Challenges of meeting MDG4 and MDG 5 in Bangladesh Prof. Kishwar Azad Project Director DAB-Perinatal Care Project

Area  147,570 kmArea  147,570 km Population  142 million TFR 3 Population  142 million* TFR 3 Per capita GDP  $456Per capita GDP  $456 ** Life Expectancy (2004)  65.1 years Life Expectancy (2004)  65.1 years ** Overall Literacy Rate (2004)  50.0% Overall Literacy Rate (2004)  50.0% ** *BDHS 2007, **BBS 2006

MDG 4: Reduce U5MR by two thirds BANGLADESH Target : (2005) (1990) (2006) 31

Trends in Newborn Infant and Under-5 Mortality Rates by Year, Bangladesh

Challenges of meeting MDG4 and MDG5 in Bangladesh Causes of Under-5 mortality

Challenges of meeting MDG4 and MDG5 in Bangladesh Tetanus Toxoid Safe and Clean Delivery Prophylactic Eye Care Early and Exclusive Breastfeeding Management of infections Immunization Case management in community and facility (IMCI/Community IMCI) ORS Zinc Birth spacing Maternal Nutrition Malaria Control Kangaroo Care Warming Resuscitation Syphilis Control Folate Supplementation Interventions to achieve MDG-4

Causes of Neonatal Deaths BDHS:2004 Infection: 50% Asphyxia : 21% LBW/PT : 11%

MDG 5: Reduce by three-fourths the Maternal Mortality Ratio BANGLADESH Targets (2005) 3.0 (1990) 13.8%

Interventions to achieve MDG-5 Iron supplements, Intermittent Treatment of Malaria Antiretrovirals for HIV Active Management of the Third Stage of Labor Management of postpartum Hemorrhage Tetanus Toxoid Clean delivery Treatment of postpartum infection Magnesium Sulfate Calcium supplementation Family Planning and Postabortion Care Partogram

Active Management of the Third Stage of Labor Management of postpartum Hemorrhage Tetanus Toxoid Clean delivery Treatment of postpartum infection Partogram Iron supplements, Intermittent Treatment of Malaria Most life-saving interventions require considerable skill Magnesium Sulfate Calcium supplementation Family Planning Postabortion Care

Maternal Health Strategy (2001)Maternal Health Strategy (2001) Comprehensive and emergency obstetrics servicesComprehensive and emergency obstetrics services Community-based Skilled Birth Attendant (C-SBA) Program Demand Side Financing: Maternal Health Voucher Scheme (MHVS)Demand Side Financing: Maternal Health Voucher Scheme (MHVS) Improved maternal nutrition in pregnancy and postpartum Birth preparedness and complication readiness Scaling up evidence-based practices for FP and maternal health Maternal Health and FP Programmes (existing )

Challenges of meeting MDG4 and MDG5 in Bangladesh Existing neonatal and child health programmes Essential newborn care Special care for LBW babies Exclusive and breastfeeding Management of birth asphyxia and neonatal sepsis in the facility and community Immunization IMNCI/Community-IMNCI Routine Vitamin-A supplementation Infant and young child feeding (National Nutrition Programme) National Neonatal Health Strategy (under development)

Opportunities to overcome challenges-1 STRENGTHEN and EXPAND EXISTING PROGRAMMES Political commitment is critical - Strong government commitment present – Governments, donors, partners, professionals and civil society need to work in concert Strategic focus for mother and child – Care during delivery is the priority – All women should ideally be able to deliver in health centres, with skilled birth attendants/midwives working in teams – Target the women in greatest need: e.g., poor rural women – Breastfeeding, EPI, NNP, IMNCI at facility and community

Greater financial resources – Protect poorest from catastrophic payments, ensure equitable coverage by demand side financing eg voucher scheme – More investment Continued – Investment in family planning and safe menstrual regulation – Strengthening of emergency obstetric care in hospitals Additional policies, such as those that bring about expansion of female education, reduction of maternal malnutrition, better financial access for the poor, and poverty reduction, are essential Opportunities to overcome challenges- 2