Young Child Survival and Development

Maternal and newborn health

A pregnant woman is examined in Ethiopia. Across ESAR, progress in reducing maternal and newborn deaths is insufficient due to factors such as poor health infrastructure, low service delivery, and a lack of qualified health workers.

Across Eastern and Southern Africa, the most basic and natural act of giving life causes the death of almost 10 women every hour. In 2008, some 79,000 women died in the region related to pregnancy and delivery, accounting for more than one fifth of all such deaths in the world. Most maternal deaths are caused by obstetric complications such haemorrhage, hypertensive disorders and sepsis as well as abortions. HIV/AIDS is also a big killer in some countries, particularly in Southern African where HIV prevalence rates are high.

Obstetric complications could be avoided if skilled health personnel and essential supplies, equipment and facilities were available. And yet, more than 60 percent of all births in the region occur without the support of a skilled birth attendant.

In Ethiopia, for example, 94 percent of women deliver their babies without any trained health professional. In Somalia, a woman’s lifetime risk of dying from maternal causes is 1 in 14, one of the highest in the world, and is second only to Afghanistan. For the region, the maternal mortality rate stood at 550 deaths per 100,000 live births in 2008, compared to 750/100,000 in 1990. Progress is being made, but the annual reduction rate of 1.7 percent is among the lowest in the world. With the stagnating efforts in reducing maternal mortality in many countries, only one country in the region – Eritrea - is on track towards achieving the Millennium Development Goal of reducing maternal mortality by three quarters between 1990 and 2015.

Like their mothers, babies are just as vulnerable during and immediately after birth. Across the continent, the main causes of newborn deaths are common: sepsis, low birth weight and asphyxia. About 40 percent of all deaths among children under five occur within the first months of life, while 70 percent occur within the first year of life. However, until recently, most child survival efforts used to focus on older children, with very little attention being given to reducing neonatal deaths. It is particularly poignant that many neonatal deaths occur in the community, without the child ever having had contact with the health services they needed.

In all countries across the region, there is also a significant inequity between rich and poor population groups when it comes to skilled assistance during birth. Even in Botswana where 95 percent of all births are assisted by a skilled birth attendant, the rate is much lower for the poorest 20 percent of the population than among the richest 20 percent (84/100 percent).

Country	% of skilled attendant at birth				Maternal mortality ratio (per 100,000 live births)	Neonatal mortality rate (first 28 days of life, per 1000 live births)
Country	Total	Poorest 20%	Richest 20%	Ratio of richest to poorest	Maternal mortality ratio (per 100,000 live births)
Angola	47	23	67	3.0	-	42
Botswana	95	84	100	1.2	200	22
Burundi	34	25	55	2.2	620	42
Comoros	62	49	77	1.6	380	37
Eritrea	28	7	81	12.1	1000	17
Ethiopia	6	1	27	38	70	36
Kenya	44	20	81	4.0	490	27
Lesotho	62	34	83	2.5	760	34
Madagascar	44	22	90	4.1	500	21
Malawi	54	43	77	1.8	810	30
Mozambique	55	37	89	2.4	410	41
Namibia	81	60	98	1.6	450	19
Rwanda	52	43	71	1.7	750	33
Somalia	33	11	77	7.2	1000	52
South Africa	91	-	-	-	170	19
Swaziland	69	45	86	1.9	590	20
Uganda	42	28	76	2.7	440	30
Tanzania (United Republic of)	43	26	85	3.3	580	33
Zambia	47	27	91	3.4	590	35
Zimbabwe	60	39	92	2.4	560	29

Source: The State of the World’s Children Report 2011, UNICEF

Kashifa Nanjala, 18, lies with her one-day old baby in a district hospital in western Uganda. Nine countries in ESAR, including Uganda are with the worst indicators on maternal health, and they are UNICEF's priority countries in this area.

UNICEF in action

The lack of progress in reducing maternal and newborn mortality is in large part due to poor health and social infrastructure, weak service delivery, and a shortage of qualified health workers. In 2008, four UN agencies, WHO, UNFPA, World Bank and UNICEF, committed themselves to harmonizing their approaches towards improving maternal and newborn health (MNH) at country levels. Within the 25 countries identified as having the worst indicators on maternal health, nine (Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Uganda, Tanzania, Zambia and Zimbabwe) are in Eastern and Southern Africa. The harmonized UN efforts now focus on these countries.

Critical issues highlighted by the partnership include addressing maternal health as part of a continuum of care that links essential MNH;

improving the availability and quality of obstetric care;
and scaling up of interventions through skilled service delivery throughout pregnancy, child birth and during the postnatal period.

For UNICEF, the core areas of support include antenatal care, skilled attendance at birth, basic emergency obstetric and newborn care, and maternal and neonatal nutrition. The combination of basic and comprehensive emergency obstetric and newborn care with referral support is considered to be the most cost-effective measure to reduce maternal deaths.

Studies have shown that the majority of women identified as being “at risk” will not have complications in the end, while the majority of women who develop complications had originally been registered as “low-risk”. With this improved understanding has come a refocusing of maternal health programmes to ensure that women have access to care during the critical period around labour and delivery, which is when most deaths occur, coupled with referral for the management of obstetric emergencies.

Results for children

In 15 countries in Eastern and Southern Africa, national Emergency Obstetric and Newborn Care needs assessments were undertaken with UNICEF’s support. The assessments provided a solid evidence basis for policy formulation, planning as well as monitoring and evaluation of maternal health programmes in these countries.

UNICEF has also taken the lead in scaling up community-based newborn care, which is found to have reduced newborn deaths by 30 to 61 percent in communities where health workers make home visits. Together with partners, UNICEF supported training workshops, including a two-week orientation on home-based newborn care, for programme managers from Ethiopia, Malawi, Uganda, Kenya, Madagascar, Tanzania, Zimbabwe and Zambia.

One of the most ambitious initiatives that UNICEF supports to address maternal and newborn mortality is to be found in Ethiopia, where health-extension workers are being trained to help mothers deliver their babies safely. Trained health extension workers are assigned to health posts in villages where they provide basic preventive and curative services to the rural population. In addition to providing curative services, health extension workers also promote behaviours and practices to improve the overall chances of survival for children, such as breastfeeding, sleeping under a mosquito net, hand washing with soap and other hygiene measures. As of end 2009, around 30,000 health extension workers had been deployed in communities all around Ethiopia.

UNICEF contributed US$1 million to equip the health-extension workers with medical kits. In addition, UNICEF and its partners are supporting Ethiopia’s Ministry of Health to ensure that every delivery room in every hospital and large clinic has a “newborn corner” where infants can receive emergency care.
Eritrea introduced maternal waiting homes in 2007 as a strategy to mitigate against high maternal mortality rates in hard-to-reach areas. This involved deploying health workers with lifesaving skills in emergency obstetric care to remote parts of the country and ensuring that local health centers had at least one ambulance ready for referral to higher level facilities during emergencies.

A rapid assessment of maternity homes in two regions of the country revealed that deliveries in health facilities with maternal waiting homes increased by 56 percent with no reported maternal deaths in the 20 months following the establishment of the waiting facilities. Eritrea has also made great investments in training midwives and strengthening the referral system. Blood bank services have been revitalized and community awareness about safe motherhood and childbirth is on the increase.

Español Français