Unfpa supported maternal health interventions in three asian countries china philippines vietnam
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Annual UN Inter- Agency Support Group on Indigenous Peoples Issues 22 November 2011 - PowerPoint PPT Presentation

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Unfpa -supported Maternal Health interventions in three asian countries: china, Philippines, Vietnam. Annual UN Inter- Agency Support Group on Indigenous Peoples Issues 22 November 2011. CHINA - background. 55 ethnic minorities - 105 million people (8.1% total pop)

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Annual UN Inter- Agency Support Group on Indigenous Peoples Issues 22 November 2011

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Unfpa-supported Maternal Health interventions in three asian countries: china, Philippines, Vietnam

Annual UN Inter- Agency Support Group on Indigenous Peoples Issues

22 November 2011

CHINA - background

  • 55 ethnic minorities - 105 million people (8.1% total pop)

  • Southwest China: Yunnan 14.5 m. ethnic minority pop. Guizhou 13.6 m. ethnic minority pop.

  • Constraints: less developed, poorer, geographical challenges

Higher MMR and IMR among minorities: home deliveries unattended by skilled providers, poor uptake of ANC & PNC, high anemia in pregnant women

Cultural barriers – traditional beliefs & practices

Spanish MDG Fund: Improving MCH in Minority Areas 2009 –2011

  • UNFPA supported base & end-line qualitative studies in 6 counties, among 6 ethnic groups: Miao, Dong, Jingpo, Dai, Hui and Tibetans

  • Ethnic minority researchers used wherever possible

  • Data collected on:

    • traditional & spiritual practices relating to maternal and child health and health-seeking behaviour

    • harmful practices (delivery-related, dietary restrictions, feeding practice for infants and young children etc.)

    • perceived barriers of minorities to uptake of MCH services

    • community suggestions for increasing uptake of services

UNFPA inputs to improving service delivery

  • Manual developed on culturally sensitive service provision; each training includes inputs from minority people in person

  • IEC materials in local languages developed; MCH messages transmitted through ethnic cultural media

  • Local religious/spiritual leaders consulted & involved

Advocacy at local and national levels: resulted in the National Centre for Women and Children’s Health recognizing value of ‘culturally sensitive’ programming & adopting the tool for minority areas

Achievements: Improved access to and uptake

of MCH services in project counties

Annual percentage increase in Hospital Delivery Rate and Antenatal Care coverage (%)


Data source: Baseline survey & endline survey; & China Health Statistical Abstract, 2011

PHILIPPINES: background

  • 10-15% total population (between 6.5 and 12 million people) are IPs comprising 110 ethno-linguistic groups

  • National MMR is 162 per 100,000 live births

    MMR among IPs (data is available in 3 IP Provinces: Bukidnon (2009 FHSIS): 18 deaths/ 1,000 pop.; North Cotabato 14 deaths/1,000 pop. ; Misamis Oriental 8 deaths/ 1000 population

  • Challenges: securing availability of FP supplies & other life saving RH commodities, geographical isolation, difficult terrain, security

Community Empowerment to advance RH and rights among IPS in Mt. Province and Ifugao

  • Participatory Community Needs Assessment

  • Strengthening of IP organizations for RH service delivery and referrals for FP and EmONCcases

  • RH and gender education informed by needs assessment findings, designed to use IP community health systems

  • Federation building of IP organizations as a sustainability mechanism


  • Network of community RH advocates established

  • Mechanisms in place for dialogue between health providers & community leaders to ensure inclusive community health planning

  • Revitalization of the “Ayod” system (indigenous term for hammock, also system for transporting sick people to traditional healer or health clinic)

  • Emergency health fund from livelihood incomes established for women with pregnancy-related complications

  • IEC developed in local languages, used for awareness raising

  • Increased male involvement (adoption of non scalpel vasectomy)

VIETNAM: Background

  • 13.7% population ethnic minorities, located mainly in remote mountainous and coastal regions

  • Socio-economic and health status of EMs low compared to national average, especially in mountainous areas

  • National MMR is 69 per 100,000 live births (MOH, 2010)

  • MMR is over 200/100,000 live births in mountainous and remote regions

  • Diff. terrain & cultural barriers affect access to services

  • Health services in general, and RH services in particular, are under-utilized in ethnic minority regions

Addressing high maternal mortality

  • A 2009 national maternal mortality assessment identified major causes of high maternal deaths:

    • shortage of skilled birth attendants

    • poor capacity of service providers in EM regions

    • cultural barriers limited access to RH services (even when basic EmOC services were available, they were under-utilized).

  • National Safe Motherhood Master Plan 2003-2010 was developed by MoH supported by UNFPA (in collaboration with UNICEF and WHO).

  • Focusing on reduction of maternal mortality, the following approach was adopted:

    • Improve skills and competencies of RH providers to deliver BEmOC and CEmOC in mountainous and difficult-to-reach regions: network of ethnic minority midwives established; their work is monitored by the MOH

    • Conduct culturally sensitive community-based activities using behavior change approach to create demand for RH services

    • Develop and implement appropriate local human resource policies to ensure availability of trained birth attendants in mountainous and difficult-to-reach villages

Ethnic minority midwifery training

Why special training programmes?

  • Home deliveries are common, and unsafe for women

  • Poor socio-economic status results in high drop out rates amongst ethnic minority girls

  • Few people from local communities complete high school (minimum condition for formal midwifery training courses)

  • Two training programmes developed for ethnic minority with low education levels; participants selected by communities

Focus of the two ethnic minority courses

  • 6 month training programme :

    • Focuses on normal deliveries, early detection of complications and referral of complicated cases to higher levels.

    • So far, the programme has trained 783 ethnic minority midwives, most of whom have returned home to serve their local communities

  • 18 month training programme:

    • Initiated in 2007, this 18-month programme has been piloted in three mountainous and coastal provinces.

    • Building on the 6-month programme, it focuses more on skills required for management of complicated deliveries.

    • By the end of 2011, the first 78 ethnic minority womengraduatedand returned to work at their community

Challenges and the way foward

  • Challenges:

    • Retention and recognition from authorities

    • Supportive supervision and quality assurance of services

  • Way forward:

    • Document cost effective evidence of the interventions

    • Support development and implementation of evidenced-based policies on human resource policies including ethnic minority midwives

    • Support the government to scale up best practices of the interventions in ethnic minority regions

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