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] 182,142,594 Maternal mortality ratio (213) [3] Total women aged 1549 years (213) [1] 47,294,264 Annual number of maternal deaths (213) [3] Annual number of births (213) [1] 4,461,464 Perinatal moratlity rate (21213)[4] Sex ratio at births (251) [1] 1.9 Stillbirth rate (29)[3] Birth registration coverage [2] 26.5 Neonatal mortality rate per 1 live births (213) [5] Total fertility rate (213) [1] 3.2 Annual number of neonatal deaths (213) [5] Adolescent fertility rate [per 1 woman] (2521) [1] Under five population (213) [1] Coverage of vital registration of deaths [2] 31 21,761,417 17 7,9 75 47 42 193,718 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 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: Demographic Health Survey (21213) 44.7 11.3.2 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 199213 Average annual % change in MMR 199213 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 215 57 3.6 4.1 3 making progress 1 5 4 3 2 1 4 33 28 23 17 MDG5 Target, 1 199 1995 2 25 21 215 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.
Per 1 births Per 1 births Total First pregnancy <15 39+ 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 18 16 159. 14 12 124. 1 8 75. 6 4 42.1 34.7 33. 2 267 21213 1 8 6 4 2 75 95 56 51 Previous pregnancy interval in months Place of residence 85 87 54 Mother's education 46 Wealth quintile Stillbirth rate Early neonatal deaths rate PMR Source: Demographic Health Survey Source: Demographic Health Survey (21213) 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 1 9 8 7 6 5 4 3 2 1 75 77 78 Total Punjab Sindh Khyber Pakhtunkhwa 63 88 43 37 Balochistan ICT Islamabad Gilgit Baltistan Source: Demographic Health Survey (21213)
Early and late neonatal deaths (proportion of death by timing) A neonatal death is defined as a death during the first 28 days of life (27 days). Early neonatal death refers to a death between 6 days after birth. Late neonatal death refer to a death between 727 days after birth. within 24 hours 31% 2448 hours 19% Late neonatal deaths 21% Source: Demographic and Health Survey Other 79% Day 6 3% Day 5 3% Day 4 6% Day 3 1% 48 72hours 7% Source: Demographic Health Survey (21213) Trend of intervention coverage across continuum of care for maternal and perinatal health 1 8 6 4 2 % of women currently using modern contraceptives % of women received ANC (at least once) % women who IPT during ANC visit Place of delivery received ANC 4 times Any health facility or more % of births delivered by Csection % of women who had PNC within 2 days 19991 267 21213 Source: Demographic and Health Survey
Place of birth and type of provider Place of Births Where are babies born? Type of postnatal care provider who provides the postnatal care? Others.1% Public hospital 14.6% t known.1% ntrained providers 12.5% Private hospital 33.6% Home 51.6% checkup 39.7% Doctor/N urse/mid wife's 47.8% Source: Demographic Health Survey (21213) Source: Demographic Health Survey (21213) Intervention coverage across continuum of care by geographical areas 1% 8% 6% 4% 2% % Punjab Sindh Khyber Pakhtunkhwa Balochistan ICT Islamabad Gilgit Baltistan % of births assisted by skilled birth attendant % of births received postnatal care within 48 h % of births delivered by Csection % of births in health facilities Source: Demographic Health Survey (21213)
% of birth in health facility % of births assisted by skilled personnel Percent Equity across continuum of care 1 96.6 te: 8 6 4 2 32 31.6 26.1 23.1 18.1 % 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: Demographic Health Survey (21213) 87.8 73.1 66.7 5.9 85.2 71 52.1 44.4 29.8 % women who % births assisted by received any ANC skilled personnel by skilled provider 33.9 23.6 14.1 1.2 4.3 % of births by C section Poorest Richest Urban Rural Total 84 67.9 48.2 4.1 27.1 % births in health facilities 81.7 73.9 6.3 54.6 42 % 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 8 7 6 5 4 3 2 1 Lowest Second Middle Fourth Highest 1 9 Equity gap 8 7 6 5 4 3 2 1 Lowest Second Middle Fourth Highest Source: Demographic Health Survey (21213) Source: Demographic Health Survey (21213)
% of births delivered by Csection % of birthts received postnatal care % of births delivered by Csection % of mothers with postnatal checkup in <2 days of delivery 1 9 Equity gap 8 7 Data Available 6 5 4 3 2 1 Lowest Second Middle Fourth Highest 1 Equity gap 9 8 7 6 5 4 3 2 1 Lowest Second Middle Fourth Highest Source: Demographic Health Survey (21213) Source: Demographic Health Survey (21213) 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. Signs of pregnancy complicatio ns 8 6 4 2 Weight measured Any of the specified problems Getting permission to go for treatment 1 8 6 4 2 Getting money for treatment Blood sample taken Blood pressure measured t wanting to go alone Distance to health facility Urine sample taken Richest Poorest Total Having to take transport Total Source: Demographic Health Survey (21213) Source: Demographic Health Survey (21213)
Workforce availability Number of nurses/ midwives/ auxilliary nursemidwives 1 Number of physicians, generalists Number of obstetricians and gynaecologists 215,86 138,421 1,795 Source: UNFPA, State of the World's Midwifery 214 report (http://www.unfpa.org/sites/default/files/pubpdf/en_sowmy214_complete.pdf). 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 291, 211 & 21314 >4 27 27 21