7%

Embolism 12%

Other direct 14%

Asphyxia* 11%

Neonatal death: 47%

Sepsis 6%

Other 3%

Haemorrhage 30%

Indirect 17%

Malaria 0%

Sepsis** 8%

Injuries 8%

0%

7%

Measles 0%

Hypertension 15%

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Diarrhoea

* Intrapartum-related events

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

86

86

83

91

88

Percent

Demand for family planning satisfied (%)

72

(2011)

Antenatal care (4 or more visits, %)

78

(2008)

-

-

10, 14, 5

(2008)

76

(2012)

-

-

77

(2008)

-

-

Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

80

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

(within 2 days for home births, %)

20

Postnatal visit for mother

0

(within 2 days for home births, %)

1993 DHS

1998 DHS

2000 MICS

2003 DHS

2008 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

-

42

2003 DHS

2008 DHS

Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

80 Percent

49

60

1 7

0 8 31

52

1 8

3

100

60

43

40

24

9

0

1990

26

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

Rural

8 8

16

15

31 17

23

12 3

22

16

10

20

74

57

No

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

No

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

0

(2013)

2

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

71.5

(2004)

-

-

203

(2012)

General government expenditure on health as % of total government expenditure (%)

10

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

52

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

69

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

2

(2011)

ODA to maternal and neonatal health per live birth (US$)

5

(2011)

Note: See annexes for additional information on the indicators above

79 69 45

0 2012

8 2

12

40

61

20

16

80 15

66

40

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

22 65

60

Maternity protection (Convention 183)

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

1 7

14

3

Per capita total expenditure on health (Int$)

No Data

WATER AND SANITATION

100 2

Midwives authorized for specific tasks

FINANCING

47

27

1998 DHS

1

(% of recommended minimum)

60

1993 DHS

Legal status of abortion (X of 5 circumstances)

National availability of Emergency Obstetric Care services

76 43

Partial

(X of 7 tasks)

Congenital 8%

HIV/AIDS 0%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for South-eastern Asia, 2013

1990

2012 Total

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

157

Fulfilling the Health Agenda for Women and Children The 2014 Report

Rwanda DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

11,458

(2012)

1,945

(2012)

410

(2012)

Birth registration (%) Total under-five deaths (000)

63 24

(2010)

Neonatal deaths: % of all under-5 deaths

39

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

21 39

(2012)

Stillbirth rate (per 1000 total births)

(2012)

(2012)

23

(2009)

1,300

(2013)

Lifetime risk of maternal death (1 in N)

66

(2013)

Total fertility rate (per woman)

4.6

(2012)

41

(2008)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

280

1600

210

1400

1200

151

140

800

55

70

50

0 1990

1995

2000

2005

2010

350

MDG Target

0 1990

2015

Source: IGME 2013

320

400

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 71

69

*Postnatal care

Birth

18

Exclusive breastfeeding

Neonatal period

85

Measles

80

0

Percent

31

26

20

20 40 60 80 100

Source: DHS, MICS, Other NS

52

39

40

97 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

69

60

Infancy

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

35

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1992 DHS

2000 DHS

Percent

Coverage along the continuum of care

2005 DHS

2007-2008 DHS

2010 DHS

100 80 60 40 20 0

87 67

56

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine 98 98 100 97 98 50

40

Percent

60

Percent

Skilled attendant at delivery

20

Early initiation of breastfeeding

100 80 60 40 20

0

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

3

(2010)

7

(2010)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

40 20 0

48

45 24

1992 DHS

23

1996 Other NS

20

2000 DHS

52 18

2005 DHS

44 12 2010 DHS

13

2000 DHS

2005 DHS

2007-2008 DHS

2010 DHS

Vitamin A two dose coverage (%)

(2012)

3

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80

57

16

(2010)

100

60

4

28

Early initiation of breastfeeding (within 1 hr of birth, %) 71 Introduction of solid, semi-solid/soft foods (%) 79

80

Percent

50 28

30

1992 DHS

2012 2010

2005

Percent

Measles Vitamin A (past 6 months)

158

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

80

Antenatal care (4+ visits)

Source: DHS 2010

Pneumonia treatment

83

83

1992 DHS

2000 DHS

88

85

2005 DHS

2010 DHS

60 40 20 0

(2010)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Rwanda DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 16%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 10%

2%

Neonatal death: 39%

Other 21%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Asphyxia* 12%

Haemorrhage 25%

Other 2%

Hypertension 16%

Sepsis** 8%

Malaria 4% Injuries 7%

10% 0% Diarrhoea

Measles 1%

Indirect 29%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

94

100

98

96

94

92

Percent

Demand for family planning satisfied (%)

71

(2010)

Antenatal care (4 or more visits, %)

35

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

17

(2007-2008)

7, 16, 6

(2010)

85

(2012)

5

(2010)

18

(2010)

5

(2010)

C-section rate (total, urban, rural; %)

80

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

(within 2 days for home births, %)

20

Postnatal visit for mother

0

(within 2 days for home births, %)

1992 DHS

2000 MICS

2005 DHS

2007-2008 DHS

2010 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

28

16

1992 DHS

24

10

2000 MICS

12

2005 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

21

29

21

2007-2008 DHS

97 (2010)

Percent

80 60

11

25

7 3

7 12

18

13

26

2005 DHS

2007-2008 DHS

2010 DHS

62 63

40 20

0

67

18

4

Total

2012

Source: WHO/UNICEF JMP 2014

100 7

1990 Urban

2012 1990

0

1

Rural

2012

3 23

80

60 40

20

28

1990

67

59

59

1

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

15

No

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

No

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

3

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

7.5

(2010)

-

-

144

(2012)

General government expenditure on health as % of total government expenditure (%)

