Panama Country Profile for Demographic and Health Surveys, the Years Refer to When the Surveys Were Conducted

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Panama Country profile For Demographic and Health Surveys, the years refer to when the Surveys were conducted. Estimates from the Surveys refer to three or five years before the Surveys.

Panama and the world

1. Maternal mortality ratio: global, regional and 2. Lifetime risk of maternal death (1 in N), 2005 country data, 2005

A maternal death is defined as the death of a woman while pregnant or The lifetime risk of maternal death is the estimated risk of an individual within 42 days of termination of pregnancy, from any cause related to woman dying from pregnancy or childbirth during her adult lifetime the pregnancy or its management but not from accidental or incidental based on maternal mortality and the fertility rate in the country. The causes. The maternal mortality ratio is the number of maternal deaths lifetime risk of dying from pregnancy-related causes in Panama is 1 in per 100 000 live births per year. The ratio in Panama is 130 per 100 000 270, slightly lower than the average of 1 in 290 for Latin America and the live births, which is the same as the average of 130 per 100 000 live births Caribbean and lower than the global figure of 1 in 92. in Latin America and the Caribbean and lower than the global average of 400 per 100 000 live births.

3/250 1/92 4 5 0 1/100 400 4 0 0 3 5 0 1/125 3 0 0 2 5 0 3/500 2 0 0 1/270 1/290 death (1 in N) live births 130 130 1/250

1 5 0 Lifetime risk of 1 0 0

Deaths per 100 000 1/500 5 0 0 0 Panama Latin America World Panama Latin America World and the Caribbean and the Caribbean

Source: Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007 Source: Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007 (http://www.who.int/reproductive-health/publications/maternal_mortality_2005/index.html). (http://www.who.int/reproductive-health/publications/maternal_mortality_2005/index.html).

Demographic and health data

3. Total population (in thousands)1 3 288 (2006) Lifetime risk of maternal death (1 in N)2 270 (2005) Total maternal deaths2 91 (2005)

Source: 1 World Health Organization 2008, World Health Statistics 2008 Geneva, Switzerland (http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf). 2 Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007 (http://www.who.int/reproductive-health/publications/maternal_mortality_2005/index.html).

4. Causes of maternal deaths 1997–2002 5. Total fertility A maternal death is defined as the death of a woman while pregnant The total fertility is the average number of children that would be born or within 42 days of termination of pregnancy from any cause related to a woman over her lifetime. The total fertility rate can be separated to the pregnancy or its management but not from accidental or into the births that were planned (wanted total fertility rate) and those incidental causes. The most frequent causes of maternal deaths in that were unintended (unwanted total fertility rate). In Panama, a survey Latin America and the Caribbean (for 1997–2002) were haemorrhage conducted in 2006 indicated a total fertility rate of 2.6 per woman. (uncontrolled bleeding), hypertensive disorders (high blood pressure) and obstructed labour.

6 Other causes 20.0% 5

Ectopic pregnancy 0% Haemorrhage 4 21.0% 3.0 2.7 2.6 3 Anaemia 0.1% 2

Obstructed labour 13.0% Hypertensive 1 disorders 26.0% fertility rate (per woman) Total 0 1990 2000 2006 Abortion 12.0% Year

Latin America and the Caribbean Sepsis/infections including HIV/AIDS 8.0%

Source: Khan KS et al. WHO analysis of causes of maternal death: a systematic review. Lancet, 2006, 367:1066–1074. Source: World Health Organization 2008, World Health Statistics 2008 Geneva, Switzerland (http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf).

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6. Annual live births 7. Neonatal mortality rate, 2004

Perinatal mortality refers to deaths of fetuses in the womb and of The total number of births (in thousands): 70 (2005) newborn babies early after delivery. It includes (1) the death of a fetus in the womb after 22 weeks of gestation and during childbirth and (2) the death of a live-born child within the first seven days of life. The perinatal mortality rate reflects the availability and quality of both maternal and newborn health care. Neonatal mortality refers to the number of newborn deaths during the first 28 completed days of life per 1000 live births in a given year or other period. In Panama, the neonatal mortality 80 70 rate in 2004 was 11 per 1000 pregnancies. 60 40 12 11

20 10 8

Total number of births (in thousands) Total 0 6 2005 4 Year 2

Deaths per 1000 live births 0 2004 Year

Source: World population prospects: the 2006 revision. CD-ROM edition – extended dataset in Excel and ASCII formats. New York, United Nations Sources: Bureau of Statistics and Census, Office of the Comptroller of the Republic Department of Economic and Social Affairs, Population Division, 2007 (United Nations publications, ST/ESA/SER.A/266). World health statistics 2008. Geneva, World Health Organization, 2008 (http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf).

