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

WHO Director-General Roundtable with Women Leaders on Millennium Development Goal 5

Namibia 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.

Namibia 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 lifetime risk of dying from pregnancy-related causes in Namibia is 1 in deaths per 100 000 live births per year. The ratio in Namibia is 210 170, which is lower than the average of 1 in 22 in sub-Saharan Africa and per 100 000 live births versus an average of 900 per 100 000 live births in the global figure of 1 in 92. sub-Saharan Africa and an average of 400 per 100 000 live births globally.

1/20 1/22 1000 9/200 900 900 1/25 800 7/200 700 3/100 600 1/40 500 400 400 1/50 live births 300 3/200 210 1/92 200 1/100 Deaths per 100 000 1/170 100 Lifetime risk of death (1 in N) 1/2000 0 0 Namibia Sub-Saharan World Namibia Sub-Saharan World Africa Africa

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 2 047 (2006) Lifetime risk of maternal death (1 in N)2 170 (2005) Total maternal deaths2 110 (2005)

Sources: 1World Health Organization 2008, World Health Statistics 2008 Geneva, Switzerland (http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf). 2Maternal 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 or The total fertility is the average number of children that would be born within 42 days of termination of pregnancy from any cause related to to a woman over her lifetime. The total fertility rate can be separated into the pregnancy or its management but not from accidental or incidental the births that were planned (wanted total fertility rate) and those that causes. The most frequent causes of maternal deaths in Africa (for 1997– were unintended (unwanted total fertility rate). According to a survey 2002) were haemorrhage (uncontrolled bleeding), sepsis or infections conducted in 2000, the total fertility rate was 4.2 per woman in Namibia. including HIV, hypertensive disorders (high blood pressure) and other causes. There are no country-specific data for Namibia.

Obstructed labour 4%

. Anaemia 4% Abortion 4% . Hypertensive disorders 9% Haemorrhage . 34% . Africa Total fertility rate (per woman) Total Sepsis or Infections, including HIV 16% Other causes 30%

Sources: Making Pregnancy Safer country profiles [online database]. Geneva, World Health Organization, in press (Department of Making Pregnancy Safer; http://www.who.int/making_pregnancy_safer/en). Source: Khan KS et al. WHO analysis of causes of maternal death: a systematic review. Lancet, 2006, 367:1066–1074. Demographic and Health Surveys [web site]. Calverton, MD, MEASURE DHS, Macro International Inc. (http://www.measuredhs.com/aboutsurveys/ search/start.cfm).

Lead the fight for MDG 5 2

6. Proportions of births by urban versus rural 7. Perinatal mortality rate location Among the women interviewed in a survey conducted in 2000, about 66% of births occurred in rural areas.1

The total number of births (in thousands): 53 (2005)2

Perinatal mortality refers to deaths of fetus in womb and newborn baby early after delivery. It includes (1) death of fetus in the womb after 22 weeks of gestation and during childbirth, and (2) death of a live- born within the first seven days of life. These deaths are considered an indication of the availability and quality of both maternal and newborn health care. There are no country-specific data for Namibia.

Sources: 1Making Pregnancy Safer country profiles [online database]. Geneva, World Health Organization, in press (Department of Making Pregnancy Safer; http://www.who.int/making_pregnancy_safer/en). Demographic and Health Surveys [web site]. Calverton, MD, MEASURE DHS, Macro International Inc. (http://www.measuredhs.com/aboutsurveys/ search/start.cfm).

2World population prospects: the 2006 revision. CD-ROM edition – extended dataset in Excel and ASCII formats. New York, United Nations Department of Economic and Social Affairs, Population Division, 2007 (United Nations publications, ST/ESA/SER.A/266).

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 In Namibia, a survey conducted in 2000 found that 3% of women 15–19 years old). The adolescent pregnancy rate indicates the proportion of years old were currently pregnant with their first child, with a slightly adolescent girls who become pregnant among all girls in the same age higher rate in rural areas than urban areas. group in a given year. According to a survey conducted in 2000, the rate differed across all ages.

......

. pregnant with their first child % of women (15-19 years old) pregnant with their first child

% of women (15-19 years old) . . . . .