22

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

21

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

19

15

Maternity protection (Convention 183)

Per capita total expenditure on health (Int$)

13

5 2000 MICS

Percent

100

-

(2013)

FINANCING

70

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

3

National availability of Emergency Obstetric Care services

56

2010 DHS

Improved drinking water coverage

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

No

(X of 7 tasks)

Other direct 9%

Congenital 5%

HIV/AIDS 1%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

59

2 11

2 15

23

22

10

3

7

26 62

7

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

39

(2011)

ODA to maternal and neonatal health per live birth (US$)

52

(2011)

Note: See annexes for additional information on the indicators above

4

64

64

61

30

3

64

28

0

1990

2012 Total

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

159

Fulfilling the Health Agenda for Women and Children The 2014 Report

São Tomé and Príncipe DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

188

(2012)

31

(2012)

7

(2012)

Birth registration (%) Total under-five deaths (000)

75 0

(2008-2009)

Neonatal deaths: % of all under-5 deaths

38

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

20 38

(2012)

Stillbirth rate (per 1000 total births)

22

(2009)

Total maternal deaths

(2012)

(2012)

14

(2013)

100

(2013)

Total fertility rate (per woman)

4.1

(2012)

Adolescent birth rate (per 1000 girls)

110

(2006)

Lifetime risk of maternal death (1 in N)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

120

600

104

450

90

53

60

300

35

30

MDG Target

0 1990

1995

2000

2005

2010

410

2015

Source: IGME 2013

210

150

100

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 51

82

*Postnatal care

37

Exclusive breastfeeding

Neonatal period

51

Measles

Birth

Infancy

60

80

40

60

0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

20

92 0

82

81

79

80

2000 MICS

Percent

2006 MICS

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

72

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

40 20

0

2008-2009 DHS

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent

60

40 20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

100 80 60

75 60

47

40 20 0

2000 MICS

2012 2010

11

(2008-2009)

10

(2008-2009)

2008-2009 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 35 Introduction of solid, semi-solid/soft foods (%) 74 Vitamin A two dose coverage (%)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Percent

Percent

100

80

80

60

60

0

35

32

40 20

34

Percent of infants <6 months exclusively breastfed

100

0 10 20 30 40 50 60 70 80 90 100

Source: DHS 2008-2009

(2006) (2008-2009)

Exclusive breastfeeding

15 1986 Other NS

10 2000 MICS

29

8 2006 MICS

32 14

2008-2009 Other NS

Percent

ORT & continued feeding

160

Percent

80

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics 96 96 92

100

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

56

60

2000 MICS

2006 MICS

51

40 20 0

2008-2009 DHS

(2012)

Imp

Fulfilling the Health Agenda for Women and Children The 2014 Report

São Tomé and Príncipe DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Preterm 10%

Pneumonia 14% 2%

Globally nearly half of child deaths are attributable to undernutrition

Neonatal death: 38%

Other 23%

Sepsis 10%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10% Haemorrhage 25%

Asphyxia* 11%

Malaria 8%

Hypertension 16%

0%

9%

Indirect 29%

Diarrhoea

Injuries 7%

Source: WHO 2014

Measles 1%

* Intrapartum-related events

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

98

97

91

100

Percent

Demand for family planning satisfied (%)

51

(2008-2009)

Antenatal care (4 or more visits, %)

72

(2008-2009)

Malaria during pregnancy - intermittent preventive treatment (%)

60

(2008-2009)

5, 7, 4

(2008-2009)

C-section rate (total, urban, rural; %)

80

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

-

-

40

Postnatal visit for baby

-

-

37

(2008-2009)

-

-

(within 2 days for home births, %)

20

Postnatal visit for mother

0

(within 2 days for home births, %)

2000 MICS

2006 MICS

2008-2009 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

63 50

49 31

31

2000 MICS

2006 MICS

43 (2008-2009)

7 64

60

40

0 1

12 5

60

4 2

26

2006 MICS

2008-2009 DHS

Percent of population by type of sanitation facility, 1995-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

72

60

54

74 6 6

40 5

33

20

0

1995

Total

2012

Source: WHO/UNICEF JMP 2014

29

1995 Urban

20 3

39 13

2012 1995

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

-

Low osmolarity ORS and zinc for management of diarrhoea

-

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Rural

22

0 2012

-

-

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

-

-

-

-

Newborn health (X of 4) Child health (X of 3)

-

-

23.6

(2004)

-

-

144

(2012)

6

(2012)

52

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

-

General government expenditure on health as % of total government expenditure (%)

34

18

1995

2012 Total

68

48 66

80 5 6

5 3

41

24

2012 Urban

ODA to child health per child (US$)

112

(2011)

ODA to maternal and neonatal health per live birth (US$)

234

(2011)

Note: See annexes for additional information on the indicators above

4 7

3 4

23

13

1995

No Data

External sources General government expenditure Out-of-pocket expenditure Other

100 80

52

20

-

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

9

54

54

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Per capita total expenditure on health (Int$)

23

2000 MICS

Percent

Percent

80

2 1

-

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1995-2012 Piped on premises Other improved Surface water Unimproved 19

-

Postnatal home visits in the first week after birth

FINANCING

56

WATER AND SANITATION

100

Maternal deaths notification

National availability of Emergency Obstetric Care services

42

2008-2009 DHS

Improved drinking water coverage

No

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

1

-

Maternity protection (Convention 183)

Congenital 5% Sepsis** 7%

HIV/AIDS 1%

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks (X of 7 tasks)

Other direct 9%

Other 2%

-

1995

2012 Rural

Source: WHO/UNICEF JMP 2014

161

Fulfilling the Health Agenda for Women and Children The 2014 Report

Senegal DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

13,726

(2012)

2,313

(2012)

524

(2012)

