Remarkable progress, new horizons and renewed commitment Ending preventable maternal, newborn and child deaths in South-East Asia Region i
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Foreword MDGs 4 and 5 inspired unprecedented efforts by countries to reduce maternal and child mortality, and the results have been impressive. Between 199 and 215, the global maternal mortality ratio (MMR) decreased by 44% and under-five child mortality rate (U5MR) by 52%. The MMR in the South-East Asia Region declined from 525 per 1 live births in 199 to 164 in 215, and under-five mortality rate from 118 per 1 live births to 43 during the same period. The Region has performed much better than the global averages, with a 69% drop in MMR and 64% decline in U5MR when compared with levels in 199. Indeed, our progress on MDG 5, which is considered more difficult to achieve, has been better than all other WHO regions. Although SEAR as a whole missed MDGs 4 and 5 narrowly, our performance has been remarkable. Of the 11 countries, 7 achieved MDG 4 and 3 attained MDG 5 by December 215. Thus, the heartening reality is that Member States of the Region have been able to avert millions of maternal, newborn and child deaths, year after year, compared with the 199s. In 215, the Region had 149 fewer maternal deaths and 3 million fewer child deaths compared with 199. This is indeed unprecedented progress. Despite these achievements, challenges remain. Realizing the importance of accelerating reduction in neonatal mortality, where the least gain was made during the MDG era; in 214, I included ending preventable maternal, newborn and child deaths with focus on neonatal deaths as one of the seven Flagship Priorities for the Region, to give it the focus and resources needed. As we move to the post-215 phase, the world has committed to new horizons in health and development. The Sustainable Development Goals (SDGs) cover the world s most pressing economic, social and environmental challenges. Further, in 215, the UN Secretary-General unveiled the Global Strategy for Women s, Children s and Adolescents Health (216 23). The World Health Assembly endorsed the Strategy and its operational framework in May 216. Incorporating and aligned to the SDGs, the Global Strategy has become the guiding precept for advancing health of women, children and adolescents worldwide in the next 15 years. The Global Strategy draws its purpose and power from the SDGs. The three cardinal objectives of the Strategy, namely, Survive, Thrive and Transform, portray the aspiration to not only end preventable mortality, but also to avert illness, ensure well-being, as well as usher in a productive and empowered future. iii
The 23 targets of SDG 3 and the Global Strategy include the unfinished agenda of maternal, newborn and child survival, but with absolute reductions in MMR (per 1 live births); neonatal mortality rate (NMR) and U5MR (per 1 live births) to equal to or less than 7, 12 and 25, respectively, worldwide. In addition, the Strategy envisages addressing adolescent health, stillbirths, congenital anomalies and disabilities, childhood obesity, noncommunicable diseases in women (in particular cardiovascular disorders and carcinoma cervix and breast) and gender-based violence. This monograph is an effort to capture the remarkable achievements on MDGs 4 and 5 by Member States; to picture the post-215 horizons shaped by the SDGs and the Global Strategy; and to signal my renewed commitment, and preparedness, for a more inclusive and more dynamic flagship action for women s, children s and adolescents health and development in our Region. Dr Poonam Khetrapal Singh Regional Director iv
Content Remarkable progress 1 The gains in Maternal, Newborn and Child Survival in the MDGs era are unprecedented 1.1 The flagship priority action boosted the final push to 5 MDGs 4 and 5 in the South-East Asia Region 1.2 The MDGs 4 and 5 journey: Taking stock, looking back 1 1.3 The MDGs 4 and 5 journey: Country initiatives and 18 achievements worth admiration and emulation New horizons 29 Toward a more ambitious vision of the SDGs for women, children and adolescents 2.1 Unfinished task of MDGs 4 and 5 remains a high priority 31 in the SDGs era 2.2 SDGs envisage women s, children s and adolescents 34 health and well-being beyond survival 2.3 Global Strategy for Women s, Children s and Adolescents 35 Health is the new framework in the SDGs era Renewed commitment 39 On the move for ambitious gains in women s, children s and adolescents health and well being 3.1 Ample preparedness for the unfinished agenda and much more 41 3.2 Preparing for the agenda beyond survival across the life course 44 3.3 Inclusive, more robust Flagship Action for Women s, Children s and 54 Adolescents Health - Guided by the SDGs and the Global Strategy Annex 59 4.1 South-East Asia Region Country fact sheets 59 4.2 SDG indicators and monitoring framework 83 4.3 Global Strategy recommended life-course interventions 89 v
Ending Preventable Maternal, Newborn and Child Deaths in South East Asia Region Annex 4.1 Country Factsheets Bangladesh Bhutan Democratic People s Republic of Korea India Indonesia Maldives Myanmar Nepal Sri Lanka Thailand Timor-Leste 59
BANGLADESH ACHIEVED MDG 4 SIGNIFICANT PROGRESS FOR MDG 5 74% reduction in under 5 mortality since 199 69% reduction in maternal mortality since 199 16 14 12 1 8 6 4 2 144 199 88 MDG target 48 38 2 215 U5MR (per 1 live births) 6 5 4 3 2 1 569 399 MMR (per 1 live births) 176 142 MDG target 199 2 215 UNICEF, World Health Organization, The World Bank, United Nations Department of Economic and Social Affairs, Population Division. Levels & trends in child mortality - report 215: estimates developed by the UN inter-agency group for child mortality estimation. New York, 215. World Health Organization, United Nations Children s Fund, United Nations Population Fund, the World Bank, United Nations. Trends in maternal mortality: 199 to 215: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. http://apps.who.int/iris/ bitstream/1665/194254/1/9789241565141_eng.pdf - accessed 9 August 216. Total population 16 996 (215) Neonatal mortality rate (per 1 live births) 23 (215) Under-five mortality rate (per 1 live births) 38 (215) Infant mortality rate (deaths per 1 live births) 31 (215) Population under 5 (%) 1 Prevalence of stunting in children under 5 (%) 36.1 (215) Prevalence of wasting in children under 5 (%) 14.3 (215) Prevalence of overweight in children under 5 (%) 1.4 (215) Maternal mortality ratio (per 1 live births) 176 (215) Adolescents 1-19 years (%) 2 Adolescent Birth Rate (births 1 113 women 15-19 years) Unmet need for family planning*(%) 14 (214) World Health Organization. World health statistics 216. Geneva, 216. http://apps.who.int/iris/bitstream/1665/1725/1/978924694439_eng.pdf - accessed 9 August 216. United Nations, Department of Economic and Social Affairs. World population prospects: the 212 revision. New York: Population Division, 213. http://esa.un.org/unpd/ wpp/index.htm- accessed 7 May 215. *World Health Organization. Health in 215: from MDGs to SDGs. Geneva, 215. COVERAGE OF LIFE-SAVING INTERVENTIONS INCREASED Maternal interventions Immunization and illness treatment in children 1 8 6 4 2 39 64 At least 1 ANC visit 11 31 At least 4 ANC visits 2-24 27-214 2-24 27-214 1 77 8 84 8 6 57 42 5 37 42 23 4 13 2 3 2 Births Institutional Births by Breastfeeding Measles ORT in Taken to SBA delivery C-section initiated immunization diarrohoea health facility within 1 hour for pneumonia World Health Organization. World health statistics 26. Geneva, 26. http://www.who.int/gho/ publications/world_health_statistics/whostat26_erratareduce.pdf- accessed 9 August 216 World Health Organization. World health statistics 26. Geneva, 26. http://www.who.int/gho/ publications/world_health_statistics/whostat26_erratareduce.pdf- accessed 9 August 216 DO INEQUITIES PERSIST? In mortality In life-saving interventions Secondary Rural 1 8 6 4 2 Urban Secondary Rural 1 8 6 4 2 Urban Births attended by skilled health personnel Antenatal care coverage: At least four visits IMR U5MR Illiterate Richest Poorest Illiterate Richest Poorest DPT3 Immunization (PENTA) 6 National Institute of Population Research and Training (NIPORT), Mitra Associates, and ICF International, Bangladesh demographic and Health Survey 211. Dhaka, Bangladesh and Calverton, Maryland, USA: NIPORT, Mitra Associates, and ICF International, 213 Bangladesh Demographic and Health Survey 214
