| Statistical Yearbook for Asia and the Pacific 2007 |
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| 5 - Maternal and reproductive health |
| Close to 50 per cent of the over half a million maternal deaths in the world occur in the Asian and Pacific region.
The maternal mortality ratio (MMR), at 330 per 100,000 live births, of the Asian and Pacific region is less than half that of Africa, but it is significantly higher than that of Latin America and the Caribbean. It also contrasts with the ratios in Europe and North America, 15 and 16, respectively.
Obtaining reliable figures on maternal mortality is hampered by the lack of effective data collection and registration systems. Furthermore, improvements in the measurement of maternal mortality over the last few decades impede any trend assessments.
High-income countries of Asia and the Pacific have an MMR even below that of Europe, while middle-income countries, with a ratio of 94 deaths per 100,000 live births, are below the region's average. Low-income countries, on the other hand, have a considerably higher rate, at 523 deaths per 100,000 live births.
Landlocked developing countries and least developed countries have the highest MMRs in Asia and the Pacific. While least developed countries have an MMR of 646 deaths per 100,000 live births, landlocked developing countries have a ratio of 818, which is quite close to the 834 deaths per 100,000 live births found in Africa.
In North and Central Asia, only Georgia, Turkmenistan and Uzbekistan have achieved MMRs of 32 deaths per 100,000 live births or less. The MMRs in Kyrgyzstan and Tajikistan exceed 100 and in Kazakhstan it is 210 deaths per 100,000 live births.
In both absolute and relative terms, maternal mortality is highest in the SAARC region. With 226,077 deaths, this region accounted for more than two thirds of the maternal deaths in Asia and the Pacific in 2000. Nepal had the highest MMR, at 740, while India and Pakistan also had high levels, at 540 and 500, respectively. These rates are among the highest in the world.
The ASEAN region, in contrast, has a MMR of 208 deaths per 100,000 live births. Within South-East Asia, however, the MMR in Cambodia is 450 and in the Lao People's Democratic Republic it is 650.
Figure 5.1 Maternal mortality ratios in Asia and the Pacific, 2000
MMRs also diverge widely at subnational levels, with sizeable disparities between economic groups and between urban and rural areas, as shown in table 5.1. The vast majority of maternal deaths can be prevented if appropriate reproductive health services are provided, but such services are often not available to the poorest income quintiles or in rural areas.
Antenatal care and the attendance of deliveries by skilled birth personnel can help to detect health problems early and refer patients to emergency obstetric care, thus considerably reducing maternal mortality. It is therefore not surprising that the subregions with the lowest birth attendance by skilled personnel are the ones with the highest MMRs.
In Asia and the Pacific, the countries with the lowest number of births attended by skilled health personnel are in South and South-West Asia. In Bangladesh, for example, only 13 per cent of births are attended by skilled health personnel, resulting in a high MMR of 380. In Nepal, where the MMR is 740, only one in five births is attended by skilled health personnel.
Other countries in the Asian and Pacific region also have low treatment rates for pregnant women. Cambodia, for example, has an antenatal care rate (one visit) of 44 per cent and an MMR of 450 deaths per 100,000 live births. In Afghanistan, with antenatal care coverage at 52 per cent, the MMR is 1,900 deaths per 100,000 live births.
Apart from these aspects, socio-cultural factors that inhibit women from accessing appropriate reproductive and sexual health services also play a major role in increasing maternal mortality. Many countries in the region have low rates of contraceptive use; this results in high levels of adolescent fertility, which is also a cause of high maternal mortality.
Afghanistan, for example, has the lowest contraceptive prevalence rate in Asia and the Pacific, at 5 per cent of women aged 15 to 49, resulting in the second highest adolescent fertility rate in the region, at 132 births per 1,000 women (see table 1.5 and figure 5.4). The Lao People's Democratic Republic, with a contraceptive rate below 32 per cent, also has a high adolescent fertility rate, at 88 births per 1,000 women.
Figure 5.2 Births attended by skilled health personnel in Asia and the Pacific, latest year from 2000-2005
Figure 5.3 Contraceptive prevalence among women aged 15-49 in Asia and the Pacific, latest year from 1996-2004
Figure 5.4 Fertility rate among adolescents aged 15-19 in Asia and the Pacific, 1995-2000 and 2000-2005
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Maternal mortality (number): The number of deaths of
women from pregnancy-related causes, while pregnant or
within 42 days of termination of pregnancy, during a specified
year. Aggregates: Sum of individual country values. Source:
Calculated by ESCAP using data from United Nations
Millennium Development Goals Indicators, (online database,
accessed on September 2007).