Birth registration (%) Total under-five deaths (000)

75 30

(2010-2011)

Neonatal deaths: % of all under-5 deaths

42

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

24 45

(2012)

Stillbirth rate (per 1000 total births)

(2012)

(2012)

34

(2009)

1,700

(2013)

Lifetime risk of maternal death (1 in N)

60

(2013)

Total fertility rate (per woman)

5.0

(2012)

80

(2011)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

600

142

150

530

450

100

320

300

60

50

47

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: IGME 2013

150

130

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 38

65

*Postnatal care

Birth

68

Exclusive breastfeeding

Neonatal period

39

80 60

Measles

0

20 40 60 80 100

Source: DHS, MICS, Other NS

47

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

65

58

60

52

47

20

84 0

58

40

Infancy

Percent

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

50

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1992-93 DHS

1997 DHS

2000 MICS

2002 Other NS

2005 DHS

2010-11 DHS

40

20 0

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

40 20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

100 80 60 40 20 0

27

18

1992-93 DHS

2012 2010

9

(2012)

19

(2010-2011)

50

47 31

2000 MICS

2005 DHS

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

20 0

-

-

100 80

60

40

(2010-2011)

Percent of infants <6 months exclusively breastfed

80

Percent

Percent

Source: DHS 2010-2011

(2010-2011)

Exclusive breastfeeding

34

22

1992-93 DHS

20

29

1996 MICS

20

Percent

Careseeking for pneumonia

2010-11 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 48 Introduction of solid, semi-solid/soft foods (%) 67 Vitamin A two dose coverage (%)

ORT & continued feeding

162

Percent

60

Percent

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

92 92 84

80

Antenatal care (4+ visits)

Pneumonia treatment

30

2000 MICS

15 20

2005 DHS

14 16 2012 Other NS

60 40 20 0

34

39

2005 DHS

2010-11 DHS

12

5

6

1986 DHS

1992-93 DHS

1997 DHS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Senegal DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Preterm 13%

Pneumonia

Globally nearly half of child deaths are attributable to undernutrition

2%

11% Other 17%

Neonatal death: 42%

Embolism 2%

Sepsis 10% Abortion 10%

Asphyxia* 12%

Haemorrhage 25%

Other direct 9%

Other 2%

HIV/AIDS 1%

Regional estimates for Sub-Saharan Africa, 2013

Hypertension 16%

0% 7% Diarrhoea

Injuries 5% Measles 1%

Indirect 29%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100 74

80 Percent

82

93

87

79

Demand for family planning satisfied (%)

38

(2012-2013)

Antenatal care (4 or more visits, %)

50

(2010-2011)

Malaria during pregnancy - intermittent preventive treatment (%)

41

(2012-2013)

6, 11, 3

(2010-2011)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

91

(2012)

40

Postnatal visit for baby

41

(2010-2011)

Postnatal visit for mother

68

(2010-2011)

Women with low body mass index

19

(2010-2011)

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1992-93 DHS

1997 DHS

2000 MICS

2005 DHS

2010-11 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

43

34 15

7 1992-93 DHS

13

1997 DHS

2000 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

42 22

15

2005 DHS

21 (2012-2013)

29

35

2008-09 Other NS

2010-11 DHS

16

2

7

2000 MICS

2005 DHS

2006 Other NS

Percent

80

25

39

0 11

0 8 15

43

40 42

37

77 46

46

20

42

100

Total

Source: WHO/UNICEF JMP 2014

1990 Urban

2012 1990

15

60 17 40

20

Rural

2012

1 8

9 13

24

20

29 55

20

16

11 52

35

58

67

11

19 5

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

3

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

4.8

(2008)

38

(2000)

Per capita total expenditure on health (Int$)

96

(2012)

General government expenditure on health as % of total government expenditure (%)

10

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

34

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

1990

2012 Total

1990

2012 Urban

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

22

(2011)

ODA to maternal and neonatal health per live birth (US$)

44

(2011)

Note: See annexes for additional information on the indicators above

40

21

0

0

2012

17

80 37

23

18

1990

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

39

56

28

60

0

1

2

Partial

Maternal deaths notification

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

1

100 1

7

National availability of Emergency Obstetric Care services

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

Midwives authorized for specific tasks

FINANCING

2010-11 DHS

Improved drinking water coverage

1

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Legal status of abortion (X of 5 circumstances)

Maternity protection (Convention 183)

Sepsis** 9%

Yes

(X of 7 tasks)

Congenital 5% Malaria 17%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

163

Fulfilling the Health Agenda for Women and Children The 2014 Report

Sierra Leone DEMOGRAPHICS Total population (000)

5,979

(2012)

Total under-five population (000)

928

(2012)

Births (000)

222

(2012)

Birth registration (%) Total under-five deaths (000)

78 39

(2010)

Neonatal deaths: % of all under-5 deaths

27

(2012)

50 117

(2012)

30

(2009)

2,400

(2013)

21

(2013)

Total fertility rate (per woman)

4.8

(2012)

Adolescent birth rate (per 1000 girls)

125

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Stillbirth rate (per 1000 total births) Total maternal deaths Lifetime risk of maternal death (1 in N)

(2012)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

400

2800

300

2300

2100

257 182

200

1400

100

86 MDG Target

0 1990

1995

2000

2005

2010

580

0 1990

2015

Source: IGME 2013

1100

700

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 29 75 63

*Postnatal care Exclusive breastfeeding

Neonatal period

32

80

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

42

43

42

40

80 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

63

60

Infancy

Measles

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy Birth

58

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2000 MICS

Percent

2005 MICS

2008 DHS

2010 MICS

100 80 60 40 20 0

93 69 51

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

40 0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

9

(2010)