BANGLADESH NEW HORIZONS SDG targets 176 38 Ending preventable maternal, newborn and child deaths in the South-East Asia Region Regional Flagship Area U5 MR MMR 25 NMR 25 215 7 215 12 By 23 Still births reduced to single digit By 23 World Health Organization, United Nations Children s Fund, United Nations Population Fund, the World Bank, United Nations. Trends in maternal mortality: 199 to 215: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. http://apps.who.int/iris/bitstream/1665/194254/1/9789241565141_eng.pdf - accessed 9 August 216. ADOLESCENTS: TOWARDS HEALTHY TRANSITIONS Adolescent marriage and childbearing (15 19 years) Diet, physical activity and tobacco use 1 8 6 4 2 59 Married by 18 years 58 Began childbearing by 19 years 17 Unmet need for contraception 113 Adolescent birth rate* 12 1 8 6 4 2 Per 1 girls Anaemia Undernourished BMI<18.5 Overweight adolescents Students (13 17 yrs) who experienced serious injury Ever smoked tobacco (GYTS) 2% 31% 44% 49% 11% Bangladesh Demographic and health Survey 214; *World Health Statistics, WHO Publication. 216. Available from: http://www.who.int/gho/publications/world_health_statistics/216/en/ Bangladesh DHS 211-214; Bangladesh Global School Health Survey 214; Government of the People s Republic of Bangladesh, Ministry of Health and Family Welfare.Bangladesh - Dhaka global youth tobacco survey. Dhaka: MOF&FW, 213; Government of the People s Republic of Bangladesh, Ministry of Health and Family Welfare.Bangladesh - Dhaka global youth tobacco survey. Dhaka: MOF&FW, 213. REPRODUCTIVE HEALTH Access to reproductive health-care services Cervical cancer 12% 62% Number of girls between 9 13 years (eligible for HPV vaccination) 7 751 Opportunity for HPV vaccination National Cervical Cancer Screening Programme (Launched in 25) Cancer Cervix Incidence (per 1 ) 19.2 Cancer Cervix Mortality (per 1 ) 11.5 Unmet need for family planning Bangladesh Demographic and Health Survey 214 Contraceptive prevalence Need for population-based cancer registry Strategic framework for the Comprehensive Control of Cancer Cervix in South-East Asia; http://apps.who.int/iris/bitstre am/1665/15298/1/978929224723-mrh.pdfregion,http://apps.who.int/iris/bitstream/1665/15298/1/978929224723- MRH.pdf COVERAGE EQUITY QUALITY ACCOUNTABILITY 61
BHUTAN ACHIEVED MDG 4 75% reduction in under 5 mortality since 199 84% reduction in maternal mortality since 199 16 14 12 1 8 6 4 2 134 199 8 MDG target 45 33 2 215 U5MR (per 1 live births) ACHIEVED MDG 5 1 9 8 7 6 5 4 3 2 1 945 423 MMR (per 1 live births) MDG target 236 199 2 215 148 UNICEF, World Health Organization, The World Bank, United Nations Department of Economic and Social Affairs, Population Division. Levels & trends in child mortality - report 215: estimates developed by the UN inter-agency group for child mortality estimation. New York, 215. Trends in maternal mortality: 199 to 215: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Total population 775 (215) Neonatal mortality rate (per 1 live births) 18 (215) Under-five mortality rate (per 1 live births) 33 (215) Infant mortality rate (deaths per 1 live births) 27 (215) Population under 5 (%) 9 (215) Prevalence of stunting in children under 5(%) 33.6 (215) Prevalence of wasting in children under 5(%) 5.9 (215) Prevalence of overweight in children under 5 (%) 7.6 (215) Maternal mortality ratio (per 1 live births) 148 (215) Adolescent 1-19 years (%) 18.4 (215) Adolescent Birth Rate (per 1 women 28.4 (215) 15-19 years) Unmet need for family planning*(%) 12 (215) World Health Statistics [Internet]. WHO Publication. 216. *World Health Statistics [Internet]. WHO Publication. 215. COVERAGE OF LIFE-SAVING INTERVENTIONS INCREASED Maternal interventions Immunization and illness treatment in children 1 8 6 4 2 At least 1 ANC visit 74 77 At least 4 ANC visits 24 58 Births SBA 2 27-214 87 94 24 27-214 1 81 8 74 63 59 6 4 12 2 Institutional Births by Measles ORT in delivery C-section immunization diarrohoea Breastfeeding initiated within 1 hour Taken to health facility for pneumonia Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4; World Health Organization. World health statistics 26. Geneva, 26. World Health Organization. World health statistics 215. Geneva, 215. Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4; World Health Organization. World health statistics 26, World Health Organization. World health statistics 215 BUT INEQUITIES PERSIST In mortality In life-saving interventions IMR U5MR Stunting Secondary Illiterate Rural 1 8 6 4 2 Richest Urban Poorest Secondary Illiterate Rural 1 8 6 4 2 Richest Urban Poorest Births attended by skilled health personnel Antenatal care coverage: At least four visits Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4-National Statistics Bureau, Royal Government of Bhutan( Bhutan ) Multiple Indicator Survey 21.Thimphu, Bhutan: National Statistics Bureau, 211. Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4-National Statistics Bureau, Royal Government of Bhutan( Bhutan ) Multiple Indicator Survey 21.Thimphu, Bhutan: National Statistics Bureau, 211. 62
BHUTAN NEW HORIZONS SDG targets 148 33 Ending preventable maternal, newborn and child deaths in the South-East Asia Region Regional Flagship Area 215 MMR 7 18 215 U5 MR NMR 25 12 By 23 Still births reduced to single digit By 23 Levels & Trends in Child mortality - Report 215: Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation Trends in maternal mortality: 199 to 215: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. ADOLESCENTS: TOWARDS HEALTHY TRANSITIONS Adolescent marriage and childbearing (15 19 years) Diet, physical activity and tobacco use 1 8 6 4 2 31 Married by 18 years 15 Began childbearing by 19 years 27 28 Unmet need for contraception Adolescent birth rate* 6 4 2 Per 1 girls Anaemia Undernourished BMI<18.5 Overweight adolescents Students (13 17 yrs) who experienced serious injury Ever smoked tobacco (GYTS) Data Unavailable Data Unavailable Data Unavailable Data Unavailable 3% Adolescent Pregancy. Situation in South-East Asia Region. WHO Publication 214 *World Health Organization. World health statistics 216. Geneva, 216. Global Youth Tobacco Survey (GYTS)-, Bhutan-213 REPRODUCTIVE HEALTH Access to reproductive health-care services 12% 66% Cervical cancer Number of girls between 9 13 years (eligible for HPV vaccination) 35 Opportunity for HPV vaccination 211, Quadrivalent vaccine introduced in National Immunization Program Reaching all girls up to 12 years through health facility Unmet need for family planning World Health Statistics, WHO Publication. 215. Contraceptive prevalence Cancer Cervix Incidence (per 1 ) 12.8 Cancer Cervix Mortality (per 1 ) 7 Need for population-based cancer registry World Health Organization, Regional Office for South-East Asia. Strategic framework for the comprehensive control of cancer cervix. New Delhi, 215. COVERAGE EQUITY QUALITY ACCOUNTABILITY 63