8. Adolescent pregnancy rate by age for girls 9. Adolescent pregnancy rate by urban versus rural 15–19 years old location Adolescent pregnancy is pregnancy in an adolescent girl (girls 10–19 years old). The adolescent pregnancy rate indicates the proportion of adolescent girls who become pregnant among all girls in the same age group in a given year. In 2006, the adolescent pregnancy rate increased steadily with age, peaking at 29.5% at age 19 years.

29.5 30 Adolescent pregnancy rates tend to vary between urban and rural 24.8 parts within countries. The rates can vary for many reasons including 25 cultural norms, socioeconomic deprivation, education, access to sexual 19.8 20 health information and contraceptive services and supplies. There are no country-specific data on urban versus rural differences in adolescent 13.9 15 pregnancy for Panama.

10 7.9 pregnant with their first child % of women (15-19 years old) 5

0 15 16 17 18 19

Sources: Bureau of Statistics and Census, Office of the Comptroller of the Republic

10. Adolescent pregnancy by subregion Adolescent pregnancy rates also vary between different areas within countries. In 2006 in Panama the rate varied from 26% in Chiriquí to about 34% in Bocas del Toro.

4 0 . 0 34.1 32.9 3 5 . 0 32.0 28.7 29.8 3 0 . 0 26.5 26.0 26.1 26.0 26.1 26.1 2 5 . 0 2 0 . 0 1 5 . 0 1 0 . 0 5 . 0 0 . 0 % of pregnancy in adolescents

Coclé Colón Darién Herréra Chiriquí Panama Veraguas Kuna Yala Los Santos Ngobe Bugle

Bocas del toro

Source: Bureau of Statistics and Census, Office of the Comptroller of the Republic

Panama 3

Intervention coverage for mothers and newborns

11. Unmet need for family planning Unknown 13. Contraceptive use by urban versus rural location The unmet need for family planning is the proportion of all women who are at risk of pregnancy and who want to space or limit their childbearing but are not using contraceptives.

12. Family planning: modern contraceptive use by age group

The prevalence of contraceptive use can vary between rural and urban areas within countries. There are no country-specific data on contraceptive use by urban versus rural location in Panama. Modern contraceptive methods include oral and injectable hormones, intrauterine devices, diaphragms, hormonal implants, female and male sterilization, spermicides and condoms. In 2006, 10% of currently married women used modern contraceptives.

Source: Ministry of Health, Department of Health Analysis and Trends, Medical and Statistical Records Section.

14. Contraceptive use by subregion 15. Antenatal care Antenatal care visits include all visits made by the pregnant woman (15–49 years old) to a skilled health worker for reasons relating to pregnancy among all women who gave birth in a given time period. In 2006, about 85% of women in Panama attending public health facilities received antenatal care during pregnancy from a skilled health-care worker.

90 85.2

The prevalence of contraceptive use also tends to vary in different 60 subregions within countries. There are no country-specific data on 50 contraceptive use by subregion for Panama. 40

30 once for antenatal care

20 % of women who attended at least 10

0 2006 Year

Source: Ministry of Health, Department of Health Analysis and Trends, Medical and Statistical Records Section

16. Utilization of skilled birth attendants

A skilled birth attendant is an accredited health professional – such as 9 2 a midwife, doctor or nurse – who has been educated and trained to 9 1 proficiency in the skills needed to manage normal (uncomplicated) 9 0 pregnancies, childbirth and the immediate postnatal period, and in 8 9 the identification, management and referral of complications among 8 8 8 7 women and newborns. All women should have access to skilled care 8 6 during pregnancy and at delivery to ensure that complications are 8 5 skilled birth attendant

detected and managed. In Panama, according to a survey conducted in % of births assisted by 8 4 2000–2006 , 91% of births are assisted by a skilled birth attendant. 8 3 1990–1999 2000–2006

Source: World health statistics 2008. Geneva, World Health Organization, 2008 (http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf).

