THE STATE OF THE WORLD’S CHILDREN 2009 Maternal and Newborn Health

Maternal mortality ratio per 100,000 births Uttar Pradesh 517 2001-2003 India: 301 Kerala 110 per 100,000 live births Less than equal to 150 151 - 300 More than 300 Missing Data Source: SRS

Medical causes of maternal deaths in India Other Conditions 34% Haemorrhage 38% Abortion 8% Sepsis 11% Obstructed Labour 5% Hypertensive Disorders 5% Medical causes of maternal deaths in India Source: SRS

Age at marriage Percentage of women aged 20-24 married before age 18 Early marriage leads to early childbearing thereby enhancing maternal health risks Source: NFHS

Nutrition among women Percentage of ever-married women age 15-49 with any anaemia and Body Mass Index (BMI) below 18.5 kg/m2 High percentage of women with anaemia and low BMI results in higher risk of low birth weight and peri-natal deaths Source: NFHS

Antenatal care Percentage of ever-married women age 15-49 years having at least one ante-natal care There has been a significant increase in ante-natal care in the last 7 years. Further increases are seen in the latest DLHS results Source: NFHS

Deliveries at institutions / by skilled birth attendants Institutional births have shown significant improvement in the DLHS results Source: NFHS

Birth spacing Average (Median) number of months since preceding birth Intervals between 2 consecutive births in India have remained low, adversely affecting mothers’ health and children’s chances of survival Source: www.measuredhs.com

Post natal care for mothers Percentage of women having at least one postnatal care within two days of delivery Only 37% of women received postnatal check-ups within the recommended period of two days of delivery Source: NFHS

Share of under-five mortality in India Infant deaths within 7 days of birth 40% Neonatal deaths 50% Infant deaths 76% Infant deaths between 7 days of birth and within 28 days 10% Infant deaths between 28 days and within one year of birth 26% Child deaths between one year and within five years of birth 24% Source : SRS 2007

Medical Causes of Neonatal Deaths Diarrhoea Asphyxia Preterm Tetanus Other Congenital Infection Source: Lawn JE Cousen SN for CHERG (Nov 2006)

Birth weight Percentage of children with reported birth weight less than 2.5 kg Based on reported birth weight data: 30% in NFHS 2 and 34% in NFHS 3 Every year at least six million children in India are born with low birth weight which gives them a disadvantaged start in life Source: NFHS

Initiation of breastfeeding within an hour Percentage of children born in the last three years who started breastfeeding within one hour of birth Only one in four children in India are breastfed within 1 hour of birth Source: NFHS

Proposed action framework Central premise “.. Essential services for mothers, newborns and children are most effective when delivered in an integrated package at critical points in life cycle, in a dynamic health system, in an environment supportive of women’s rights”

Continuum of care Critical points for service delivery: Adolescence, Pre-pregnancy, Pregnancy, Birth, Post-partum, Neonatal, Infancy, Childhood Essential Services: Basic health care, quality maternal-newborn care, adequate nutrition

Continuum of care Key delivery modes: Household & Community, outreach, health facilities Supportive environment: Quality education, women’s status, age at marriage and childbirth

Key actions Create a supportive environment by promoting gender equality Enhance girl’s education Increase age at marriage & childbirth

Key actions Ensure continuum of care across time and locations Improve quality of reproductive health services Enhance nutrition of adolescent girls Ensure adequacy of antenatal care Ensure skilled assistance during pregnancy & childbirth Provide access to quality Basic and Comprehensive Emergency Obstetric & Newborn care when required Expand post-natal care for mothers & newborns Promote safe water & hygiene practices at households and in facilities Initiation of breastfeeding within one hour of birth

What will make it happen Building synergy and partnerships Generating and sustaining strong political leadership for health of women and children Mobilizing resources for maternal and newborn health Empowering families and communities for promoting health and accessing healthcare