DPR KOREA PROGRESS TOWARDS MDG 4 SIGNIFICANT PROGRESS FOR MDG 5 42% reduction in under 5 mortality since 199 Slow reduction in maternal mortality since 199 7 6 6 U5MR (per 1 live births) 14 12 128 MMR (per 1 live births) 5 4 43 1 8 75 82 3 2 1 25 MDG target 14 199 2 215 6 4 2 MDG target 19 199 2 215 UNICEF, World Health Organization, The World Bank, United Nations Department of Economic and Social Affairs, Population Division. Levels & trends in child mortality - report 215: estimates developed by the UN inter-agency group for child mortality estimation. New York, 215 World Health Organization, United Nations Children s Fund, United Nations Population Fund, the World Bank, United Nations. Trends in maternal mortality: 199 to 215: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Total population 25 155 (215) Neonatal mortality rate (per 1 live births) 14 (215) Under-five mortality rate (per 1 live births) 25 (215) Infant mortality rate (deaths per 1 live births) 2(215) Population under 5 (%) 7 (215) Prevalence of stunting in children under 5 (%) 27.9 (215) Prevalence of wasting in children under 5 (%) 4. (215) Prevalence of overweight in children under 5 (%). (215) Maternal mortality ratio (per 1 live births) 82 (215) Adolescent 1-19 years (%) 15.2 (215) Adolescent Birth Rate (per 1 women.7 (215) 15-19 years) Unmet need for family planning*(%) 15 (215) World Health Organization. World health statistics 216. Geneva, 216. *World Health Organization. World health statistics 215. Geneva, 215. COVERAGE OF LIFE-SAVING INTERVENTIONS INCREASED Maternal interventions Immunization and illness treatment in children 1 8 6 4 2 2 27-214 24 27-214 98 1 94 97 1 95 12 1 95 99 92 8 8 6 4 13 2 18 At least 1 ANC visit At least 4 ANC visits Births SBA Institutional delivery Births by C-section Breastfeeding initiated within 1 hour Measles immunization ORT in diarrohoea Taken to health facility for pneumonia Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4; World Health Organization. World health statistics 26. Geneva, 26. World Health Organization. World health statistics 215. Geneva, 215. Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4; World Health Organization. World health statistics 26. Geneva, 26. World Health Organization. World health statistics 215. Geneva, 215. VERY FEWINEQUITIES In mortality and nutritional status In coverage of interventions IMR U5MR Stunting Higher Secondary Rural 1 5 Richest Urban Poorest Higher Secondary Rural 1 8 6 4 2 Richest Urban Poorest Births by skilled health personnel ORS in Diarrohoea Taken to facility for pneumonia Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4; World Health Organization. World health statistics 26. Geneva, 26. World Health Organization. World health statistics 215. Geneva, 215. Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4; World Health Organization. World health statistics 26. Geneva, 26. World Health Organization. World health statistics 215. Geneva, 215. 64
DPR KOREA NEW HORIZONS SDG targets 82 Ending preventable maternal, newborn and child deaths in the South-East Asia Region Regional Flagship Area MMR 25 U5 MR 25 215 7 By 23 14 215 NMR Still births reduced to single digit 12 By 23 Levels & Trends in Child mortality - Report 215: Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation Trends in maternal mortality: 199 to 215: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. ADOLESCENTS: TOWARDS HEALTHY TRANSITIONS Adolescent marriage and childbearing (15 19 years) Diet, physical activity and tobacco use Married by 18 years Data unavailable Began childbearing by 19 years Unmet need for contraception.7 Adolescent birth rate* 5 4.5 4 3.5 3 2.5 2 1.5 1.5 Per 1 girls Anaemia Undernourished BMI<18.5 Overweight adolescents Physically active 13-15 year olds Ever smoked tobacco (GYTS) Data unavailable Data unavailable Data unavailable Data unavailable Data unavailable *World Health Organization. World health statistics 216 Data Unavailable REPRODUCTIVE HEALTH Access to reproductive health-care services Cervical cancer 15% 71% Number of girls between 9 13 years (eligible for HPV vaccination) 99 Opportunity for HPV vaccination Unmet need for family planning Contraceptive prevalence Cancer Cervix Incidence (per 1 ) 12.4 Cancer Cervix Mortality (per 1 ) 7.2 No population-based cancer registry World Health Organization, Regional Office for South-East Asia. Strategic framework for the comprehensive control of cancer cervix. New Delhi, 215. World Health Organization. World health statistics 216. Geneva, 216 COVERAGE EQUITY QUALITY ACCOUNTABILITY 65
INDIA JUST MISSED MDG 4 SIGNIFICANT PROGRESS TOWARD MDG 5 62 % reduction in under 5 mortality since 199 69% reduction in maternal mortality since 199 14 12 1 8 6 4 2 126 199 91 48 MDG target 42 2 215 U5MR (per 1 live births) 6 5 4 3 2 1 556 374 MMR (per 1 live births) 174 MDG target 139 199 2 215 UNICEF, World Health Organization, The World Bank, United Nations Department of Economic and Social Affairs, Population Division. Levels & trends in child mortality - report 215: estimates developed by the UN inter-agency group for child mortality estimation. New York, 215 World Health Organization, United Nations Children s Fund, United Nations Population Fund, the World Bank, United Nations. Trends in maternal mortality: 199 to 215: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Total population 1 311 51 (215) Neonatal mortality rate (per 1 live births) 28 (215) Under-five mortality rate (per 1 live births) 48 (215) Infant mortality rate (deaths per 1 live births) 38 (215) Population under 5 (%) 9 (215) Prevalence of stunting in children under 5(%) 38.7(215) Prevalence of wasting in children under 5(%) 15.1(215) Prevalence of overweight in children under 5 (%) 1.9(215) Maternal mortality ratio (per 1 live births) 178 (215) Adolescent 1-19 years (%) 18.8 (215) Adolescent Birth Rate (per 1 women 28.1 (215) 15-19 years) Unmet need for family planning*(%) 21 (215) *World Health Organization. World health statistics 215 World Health Organization. World health statistics 216 COVERAGE OF LIFE-SAVING INTERVENTIONS INCREASED Maternal interventions Immunization and illness treatment in children 1 8 6 4 2 65 75 At least 1 ANC visit 3 72 At least 4 ANC visits 43 67 Births SBA 1998-1999 47 Institutional delivery 27-214 7 8 Births by C-section 1 8 6 4 2 77 Breastfeeding initiated within 1 hour 74 56 Measles immunization 24 54 ORT in diarrohoea 27-214 83 Taken to health facility for pneumonia Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4; World Health Organization. World health statistics 26, World Health Organization. World health statistics 215 Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4; World Health Organization. World health statistics 26, World Health Organization. World health statistics 215 BUT INEQUITIES PERSIST In mortality and nutritional status In coverage of life-saving interventions Secondary Rural 1 8 6 4 2 Urban Secondary Rural 1 8 6 4 2 Urban Births attended by skilled health personnel ORS in Diarrohoea IMR U5MR Stunting Illiterate Richest Poorest Illiterate Richest Poorest Taken to facility for pneumonia International Institute for Population Sciences. National family health survey (NFHS-2) 1998-1999: India. 2 vols. Mumbai: IIPS, 2 International Institute for Population Sciences. National family health survey (NFHS-2) 1998-1999: India. 2 vols. Mumbai: IIPS, 2 66
INDIA NEW HORIZONS SDG targets 174 48 Ending preventable maternal, newborn and child deaths in the South-East Asia Region Regional Flagship Area U5 MR 215 MMR 7 28 215 NMR 25 12 By 23 Still births reduced to single digit By 23 Levels & Trends in Child mortality - Report 215: Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation Trends in maternal mortality: 199 to 215: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. ADOLESCENTS: TOWARDS HEALTHY TRANSITIONS Adolescent marriage and childbearing (15 19 years) Nutrition, physical activity and tobacco use 1 8 6 4 2 47 Married by 18 years 36 Began childbearing by 19 years 27 Unmet need for contraception 28 Adolescent birth rate* 12 1 8 6 4 2 Per 1 girls Anemia in girls (15-19 years) Undernourished BMI<18.5 Overweight adolescents Physically active 13-15 year olds Current tobacco use (GYTS) 11% 3% 47% 56% 18% International Institute for Population Sciences. National family health survey (NFHS-2) 1998-1999: India. 2 vols. Mumbai: IIPS, 2 *World Health Organization. World health statistics 216. Geneva, 216. International Institute for Population Sciences. National family health survey (NFHS-2) 1998-1999: India. 2 vols. Mumbai: IIPS, 2.; Global school-based student health survey, India (CBSE), 27 fact sheet. REPRODUCTIVE HEALTH Access to reproductive health-care services Cervical cancer 21% 55% Number of girls between 9 13 years (eligible for HPV vaccination) 58 85 Opportunity for HPV vaccination Bivalent and Quadrivalent vaccine licensed Unmet need for family planning Contraceptive prevalence Cancer Cervix Incidence (per 1 ) 22. Cancer Cervix Mortality (per 1 ) 12.4 Population-based cancer registry in select areas <5% population covered World Health Organization, Regional Office for South-East Asia. Strategic framework for the comprehensive control of cancer cervix. New Delhi, 215. World Health Organization. World health statistics 215: Geneva, 215 COVERAGE EQUITY QUALITY ACCOUNTABILITY 67
