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Achieving MDG 4: Focusing on Neonatal Mortality in Armenia

© UNICEF Armenia/2007/Igor Dashevskiy
A newborn at a maternity in Echmiadzin, 25 km of capital Yerevan.

By Frale Oyen/UNICEF Armenia

Much still needs to be done to ensure that Armenia’s children survive their first month of life. For, although the 2005 Armenia Demographic and Health Survey found that the overall infant mortality rate has gone down, of particular concern is the increase observed in the country’s neonatal mortality rate.

"In the past four to five years, the statistics for under-five and infant mortality has remained stagnant," said Mihran Hakobyan, assistant Health Nutrition Officer for UNICEF. That’s because, although the number of post-neonatal deaths is decreasing, the number of neonatal deaths, as seen over the past two years, is increasing.

According to the National Statistical Service, neonatal mortality currently constitutes about 70 per cent of overall infant mortality.

Although this trend isn’t only common to Armenia, it is an issue of concern to UNICEF, the country’s health officials and the government, which has made the care of mother and child a priority for the country.

But why the increase?

Part of the problem lies with poor antenatal care. According to Mr Hakobyan, maternal health is a huge determinant of whether a child will survive the first month of life.

"If a pregnant mother has health problems, it will negatively affect the health of the newborn child," Mr Hakobyan said.

Further aggravating the issue is the lack of qualified staff and the lack of basic equipment, conditions that make it difficult for healthcare providers, especially those based in rural areas, to provide "quality or satisfactory services for neonatal care".

To better meet the country’s newborn care needs, UNICEF and the Ministry of Health are developing a new neonatal strategy, which they hope to start implementing by mid-2008. The Intensive Neonatal Care Strategy would establish standards for the country’s healthcare providers to follow when taking care of infants and their mothers. It builds on the concepts incorporated in the Essential Newborn Care strategy UNICEF implemented in 2005.

"This would mean that all neonatal services would be available in every facility, ensuring that all newborns receive quality healthcare," said Mr Hakobyan.

"Infant mortality," according to Stepan Astvatsaturyan, UNICEF’s Officer in Charge for Health and Nutrition, "is a complex issue, which has several components. You can’t only address one issue; you must address the entire problem."

"This also applies to the issue of establishing standards," he said. "Every provider in the country should do the same thing otherwise it will be a mess, as it is now. In some areas, healthcare providers have their own way of approaching a particular problem but you can’t do it like that. The health system needs to have certain standards."

Also important in the fight to reduce infant mortality is parental education. Since 2005, UNICEF has been holding maternal education classes in four marzes in Armenia. Sessions, to which the entire family is invited, are held in healthcare facilities in the region and cover a range of topics from infant care to nutrition and health to the social development of children.

However, if additional headway is to be made, a comprehensive maternal education program is needed. Currently, the effectiveness of these classes depends on the performance of individual healthcare providers. Some areas are better than others.

"If they do not have universal standards and approaches, then we need to support them and to monitor them," Mr Hakobyan said. "To show that the strategy is effective, we need to ensure that, throughout the country, the same standards are implemented."

The same may be said about gathering data.

In 2005, Armenia, which had been following the Soviet standard of reporting newborn, stillbirths and live births, fully adopted international reporting standards on infant mortality. It was one of the few Commonwealth of Independent States (CIS) countries in the region to do so.

This means the statistics now provides a more realistic picture of what is happening in the country.

"Based on more reliable statistical data, we will have more chances to better assess and meet the needs of children," said Mr Hakobyan.



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