117 4,904, making progress

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1 Per 1 LB Eastern Mediterranean Region Maternal and Perinatal Health Profile Department of Maternal, Newborn, Child and Adolescent Health (MCA/WHO) Demographics and Information System Health status indicators - Maternal and Perinatal mortality Total population (213) [1] 3,551,674 Maternal mortality ratio (213) [3] 4 Total women aged years (213) [1] 6,792,818 Annual number of maternal deaths (213) [3] Annual number of births (213) [1] 1,47,942 Perinatal moratlity rate (21-11)[4] Sex ratio at births (25-1) [1] 1.6 Stillbirth rate (29)[3] Birth registration coverage [2] 37 Neonatal mortality rate per 1 live births (213) [5] Total fertility rate (213) [1] 4.9 Annual number of neonatal deaths (213) [5] Adolescent fertility rate [per 1 woman] (25-21) [1] Under five population (213) [1] Coverage of vital registration of deaths [2] 117 4,94,773-4, ,777 Sources: [1] Population Division, Department of Economic and Social Affairs, United Nations, World Population Prospects: The 212 Revision. [2] WHO, World Health Statistics 214. [3] WHO, UNICEF, UNFPA and The World Bank estimates. Trends in maternal mortality: 199 to 213. [4] Demographic Health Survey. [5] UNICEF/WHO/The World Bank/UN Pop Div. Levels and Trends in Child Mortality. Report 214. Maternal nutrition Pregnancy involving risks Prevalence of anaemia among pregnant women 21.4 Birth interval <24 months and birth order >3 Night blindness (adjusted) - Total age <18 and birth interval <24 months Iron tablets taken during pregnancy (any tablets) Source: Special Mortality Survey Maternal mortality One of the eight Millennium Development Goals (MDGs) that has made some progress, albeit slow, is MDG 5: Improve maternal health. The two targets for assessing MDG 5 are reducing the maternal mortality ratio (MMR) by three quarters between 199 and 215, and achieving universal access to reproductive health by 215. Maternal mortality ratio (MMR): maternal mortality per 1 live births % change in MMR between Average annual % change in MMR Range of uncertainly on annual % change in MMR (lower estimate) Range of uncertainly on annual % change in MMR (upper estimate) Progress towards improving maternal health MDG 5 target by making progress MDG5 Target, te: Consultations with countries were carried out following the development of the MMR estimates. The purposes of the consultations were primarily: to give countries the opportunity to review the country estimates, data sources and methods; to obtain additional primary data sources that may not have been previously reported or used; and to build mutual understanding of the strengths and weaknesses of available data and ensure broad ownership of the results. Source: WHO, UNICEF, UNFPA and The World Bank estimates. Trends in maternal mortality: 199 to 213.

2 Per 1 births Total First pregnancy < Urban Rural education Secondary lowest highest Per 1 births Perinatal mortality The perinatal mortality rate expressed per 1 pregnancies of seven or more months' duration, is used as an indicator of the quality of antenatal and perinatal care. Perinatal deaths include pregnancy losses of at least seven months gestation (stillbirths) and deaths to live births within the first seven days of life (early neonatal deaths). Perinatal mortality rate (PMR): Trend Perinatal mortality by background characteristics Previous pregnancy interval in months Place of residence Mother's education Wealth quintile Source: Special Mortality Survey 21 te: information on stillbirths and deaths to infants within the first week of life are highly susceptible to omission and misreporting. Perinatal mortality by region Total Central Central Highlands rth rth-east West Source: Special Mortality Survey 21

3 Place of birth and type of provider Place of Births - Where are babies born? Type of postnatal care provider - who provides the postnatal care? t known Private 2.1% hospital 4.9% Public hospital 28.% Others.2% Home 64.8% wife/auxill Data Available Qualified doctor 15.3% Nurse/mid ary nurse 12.4% ntrained providers.6% checkup 71.5% Health/ Communit y-health workers.2% Source: Multiple Indicator Cluster Survey (21-11) Source: Multiple Indicator Cluster Survey (21-11) Intervention coverage across continuum of care by geographical areas 1% 8% 6% 4% 2% % Central Central Highlands East rth rth-east South South East West % of births assisted by skilled birth attendant % of births received post-natal care within 48 h % of births delivered by C-section % of births in health facilities Source: Multiple Indicator Cluster Survey (21-11) and post natal care data from special mortality survey (21)