INDONESIA ACHIEVED MDG 4 SIGNIFICANT PROGRESS TOWARD MDG 5 68% reduction in under 5 mortality since 199 72% reduction in maternal mortality since 199 9 8 7 6 5 4 3 2 1 85 199 52 MDG target 28 27 2 215 U5MR (per 1 live births) 5 45 4 35 3 25 2 15 1 5 446 265 MMR (per 1 live births) 126 MDG target 112 199 2 215 UNICEF, World Health Organization, The World Bank, United Nations Department of Economic and Social Affairs, Population Division. Levels & trends in child mortality - report 215: estimates developed by the UN inter-agency group for child mortality estimation. New York, 215 World Health Organization, United Nations Children s Fund, United Nations Population Fund, the World Bank, United Nations. Trends in maternal mortality: 199 to 215: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Total Population 257 564 (215) Neonatal mortality rate (per 1 live births) 14 (215) Under-five mortality rate (per 1 live births) 27 (215) Infant mortality rate (deaths per 1 live births) 23(215) Population under 5 (%) 1 (215) Prevalence of stunting in children under 5(%) 36.4 (215) Prevalence of wasting in children under 5(%) 13.5 (215) Prevalence of overweight in children under 5 (%) 11.5(215) Maternal mortality ratio (per 1 live births) 126 (215) Adolescent 1-19 years (%) 18.2 (215) Adolescent Birth Rate (per 1 women 15-19 years) 47 (215) Unmet need for family planning*(%) 11 (215) *World Health Organization. World health statistics 215 World Health Organization. World health statistics 216 COVERAGE OF LIFE-SAVING INTERVENTIONS INCREASED Maternal interventions Immunization and illness treatment in children 1 8 6 4 2 97 96 At least 1 ANC visit 81 88 66 At least 4 ANC visits 22-23 27-214 2-24 27-214 1 84 83 8 72 63 61 61 6 44 47 4 28 4 12 2 Births Institutional Births by Breastfeeding Measles ORT in Taken to SBA delivery C-section initiated immunization diarrohoea health facility within 1 hour for pneumonia World Health Organization. World health statistics 26, World Health Organization. World health statistics 215 Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4; World Health Organization. World health statistics 26, World Health Organization. World health statistics 215 BUT INEQUITIES PERSIST In mortality In coverage of interventions Secondary Rural 1 8 6 4 2 Urban Secondary Rural 1 8 6 4 2 Urban Births attended by skilled health personnel ORS in Diarrohoea IMR U5MR Illiterate Richest Poorest Illiterate Richest Poorest Taken to facility for pneumonia Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4, World Health Organization, 214. Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4, World Health Organization, 214. 68
INDONESIA NEW HORIZONS SDG targets 126 27 Ending preventable maternal, newborn and child deaths in the South-East Asia Region Regional Flagship Area 215 MMR 7 14 215 U5 MR NMR 25 12 By 23 Still births reduced to single digit By 23 UNICEF, World Health Organization, The World Bank, United Nations Department of Economic and Social Affairs, Population Division. Levels & trends in child mortality - report 215: estimates developed by the UN inter-agency group for child mortality estimation. New York, 215 ADOLESCENTS: TOWARDS HEALTHY TRANSITIONS Adolescent marriage and childbearing (15 19 years) Diet, physical activity and tobacco use 1 8 6 4 2 43 Married by 18 years 1 1 Began childbearing by 19 years Unmet need for contraception 47 Adolescent birth rate* 6 4 2 Per 1 girls Anemia in girls (15-49 years) Unintentional injuries and violence Overweight adolescents Physically active 13-15 year olds Ever smoked tobacco (GYTS) Data unavailable Data unavailable Data unavailable Data unavailable 3% * World Health Organization. World health statistics 216. Geneva, 216. Global Touth Tobacco Survey, Indonesia 211 REPRODUCTIVE HEALTH Access to reproductive health-care services Cervical cancer 11% 62% Number of girls between 9 13 years (eligible for HPV vaccination) 1 75 Opportunity for HPV vaccination HPV Vaccine available in private sector Unmet need for family planning Contraceptive prevalence Cancer Cervix Incidence (per 1 ) 17.3 Cancer Cervix Mortality (per 1 ) 8.1 Hospital based registry in 23 teaching hospitals Need for population-based cancer registry World Health Organization, Regional Office for South-East Asia. Strategic framework for the comprehensive control of cancer cervix. New Delhi, 215. World Health Organization. World health statistics 215. Geneva, 215. COVERAGE EQUITY QUALITY ACCOUNTABILITY 69
MALDIVES ACHIEVED MDG 4 ACHIEVED MDG 5 9% reduction in under 5 mortality since 199 9% reduction in maternal mortality since 199 1 9 8 7 6 5 4 3 2 1 94 199 44 MDG target 31 9 2 215 U5MR (per 1 live births) 8 7 6 5 4 3 2 1 667 MMR (per 1 live births) MDG target 163 167 199 2 215 68 UNICEF, World Health Organization, The World Bank, United Nations Department of Economic and Social Affairs, Population Division. Levels & trends in child mortality - report 215: estimates developed by the UN inter-agency group for child mortality estimation. New York, 215 World Health Organization, United Nations Children s Fund, United Nations Population Fund, the World Bank, United Nations. Trends in maternal mortality: 199 to 215: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Total population 364 (215) Neonatal mortality rate (per 1 live births) 5(215) Under-five mortality rate (per 1 live births) 9 (215) Infant mortality rate (deaths per 1 live births) 7(215) Population under 5 (%) 1 (215) Prevalence of stunting in children under 5(%) 2.3 (215) Prevalence of wasting in children under 5 (%) 1.2(215) Prevalence of overweight in children under 5 (%) 6.5 (215) Maternal mortality ratio (per 1 live births) 68 (215) Adolescent 1-19 years (%) 17.8 (215) Adolescent Birth Rate (per 1 women 13.7 (215) 15-19 years) Unmet need for family planning*(%) 29 (215) *World Health Organization. World health statistics 215 World Health Organization. World health statistics 216 COVERAGE OF LIFE-SAVING INTERVENTIONS INCREASED Maternal interventions 1 8 6 4 2 98 99 At least 1 ANC visit 81 85 7 At least 4 ANC visits Births SBA 21-24 99 95 Births in Health Facility 27-214 41 Births by C-section Immunization and illness treatment in children 1 8 6 4 2 64 Breastfeeding initiated within 1 hour 97 99 Measles immunization 24 63 ORT in diarrohoea 27-214 74 Taken to health facility for pneumonia World Health Organization. World health statistics 26, World Health Organization. World health statistics 215 World Health Organization. World health statistics 26, World Health Organization. World health statistics 215 FEWINEQUITIES PERSIST In mortality and nutritional status In coverage of interventions Secondary Rural 1 8 6 4 2 Urban Secondary Rural 1 8 6 4 2 Urban Births attended by skilled health personnel Taken to Facility for Pneumonia IMR U5MR Stunting Illiterate Richest Poorest Illiterate Richest Poorest Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4, World Health Organization, 214. Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4, World Health Organization, 214. 7
MALDIVES NEW HORIZONS SDG targets Ending preventable maternal, newborn and child deaths in the South-East Asia Region Regional Flagship Area 68 Achived SDG MMR target 7 By 23 9 5 Achived SDG U5 MR target Achived SDG NMR target 25 12 By 23 215 215 Still births reduced to single digit UNICEF, World Health Organization, The World Bank, United Nations Department of Economic and Social Affairs, Population Division. Levels & trends in child mortality - report 215: estimates developed by the UN inter-agency group for child mortality estimation. New York, 215 ADOLESCENTS: TOWARDS HEALTHY TRANSITIONS Adolescent marriage and childbearing (15 19 years) Diet, physical activity and tobacco use 1 8 6 4 2 4 7 Married by 18 years Began childbearing by 19 years 36 Unmet need for contraception 14 Adolescent birth rate* 6 4 2 Per 1 girls Undernourished BMI<18.5 4% Overweight adolescents 2% Physically active 13-15 year olds 2% Ever smoked tobacco (GYTS) 17% Adolescent Pregnancy - Fact sheet. Situation in South-East Asia Region 214 *World Health Organization. World health statistics 216. Geneva, 216. Maldives demographic and health survey 29; Republic of Maldives. Global school-based student health survey (GSHS). Male, 29. REPRODUCTIVE HEALTH Access to reproductive health-care services 29% 35% Cervical cancer Number of girls between 9 13 years (eligible for HPV vaccination) 15 Opportunity for HPV vaccination Opportunity for HPV Vaccination Unmet need for family planning Contraceptive prevalence Cancer Cervix Incidence (per 1 ) 11. Cancer Cervix Mortality (per 1 ) 6.3 Need for population-based cancer registry World Health Organization, Regional Office for South-East Asia. Strategic framework for the comprehensive control of cancer cervix. New Delhi, 215. World Health Organization. World health statistics 215. Geneva, 215. COVERAGE EQUITY QUALITY ACCOUNTABILITY 71