Maternal mortality ratio (deaths per 100,000 live births):
The number of deaths of women from pregnancy-related
causes, while pregnant or within 42 days of termination
of pregnancy, expressed per 100,000 live births, during
a specified year. Aggregates: Averages are calculated using the
total number of births as weight. Source: United Nations
Millennium Development Goals Indicators, (online database,
accessed on September 2007).
Proportion of births attended by skilled health personnel
(percentage): The proportion of births attended by health
personnel trained in providing life saving obstetric care,
including giving the necessary supervision, care and advice
to women during pregnancy, labour and the post-partum
period; to conduct deliveries on their own; and to care for
new borns. Includes doctors, nurses and midwives, but not
traditional birth attendants, even if they have received a short
training course. Source: United Nations Millennium
Development Goals Indicators, (online database, accessed on
September 2007).
Proportion of births attended by skilled health personnel,
poorest quintile (percentage): The proportion of births in
the poorest wealth quintile attended by skilled health
personnel (doctors, nurses or midwives). Source: World Health Organization, WHO Statistical Information System,
(online database, accessed on September 2007).
Proportion of births attended by skilled health personnel,
richest quintile (percentage): The proportion of births of
the richest wealth quintile attended by skilled health
personnel (doctors, nurses or midwives). Source: World Health Organization, WHO Statistical Information System,
(online database, accessed on September 2007).
Proportion of births attended by skilled health personnel,
rural (percentage): The percentage of live births attended
by skilled health personnel (doctors, nurses or midwives) in
rural areas. Source: World Health Organization, WHO Statistical Information System, (online database, accessed on
September 2007).
Proportion of births attended by skilled health personnel,
urban (percentage): The percentage of live births attended
by skilled health personnel (doctors, nurses or midwives) in
urban areas. Source: World Health Organization, WHO Statistical Information System, (online database, accessed on
September 2007).
Contraceptive prevalence rate (percentage): The proportion
of women of reproductive age (15-49 years) who are using,
or whose partner is using, a contraceptive method at a given
point in time. Contraceptive methods include clinic and
supply (modern) methods and non-supply (traditional)
methods. Clinic and supply methods include female and male
sterilization, intra uterine devices (IUDs), hormonal methods
(oral pills, injectables, and hormone-releasing implants, skin
patches and vaginal rings), condoms and vaginal barrier
methods (diaphragm, cervical cap and spermicidal foams,
jellies, creams and sponges). Traditional methods include
rhythm, withdrawal, abstinence and lactational amenorrhoea. Source: World Health Organization, WHO Statistical Information System, (online database, accessed on September
2007).
Pregnant women receiving antenatal care coverage, at least
one visit (percentage): The proportion of women aged
15-49 who used antenatal care provided by skilled health
personnel for reasons related to pregnancy at least once during
pregnancy, expressed as a percentage of live births in a given time period. Antenatal care includes recording medical
history, assessment of individual needs, advice and guidance
on pregnancy and delivery, screening tests, education on
self-care during pregnancy, identification of conditions detrimental to health during pregnancy, first-line management
and referral if necessary. Source: World Health Organization,
WHO Statistical Information System, (online database,
accessed on September 2007).
Pregnant women receiving antenatal care coverage, at least
four visits (percentage): The proportion of women aged
15-49 who utilized at least four times during pregnancy,
antenatal care provided by skilled health personnel for reasons
relating to pregnancy among all women who gave birth
to a live child in a given time period. WHO recommends
a minimum of four antenatal visits at specific times for all
pregnant women. Antenatal care includes recording medical
history, assessment of individual needs, advice and guidance on pregnancy and delivery, screening tests, education on
self-care during pregnancy, identification of conditions
detrimental to health during pregnancy, first-line management
and referral if necessary. Source: World Health Organization, WHO Statistical Information System, (online
database, accessed on September 2007). |
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Tables  |
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Figures  |
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Figure 5.1 Maternal mortality ratios in Asia and the Pacific, 2000 |
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Figure 5.2 Births attended by skilled health personnel in Asia and the Pacific, latest year from 2000-2005 |
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Figure 5.3 Contraceptive prevalence among women aged 15-49 in Asia and the Pacific, latest year from 1996-2004 |
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Figure 5.4 Fertility rate among adolescents aged 15-19 in Asia and the Pacific, 1995-2000 and 2000-2005 |
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| Definitions |
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