Sources: Making Pregnancy Safer country profiles [online database]. Geneva, World Health Organization, in press (Department of Making Pregnancy Sources: Making Pregnancy Safer country profiles [online database]. Geneva, World Health Organization, in press (Department of Making Pregnancy Safer; http://www.who.int/making_pregnancy_safer/en). Safer; http://www.who.int/making_pregnancy_safer/en). Demographic and Health Surveys [web site]. Calverton, MD, MEASURE DHS, Macro International Inc. (http://www.measuredhs.com/aboutsurveys/ Demographic and Health Surveys [web site]. Calverton, MD, MEASURE DHS, Macro International Inc. (http://www.measuredhs.com/aboutsurveys/ search/start.cfm). search/start.cfm).

10. Adolescent pregnancy by subregion Adolescent pregnancy rates vary between different parts of Namibia. According to a survey conducted in 2000, the rate was highest in the Northeast subregion (3.9%) and lowest in the Northwest subregion (2.5%). Adolescent pregnancy rates can vary for many reasons including cultural norms, socioeconomic deprivation, and education, access to sexual health information and contraceptive services and supplies.

. .

. . . with their first child % of women (15-19 years old) pregnant

Sources: Making Pregnancy Safer country profiles [online database]. Geneva, World Health Organization, in press (Department of Making Pregnancy Safer; http://www.who.int/making_pregnancy_safer/en). Demographic and Health Surveys [web site]. Calverton, MD, MEASURE DHS, Macro International Inc. (http://www.measuredhs.com/aboutsurveys/ search/start.cfm).

Namibia 3

Intervention coverage for mothers and newborns

11. Unmet need for family planning, 2000 25.1% 13. Contraceptive use by urban versus rural location The unmet need for family planning is the proportion of all women who In Namibia, a survey conducted in 2000 showed that 43% of currently are at risk of pregnancy and who want to space or limit their childbearing married women reported using modern contraceptive methods: 53% in but are not using contraceptives.es. urban areas and 34% in rural areas. Source: World contraceptive use 2007. New York, United Nations Department of Economic and Social Affairs, Population Division, 2007 (http://www.un.org/esa/population/publications/contraceptive2007/contraceptive2007.htm).

12. Family planning: modern contraceptive use by age group . Modern contraceptive methods include oral and injectable hormones, . intrauterine devices, diaphragms, hormonal implants, female and male . . sterilization, spermicides and condoms. Surveys conducted in 1992 and . . 2000 show that contraceptive use increased in all age groups, especially . those 20–24 and 30–34 years old. . .

...... % currently married women using modern contraceptives using modern ...... modern contraceptives % currently married women using

15–19 20–24 25–29 30–34 35–39 40–44 45–49 Age (years)

14. Contraceptive use by subregion 15. Antenatal care The prevalence of contraceptive use varies in different subregions of Antenatal care visits (ANC) include all visits made by pregnant Namibia. According to surveys conducted in 1992 and 2000, modern women for reasons relating to pregnancy. According to a survey contraceptive use was consistently highest in the Central/South conducted in 2000, approximately 85% of women received ANC for subregion and lowest in the Northwest subregion. their latest pregnancy that ended in a live birth. Of the pregnancies that ended in a live birth, approximately 91% were given ANC by a skilled provider at least once.

......

. . .

. . % currently married women using modern contraceptives using modern

% women who gave birth . . . .

- Unknown or missing

16. Utilization of skilled birth attendants . A skilled birth attendant is an accredited health professional – such . as a midwife, doctor or nurse – who has been educated and trained . . to proficiency in the skills needed to manage normal (uncomplicated) . . pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications among women and newborns. All women should have access to skilled care during

pregnancy and at delivery to ensure that complications are detected skilled birth attendant % of births assisted by and managed. According to a survey conducted in 2000, 65% of births were assisted by a skilled birth attendant: 76% in urban areas and 59% in rural areas.

Sources: Making Pregnancy Safer country profiles [online database]. Geneva, World Health Organization, in press (Department of Making Pregnancy Safer; http://www.who.int/making_pregnancy_safer/en). Demographic and Health Surveys [web site]. Calverton, MD, MEASURE DHS, Macro International Inc. (http://www.measuredhs.com/aboutsurveys/ search/start.cfm).

Lead the fight for MDG 4

17. Utilization of skilled birth attendants by wealth 18. Utilization of skilled birth attendants by subregion quintile The percentage of women giving birth with the assistance of a skilled attendant varies by subregional location within Namibiaa. According to a survey conducted in 2000, the percentage of births assisted by a skilled birth attendant was highest in Erongo (95%) and lowest in Kavango (51%).