MYANMAR PROGRESS TOWARD MDG 4 SIGNIFICANT PROGRESS TOWARD MDG 5 55% reduction in under 5 mortality since 199 61% reduction in maternal mortality since 199 12 1 8 6 4 2 11 199 82 5 MDG target 37 2 215 U5MR (per 1 live births) 5 45 4 35 3 25 2 15 1 5 453 38 MMR (per 1 live births) 178 MDG target 113 199 2 215 UNICEF, World Health Organization, The World Bank, United Nations Department of Economic and Social Affairs, Population Division. Levels & trends in child mortality - report 215: estimates developed by the UN inter-agency group for child mortality estimation. New York, 215 World Health Organization, United Nations Children s Fund, United Nations Population Fund, the World Bank, United Nations. Trends in maternal mortality: 199 to 215: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Total Population 53 897 (215) Neonatal mortality rate (per 1 live births) 26 (215) Under-five mortality rate (per 1 live births) 5 (215) Infant mortality rate (deaths per 1 live births) 4(215) Population under 5 (%) 8 (215) Prevalence of stunting in children under 5(%) 35.1(215) Prevalence of wasting in children under 5(%) 7.9(215) Prevalence of overweight in children under 5 (%) 2.6(215) Maternal mortality ratio (per 1 live births) 178 (215) Adolescent 1-19 years (%) 16.7 (215) Adolescent Birth Rate (per 1 women 3.3 (215) 15-19 years) Unmet need for family planning (%) na (215) World Health Organization. World health statistics 216 COVERAGE OF LIFE-SAVING INTERVENTIONS INCREASED Maternal interventions Immunization and illness treatment in children 1 8 6 4 2 83 At least 1 ANC visit 76 43 At least 4 ANC visits 56 78 Births SBA 21 27-214 24 27-214 1 76 78 86 8 66 69 6 36 4 2 Births in health facility Births by C-section Breastfeeding initiated within 1 hour Measles immunization ORT in diarrohoea Taken to health facility for pneumonia World Health Organization. World health statistics 26, World Health Organization. World health statistics 215 World Health Organization. World health statistics 26, World Health Organization. World health statistics 215 BUT INEQUITIES PERSIST In mortality and nutritional status In coverage of life-saving interventions Secondary No/ IMR Primary U5MR Education Stunting Rural 1 8 6 4 2 Richest Urban Poorest Secondary No/Primary Education Rural 1 8 6 4 2 Richest Urban Poorest Births attended by skilled health personnel ORS in Diarrohoea Taken to facility for pneumonia Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4, World Health Organization, 214. Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4, World Health Organization, 214. 72
MYANMAR NEW HORIZONS SDG targets 178 5 Ending preventable maternal, newborn and child deaths in the South-East Asia Region Regional Flagship Area U5 MR MMR 26 NMR 25 215 7 215 12 By 23 Still births reduced to single digit By 23 UNICEF, World Health Organization, The World Bank, United Nations Department of Economic and Social Affairs, Population Division. Levels & trends in child mortality - report 215: estimates developed by the UN inter-agency group for child mortality estimation. New York, 215 ADOLESCENTS: TOWARDS HEALTHY TRANSITIONS Adolescent marriage and childbearing (15 19 years) Nutrition, Physical Activity and Tobacco Use 1 8 6 4 2 7 Married by 18 years 72 Began childbearing by 19 years Unmet need for contraception 3 Adolescent birth rate* 6 4 2 Per 1 girls Anemia in girls (15-49 years) Unintentional injuries and violence (seriously injured in past year) Overweight adolescents Physically active 13-15 year olds Ever smoked tobacco (GYTS) Data unavailable 27% 5% Data unavailable 15% Union of Myanmar, Ministry of Immigration and Population, UNFPA. Country report on 27:fertility and reproductive health survey. Yangon: Department of Population and UNFPA, 27. Multiple indicator cluster survey 29-21 *World Health Organization. World health statistics 216. Geneva, 216. Union of Myanmar, Ministry of Health. Global school-based student health survey. Yangon: MOH,27. Global school-based student health survey. 27. REPRODUCTIVE HEALTH Access to reproductive health-care services % 46% Cervical cancer Number of girls between 9 13 years (eligible for HPV vaccination) 2 3 Opportunity for HPV vaccination Inclusion of HPV in National Immunization Program accepted by MoH Unmet need for family planning Contraceptive prevalence Cancer Cervix Incidence (per 1 ) 2.6 Cancer Cervix Mortality (per 1 ) 12.3 High burden of cervical cancer No population-based cancer registry World Health Organization. World health statistics 215. Geneva, 215. World Health Organization, Regional Office for South-East Asia. Strategic framework for the comprehensive control of cancer cervix. New Delhi, 215. COVERAGE EQUITY QUALITY ACCOUNTABILITY 73
NEPAL ACHIEVED MDG 4 JUST MISSED MDG 5 74% reduction in under 5 mortality since 199 71% reduction in maternal mortality since 199 16 14 12 1 8 6 4 2 141 199 81 MDG target 47 36 2 215 U5MR (per 1 live births) 1 9 8 7 6 5 4 3 2 1 91 548 MMR (per 1 live births) 258 MDG target 225 199 2 215 UNICEF, World Health Organization, The World Bank, United Nations Department of Economic and Social Affairs, Population Division. Levels & trends in child mortality - report 215: estimates developed by the UN inter-agency group for child mortality estimation. New York, 215 World Health Organization, United Nations Children s Fund, United Nations Population Fund, the World Bank, United Nations. Trends in maternal mortality: 199 to 215: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Total population 28 514 (215) Neonatal mortality rate (per 1 live births) 22 (215) Under-five mortality rate (per 1 live births) 36 (215) Infant mortality rate (deaths per 1 live births) 29(215) Population under 5 (%) 1 (215) Prevalence of stunting in children under 5 (%) 37.4(215) Prevalence of wasting in children under 5 (%) 11.3(215) Prevalence of overweight in children under 5 (%) 2.1(215) Maternal mortality ratio (per 1 live births) 258 (215) Adolescent 1-19 years (%) 23.1 (215) Adolescent Birth Rate (per 1 women 71 (215) 15-19 years) Unmet need for family planning*(%) 28 (215) *World Health Organization. World health statistics 215 World Health Organization. World health statistics 216 COVERAGE OF LIFE-SAVING INTERVENTIONS INCREASED Maternal interventions Immunization and illness treatment in children 1 8 6 4 2 49 58 At least 1 ANC visit 15 5 At least 4 ANC visits 11 2-1 27-214 1 2-1 27-214 88 8 73 6 5 45 5 36 35 4 27 26 1 5 2 Births in Births by Measles ORT in health facility C-section immunization diarrohoea Births SBA Breastfeeding initiated within 1 hour Taken to health facility for pneumonia World Health Organization. World health statistics 26, World Health Organization. World health statistics 215 World Health Organization. World health statistics 26, World Health Organization. World health statistics 215 BUT INEQUITIES PERSIST In mortality and nutritional status In coverage of life-saving interventions IMR U5MR Stunting Secondary Illiterate Rural 1 8 6 4 2 Richest Urban Poorest Secondary Illiterate Rural 1 8 6 4 2 Richest Urban Poorest Births by skilled health personnel ORS in Diarrohoea Pneumonia taken to facility Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4, World Health Organization, 214. Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4, World Health Organization, 214. 74