11

(2010)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

20 0

48 21

58

2005 MICS

27

2008 DHS

2010 MICS

(2010)

Vitamin A two dose coverage (%)

(2012)

99

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100 80

60

40

50

46

Early initiation of breastfeeding (within 1 hr of birth, %) 45 Introduction of solid, semi-solid/soft foods (%) 25

80

Percent

40 20 0

74

2000 MICS

Underweight and stunting prevalence

Careseeking for pneumonia

100 80 60

2012 2010

2005

47

41 25

38 25

28

45

37 21

21

Percent

Measles Vitamin A (past 6 months)

Source: MICS 2010

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

20

Early initiation of breastfeeding

164

84 84 83 80

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

60

20 1990 Other NS

2000 MICS

2005 MICS

2008 DHS

2010 MICS

32

40

0

4

8

2000 MICS

2005 MICS

11 2008 DHS

2010 MICS

(2010)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Sierra Leone DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Preterm 7%

Pneumonia

Globally nearly half of child deaths are attributable to undernutrition

2%

14%

Asphyxia* 8%

Neonatal death: 27%

Other 21%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Other 1%

Haemorrhage 25%

Other direct 9%

Congenital 2%

Malaria 14%

Hypertension 16%

0%

14% Diarrhoea Injuries 4%

* Intrapartum-related events

Indirect 29%

Measles 6%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

87

81

80

93

Demand for family planning satisfied (%)

29

(2010)

Antenatal care (4 or more visits, %)

75

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

41

(2010)

5, 6, 4

(2010)

87

(2012)

-

-

58

(2008)

-

-

C-section rate (total, urban, rural; %)

68

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

(within 2 days for home births, %)

20

Postnatal visit for mother

0

(within 2 days for home births, %)

2000 MICS

2005 MICS

2008 DHS

2010 MICS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

57

54 39 42

2000 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

73

68

55

31

2005 MICS

2008 DHS

31 (2010)

2

5

6

2000 MICS

2005 MICS

30

2008 DHS

2010 MICS

28

Percent

80 35 60

28

12 28

76

50

40

55

20 31

0

21

6

1990

17

29

16

5

Total

2012

Source: WHO/UNICEF JMP 2014

1990 Urban

11

2012 1990

1

Rural

28

31

40

20

1

0

34

10

26

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

No

International Code of Marketing of Breastmilk Substitutes

No

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

2

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

1.9

(2010)

24

(2008)

205

(2012)

General government expenditure on health as % of total government expenditure (%)

12

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

76

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

23

28

11

13

1990

2012 Total

43

23

42

22

1990

2012 Urban

55

No Data

External sources General government expenditure Out-of-pocket expenditure Other 39

26

60 48

41

2012

0

18

80

41

49

No

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100

8 5

Maternity protection (Convention 183)

Per capita total expenditure on health (Int$)

26

Improved sanitation coverage

Percent

100

7

National availability of Emergency Obstetric Care services

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

3

FINANCING

2010 MICS

Improved drinking water coverage

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

No

(X of 7 tasks)

Sepsis** 6% HIV/AIDS 0%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

35

ODA to child health per child (US$)

39

(2011)

ODA to maternal and neonatal health per live birth (US$)

64

(2011)

Note: See annexes for additional information on the indicators above

19

14

7

5

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

165

Fulfilling the Health Agenda for Women and Children The 2014 Report

Solomon Islands DEMOGRAPHICS Total population (000)

550

(2012)

Total under-five population (000)

82

(2012)

Births (000)

17

(2012)

1

(2012)

Neonatal deaths: % of all under-5 deaths

44

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

14 26

(2012)

Stillbirth rate (per 1000 total births)

15

(2009)

Birth registration (%) Total under-five deaths (000)

Total maternal deaths

-

(2012)

23

(2013)

Lifetime risk of maternal death (1 in N)

180

(2013)

Total fertility rate (per woman)

4.1

(2012)

62

(2008)

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

400

60 45

31

30

200

15

13

0 1990

320

300

39

MDG Target

1995

2000

2005

2010

2015

Source: IGME 2013

130

100

80

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 76

86

*Postnatal care Exclusive breastfeeding

Birth

Neonatal period

74

Measles

100

Pre-pregnancy Pregnancy

65

Infancy

0

85

84

80

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

60 40

No Data

0

20 40 60 80 100

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

86

20

85

Source: DHS, MICS, Other NS

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1994 Other NS

Percent

1999 Other NS

2007 DHS

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

100

40 0

No Data

Measles

1990

2000

100 80 60

73

40 20 0

23

2007 DHS

2012 2010

2005

NUTRITION Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

4

(2007)

13

(2007)

Early initiation of breastfeeding (within 1 hr of birth, %) 75 Introduction of solid, semi-solid/soft foods (%) 80 Vitamin A two dose coverage (%)

ORT & continued feeding

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia

100

0 10 20 30 40 50 60 70 80 90 100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Percent of infants <6 months exclusively breastfed

100 80

60 34

40 20 0

-

Exclusive breastfeeding

80

Percent

166

1995

Source: WHO/UNICEF 2013

16 1989 Other NS

33 12 2007 DHS

Percent

DTP3

60

20

Early initiation of breastfeeding ITN use among children <5 yrs

Percent

Percent

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

90 90 85

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

65

74

60 40 20 0

2000 Other NS

2007 DHS

(2007) (2007) -

Impr

Fulfilling the Health Agenda for Women and Children The 2014 Report

Solomon Islands DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 16% 2%

Preterm 12%

Neonatal death: 44%

Other 22%

Globally nearly half of child deaths are attributable to undernutrition

Abortion 7%

Sepsis 5%

Embolism 15%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Oceania, 2013

Other direct 12%

Asphyxia* 12%

Other 3% Haemorrhage 30%

Indirect 17%

Sepsis** 8%

Malaria 2% Injuries 9%

7%

Measles 0%

* Intrapartum-related events

0%

Hypertension 14%

Diarrhoea Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

76

Antenatal care (4 or more visits, %)