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17. Utilization of skilled birth attendants by wealth 18. Utilization of skilled birth attendants by province quintile and comarca indigena, 2006

The utilization of skilled birth attendants varies substantially by province and comarca indigena (provincial-level indigenous regions). According to a survey conducted in 2006, utilization of skilled birth attendants ranged from 52% in Panama to 0.1% in Veraguas.

52.4

Whether a woman delivers with the assistance of a skilled attendant is 40 highly influenced by how rich they are. There are no country-specific 30 data on skilled birth attendants by wealth quintile in Panama.

20 13.2 7.8 10 5.1 6.0 6.1 2.7 1.3 1.7 1.2 2.3 0.1 0 % of births assisted by skilled birth attendant Yala Cocl é Bugle Col ó n Dari é n Herrera Chiriqu í Panama Veraguas Kuna C. Ember á Los Santos Ngobe Bocas del Toro

Source: Bureau of Statistics and Census, Office of the Comptroller of the Republic

19. Place of delivery 20. Caesarean section rates by urban versus rural location Delivery in a health facility can reduce maternal and neonatal death and morbidity. According to latest available data the majority of (90%) of births occured in a health facility.

100% 90.0 90%

80%

70% Caesarean section is a surgical procedure in which incisions are made through a woman’s abdomen and womb to deliver her baby. It is 60% performed whenever abnormal conditions complicate vaginal delivery, 50% threatening the life and health of the mother and/or the baby. There are 40% no country-specific data for Panama.

30%

20% 10.0 10% % of births assisted by skilled birth attendant 0% Health facility Other places

Source: Bureau of Statistics and Census, Office of the Comptroller of the Republic

21. Caesarean section by subregion 22. Low birth weight Rates of caesarean section vary between different parts of a country. Babies weighing less than 2500 g at birth are considered to have low In 2006, the rate of caesarean section varied substantially from about birth weight. In 2006, of the babies who were weighed at birth, 9% were 49% in Panama and 25% in Chiriquí to about 0% in Bocas del Toro, reported to weigh less than 2500 g (2.5 kg). Low-birth-weight babies Colón, Darién, Kuna Yala and Ngöbe-Buglé. Low caesarean section rates, often face severe short- and long-term health consequences and tend in particular in rural areas, could indicate an unmet need for access to have higher mortality and morbidity. to adequate health system infrastructure, which needs to be met if maternal deaths are to be reduced.

10 60.0 9.3 9 48.7 50.0 8

7 40.0 6 30.0 25.0 5

20.0 4

3 8.9 10.0 6.8 7.0 3.4 2 0.0 0.0 0.0 0.1 0.0 0.0 1 less than 2500 g % babies weighing

éra % of births delivered by caesarean section % of births delivered 0 Coclé Colón Darién Chiriquí Herr 2006 Panama Veraguas Kuna Yala Los Santos Year Ngobe Bugle Bocas del toro

Source: Ministry of Health, Department of Health Analysis and Trends, Medical and Statistical Records Section Source: Ministry of Health, Department of Health Analysis and Trends, Medical and Statistical Records Section

Panama 5

23. Anaemia in pregnancy 24. Prevention of mother-to-child transmission of HIV

Anaemia refers to abnormally low levels of haemoglobin (iron- containing oxygen proteins) in the blood. The percentage of pregnant women with low haemoglobin levels (less than 110 g/l) was approximately 36% according to a survey conducted in 1999. Severe anaemia is an important contributing factor to maternal deaths due to haemorrhage during childbirth.

40 36.3 35 The percentage of pregnant women living with HIV and receiving 30 antiretroviral drugs (ARVs) to prevent the transmission of HIV to their 25 child (PMTCT) was 30% in 2006.

10 % of pregnant women with anaemia 5

0 1999

Year Source: Seguimiento a la Declaracíon de compromiso sobre VIH/SIDA: informe nacional sobre los progresos realizados en la aplicacíon del UNGASS – Panama, Enero 2006 – Diciembre 2007 [Monitoring the Declaration of Commitment on HIV/AIDS: national progress report on UNGASS – Panama, January 2006 – December 2007]. Panama City, Ministry of Health and UNAIDS, 2008 (http://www.unaids.org/en/KnowledgeCentre/HIVData/ Source: Ministry of Health, national survey on vitamin A and anaemia due to iron deficiency, Panama, 1999 CountryProgress/2007CountryProgressAllCountries.asp).