NEPAL NEW HORIZONS SDG targets 258 36 Ending preventable maternal, newborn and child deaths in the South-East Asia Region Regional Flagship Area U5 MR MMR 22 NMR 25 215 7 215 12 By 23 By 23 Still births reduced to single digit Same as Graph 1&2 ADOLESCENTS: TOWARDS HEALTHY TRANSITIONS Adolescent marriage and childbearing (15 19 years) Nutrition, exposure to violence and tobacco use 1 8 6 4 2 41 39 42 Married by 18 years Began childbearing by 19 years Unmet need for contraception 71 Adolescent birth rate* 8 6 4 2 Per 1 girls Anemia in girls (15-19 years) Undernourished BMI<18.5 Overweight/obese Adolescents who have ever experienced physical violence Current tobacco use (GYTS) 19% 12% 1% 39% 1% Nepal demographic and health survey 211; 5. World Health Organization. World health statistics 216. Geneva, 216 REPRODUCTIVE HEALTH Access to reproductive health-care services Cervical cancer Nepal demographic and health survey 211; World Health Organization. World health statistics 216. Geneva, 216;Nepal, Ministry of Health and Population. Nepal demographic and health survey 211. Kathmandu: MOPH, New ERA, ICF International, 212, Nepal, Ministry of Health and Population. Nepal Demographic and health survey 211. Kathmandu: MOPH, New ERA, Macro International Inc., 27. Statistical Yearbook for Asia and the Pacific 213, United Nations Economic and Social Commission for Asia and the Pacific, Bangkok, Thailand. The World s Youth 213 Data Sheet, Washington, DC: Population Reference Bureau, 213.; Nepal GYTS 211 28% 5% Number of girls between 9 13 years (eligible for HPV vaccination) 1 89 Opportunity for HPV vaccination Opportunity to include HPV in National Immunization Program Unmet need for family planning Contraceptive prevalence Cancer Cervix Incidence (per 1 ) 19. Cancer Cervix Mortality (per 1 ) 12. No population-based cancer registry Select areas hospital based data World Health Organization, Regional Office for South-East Asia. Strategic framework for the comprehensive control of cancer cervix. New Delhi, 215. World Health Organization. World health statistics 215. Geneva, 215 COVERAGE EQUITY QUALITY ACCOUNTABILITY 75
SRI LANKA PROGRESS MADE ON MDG 4 PROGRESS MADE ON MDG 5 52% reduction in under 5 mortality since 199 6% reduction in maternal mortality since 199 25 2 15 1 5 21 199 16 1 MDG target 7 2 215 U5MR (per 1 live births) 8 7 6 5 4 3 2 1 75 57 MMR (per 1 live births) 3 19 MDG target 199 2 215 UNICEF, World Health Organization, The World Bank, United Nations Department of Economic and Social Affairs, Population Division. Levels & trends in child mortality - report 215: estimates developed by the UN inter-agency group for child mortality estimation. New York, 215 World Health Organization, United Nations Children s Fund, United Nations Population Fund, the World Bank, United Nations. Trends in maternal mortality: 199 to 215: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Total population 2 715 (215) Neonatal mortality rate (per 1 live births) 5 (215) Under-five mortality rate (per 1 live births) 1 (215) Infant mortality rate (deaths per 1 live births) 8 (215) Population under 5 (%) 8 (215) Prevalence of stunting in children under 5 (%) 14.7 (215) Prevalence of wasting in children under 5 (%) 21.4 (215) Prevalence of overweight in children under 5 (%).6 (215) Maternal mortality ratio (per 1 live births) 3 (215) Adolescent 1-19 years (%) 15.2 (215) Adolescent Birth Rate (per 1 women 2.3 (215) 15-19 years) Unmet need for family planning*(%) 7 (213) *World Health Organization. World health statistics 215 World Health Organization. World health statistics 216 COVERAGE OF LIFE-SAVING INTERVENTIONS INCREASED Maternal interventions 1 8 6 4 2 2-21 27-214 2-24 27-214 99 99 98 1 93 97 99 98 96 8 8 6 63 58 31 4 2 At least 4 Births Births in Births by Measles ORT in ANC visits SBA health facility* C-section immunization diarrohoea At least 1 ANC visit Immunization and illness treatment in children Breastfeeding initiated within 1 hour Taken to health facility for pneumonia World Health Organization. World health statistics 26. Geneva, 26; 4. World Health Organization. World health statistics 215. Geneva, 215 World Health Organization. World health statistics 26. Geneva, 26; 4. World Health Organization. World health statistics 215. Geneva, 215 BUT INEQUITIES PERSIST In mortality and nutritional status In Coverage of interventions Secondary Rural 1 8 6 4 2 Urban Secondary Rural 1 5 Urban Births attended by skilled health personnel Taken to facility for Pneumonia IMR U5MR Stunting Illiterate Richest Poorest Illiterate Richest Poorest Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4, World Health Organization, 214. Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4, World Health Organization, 214. 76
SRI LANKA NEW HORIZONS SDG targets Ending preventable maternal, newborn and child deaths in the South-East Asia Region Regional Flagship Area 3 215 Achived SDG MMR target 7 By 23 1 5 215 Achived SDG U5 MR target Achived SDG NMR target 25 12 By 23 Still births reduced to single digit UNICEF, World Health Organization, The World Bank, United Nations Department of Economic and Social Affairs, Population Division. Levels & trends in child mortality - report 215: estimates developed by the UN inter-agency group for child mortality estimation. New York, 215 ADOLESCENTS: TOWARDS HEALTHY TRANSITIONS Adolescent marriage and childbearing (15 19 years) Diet, physical activity and tobacco use 1 8 6 4 2 12 17 14 Married by 18 years Began childbearing by 19 years Unmet need for contraception 2 Adolescent birth rate* 6 4 2 Per 1 girls Anaemia Undernourished BMI<18.5 Overweight adolescents Physically active 13-15 year olds Ever smoked tobacco (GYTS) 5% 14% 4% 58% 7% Sri Lanka demographic and health survey 26/7 *World Health Organization. World health statistics 216. Geneva, 216 Sri Lanka demographic and health survey 26/7 REPRODUCTIVE HEALTH Access to reproductive health-care services 7% 68% Cervical cancer Number of girls between 9 13 years (eligible for HPV vaccination) 829 Opportunity for HPV vaccination 211, Quadrivalent vaccine introduced in National Immunization Program Reaching all girls up to 12 years through health facility Unmet need for family planning Contraceptive prevalence Cancer Cervix Incidence (per 1 ) 13.1 Cancer Cervix Mortality (per 1 ) 5. Need for population-based cancer World Health Organization, Regional Office for South-East Asia. Strategic framework for the comprehensive control of cancer cervix. New Delhi, 215. World Health Organization. World health statistics 215. Geneva, 215 COVERAGE EQUITY QUALITY ACCOUNTABILITY 77
THAILAND ACHIEVED MDG 4 SIGNIFICANT PROGRESS FOR MDG 5 68% reduction in under 5 mortality since 199 5% reduction in maternal mortality since 199 4 35 3 25 2 15 1 5 37 199 23 MDG target 12 12 2 215 U5MR (per 1 live births) 45 4 35 3 25 2 15 1 5 4 25 MMR (per 1 live births) 2 1 MDG target 199 2 215 UNICEF, World Health Organization, The World Bank, United Nations Department of Economic and Social Affairs, Population Division. Levels & trends in child mortality - report 215: estimates developed by the UN inter-agency group for child mortality estimation. New York, 215 World Health Organization, United Nations Children s Fund, United Nations Population Fund, the World Bank, United Nations. Trends in maternal mortality: 199 to 215: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Total population 67 959 (215) Neonatal mortality rate (per 1 live births) 7 (215) Under-five mortality rate (per 1 live births) 12 (215) Infant mortality rate (deaths per 1 live births) 11(215) Population under 5 (%) 6 (215) Prevalence of stunting in children under 5(%) 16.3 (215) Prevalence of wasting in children under 5 (%) 6.7 (215) Prevalence of overweight in children under 5 (%) 1.9 (215) Maternal mortality ratio (per 1 live births) 2 (215) Adolescent 1-19 years (%) 12.8 (215) Adolescent Birth Rate (per 1 women 6 (215) 15-19 years) Unmet need for family planning*(%) 7 (213) *World Health Organization. World health statistics 215 World Health Organization. World health statistics 216 COVERAGE OF LIFE-SAVING INTERVENTIONS INCREASED Maternal interventions 1 8 6 4 2 98 At least 1 ANC visit 2-21 86 93 99 1 99 At least 4 ANC visits Births SBA Births in health facility 27-214 32 Births by C-section Immunization and illness treatment in children 1 8 6 4 2 5 Breastfeeding initiated within 1 hour 96 99 Measles immunization 24 65 ORT in diarrohoea 27-214 83 Taken to health facility for pneumonia Thailand MICS 212; World Health Organization. World health statistics 26. Geneva, 26; 4. World Health Organization. World health statistics 215. Geneva, 215 World Health Organization. World health statistics 26. Geneva, 26; 4. World Health Organization. World health statistics 215. Geneva, 215 FEWINEQUITIES PERSIST In mortality and nutritional status In coverage of interventions IMR U5MR Stunting Secondary Illiterate Rural 1 8 6 4 2 Richest Urban Poorest Secondary Illiterate Rural 1 8 6 4 2 Richest Urban Poorest Births by skilled health personnel Diarrhoea treated with ORS Taken to facility for Pneumonia Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4, World Health Organization, 214. Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4, World Health Organization, 214. 78