65

(2007)

1

(2007)

6, 8, 6

(2007)

85

(2012)

C-section rate (total, urban, rural; %)

74

80 Percent

Demand for family planning satisfied (%)

(2007)

Malaria during pregnancy - intermittent preventive treatment (%)

100

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

2007 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

76 Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

38

100 80 60 40 20 0

Percent of population by type of drinking water source, 2012 Piped on premises Other improved Surface water Unimproved

Percent

80 60

1 6 32

55

26

No

Maternal deaths notification

No

Postnatal home visits in the first week after birth

No

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

No

Antenatal corticosteroids as part of management of preterm labour

No

International Code of Marketing of Breastmilk Substitutes

-

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

No

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

2 3

(2013)

22.8

(2009)

-

-

252

(2012)

20

(2012)

2

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

National availability of Emergency Obstetric Care services

(2013)

Per capita total expenditure on health (Int$) General government expenditure on health as % of total government expenditure (%)

No Data

Reproductive, maternal, newborn and child health expenditure by source

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

142

(2011)

ODA to maternal and neonatal health per live birth (US$)

335

(2011)

Note: See annexes for additional information on the indicators above

16

0

Total

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

9

61

20

Improved sanitation coverage

14

61

40

-

Maternity protection (Convention 183)

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

7 12

-

FINANCING 40

WATER AND SANITATION

100

1

(% of recommended minimum)

2007 DHS

2007 DHS

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks (X of 7 tasks)

Congenital 9%

HIV/AIDS 0%

No

Urban

Rural

Source: WHO/UNICEF JMP 2014

167

Fulfilling the Health Agenda for Women and Children The 2014 Report

Somalia DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

10,195

(2012)

1,923

(2012)

452

(2012)

Birth registration (%) Total under-five deaths (000)

3 65

(2006)

Neonatal deaths: % of all under-5 deaths

31

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

46 91

(2012)

Stillbirth rate (per 1000 total births)

30

(2009)

3,900

(2013)

Lifetime risk of maternal death (1 in N)

18

(2013)

Total fertility rate (per woman)

6.7

(2012)

Adolescent birth rate (per 1000 girls)

123

(2005)

Total maternal deaths

(2012)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

200

Deaths per 100,000 live births 1300

1400

177 147

150

1050

100

850

700

50

350

59

0 1990

MDG Target

1995

2000

2005

2010

0 1990

2015

Source: IGME 2013

330 MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

33

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

9

60 33

15

33

25

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

20

40

46 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

Measles

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

6

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1999 MICS

Percent

2002 Other NS

10 5

0

2006 MICS

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent

60

Percent

80

Skilled attendant at delivery

46 42

40 20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2000

100 80 60 32

40 20 0

13 2006 MICS

2012 2010

2005

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

13

(2006)

-

-

Early initiation of breastfeeding (within 1 hr of birth, %) 26 Introduction of solid, semi-solid/soft foods (%) 16 Vitamin A two dose coverage (%)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Percent of infants <6 months exclusively breastfed

100

80

Percent

80

60

40 20 0

-

Exclusive breastfeeding

23

29

1999 MICS

33

42

Percent

ORT & continued feeding

168

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

Source: MICS 2006

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

60 40 20

2006 MICS

0

9

9

1999 MICS

2006 MICS

(2006) (2006) -

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Somalia DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 17% 2%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 8%

Neonatal death: 31%

Other 21%

Embolism 2%

Sepsis 10%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

Abortion 10%

Asphyxia* 10%

Haemorrhage 25%

Other direct 9%

Other 2%

Sepsis** 6%

Malaria 2% Injuries 4%

Hypertension 16%

0% 12% Diarrhoea

Indirect 29%

Measles 13%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

80 60 40

-

Antenatal care (4 or more visits, %)

6

(2006)

Malaria during pregnancy - intermittent preventive treatment (%)

1

(2006)

C-section rate (total, urban, rural; %)

-

-

64

(2012)

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

Neonatal tetanus vaccine

32

26

(within 2 days for home births, %)

20 0

Demand for family planning satisfied (%)

-

(Minimum target is 5% and maximum target is 15%)

(within 2 days for home births, %)

1999 MICS

2006 MICS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

30 7 1999 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

13

2006 MICS

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

10 (2006)

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

No Data

1

5

Maternity protection (Convention 183)

No

Maternal deaths notification

No

Postnatal home visits in the first week after birth

No

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

No

Antenatal corticosteroids as part of management of preterm labour

No

International Code of Marketing of Breastmilk Substitutes

No

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

-

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

0

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

1.5

(2006)

56

(2005)

Per capita total expenditure on health (Int$)

-

-

General government expenditure on health as % of total government expenditure (%)

-

-

Out of pocket expenditure as % of total expenditure on health(%)

-

-

Density of doctors, nurses and midwives (per 10,000 population)

National availability of Emergency Obstetric Care services

(2013)

(% of recommended minimum)

FINANCING 11 2006 MICS

WATER AND SANITATION Improved drinking water coverage

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks (X of 7 tasks)

Congenital 1% HIV/AIDS 0%

No

Improved sanitation coverage

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

No Data

Reproductive, maternal, newborn and child health expenditure by source

No Data

External sources General government expenditure Out-of-pocket expenditure Other

ODA to child health per child (US$)

11

(2011)

ODA to maternal and neonatal health per live birth (US$)

19

(2011)

Note: See annexes for additional information on the indicators above

169

Fulfilling the Health Agenda for Women and Children The 2014 Report

South Africa DEMOGRAPHICS Total population (000)

