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

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Lesotho 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.

Lesotho 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 Lesotho is 1 in 45, per 100 000 live births per year. The ratio in Lesotho is 960 per 100 000 lower than the average of 1 in 22 for sub-Saharan Africa but higher than live births, which is higher than the average of 900 per 100 000 live the global average of 1 in 92. births in sub-Saharan Africa and the global average of 400 per 100 000 live births.

1/22 1/20

1/25 1500 960 900 3/100 1000 1/45 500 400 1/50 Deaths per 1/92 100 000 live births 0 1/10 Lesotho Sub-Saharan World Africa 0 Lifetime risk of death (1 in N) Lesotho Sub-Saharan World 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 1 995 (2006) Lifetime risk of maternal death (1 in N)2 45 (2005) Total maternal deaths2 480 (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 the were unintended (unwanted total fertility rate). According to a survey period of 1997–2002) were haemorrhage (uncontrolled bleeding), conducted in 2004, the total fertility rate is 3.5 per woman in Lesotho. infection (including HIV), hypertensive disorders (high blood pressure)

and other causes. There is no country specific data for Lesotho. 4

3.5

Obstructed labour 4% 3 1

2.5 Anaemia 4% Abortion 4% 2

Hypertensive 1.5 disorders 9% Haemorrhage 2.5 34% 1 0.5 Total fertility rate (per woman) Total Africa 0 Sepsis or Infections, Lesotho 2004 including HIV 16% Wanted total fertility rate Unwanted total fertility rate 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). Demographic and Health Surveys [web site]. Calverton, MD, MEASURE DHS, Macro International Inc. (http://www.measuredhs.com/aboutsurveys/ Source: Khan KS et al. WHO analysis of causes of maternal death: a systematic review. Lancet, 2006, 367:1066–1074. search/start.cfm).

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6. Proportions of births by urban versus rural 7. Perinatal mortality rate location Among the women interviewed in a survey conducted in 2004, about 86% of births occurred in rural areas.1

The total number of births (in thousands): 59 (2005)2

Urban Perinatal mortality refers to deaths of fetuses in the womb and of 14% 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 Rural newborn health care. There are no country-specific data for Lesotho. 86%

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 women 9. Adolescent pregnancy rate by urban versus rural 15–19 years old location In Lesotho, a survey conducted in 2004 indicated that approximately 5% of women aged 15-19 years were pregnant with their first child. The adolescent pregnancy rate was higher in rural than in urban areas.

Adolescent pregnancy is pregnancy in an adolescent girl (girls 10–19 6 5.4 years old). The adolescent pregnancy rate indicates the proportion of 4.9 adolescent girls who become pregnant among all girls in the same age group in a given year. There are no country-specific data by age 4 for Lesotho. 2.6

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

0 Total Urban Rural

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).

10. Adolescent pregnancy by subregion Adolescent pregnancy rates vary between different parts of Lesotho. According to a survey conducted in 2004, the prevalence varied from 3% in Mokhotlong to 6% in Berea area. 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.

6.0 5.8 6 5.7 5.3 4.9 4.1 4 3.9

2.9 with their first child 2 % of women (15-19 years old) pregnant 0 Butha- Leribe Berea Maseru Mafeteng Quthing Mokhotlong Thaba- Buthe Tseka

Lesotho 3

Intervention coverage for mothers and newborns

11. Unmet need for family planning, 2007 30.9% 13. Contraceptive use by urban versus rural location The unmet need for family planning is the proportion of all women who In Lesotho, a survey conducted in 2004 showed that the prevalence of are at risk of pregnancy and who want to space or limit their childbearing contraceptive use was 35%. The prevalence was higher in urban than in but are not using contraceptives. 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. A survey conducted in 2004 in . Lesotho showed that the prevalence of contraceptive use increased with . age, peaking among people 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)

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).

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 Lesotho. According to a survey conducted in 2004, the prevalence women for reasons relating to pregnancy. According to a survey ranged from 49% in Mafeteng to 14% in Mokhotlong. conducted in 2004, about 88% of women received ANC for their latest pregnancy that ended in a live birth. Of the pregnancies that ended in a live birth, about 90% were given ANC by a skilled provider at least once.

...... % currently married women % women who gave birth using modern contraceptives using modern . .

– Unknown or missing

16. Utilization of skilled birth attendants 100 A skilled birth attendant is an accredited health professional – such 87.8 as a midwife, doctor or nurse – who has been educated and trained 80 to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in 60 55.4 50.0 the identification, management and referral of complications among women and newborns. All women should have access to skilled care 40 during pregnancy and at delivery to ensure that complications are birth attendants detected and managed. According to a survey conducted in 2004, 20 overall, approximately 55% of childbirths were assisted by a skilled % of births assisted by skilled 0 birth attendant. The rate was higher in urban areas (88%) compared Total Urban Rura l to the rural areas (50%).

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17. Utilization of skilled birth attendants by wealth 18. Utilization of skilled birth attendants by subregion quintile Whether a woman delivers with the assistance of a skilled attendant is highly influenced by how rich she is. A survey conducted in Lesotho in The percentage of women giving birth with the assistance of a skilled 2004 showed that 83% of women in the highest wealth quintile had a attendant also varies by regions within Lesotho. A survey in 2004 showed skilled attendant present at birth versus 34% of women in the lowest that coverage ranged from 40% in Mokhotlong to 63% in Maseru. wealth quintile: 2.4 times as high.