THAILAND NEW HORIZONS SDG targets Ending preventable maternal, newborn and child deaths in the South-East Asia Region 7 Regional Flagship Area 2 Achived SDG MMR target By 23 12 7 Achived SDG U5 MR target Achived SDG NMR target 25 12 By 23 215 215 Still births reduced to single digit UNICEF, World Health Organization, The World Bank, United Nations Department of Economic and Social Affairs, Population Division. Levels & trends in child mortality - report 215: estimates developed by the UN inter-agency group for child mortality estimation. New York, 215 ADOLESCENTS: TOWARDS HEALTHY TRANSITIONS Adolescent marriage and childbearing (15 19 years) Diet, physical activity and tobacco use 1 8 6 4 2 22 Married by 18 years 11 12 Began childbearing by 19 years Unmet need for contraception 6 Adolescent birth rate* 6 4 2 Per 1 girls Overweight adolescents 16% Viloence & unintentional injury (seriously injured in the past year) 47% Drank alcohol once or more Ever smoked tobacco (GYTS) 47% 26% Thailand Multiple Indicator Cluster Survey 212; * World Health Organization. World health statistics 216. Geneva, 216 Thailand Multiple Indicator Cluster Survey 212; The Global School-based Student Health Survey (GSHS) in Thailand, 28 REPRODUCTIVE HEALTH Access to reproductive health-care services 7% 79% Cervical cancer Number of girls between 9 13 years (eligible for HPV vaccination) 2 381 Opportunity for HPV vaccination National Cervical Cancer Screening Program since 25 Unmet need for family planning Contraceptive prevalence Cancer Cervix Incidence (per 1 ) 17.8 Cancer Cervix Mortality (per 1 ) 9.7 Need for population-based cancer registry World Health Organization, Regional Office for South-East Asia. Strategic framework for the comprehensive control of cancer cervix. New Delhi, 215. World Health Organization. World health statistics 215. Geneva, 215 COVERAGE EQUITY QUALITY ACCOUNTABILITY 79
Timor-Leste ACHIEVED MDG 4 SIGNIFICANT PROGRESS FOR MDG 5 7% reduction in under 5 mortality since 199 8% reduction in maternal mortality since 199 2 18 16 14 12 1 8 6 4 2 199 176 11 2 U5MR (per 1 live births) MDG target 59 53 215 12 1 8 6 4 2 18 694 MMR (per 1 live births) MDG target 27 215 199 2 215 UNICEF, World Health Organization, The World Bank, United Nations Department of Economic and Social Affairs, Population Division. Levels & trends in child mortality - report 215: estimates developed by the UN inter-agency group for child mortality estimation. New York, 215 World Health Organization, United Nations Children s Fund, United Nations Population Fund, the World Bank, United Nations. Trends in maternal mortality: 199 to 215: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Total population 1 185 (215) Neonatal mortality rate (per 1 live births) 22 (215) Under-five mortality rate (per 1 live births) 53 (215) Infant mortality rate (deaths per 1 live births) 45 (215) Population under 5 (%) 9 (215) Prevalence of stunting in children under 5(%) 5.2 (215) Prevalence of wasting in children under 5(%) 11 (215) Prevalence of overweight in children under 5 (%) 1.5 (215) Maternal mortality ratio (per 1 live births) 215 (215) Adolescent 1-19 years (%) 18.4 (215) Adolescent Birth Rate (per 1 women 5 (215) 15-19 years) Unmet need for family planning*(%) 32 (215) *World Health Organization. World health statistics 215 World Health Organization. World health statistics 216 COVERAGE OF LIFE-SAVING INTERVENTIONS INCREASED Maternal interventions Immunization and illness treatment in children 1 8 6 4 2 84 At least 1 ANC visit 55 At least 4 ANC visits 2 27-214 24 27-214 1 82 78 8 7 71 6 55 4 21 22 2 2 Births in Births by Measles ORT in health facility C-section immunization diarrohoea Births SBA Breastfeeding initiated within 1 hour Taken to health facility for pneumonia Timor-Leste Demographic and health survey 29-21; World Health Organization. World health statistics 26. Geneva, 26; 4. World Health Organization. World health statistics 215. Geneva, 215 Timor-Leste Demographic and Health survey 212; World Health Organization. World health statistics 26. Geneva, 26; 4. World Health Organization. World health statistics 215. Geneva, 215 BUT INEQUITIES PERSIST In mortality and nutritional status In coverage of interventions IMR U5MR Stunting Secondary Illiterate Rural 1 8 6 4 2 Richest Urban Poorest Secondary Illiterate Rural 1 8 6 4 2 Richest Urban Poorest Births attended by skilled health personnel ORS in Diarrhoea Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4, World Health Organization, 214. Situation of Newborn and Child Health in South-East Asia: Progress towards MDG4, World Health Organization, 214. 8
Timor-Leste NEW HORIZONS SDG targets 215 53 Ending preventable maternal, newborn and child deaths in the South-East Asia Region Regional Flagship Area U5 MR MMR 22 NMR 25 215 7 215 12 By 23 Still births reduced to single digit By 23 UNICEF, World Health Organization, The World Bank, United Nations Department of Economic and Social Affairs, Population Division. Levels & trends in child mortality - report 215: estimates developed by the UN inter-agency group for child mortality estimation. New York, 215 ADOLESCENTS: TOWARDS HEALTHY TRANSITIONS Adolescent marriage and childbearing (15 19 years) Nutrition, violence and tobacco use 1 8 6 4 2 6 Married by 18 years 2 Began childbearing by 19 years 27 Unmet need for contraception 5 Adolescent birth rate* 6 4 2 Per 1 girls Anemia 26% Undernourished BMI<18.5 Girls who experienced physical of sexual violence (15-19 yrs) Current tobacco users (13-15 yrs) 33% 31% 42% Timor-Leste Demographic and health survey 29-21 *World Health Organization. World health statistics 216. Geneva, 216 Timor-Leste Demographic and health survey 23, 29-21 REPRODUCTIVE HEALTH Access to reproductive health-care services Cervical cancer 32% 22% Number of girls between 9 13 years (eligible for HPV vaccination) 8 Opportunity for HPV vaccination Opportunity for vaccinatione PAP smear available for symptomatic patients Cancer Cervix Incidence (per 1 ) Cancer Cervix Mortality (per 1 ) Data NA Data NA Unmet need for family planning Contraceptive prevalence No population-based cancer registry World Health Organization, Regional Office for South-East Asia. Strategic framework for the comprehensive control of cancer cervix. New Delhi, 215. World Health Organization. World health statistics 215. Geneva, 215 COVERAGE EQUITY QUALITY ACCOUNTABILITY 81
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Ending Preventable Maternal, Newborn and Child Deaths in South East Asia Region Annex 4.2 SDG indicators and monitoring framework 83