. Whether a woman delivers with the assistance of a skilled attendant . . is highly influenced by how rich she is. In many developing countries, . wealthier women (in the higher wealth quintile) have higher rates of . utilization of a skilled attendant at birth than poorer women in the . lowest wealth quintile. All women should have access to skilled care . . during pregnancy and at delivery to ensure that complications are . skilled birth attendants detected and managed. There are no country-specific data for Namibia. % of births assisted by . . .

Sources: Making Pregnancy Safer country profiles [online database]. Geneva, World Health Organization, in press (Department of Making Pregnancy Safer; http://www.who.int/making_pregnancy_safer/en). Demographic and Health Surveys [web site]. Calverton, MD, MEASURE DHS, Macro International Inc. (http://www.measuredhs.com/aboutsurveys/ search/start.cfm).

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 a survey conducted in 2000, 75% of Caesarean section is a surgical procedure in which incisions are made pregnant women in Namibia delivered in a health facility, and 24% through a woman’s abdomen and womb to deliver her baby. It is gave birth at home, with the associated risks. performed whenever abnormal conditions complicate vaginal delivery, threatening the life and health of the mother and/or the baby. A survey conducted in 1992 found that 7% of births were delivered by caesarean section in Namibia: 5% in rural areas and 10% in urban areas.

74.7 66.9

32.0 % of births 24.1

0.5 0.2 Caesarean section % of births delivered by

21. Caesarean section by subregion 22. Low birth weight

Caesarean section rates also vary between subregions in Namibia. Babies weighing less than 2500 g at birth are considered to have low According to a survey conducted in 1992, the caesarean section rates birth weight. According to a survey conducted in 2000, of the babies varied from 9.6% in the Central/South subregion to 3.7% in the Northeast who were weighed at birth, 8% were reported to weigh less than 2500 g subregion. (2.5 kg). Low-birth-weight babies often face severe short- and long-term health consequences and tend to have higher mortality and morbidity.

9.6 8.0

5.7 5.3

3.7 Caesarean section % of births delivered by % of births % babies weighing less than 2500 g % babies weighing

Namibia 5

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

Anaemia refers to abnormally low levels of haemoglobin (iron-containing Antiretroviral drugs help to prevent the transmission of HIV from the oxygen proteins) in the blood. Severe anaemia is an important mother to the child in pregnant women living with HIV. There are no contributing factor to deaths due to haemorrhage during childbirth. country-specific data for Namibia. There are no country-specific data for Namibia.

Equity Policies

26. Reproductive health Yes 25. Equity – gap in coverage of four major Maternal health Yes interventions by wealth quintile Source: WHO database on national health policies, 2008

Resources

27. Financial flow (per capita total expenditure on health at average exchange rate in US dollars) 2005 165 Coverage of four key interventions (family planning, maternal and newborn care, immunization, and treatment of childhood illness) varies Source: World health statistics 2008. Geneva, World Health Organization, 2008 (http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf). by wealth. The coverage gap reflects the difference between the goal of universal coverage of everyone (universal coverage) in these four intervention areas and actual coverage. Where the gap is larger, it means 28. Human resources that there is less adequate coverage. The opposite indicates better coverage. Achieving equity requires improving coverage levels in the The work of at least 23 health workers (doctors, nurses or midwives) per poorest quintiles. There are no country-specific data for Namibia. 10 000 population is estimated to be necessary to support the delivery of the basic interventions required to achieve the Millennium Development Goals related to health. Globally, 57 countries have been identified with critical shortages below this minimum. These countries have a severe crisis in human resources for health. Of these 57 countries, 36 are in sub-Saharan Africa. Namibia, with about 34 health workers (as defined above) per 10 000 population, is slightly above the threshold of the 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. This, however, does not necessarily mean that it commands sufficient human resources to satisfy all the health needs throughout the country.

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.

Source: WHO Global Atlas of the Health Workforce [online database]. Geneva, World Health Organization, 2008 (www.who.int/globalatlas/autologin/ hrh_login.asp).

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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

International Conference on Population and Development Yes

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) 36 (2006)

Internet users (per 100 population) 4.4 (2006)

Roads paved (% of total roads) Unknown

Improved water source (% of population with access) 93 (2006)

Improved sanitation facilities (% of urban population with access) 66 (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

Namibia