Countdown to 2015 Report by News Hour

COUNTDOWN TO 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

THE 2015 REPORT

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Contributors Lead writers: Jennifer Requejo (PMNCH), Cesar Victora (Federal University of Pelotas), Jennifer Bryce (Johns Hopkins University) Additional writing team: Aluisio Barros (Federal University of Pelotas), Peter Berman (Harvard School of Public Health), Zulfiqar Bhutta (SickKids Center for Global Child Health, Aga Khan University), Ties Boerma (WHO), Mickey Chopra (UNICEF), Bernadette Daelmans (WHO), Andres de Francisco (PMNCH), Adam Deixel (Family Care International), Elizabeth Hazel (Johns Hopkins University), Joy Lawn (LSHTM), Blerta Maliqi (WHO) Profile development team: Tessa Wardlaw (UNICEF), Holly Newby (UNICEF), Archana Dwivedi (UNICEF), Colleen Murray (UNICEF), Agbessi Amouzou (UNICEF) Countdown Scientific Review Group: Cesar Victora (chair, Federal University of Pelotas), Jennifer Bryce (alternate chair, Johns Hopkins University), Agbessi Amouzou (UNICEF), Peter Berman (Harvard School of Public Health), Bernadette Daelmans (WHO), Andres de Francisco (PMNCH), Joy Lawn (LSHTM), Holly Newby (UNICEF), Jennifer Requejo (PMNCH), Noelle Battle (Johns Hopkins University) Countdown Leadership Group: Mickey Chopra (co-chair, UNICEF), Zulfiqar Bhutta (co-chair, Sickkids Center for Global Child Health, Aga Khan University), Cesar Victora (Federal University of Pelotas), Adam Deixel (Family Care International),

Robin Gorna (PMNCH), Matthews Mathai (WHO), Jennifer Requejo (PMNCH) Production team: Christopher Trott and Elaine Wilson (Communications Development Incorporated), Jennifer Requejo (PMNCH) Technical Working Groups Coverage: Jennifer Bryce (co-chair), Agbessi Amouzou/Holly Newby (co-chair), Archana Dwivedi, Doris Chou, Jocelyn DeJong, Shams El Arifeen, Elizabeth Hazel, Sennen Hounton, Allisyn Moran, Jamie Perin, Jennifer Requejo, James Tibanderana, Nancy Terreri, Lara Vaz Equity: Cesar Victora (co-chair), Ties Boerma (co-chair), Aluisio Barros, Zulfiqar Bhutta, Xing Lin Feng, Wendy Graham, Ahmad Hosseinpoor, Kate Kerber, Betty Kirkwood, Edilberto Loiaza, Alexander Manu, Carine Ronsmans, Inacio Crochemore Silva Financing: Peter Berman (chair), Josephine Borghi, Lara Brearley, Rafael Cortes, Howard Friedman, Geir Li, Gemini Mte, Ravi Rannan-Eliya, Nirmala Ravishankar Health systems and policies: Bernadette Daelmans (co-chair), Joy Lawn (co-chair), Neha Singh (coordinator), Blerta Maliqi, Michel Brun, Tim Colbourn, Giorgio Cometto, Andres de Francisco, Lisa Hedman, Sennen Hounton, Tiziana Leone, Matthews Mathai, Zoe Matthews, Allisyn Moran, Jennifer Requejo, Deborah Sitrin, Amani Siyam, Nancy Terreri

ISBN: 978-92-806-4814-0 © Copyright UNICEF and World Health Organization, 2015. All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications— whether for sale or for noncommercial distribution— should be addressed to WHO Press through the WHO web site (http://www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. This publication has been prepared to facilitate the exchange of knowledge and to stimulate discussion. The logos that appear on the back cover represent the institutional affiliations of individual participants in report preparation and do not imply institutional endorsement of the contents or recommendations or approval of any specific intervention for which data are included. Implementation of specific intervention is dependent on the legal context in each country. While all reasonable precautions have been taken to verify the information contained in this publication, Countdown partners accept no responsibility for errors. Photo credits: front cover, © UNICEF/NYHQ2009-1930/Pirozzi; page v, © UNICEF/NYHQ2015-1476/Calvin; page vi, Dominic Chavez/World Bank; page 2, © UNICEF/ NYHQ2015-1235/Newar; page 4, Dominic Chavez/World Bank; page 14, © 2012 Kyalie Photography, Courtesy of Photoshare; page 26, Arne Hoel/World Bank; page 29, Chhor Sokunthea/World Bank; page 31, Scott Wallace/World Bank; page 41, © 2006 Enriqueta Valdez-Curiel, Courtesy of Photoshare; page 216, © 2012 Diana Mrazikova/Networks/Senegal, Courtesy of Photoshare; page 221, Arne Hoel/World Bank; page 222, © UNICEF/UGDA2010-00011/Hyun. Editing and layout by Communications Development Incorporated, Washington, DC USA.