4 % of birth in health facility % of births assisted by skilled personnel Percent Equity across continuum of care te: % of women currently using modern contraceptive If more than one source of ANC was mentioned, only the provider with highest qualification is conserved in this tabulation. Source: Multiple Indicator Cluster Survey (21-11) and post natal care data from special mortality survey (21) % women who % births assisted by received any ANC by skilled personnel skilled provider % of births by C- section Poorest Richest Urban Rural Total % births in health facilities % of births received postnatal care Utilization of services by wealth quintile % of births in health facility % of births assisted by skilled personnel 1 9 Equity gap Lowest Second Middle Fourth Highest 1 9 Equity gap Lowest Second Middle Fourth Highest Source: Multiple Indicator Cluster Survey (21-11) Source: Multiple Indicator Cluster Survey (21-11)

5 % of births delivered by C-section % of birthts received post-natal care % of births delivered by C-section % of mothers with postnatal checkup in <2 days of delivery 1 9 Equity gap 8 7 Data Available Lowest Second Middle Fourth Highest 1 Equity gap Lowest Second Middle Fourth Highest Source: Multiple Indicator Cluster Survey (21-11) Source: Multiple Indicator Cluster Survey (21-11) Quality of care indicators Contents of ANC can be an important indicator for accessing the quality of ANC services that pregnant women receive in order to be prepared for complications and any danger signs associated with pregnancy and childbirth. Reasons for not seeking medical care Many barriers can prevent women from seeking medical care in general when needed. Understanding these factors is critical to improve the accessibility and utilization of medical care during pregnancy and childbirth. Blood pressure measured Urine sample taken Concern there 8 may not be a female provider t wanting to go alone Having to take transport Knowing where to go for treatment Getting permission to go for Distance to health facility Getting money for treatment Blood sample Richest takenpoorest Total Total Source: Multiple Indicator Cluster Survey (21-11) Source: Multiple Indicator Cluster Survey (21-11)

6 Workforce availability Number of nurses/ midwives/ auxilliary nurse-midwives 1 Number of physicians, generalists Number of obstetricians and gynaecologists 3,5 4,2 4 Source: UNFPA, State of the World's Midwifery 214 report ( 1 These figures do not necessarily reflect the number of practicing midwives or the ICM definition of a midwife. Health system and policy indicators Health system and policy indicators Does the national policy/policy statement indicate the minimum ANC visits during the normal pregnancy? Is there a national policy on discharge of mother and the baby after normal cildbirth at facility? Does the national policy require all maternal deaths to be reviewed? Is there a national panel (committee) to review maternal deaths in place? Is there a subnational panel (committee) to review maternal deaths in place? Stillbirths Is there a policy that requires all stillbirths (fresh or macerated) to be reviewed? Is there a facility stillbirth review (audit) process in place? Is there a policy that requires all neonatal deaths (-28 days) to be reviewed? Is there a facility neonatal deaths review (audit) process in place? Is there a community neonatal death review (audit) process in place? If yes, how many visits Is there a national policy or policy statement on the right of every woman to have access to skilled care at childbirth? Is there a policy recommending postnatal follow up visit/review by a trained provider for mother and newborn? Maternal deaths review Does national policy require all maternal deaths to be notified within 24h to a central authority? Neonatal deaths Essential drugs list for maternal and newborn health What year was the policy adopted? If yes, what year was the policy adopted? Is there a facility maternal death review (audit) process in place? Is there a community maternal death review (audit) process in place? How often does the panel meet? What year was the policy adopted? What year was the policy adopted? Does national Essential Drugs List include the following drugs indicated for use during pregnancy, childbirth? Magnesium Sulphate Oxytocin Source: WHO: Global maternal newborn, child and adolescent health policy indicator database (214) based on key informant surveys in 29-1, 211 & Monthly - 213