Remarkable progress, new horizons and renewed commitment SURVIVE Target Included in SDGs Additional Reduce global maternal mortality to less than 7 per 1 live births (SDG 3.1) Reduce newborn mortality to at least as low as 12 per 1 live births in every country (SDG 3.2) Reduce under-5 mortality to at least as low as 25 per 1 live births in every country (SDG 3.2) End epidemics of HIV, tuberculosis, malaria, neglected tropical diseases and other communicable diseases (SDG 3.3) Reduce by 1/3 premature mortality from noncommunicable diseases and promote mental health and well- being (SDG 3.4) Maternal mortality ratio (3.1.1 Proportion of births attended by skilled health personnel (3.1.2) Neonatal mortality rate (3.2.2) Under-5 mortality rate (3.2.1) Number of new HIV infections per 1 uninfected population, by age and sex (3.3.1) Malaria incident cases per 1 persons per year (3.3.3) Age-standardized prevalence of current tobacco use among persons 15 years and older, by age and sex (3.a.1) Mortality between ages 3 and 7 years from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases, by sex (3.4.1) Suicide mortality rate, by age and sex (3.4.2) Proportion of women aged 15-49 who received 4 or more antenatal care visits Proportion of women who have postpartum contact with a health provider within 2 days of delivery Stillbirth rate Proportion of infants who were breastfed within the first hour of birth Proportion of newborns who have postnatal contact with a health provider within 2 days of delivery Proportion of women in antenatal care (ANC) who were screened for syphilis during pregnancy Percentage of children with diarrhea receiving oral rehydration salts (ORS) Proportion of children with suspected pneumonia taken to an appropriate health provider Percentage of infants <6 months who are fed exclusively with breast milk Percentage of children fully immunized Use of insecticide-treated nets (ITNs) in children under 5 (% of children) Percentage of people living with HIV who are currently receiving antiretroviral therapy (ART), by age and sex Proportion of households with at least 1 ITN for every 2 people and/or sprayed by indoor residual spray (IRS) within the last 12 months Adolescent mortality rate, by sex Proportion of women aged 3-49 who report they were screened for cervical cancer 84
Ending Preventable Maternal, Newborn and Child Deaths in South East Asia Region THRIVE Target Included in SDGs Additional End all forms of malnutrition and address the nutritional needs of adolescent girls, pregnant and lactating women and children (SDG 2.2) Ensure universal access to sexual and reproductive health-care services (including for family planning) and rights (SDG 3.7 and 5.6) Ensure that all girls and boys have access to good-quality early childhood development (SDG 4.2) Substantially reduce pollution-related deaths and illnesses (SDG 3.9) Prevalence of stunting (height for age <-2 standard deviation from the median of the WHO Child Growth Standards) among children under 5 years of age (2.2.1) Prevalence of malnutrition (weight for height >+2 or <-2 standard deviation from the median of the WHO Child Growth Standards) among children under 5 years of age, by type (wasting and overweight) (2.2.2) Percentage of women of reproductive age (15-49) who have their need for family planning satisfied with modern methods (3.7.1) Adolescent birth rate (1-14, 15-19) per 1 women in that age group (3.7.2) Proportion of women aged 15-49 who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care (5.6.1) Number of countries with laws and regulations that guarantee women aged 15-49 access to sexual and reproductive health care, information and (5.6.2) Percentage of children under 5 years of age who are developmentally on track in health, learning and psychosocial wellbeing, by sex (4.2.1) Participation rate in organized learning (one year before the official primary entry age), by sex (4.2.2) Mortality rate attributed to household and ambient air pollution, by age and sex (3.9.1) Proportion of population with primary reliance on clean fuels and technology (7.1.2) Proportion of women aged 15-49 who received 4 or more antenatal care visits revalence of insufficient physical activity among adolescents Prevalence of anaemia in women aged 15-49, disaggregated by age and pregnancy status Proportion of children aged 6-23 months who receive a minimum acceptable diet Proportion of men and women aged 15-24 with basic knowledge about sexual and reproductive health services and rights 85
Remarkable progress, new horizons and renewed commitment Achieve universal health coverage, including financial risk protection and access to quality essential services, medicines and vaccines (SDG 3.8) Coverage of essential health services (index based on tracer interventions that include reproductive, maternal, newborn and child health, infectious diseases, non- communicable diseases and service capacity and access) (3.8.1) (including RMNCAH: family planning; pregnancy and childbirth care; breastfeeding; immunization; childhood illnesses treatment) [SDG 3.8.2 to be decided* * Indicator for SDG 3.8.2 proposed by the World Health Organization and the World Bank] Current country health expenditure per capita (including specifically on RMNCAH) financed from domestic sources Out of-pocket health expenses as percentage of total health expenditure TRANSFORM Target Included in SDGs Additional Eradicate extreme poverty (SDG 1.1) Ensure that all girls and boys complete free, equitable and good-quality secondary (SDG 4.1) Eliminate all harmful practices and all discrimination and violence against women and girls (SDG 5.2 and 5.3) Proportion of population below the international poverty line, by sex, age, employment status and geographical location (1.1.1) Proportion of children and young people: (a) in grades 2/3; (b) at the end of primary; and (c) at the end of lower secondary achieving at least a minimum proficiency Percentage of women aged 2-24 who were married or in a union before age 15 and before age 18 (5.3.1) Proportion of ever-partnered women and girls aged 15 and older subjected to physical, sexual or psychological violence by a current or former intimate partner in the previous 12 months, by form of violence and by age (5.2.1)* Proportion of women and girls aged 15-49 who have undergone female genital mutilation/cutting (FGM/C), by age (5.3.2) Proportion of young women and men aged 18-29 who experienced sexual violence by age 18 (16.2.3) Proportion of rape survivors who received HIV postexposure prophylaxis (PEP) within 72 hours of an incident occurring 86
Ending Preventable Maternal, Newborn and Child Deaths in South East Asia Region Achieve universal and equitable access to safe and affordable drinking water and to adequate sanitation and hygiene (SDG 6.1 and 6.2) Enhance scientific research, upgrade technological capabilities and encourage innovation (SDG 8.2) Provide legal identity for all, including birth registration (SDG 16.9) Enhance the global partnership for sustainable development (17.16) Additional equity, humanitarian and human rights cross-cutting indicators Whether or not legal frameworks are in place to promote, enforce and monitor equality and nondiscrimination on the basis Percentage of population using safely managed drinking water services (6.1.1) Percentage of population using safely managed sanitation services including a hand-washing facility with soap and Research and development expenditure as a proportion of GDP (9.5.1) (disaggregated by health/ RMNCAH Proportion of children under 5 years of age whose births have been registered with a civil authority, by age (16.9.1) Proportion of countries that (a) have conducted at least one population and housing census in the last 1 years; and (b) have achieved 1% birth registration and 8% death registration (17.19.2) Number of countries reporting progress in multi stakeholder development effectiveness monitoring frameworks that support the achievement of the SDGs (17.16.1) Proportion of indicators at the national level with full disaggregation when relevant to the target (17.18.1) (for indicators from the Global Strategy for Women s, Children s and Adolescents Health, this indicator would be relevant at regional and global levels too). Governance index (voice, accountability, political stability and absence of violence, government effectiveness, regulatory quality, rule of law, control of corruption Proportion of countries that have ratified human rights treaties related to women s, children s and adolescents health 87
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