Equity Policies

26. Reproductive health Yes 25. Equity – gap in coverage of four major Maternal health Yes interventions by wealth quintile Source: WHO/CAH, MPS and HSS Database on National Health Policies.

Resources

27. Financial flow (per capita expenditure on health, in US dollars) 2007 351

Source: World health statistics 2008. Geneva, World Health Organization, 2008 (http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf).

28. Human resources Coverage of four key interventions (family planning, maternal and newborn care, immunization and treatment of childhood illness) often varies by wealth quintiles. A coverage gap usually exists At least 23 health workers (doctors, nurses or midwives) per 10 000 between the goal of universal coverage of everyone (universal population is estimated to be necessary to support the delivery of the coverage) in these four intervention areas and actual coverage. Where basic interventions required to achieve the Millennium Development the gap is larger, it means that there is less adequate coverage. The Goals related to health. Globally, 57 countries have been identified with opposite indicates better coverage. In many countries, the coverage critical shortages below this minimum. These countries have a severe gap is highest for the poorest and is lowest for the richer members crisis in human resources for health. Of these 57 countries, 36 are in of society (wealthiest quintile). Achieving equity requires improving sub-Saharan Africa. Panama, with about 43 health workers (as defined coverage levels in the poorest quintiles. There are no country-specific above) per 10 000 population, is above the threshold value of the data for Panama. countries facing this crisis daily, with mothers and children lacking access to proper maternal and child care, HIV/TB and malaria care, and sexual and reproductive health information and services, including skilled birth attendants. But this does not mean that it commands sufficient human resources to satisfy all the health needs throughout the country.

A shortage of access to health workers, in particular among underserved communities, can be exacerbated by staff losses due to migration (in search of a better life) of skilled staff to high-income countries, leaving behind already impoverished health services and systems.

Increasing the human resources around the world and establishing a balance between the services needed and the personnel available, and their distribution, are key elements of a well-functioning health system and critical requirements for achieving Millennium Development Goals.

Countdown to 2015. Tracking progress in maternal, newborn & child survival: the 2008 report. New York, United Nations Children’s Fund, 2008 (http://www. countdown2015mnch.org/index.php?option=com_content&view=article&id=68&itemid=61).

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29. Ratification of treaties and support of international consensus

Convention on the Elimination of All Forms of Discrimination against Women Yes

Convention on the Rights of the Child Yes

International Covenant on Economic, Social and Cultural Rights Yes

Signature International Conference on Population and Development only Fourth World Conference on Women Yes

Sources: Ratifications and reservations [web site]. Geneva, Office of the United Nations High Commissioner for Human Rights, 2008 (http://www2.ohchr.org/english/bodies/ratification/index.htm).

Report of the Fourth World Conference on Women, Beijing, 4–15 September 1995. New York, United Nations, 1996 (http://www.un.org/womenwatch/confer/beijing/reports).

Report of the International Conference on Population and Development, Cairo, 5–13 September 1994. New York, United Nations, 1994 (http://www.un.org/popin/icpd/conference/offeng/poa.html).

30. Other determinants of health: water, sanitation, communication and road networks

Fixed-line and mobile phone subscribers (per 100 population) 81 (2006)

Internet users (per 100 population) 15 (2006)

Roads paved (% of total roads) 35 (2000)

Improved water source (% of population with access) 92 (2006)

Improved sanitation facilities (% of urban population with access) 78 (2006)

Source: World Bank indicators [online database]. Washington, DC, World Bank, 2008 (http://ddp-ext.worldbank.org/ext/ddpreports/ViewSharedReport?&CF=&REPORT_ID=9147&REQUEST_ TYPE=VIEWADVANCED&HF=N/CPP&WSP=N).

For further information contact:

Child and Adolescent Health and Development Gender, Women and Health Immunization, Vaccines and Biologicals Tel: +41 22 791 3281 Tel: +41 22 791 2394 Tel: +41 22 791 4612 E-mail: [email protected] E-mail: [email protected] E-mail: [email protected] Web site: www.who.int/child_adolescent_health/en Web site: www.who.int/gender Web site: www.who.int/immunization/en

Making Pregnancy Safer Reproductive Health and Research Tel: +41 22 791 3966 Tel: +41 22 791 3372 E-mail: [email protected] E-mail: [email protected] Web site: www.who.int/making_pregnancy_safer/en Web site: www.who.int/reproductive-health

Panama