Overview: Maternal and Child Health in Underdeveloped Countries
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Overview: Maternal and Child Health in Underdeveloped Countries or: The World is Not Flat HSERV/GH 544 Winter Term 2011. Objectives of session. Provide an overview of main health problems of women, newborns, and children in underdeveloped countries, including the underlying inequalities

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Overview: Maternal and Child Health in Underdeveloped Countries or: The World is Not FlatHSERV/GH 544Winter Term 2011

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Objectives of session Countries

  • Provide an overview of main health problems of women, newborns, and children in underdeveloped countries, including the underlying inequalities

  • Present the main interventions that address those problems

  • Present some challenges in promoting maternal and newborn health in resource-poor settings, with examples from Nepal

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Terms used in global MCH Countries


IMR= Infant mortality rate (deaths 0-11 months/1000 live births)

MMR= Maternal mortality ratio (pregnancy-related deaths per 100,000 births)

LTR=Lifetime risk of dying of a pregnancy-related cause (expressed as a ratio of 1:x women of childbearing age)

TFR=Total fertility rate (expected pregnancies per woman CBA)

CPR=Contraceptive prevalence rate (proportion of couples in union using a modern contraceptive method)

ANC=Antenatal care (variously defined)

SBA=Skilled Birth Attendant (doctor, nurse or midwife)

PC/GNI=Per capita gross national product

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Some inequalities in global health: Countries

MMR LTR PC/GNIItaly 3 26,600 32,020

United States 11 4800 44,970

Thailand 44 900 2990Ecuador 210 170 2840

India 450 70 820Mozambique 520 45 290

Timor-Leste 380 35 840

Nepal 830 31 260

Source: State of the World’s Children 2008, UNICEF

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Why such economic inequities? Countries

  • Post-colonial legacy

  • Current economic system -- e.g. national debt, international bank policies (“conditionalities”), terms of trade, etc.

  • “Aid” focus on technological solutions, specific diseases

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Maternal Health Problems Countries

  • ~200 million pregnancies per year

  • ~75 million unwanted pregnancies

  • ~20 million unsafe abortions

  • ~350,000 maternal deaths (1-2 per minute)

  • 1 maternal death = 30 maternal morbidities

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What are the medical causes of maternal deaths? Countries

*other direct causes include ectopic pregnancy, embolism, anaesthesia-related** indirect causes include: anaemia, malaria, heart disease, HIV/AIDS.

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Where do the maternal deaths occur? Countries


(50% of all deaths in 2008 were in only 6 countries: India, Nigeria,

Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of the Congo)


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Skilled Care at Delivery and Maternal Deaths: Countries

Sub-Saharan Africa

South Asia

Middle East and

North Africa

Latin America/


East Asia

and Pacific

Central, Eastern

Europe/ Baltics/ CIS*

* Commonwealth of Independent States (former Soviet Union).

Source: UNICEF End of Decade Databases—Delivery Care and

Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF, and UNFPA, 2004.

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Remember equity….? Countries

From: A global picture of poor-rich differences in the utilisation of delivery care, Anton Kunst and Tanja Houweling, Health Services Organization and Policy, 17, 2001

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Why do so many women lack skilled birth care? Countries

  • Delay in decision to seek care

    • Lack of understanding of complications

    • Acceptance of maternal death

    • Low status of women

    • Socio-cultural barriers to seeking care

  • Delay in reaching care

    • Geography (mountains, islands, rivers) – no realistic access

    • Poor transport & organization

  • Delay in receiving quality care

    • Shortages of supplies, personnel, transport to higher facility

    • Poorly trained personnel with punitive attitude

    • Finances

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Current approaches to reducing Countries maternal mortality

  • Antenatal care

  • Improving skills of birth attendants

    • Traditional birth attendants (TBAs)

    • Skilled professional attendant at delivery (SBAs)

  • Emergency Obstetric Care (EmOC)

  • Postpartum care

  • Family planning

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Status of child health today Countries

  • ~8 million children under 5 die every year

  • ~22,000 will die today

    • equivalent to a tsunami every week

    • Over one-third of these deaths are to newborns

  • More than half of these deaths are preventable and/or treatable with relatively simple measures

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Causes of Mortality among Preschool Children Countries



Deaths associated

with malnutrition



AcuteRespiratory Infection



Source: WHO (2003)


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How effective are global child health programs? Countries

At least a quarter of children are not routinely immunized

Almost half do not have access to antibiotics to treat pneumonia

Nearly two-thirds do not receive oral rehydration solution to treat diarrhea

90% do not sleep under insecticide-treated nets to prevent malaria

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But remember -- technology is not the only answer…. Countries

Fall in the standardized death rate per 100,000 population for nine common

infectious diseases in relation to specific medical measures for the United States, 1900-1973

(Source: McKinlay , J. B., & McKinlay, S. M. (1977). The questionable contribution of medical

measures to the decline of mortality in the United States in the twentieth century. Milbank Memorial

Fund Quarterly. Health and Society, 55 (3), 405-428.)

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Where are newborns dying? Countries


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Other Countries


SEPSIS (septicemia, pneumonia, meningitis, diarrhea)






Causes of newborn deaths

(Bang AT, Lancet 1999;354:1955-61))

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In summary: Countries

  • Maternal health problems are often not predictable, may require relatively sophisticated medical interventions

  • Most common child health problems can be dealt with at the community level

  • Newborn health problems require a mixture of the two approaches