100 100

83.2 80 80 69.3 63.2 58.6 60.1 60 56.5 60 5656.2,2 58.6 55.7

42.0 40.4 40.9 40 33.7 40 skilled birth attendant % of births assisted by 20 20 skilled birth attendant % of births assisted by

0 0 Poorest Poorer Middle Richer Richest Butha- Leribe Berea Maseru Mafeteng Quthing Mokhotlong Thaba- Buthe Tseka

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. In a survey conducted in 2004, more pregnant women Caesarean section is a surgical procedure in which incisions are made (45%) gave birth at home with the associated risks. Only 40% delivered through a woman’s abdomen and womb to deliver her baby. It is in a health facility. performed whenever abnormal conditions complicate vaginal delivery, threatening the life and health of the mother and/or the baby. According to a survey conducted in 2004, 5% of births were delivered by caesarean section in Lesotho: 4.6% in rural areas and 8.0% in urban areas.

100 10

9 80 8.0 8

7 60 6 5.1 45.4 4.6 39.7 5 40

% of births 4

3 20 13.8 Caesarean section 2 % of births delivered by 1 0 0 Health facility At home Other Total Urban Rural

21. Caesarean section by subregion 22. Low birth weight

Caesarean section rates also vary between subregions in Lesotho. Babies weighing less than 2500 g at birth are considered to have low According to a survey conducted in 2004, the caesarean section rates birth weight. Low-birth-weight babies often face severe short- and varied from 3% in Thaba-Tseka to 6% in Maseru. long-term health consequences and tend to have higher mortality and morbidity. According to a survey conducted in 2004, of the babies who were weighed at birth, 7% were reported to weigh less than 2500 g

10 (2.5 kg). The proportion of babies of low birth weight at birth was slightly higher in urban than in rural areas.

8 12

6.1 10 6 5.5 5.2 5.1 4.8 4.6 8 7.4 4.0 6.5 6.3 4 6 2.8

2 4

% of births delivered by Caesarean section % of births delivered 0 % babies weighing less than 2500 g % babies weighing Butha- Leribe Berea Maseru Mafeteng Quthing Mokhotlong Thaba- 0 Buthe Tseka Total Urban Rural

Lesotho 5

23. Anaemia in pregnancy 24. Prevention of mother-to-child transmission of HIV Anaemia refers to abnormally low levels of haemoglobin (iron-containing The percentage of pregnant mothers living with HIV and receiving oxygen proteins) in the blood. According to a survey conducted in 2004, antiretroviral drugs (ARVs) to prevent the transmission of HIV to their the percentage of pregnant women with low haemoglobin levels (less child (PMTCT) increased from 7% in 2004 to 17% in 2006. than 110 g/l) was approximately 37%. Severe anaemia is an important contributing factor to maternal deaths due to haemorrhage during childbirth. 20 0% 17 20% 16 15

12 3

17% 63% 8 7 4

Severe anaemia Moderate anaemia for PMTCT ARVs receiving 0 Mild anaemia Not anaemic living with HIV % of pregnant women 2004 2005 2006

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. This graph illustrates the gap in coverage of four key interventions (family planning, maternal and newborn care, immunization and treatment of childhood illness) 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 Resources the gap is larger, it means that there is less adequate coverage. The opposite indicates better coverage. According to the Multiple Indicator Cluster Survey (MICS) conducted in 2000 and the Demographic and 27. Financial flow Health Survey (DHS) conducted in 2004, the coverage gap is highest for the poorest and is lowest for the richer members of society (wealthiest (per capita expenditure on health, in US dollars) 2007 139 quintile). Overall, the gap in the survey conducted in 2004 (33%) was Source: Countdown to 2015. Tracking progress in maternal, newborn & child survival: the 2008 report. New York, United Nations Children’s Fund, 2008 slightly lower (that is, improved coverage) compared with the 2000 (http://www.countdown2015mnch.org/index.php?option=com_content&view=article&id=68&itemid=61). survey (36%). Achieving equity requires improving coverage levels in the poorest quintiles. 28. Human resources

The work of at least 23 health workers (doctors, nurses or midwives) per 100 10 000 population is estimated to be necessary to support the delivery of 80 the basic interventions required to achieve the Millennium Development Goals related to health. Globally, 57 countries have been identified with 60 critical shortages below this minimum. These countries have a severe

% crisis in human resources for health. Of these 57 countries, 36 are in sub- 40 Saharan Africa. Lesotho, with about 7 health workers (as defined above) 20 per 10 000 population, is one of the countries facing this crisis daily, with mothers and children lacking access to proper maternal and child care, 0 HIV/TB and malaria care and sexual and reproductive health information Poorest 2nd 3rd 4th Wealthiest and services, including skilled birth attendants. 2000 2004 MICS DHS The shortage is 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. Coverage gap (%) 36 33 Ratio Increasing the human resources around the world and establishing a poorest/wealthiest 1.7 2.0 balance between the services needed and the personnel available, and Difference their distribution, are key elements of a well-functioning health system poorest-wealthiest (%) 18 23 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). Source: 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

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) 21 (2006)

Internet users (per 100 population) 3 (2006)

Roads paved (% of total roads) 18 (2000)

Improved water source (% of population with access) 78 (2006)

Improved sanitation facilities (% of urban population with access) 43 (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

Lesotho