52,386

(2012)

Total under-five population (000)

5,525

(2012)

Births (000)

1,102

(2012)

Birth registration (%) Total under-five deaths (000)

95 50

(2012)

Neonatal deaths: % of all under-5 deaths

34

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

15 33

(2012)

Stillbirth rate (per 1000 total births)

(2012)

(2012)

20

(2009)

1,500

(2013)

Lifetime risk of maternal death (1 in N)

300

(2013)

Total fertility rate (per woman)

2.4

(2012)

54

(2007)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

100

200

75

150

150

61

45

50

100

25

20 MDG Target

0 1990

1995

2000

2005

140

2010

2015

Source: IGME 2013

38

50

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 81 87 91

*Postnatal care Exclusive breastfeeding

Neonatal period

8

100

Pre-pregnancy Pregnancy Birth

0

40

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

60

79

1995 Other NS

Percent

81 (2012)

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

91

84

82

80

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1998 DHS

2003 DHS

100 80 60 40 20 0

86

2010

Source: UNICEF/UNAIDS/WHO 2013

91

83

2011

2012

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

100

68 68

40 20

Early initiation of breastfeeding

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2013

DTP3

NUTRITION

Measles

2005

100 80 60

75

40 20 0 1998 DHS

2012 2010

5

(2008)

15

(1998)

65

2003 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 61 Introduction of solid, semi-solid/soft foods (%) 49 Vitamin A two dose coverage (%)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Percent of infants <6 months exclusively breastfed

100

80

Percent

80

60

40 20 0

-

Exclusive breastfeeding

29 8 1994-1995 Other NS

33

30 10 1999 Other NS

12 2003 DHS

9

24

2008 Other NS

Percent

ORT & continued feeding

Source: DHS 1998

2000

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

170

78

60

Percent

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

81 79

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

EQUITY

60 40 20 0

7

8

1998 DHS

2003 DHS

(2003) (2003) -

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

South Africa DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 14% 3%

Other 21%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 12%

Neonatal death: 34%

Sepsis 10%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Legal status of abortion (X of 5 circumstances)

Abortion 10% Haemorrhage 25%

Asphyxia* 8%

Sepsis** 4%

7%

Hypertension 16%

0% Diarrhoea

Malaria 0%

Injuries 6%

* Intrapartum-related events

Indirect 29%

Measles 1%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

94

89

97

92

81

Antenatal care (4 or more visits, %)

87

(2008)

-

-

21, 24, 15

(2003)

77

(2012)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(2004)

Malaria during pregnancy - intermittent preventive treatment (%) (Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

1994-1995 Other NS

1998 DHS

2003 DHS

2008 Other NS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

-

40

20

02

4 8

29

85

79

93

47 57

52

1990

16

Total

2012

Source: WHO/UNICEF JMP 2014

-

Antenatal corticosteroids as part of management of preterm labour

-

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

-

-

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

1

(2013)

-

-

Newborn health (X of 4) Child health (X of 3)

-

-

56.8

(2013)

-

-

982

(2012)

13

(2012)

-

-

Density of doctors, nurses and midwives (per 10,000 population)

1990 Urban

2012 1990

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

100

Rural

5 8

14

80 18

60

13

13 14

13

10

27

26

40

20

2 10

10

74

58

-

75

82

No Data

External sources General government expenditure Out-of-pocket expenditure Other

16

ODA to child health per child (US$)

12

ODA to maternal and neonatal health per live birth (US$)

8

(2011)

17

(2011)

Note: See annexes for additional information on the indicators above

7 62 40

0 2012

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

31

8

0

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Out of pocket expenditure as % of total expenditure on health(%)

1 0 6

13

29

40

Yes

General government expenditure on health as % of total government expenditure (%)

2003 DHS

Percent

Percent

60

Yes

Postnatal home visits in the first week after birth

Per capita total expenditure on health (Int$)

Very limited risk

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

80

Maternal deaths notification

(% of recommended minimum)

Improved drinking water coverage 2 3 16

No

National availability of Emergency Obstetric Care services

WATER AND SANITATION

14 5

Maternity protection (Convention 183)

FINANCING

51

1998 DHS

100

-

(X of 7 tasks)

Congenital 2%

HIV/AIDS 17%

5 (R,F)

Midwives authorized for specific tasks

Other direct 9%

Other 6%

-

1990

2012 Total

1990

2012 Urban

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

171

Fulfilling the Health Agenda for Women and Children The 2014 Report

South Sudan DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

10,838

(2012)

1,726

(2012)

396

(2012)

Birth registration (%) Total under-five deaths (000)

35 40

(2010)

Neonatal deaths: % of all under-5 deaths

35

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

36 67

(2012)

-

-

3,000

(2013)

Lifetime risk of maternal death (1 in N)

28

(2013)

Total fertility rate (per woman)

5.0

(2012)

38

(2008)

Stillbirth rate (per 1000 total births) Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2012)

(2012)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

400

2000

300

1500

251

200

1800

1000 104

100 0 1990

84

MDG Target

1995

2000

2005

2010

730

500

2015

Source: IGME 2013

450

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 13

19

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

45

Measles

60

20

19

10

0

20 40 60 80 100

Source: DHS, MICS, Other NS

30

40

62 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

17

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

2006 MICS

Percent

Percent

Coverage along the continuum of care

20

0

2010 MICS

13

10

7

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

80

40 20

Early initiation of breastfeeding

0 1990

Measles

1995

2000

(2010)

-

-

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

33

Early initiation of breastfeeding (within 1 hr of birth, %)

-

-

Introduction of solid, semi-solid/soft foods (%)

21

(2010)

Vitamin A two dose coverage (%)