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A Decade of Tracking Progress for Maternal, Newborn and Child Survival

Acknowledgements

Countdown would like to thank the following: UNICEF’s Data and Analytics Section for use of the global databases, preparation of country profiles and inputs to and review of report text. Particular recognition goes to Danzhen You for help with the child mortality estimates, Agbessi Amouzou for help with the maternal, newborn and child health coverage indicators, Julia Krasevec for help with the nutrition indicators, David Brown for help with the immunization coverage estimates, Tom Slaymaker and Robert Bain for help with the water and sanitation indicators and Priscilla Idele and Tyler Andrew Porth for help with the HIV and AIDS indicators. Johns Hopkins University colleague Lois Park for her inputs to the coverage analyses. Federal University of Pelotas colleagues Leonardo Ferreira, Giovanny Araújo França, Maria Clara Restrepo, Luis Paulo Vidaletti, Fernando Wehrmeister and Kerry Wong for their inputs to the equity analyses. Jo Borghi (London School of Hygiene and Tropical Medicine) for her analysis of the data on official development assistance, Courtney Ng (Harvard School of Public Health) for her help with the financing analysis and Geir Li (PMNCH) for his help with preparing a summary table on different tracking methods for official development assistance. Corrina Moucheraud (UCLA), Helen Owen (London School of Hygiene and Tropical Medicine), Courtney Ng and Neha Singh (London School of Hygiene and Tropical Medicine) for their help with the case study box and all case study inputs. Jenny Ruducha (Boston University Center for Global Health and Development) for her inputs on the Ethiopia case study. Ghada Saad (American University of Beirut) for her leadership on the work presented in the box on antenatal care, and Liliana Carvajal-Velez (UNICEF) for her leadership on the work presented in the box on diarrhoea secondary analysis. UNICEF colleagues Agbessi Amouzou and Ziqi Meng for the box on what constitutes a meaningful

change in progress in coverage of maternal, newborn and child health interventions. Kate Kerber (Save the Children), Nathalie Roos (WHO) and Matthews Mathai (WHO) for their help with the maternal and perinatal audit box. Neha Singh (London School of Hygiene and Tropical Medicine) for her leadership on the box on the health systems and policies tools developed for the Countdown case studies. WHO colleagues Giorgio Commetto and Amani Syam for their analyses on human resources. The Partnership for Maternal, Newborn & Child Health for hosting the Countdown Secretariat, and convening meetings and teleconferences for Countdown. Particular recognition goes to Nacer Tarif and Nick Green for providing administrative support. Matthews Mathai and Nathalie Roos (WHO), Vikas Dwivedi and Barbara Rawlins (MCSP), Susan Purcell-Gilpin (World Council of Churches) and Nynke Van Den Broek, Barbara Madaj and Luigi D’Aquino (Liverpool School of Tropical Medicine) for their inputs on the quality of care box. Robert Black and Li Liu (Johns Hopkins University) for their inputs into the causes of child deaths. Lale Say and Doris Chou (WHO) for their inputs to the maternal mortality section. Family Care International for help developing Countdown’s key advocacy messages. Carolyn Wiedemann and the US Fund for UNICEF for their support in managing the grant from the Bill & Melinda Gates Foundation for the technical work of Countdown and Noelle Battle (Johns Hopkins University) for serving as the project coordinator for that grant. The Bill & Melinda Gates Foundation, the World Bank and the governments of Australia, Canada, Norway, Sweden, the United States and the United Kingdom for their support for Countdown to 2015.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Contents

Acknowledgements

Foreword

Countdown headlines for 2015

Introduction

Countdown: The 2015 report

Progress towards Millennium Development Goals 4 and 5

Annex B Summary of Countdown data sources and analysis methods 200 Annex C Country profile indicators and data sources 202 Annex D Definitions of Countdown coverage indicators 206 Annex E Definitions of health policies, systems and finance indicators

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Intervention coverage is still too low for many interventions—and it matters!

