Maternal, Neonatal and Under Five Mortality

Home , Child mortality, Perinatal mortality

THE WAY FORWARD

Sustain high-level commitment of Member States RMNCAH and their accountability. SUSTAIN Improve the quality of care and emphasis on underfocused areas.

Mobilize domestic health spending to achieve UHC for RMNCAH services.

Make efforts to factor in the changing epidemiology and emerging priorities such as birth defects, injuries in children, prevention of stillbirths, indirect causes of maternal ACCELERATE mortality and focus on neglected sexual and reproductive health issues.

Strengthen health system actions to improve service delivery for RMNCAH, and especially augment the health workforce and financing.

Make effective use of information and communication technology (ICT) and digital health options for improving demand-side and supply-side interventions as well as better measurement of progress in RMNCAH programmes. ACCELERATE REDUCTION OF

Explore multidimensional approaches and intersectoral collaboration for INNOVATE adressing the social determinants of health to improve the health of mothers, MATERNAL, newborns and children. NEONATAL AND Encourage horizonal collaboration among countries/South-to-South collaboration for capacity-building, technology transfer and learning. UNDER FIVE MORTALITY IMPACT OF ACHIEVING FLAGSHIP TARGET

By 2016, the MDG 4 targets had already been achieved. This has further ensured that the Region is well placed to achieve the SDG target of under-five mortality by 2030.

Reaching the GPW 13 target of reducing the MMR and preventable deaths of newborns and children under 5 years of age by 30% by 2023 would mean roughly about 20 000 additional lives of mothers saved compared to 2015 and 110 000 additional newborn lives saved compared to 2017.

UNMIT/Bernardino Soares Shamila Sharma TARGETS ACHIEVEMENTS

Global Targets Under-five mortality in the Region has declined by nearly 70% compared to the baseline of 1990.2 The Region has also achieved the MDG target of two third reduction in under five mortality from the SDG targets a reduction in neonatal mortality to at least 12 per 1000 live births, under-5 mortality to 25 per 1000 live births baseline of 1990. Five countries in the Region – DPR Korea, Indonesia, Maldives, Sri Lanka and Thailand – and maternal mortality ratio (MMR)1 to a global level of 70 per 100 000 live births by 2030. GPW 13 targets a reduction in the have reached an under-five mortality rate below the 2030 SDG target of atleast 25 per 1000 live births. global MMR by 30% and in preventable deaths of newborns and children under 5 years of age by 30% by 2023.

Regional Targets Neonatal mortality declined by 60% in the Region from 1990 to 2017.

S. No. Key Performance Indicator 2013 2019 Target 2020 The maternal mortality ratio in the Region declined by 69% between 1990 and 2015; this was the largest reduction among the WHO regions. Out of the nine countries that achieved MDG target 5A globally, three Number of countries that have costed national 1 10 11 plans for RMNCAH areas. are from the SEA Region. India reported a steep reduction in the MMR in 2018 (130 per 100 000 livebirths), potentially bringing the Region below its 2015 MDG target.3 7 Number of countries that have a national (BAN, BHU, IND, 0 11 Progress in mortality reduction in the Region can be related to an increase in the coverage of some life- quality improvement framework. INO, MAV, NEP, SRL) saving evidence-based interventions. For example, the proportion of institutional deliveries has increased by 78% in the Region over the past decade. Demand for family planning with modern methods has reached Number of countries implementing 70% in the Region. 2 11 11 MDSR/MPDSR.

MDSR: maternal death surveillance and response; MPDSR: maternal perinatal death surveillance and response; RMNCAH: reproductive, maternal, neonatal, child and adolescent health. CHALLENGES

PROGRESS Coverage of several evidence-based life-saving interventions across the RMNCAH life-course has been low Status of maternal, newborn and child mortality and stillbirths in the WHO South-East Asia Region and uneven. Countries need to progressively scale up the coverage of all interventions to a high level of 95% Maternal mortality ratio Neonatal mortality rate Under-five mortality rate to end preventable mortality among women, newborns and children. (per 100 000 live births) (deaths per 1000 live births) (deaths per 1000 live births) Data year 2015 2017 2017 Source MMEIG 2015 UNIGME 2018 UNIGME 2018 There are wide disparities in mortality and coverage of interventions based on rural–urban residence, gender Bangladesh 176 18 32 and socioeconomic status. Some populations remain unreached, signifying the equity gap and the importance Bhutan 148 17 31 of addressing the social determinants of health such as poverty, illiteracy and gender issues. DPR Korea 82 10 19 India 174 ( 130 SRS ) 24 39 Indonesia 126 12 25 Karen Reidy Maldives 68 5 8 The quality of care is inadequate, which reduces the effectiveness of evidence-based life-saving interventions, Myanmar 178 24 49 especially at the time of childbirth and during the newborn period. BACKGROUND Nepal 258 21 34 The Flagship Priority Area on the unfinished MDGs agenda: Ending preventable maternal, newborn and child deaths with a Sri Lanka 30 6 9 focus on neonatal deaths, identified in 2014 (and updated in 2019), is well aligned with global priorities such as the SDGs Thailand 20 5 10 There are persistent health system constraints such as financial resources for RMNCAH, lack of skilled birth and the 13th General Programme of Work (GPW 13) of WHO. The SDG 3 targets aim to end preventable deaths of newborns Timor Leste 215 21 48 attendants (midwives, doctors, etc.), access to essential medicines and life-saving equipment, weak service and children under 5 years of age and reduce maternal mortality. This Flagship Area will also significantly contribute to these SEA Region 164 18 36 delivery and weak civil registration systems. targets and to GPW 13 to achieve the goals for women, children and adolescents under the Strategic Objective of 1 billion Achieved SDG/ENAP/Global Expected to achieve the Need to increase its current efforts more people benefiting from universal health coverage (UHC) and 1 billion more people enjoying better health and well-being. Strategy Target in 2017. SDG/EPMM/ENAP/Global and attain faster annual reduction Strategy Target by 2030. (ARR). 2 UNIGME Child Mortality Report 2018. With a quarter of the world’s population residing in the WHO South-East Asia (SEA) Region, Member States of the Region ENAP: Every Newborn Action Plan; EPMM: Ending Preventable Maternal Mortality; SDG: Sustainable Development Goal; SRS: Sample 3 India MMR as per the Sample Registration System (SRS) 2016 report is expected to be factored in the next UN estimation and is the basis of the accounted for approximately one third of the neonatal deaths in 2018. In addition, there is a huge number of stillbirths – about assumption. 2014–2017 MMR estimates will be released soon. It is now undergoing country consultation. Registeration System; MMIEG: United Nations Maternal Mortality Estimation Inter-Agency Group; as many as newborn deaths. Thus, evidently the Region faces far too large a burden of maternal and perinatal mortality. UNIGME: United Nations Inter-agency Group for Child Mortality Estimation.

Investments in early childhood, child and adolescent health and development, and in family planning, pregnancy and childbirth At the current rate of progress, the SEA Region is likely to achieve the SDG target of under-five mortality reduction. care can yield benefit-to-cost ratios of around 10:1. In addition, rates of mental health disorders and noncommunicable However, for achieving the targets of neonatal mortality and maternal mortality, countries must significantly diseases in later life can be reduced. accelerate actions. 1 This is true only for the global target. Each country has different target for the MMR SDG target. Countries need to achieve a two third reduction from the 2010 MMR and no country should have an MMR of more than 140. TARGETS ACHIEVEMENTS