70

(2012)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100

80 Percent

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

48

2010 MICS

23

Underweight and stunting prevalence

Careseeking for pneumonia

40 20 0

NUTRITION Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

100 80 60

2012 2010

2005

80

60

40

33

36

28 31

20 0

Percent

No Data

Vitamin A (past 6 months)

172

Percent

62 59

60

Percent

Skilled attendant at delivery

DTP3

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

100

Antenatal care (4+ visits)

ITN use among children <5 yrs

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

60

45

40 20

2006 MICS

2010 MICS

0

2010 MICS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

South Sudan DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 18% 2%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 12%

Neonatal death: 34%

Sepsis 10%

Abortion 10%

Haemorrhage 25%

Other 1% Congenital 2%

Hypertension 16%

0%

11%

Indirect 29%

Diarrhoea

Malaria 6%

Source: WHO 2014

Measles 2%

Injuries 5%

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

40 26

17

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

19

(2010)

1, 1, 0

(2010)

Neonatal tetanus vaccine

-

-

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(within 2 days for home births, %)

20 0

13

Antenatal care (4 or more visits, %)

(Minimum target is 5% and maximum target is 15%)

60 40

Demand for family planning satisfied (%)

(2010)

C-section rate (total, urban, rural; %)

80

(within 2 days for home births, %)

2006 MICS

2010 MICS

(<18.5 kg/m2, %)

CHILD HEALTH

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

39

23

Malaria prevention and treatment Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Percent

Diarrhoeal disease treatment

8 (2010)

-

Maternity protection (Convention 183)

-

Maternal deaths notification

No

Postnatal home visits in the first week after birth

No

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

No

Antenatal corticosteroids as part of management of preterm labour

No

International Code of Marketing of Breastmilk Substitutes

-

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

No

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

25

2006 MICS

2009 Other NS

2

(2013)

2

(2013)

Newborn health (X of 4) Child health (X of 3)

1 2

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

-

-

National availability of Emergency Obstetric Care services

-

-

33

(2012)

4

(2012)

57

(2012)

General government expenditure on health as % of total government expenditure (%)

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent of population by type of sanitation facility, 2012 Improved facilities Shared facilities Open defecation Unimproved facilities

(2013)

58 77

No Data

External sources General government expenditure Out-of-pocket expenditure Other

80 Percent

(2013)

Reproductive health (X of 3) Maternal health (X of 3)

Out of pocket expenditure as % of total expenditure on health(%)

60

Partial

Life Saving Commodities in Essential Medicine List:

Per capita total expenditure on health (Int$)

21

100

No Data

-

FINANCING

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks

(% of recommended minimum)

100 80 60 40 20 0

2010 MICS

Improved drinking water coverage

No

(X of 7 tasks)

Other direct 9%

Sepsis** 7% HIV/AIDS 3%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Asphyxia* 9%

Other 22%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

81

ODA to child health per child (US$)

-

-

ODA to maternal and neonatal health per live birth (US$)

-

-

Note: See annexes for additional information on the indicators above

40 20 0

20 6

11 3 9

16

10 2 7

Total

Urban

Rural

Source: WHO/UNICEF JMP 2014

173

Fulfilling the Health Agenda for Women and Children The 2014 Report

Sudan DEMOGRAPHICS Total population (000)

37,195

(2012)

Total under-five population (000)

5,671

(2012)

Births (000)

1,263

(2012)

Birth registration (%) Total under-five deaths (000)

59 89

(2010)

Neonatal deaths: % of all under-5 deaths

39

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

29 49

(2012)

Stillbirth rate (per 1000 total births)

(2012)

(2012)

24

(2009)

4,600

(2013)

Lifetime risk of maternal death (1 in N)

60

(2013)

Total fertility rate (per woman)

4.5

(2012)

Adolescent birth rate (per 1000 girls)

102

(2009)

Total maternal deaths

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

800

150

600

128

100

400

73

50

43

0 1990

2000

2005

2010

360

200

MDG Target

1995

720

180

0 1990

2015

Source: IGME 2013

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 24

23

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

41

60 40

0

29

23

20

85

0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80

Infancy

Measles

-

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy

47

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

2006 MICS

Percent

No Data

2010 MICS

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

100

40 20

Early initiation of breastfeeding

DTP3

0 1990

No Data

Measles

1995

Source: WHO/UNICEF 2013

2000

ORT & continued feeding

100

-

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Early initiation of breastfeeding (within 1 hr of birth, %)

-

-

Introduction of solid, semi-solid/soft foods (%)

51

(2010)

Vitamin A two dose coverage (%)

83

(2012)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100

80

Percent

80

60

40

38 27

32 35

20 0

174

(2010)

-

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

40 20 0 2010 MICS

16

Underweight and stunting prevalence

Careseeking for pneumonia

66

56

NUTRITION Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

Vitamin A (past 6 months)

100 80 60

2012 2010

2005

Percent

ITN use among children <5 yrs

75

60

Percent

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

92 92 85

80

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

EQUITY

60 40

41

20 2006 MICS

2010 MICS

0

2010 MICS

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Sudan DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 2%

16%

Preterm 11%

Neonatal death: 38%

Other 23%

Globally nearly half of child deaths are attributable to undernutrition

Sepsis 10%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Legal status of abortion (X of 5 circumstances)

Abortion 10%

Asphyxia* 11%

Other 1%

Sepsis** 9%

Malaria 2%

11% Measles 4%

Injuries 7%

* Intrapartum-related events

Hypertension 16%

0%

Indirect 29%

Diarrhoea

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

24

Antenatal care (4 or more visits, %)

47

(2010)

2

(2010)

7, 12, 5

(2010)

74

(2012)

C-section rate (total, urban, rural; %)

74

74

80 Percent

Demand for family planning satisfied (%)

