Maternal and Infant Mortality on the Agenda
By Olga Grebennikova
“For a nation to prosper it is important that it should focus on the health of its underprivileged female population as well as its children for a better developed nation in the future,” says Zulfiqar Bhutta, Aga Khan University Professor and one of the world’s leading specialists on child survival. The recommendations and conclusions of the report were discussed during the round table entitled “Maternal and Infant Mortality: an analysis of the situation and recommendations for its reduction and achieving MDGs 4 and 5 in the Kyrgyz Republic” on 27 April 2009. The discussion included the leadership and specialists from the Ministry of Health, the National Centre for Protection of Motherhood and Childhood, The Centre for Healthcare Development, rectors and senior staff of medical schools, neonatologists, heads of maternity departments from all provinces of Kyrgyzstan, and also representatives from NGOs and international organisations (UNICEF, the World Bank, USAID, the Swiss Red Cross, UNFPA, WHO, the Aga Khan Foundation and others).
In recent years, more and more attention is being paid globally to the problems of female, child and newborn mortality, as these issues are reflected in the United Nations Millennium Declaration, signed by almost all member states of the UN. There is no doubt that social and economic progress is impossible without the development of human potential, and health is a cornerstone for this development. If the results of the Demographic and Health Survey (DHS) carried out in 1997 are compared with the results of the 2006 MICS, it can be seen that indicators of infant mortality have fallen in Kyrgyzstan from 66 to 48, under five mortality from 72.3 to 44, and maternal mortality from 110 to 104 cases for every 100,000 live births. Nevertheless, all of these indicators remain at unacceptably high levels, and show that it is necessary to take urgent and coordinated action, including the financing of programmes to effectively reduce mortality rates. Since 2004, Kyrgyzstan has used international standards to record live births and stillbirths (which has led to an increase in registered cases of neonatal mortality, which grew by about 50 percent in the period 2003-2004). However, reported mortality is still nevertheless lower than the true figure, because some deaths are not registered, or are concealed or incorrectly classified. World Bank figures for 1992, 1995 and 2001, and the 1997 DHS, indicate that the real figures for infant mortality regularly exceed official state registered cases by 30-35 percent. The reasons for infant and maternal mortality are connected to a range of economic, social and cultural factors, the condition of public health, the demographic structure, behavioural skills of the population and others. And while there is a trend of decline in rates of infant and child mortality, maternal mortality has remained practically at its earlier level. Infant mortality is considered one of the most sensitive indicators of the level of poverty in any country, and in a wider sense, an important indicator of the level of socioeconomic and human development. Tackling infant, child and maternal mortality is one of the most urgent tasks that need to be prioritised by the state. Reduction in the mortality rates for these vulnerable groups as a rule is achieved through introduction of quality perinatal services and userfriendly services for children in maternity institutions. This will help to eliminate the direct causes of maternal and infant mortality. An equally important role is played by immunisation, widespread breastfeeding and provision of reproductive health equipment and services. Child, infant and maternal health can be improved with investment into training of medical workers, by the creation and support of infrastructure, and by the acquisition of equipment and protective devices. Political commitment also plays an important role. The country has a National Centre and regional branches for maternal and child health, and the state buys vaccines, and has adopted a perinatal programme. The curriculum of the Kyrgyz State Medical Institute for Training of Medical Workers now includes a modern training course on maternal and child health. In addition to all this, currently a range of programmes are being implemented in the country to improve maternal and newborn health. Having researched the state of this field, the group of academics led by Professor Bhutta has made a range of recommendations, which if implemented have the potential to seriously improve the situation, and so the country can hope for achievement of important development goals laid out in the Millennium Declaration – “reduction of child mortality” and “improving maternal health.”.