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

100

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

-

-

Postnatal visit for mother

-

-

Women with low body mass index

-

-

(within 2 days for home births, %)

20 0

(within 2 days for home births, %)

2006 MICS

2010 MICS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

31

27

12

2000 MICS

2006 MICS

22

33 (2010)

25

35

3

2 12

31

8

20

14

31

37

24

0

1990

45

78

Total

2012

Source: WHO/UNICEF JMP 2014

Urban

2012 1990

60

Rural

13

2012

46

28 12

28

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

No

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

No

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2013)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

0

(2013)

3

(2013)

Newborn health (X of 4) Child health (X of 3)

3 3

(2013)

11.2

(2008)

35

(2005)

159

(2012)

General government expenditure on health as % of total government expenditure (%)

11

(2012)

Out of pocket expenditure as % of total expenditure on health(%)

74

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2013)

48

7

6

27

52

10

44

24

0

1990

2012 Total

59

26

2012 Urban

ODA to child health per child (US$)

11

(2011)

ODA to maternal and neonatal health per live birth (US$)

35

(2011)

Note: See annexes for additional information on the indicators above

29 24

5

4

18

1990

No Data

External sources General government expenditure Out-of-pocket expenditure Other

20

24

40

20 16

1990

8

80 38

46

32

100

29

20 35

Percent of population by type of sanitation facility, 1990-2012 Improved facilities Shared facilities Open defecation Unimproved facilities

36

60

40

10

Yes

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Percent

80

10

Yes

Postnatal home visits in the first week after birth

Per capita total expenditure on health (Int$)

30

WATER AND SANITATION

100 8

Maternal deaths notification

National availability of Emergency Obstetric Care services

2006 MICS

Percent of population by type of drinking water source, 1990-2012 Piped on premises Other improved Surface water Unimproved

No

FINANCING

2010 MICS

Improved drinking water coverage

Maternity protection (Convention 183)

(% of recommended minimum)

100 80 60 40 20 0

Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

-

(X of 7 tasks)

Congenital 3% HIV/AIDS 1%

1 (R,F)

Midwives authorized for specific tasks

Haemorrhage 25%

Other direct 9%

Partial

13

1990

2012 Rural

Source: WHO/UNICEF JMP 2014

175

Fulfilling the Health Agenda for Women and Children The 2014 Report

Swaziland DEMOGRAPHICS Total population (000)

1,231

(2012)

169

(2012)

Births (000)

37

(2012)

Birth registration (%) Total under-five deaths (000)

50 3

(2010)

Neonatal deaths: % of all under-5 deaths

37

(2012)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

30 56

(2012)

Total under-five population (000)

Stillbirth rate (per 1000 total births)

(2012)

(2012)

18

(2009)

120

(2013)

Lifetime risk of maternal death (1 in N)

94

(2013)

Total fertility rate (per woman)

3.4

(2012)

89

(2009)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

160

600

120

450 80

71

80

24

MDG Target

1995

2000

2005

2010

310

300

40 0 1990

550

2015

Source: IGME 2013

150

140

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 83 77 82

*Postnatal care

22

Exclusive breastfeeding

Neonatal period

44

Measles

80

82

69

Infancy

56

20 0

Percent

1994 Other NS

2000 MICS

2002 2006-2007 Other NS DHS

79 (2012)

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

40

20 40 60 80 100

Source: DHS, MICS, Other NS

74

70

60

88 0

Eligible HIV+ pregnant women receiving ART for their own health (%, of total ARVs)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2010 MICS

100 80 60 40 20 0

87

76

2010

Source: UNICEF/UNAIDS/WHO 2013

2011

83

2012

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

40 20

Early initiation of breastfeeding

1995

DTP3

NUTRITION

2000

2005

40 20

Wasting prevalence (moderate and severe, %) Low birthweight incidence (moderate and severe, %)

ORT & continued feeding

1

(2010)

9

(2010)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

(2010)

Vitamin A two dose coverage (%)

(2012)

33

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80 40

37

40

0

2010 MICS

100

60

20

2006-2007 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 55 Introduction of solid, semi-solid/soft foods (%) 66

80

Percent

58 61 24

2000 MICS

2012 2010

9 2000 MICS

31

30 6 2006-2007 DHS

7 2008 Other NS

6 2010 MICS

Percent

Measles

73

60

0 1990

Source: WHO/UNICEF 2013

Source: MICS 2010

100 80 60

0

ITN use among children <5 yrs

Vitamin A (past 6 months)

176

Percent

60

Percent

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia: taken to appropriate health provider receiving antibiotics

95 95 88

80

Antenatal care (4+ visits)

Pneumonia treatment

60 40 20 0

24

2000 MICS

32

2006-2007 DHS

33

2008 Other NS

44

2010 MICS

(2010)

Impro

Fulfilling the Health Agenda for Women and Children The 2014 Report

Swaziland DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2012 Pneumonia 2% 13%

Other 20%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 12%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10% Haemorrhage 25%

Asphyxia* 11%

Neonatal death: 37%

Other direct 9%

Other 2%

Sepsis** 7% 9%

Malaria 0%

Diarrhoea Injuries 5%

Indirect 29%

Measles 0%

Source: WHO 2014

Source: WHO/CHERG 2014 ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

87

90

85

80 Percent

97

Demand for family planning satisfied (%)

83

(2010)

Antenatal care (4 or more visits, %)

77

(2010)

1

(2010)

12, 12, 13

(2010)

86

(2012)

-

-

22

(2006-2007)

-

-

Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60

Neonatal tetanus vaccine

40

Postnatal visit for baby

(within 2 days for home births, %)

20

Postnatal visit for mother

0

(within 2 days for home births, %)

2000 MICS

2002 Other NS

2006-2007 DHS

2010 MICS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment
<