Equity—t argeting the underserved

Determinants of coverage and equity— policies, systems and financing

Monitoring and accountability: how the Countdown experience can inform the Sustainable Development Goals

Country profiles

Annex F Technical annex for the Health Systems and Policies Technical Working Group and the Financing Technical Working Group 210 Annex G Countdown countries prioritized for malaria intervention coverage analysis and Countdown countries considered vitamin A priority countries 212 Annex H Details on estimates produced by interagency groups used in the Countdown report—mortality, immunization, and water and sanitation

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Notes

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References

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The Countdown country profile: a tool for action 46 Annex A About Countdown to 2015 for Maternal, Newborn and Child Survival

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Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

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Foreword

Every day—in fact, hundreds of thousands of times a day —in dozens of countries around the world, events occur that on their own would seem entirely unremarkable. A pregnant woman arrives at a health centre for an antenatal care appointment. A newborn baby nurses from her mother’s breast. A child cries after a vaccination injection; another coughs as he is examined for symptoms of pneumonia. A teenage girl learns about contraception; another waits at a community well to fill jugs with clean drinking water for her family. Ordinary moments in ordinary lives. And yet, taken together, these moments are anything but ordinary. They are transformative, products of a global movement that we have seen—and that so many of us have worked to bring about—especially during the past decade. Women and children are increasingly receiving health services that they need—and to which they have a fundamental human right—in numbers unimaginable a generation ago. Fewer are dying from preventable causes. More survive. More are better fed. And more are educated. The world has become a healthier place for women and children, as this final Countdown to 2015 report shows. That is a momentous achievement. However, alongside these successes lies a large portfolio of unfinished business—of unintended pregnancies, babies born too soon, children unvaccinated and chronically malnourished and illnesses untreated; of vast inequities that deprive people of basic health services; of millions upon millions of preventable deaths.

Countdown to 2015 offers an accounting of those transformative moments when lives were saved or improved by delivery of essential health services and of the many moments of disappointment and injustice when services failed to reach those who needed them. The governments of the world have made many commitments to women, newborns, children and adolescents. This accounting helps show whether and to what extent those promises have been kept. The data in this report provide a critical tool for accountability at the national, regional and global levels. For a decade, Countdown to 2015 has been counting down the days and years to the present moment, the moment of truth for the Millennium Development Goals and the transition to the Sustainable Development Goals. But all along it has also been counting up those who receive health care and those left behind, the funds invested in women’s and children’s health and those who have been helped to survive and those who have needlessly died. We count them because doing so helps us understand why preventable deaths occur, and how we can most effectively prevent many more women and children from dying. We count them because every life counts and no one should be left behind. We stand at a moment of transition, as the world’s gaze shifts from 2015 to 2030. A new countdown begins today, and this immensely important accounting work will continue until the last preventable death has been counted.

Graça Machel Chair of the Board of the Partnership for Maternal, Newborn & Child Health, former Education Minister of Mozambique, past Chair of the GAVI Alliance Board and renowned international advocate for women’s and children’s health and rights

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Countdown headlines for 2015

This is the last Countdown to 2015 report: a final accounting of progress and remaining gaps in the 75 countries that account for more than 95% of maternal, newborn and child deaths. There is good news on maternal and child survival, but Millennium Development Goals 4 and 5 have mostly not been achieved. • Maternal and child survival have improved markedly during the Millennium Development Goals era. Both under-five mortality and maternal mortality have been reduced by about half since 1990, and the rate of improvement has accelerated since 2000. • Many countries have “graduated” from Countdown. About half of the 68 countries that were included in Countdown because they exceeded specified thresholds of child or maternal mortality have reduced mortality below the thresholds. • However, Millennium Development Goals 4 and 5 remain mostly unfulfilled. Some 50 Countdown countries will fail to achieve the child mortality reductions required by Millennium Development Goal 4, and 69 will not achieve the maternal mortality reductions required by Millennium Development Goal 5. Only 4 of the 75 Countdown countries—Cambodia, Eritrea, Nepal and Rwanda—will achieve both Millennium Development Goals 4 and 5. Newborn survival and child nutrition are two key continuing challenges that must be addressed. • Newborns account for 45% of deaths among children under age 5. Neonatal conditions cause an increasing share of child deaths as interventions have reduced deaths of older children.

• Nutrition is crucial—and far too many children are still hungry. In more than half of Countdown countries, stunting (a sign of inadequate diet and repeated illness) affects at least 30% of children under age 5, and wasting (a marker of acute malnutrition) affects at least 5%. Almost half of all child deaths are attributable to undernutrition. Coverage of key interventions remains unacceptably low and varies greatly across countries. • Universal coverage remains a distant target for most interventions in most countries. Vaccines and many malaria and HIV interventions have been prioritized and have achieved substantial improvements, but most other interventions still fail to reach a third or more of the women and children who need them. • Services requiring contact with a working health system have lagged the most. Family planning, pregnancy and childbirth services and childhood disease management still have large coverage gaps. Equity has improved, but not nearly enough. • Across the Countdown countries, systematic pro-rich inequalities exist for virtually all coverage indicators. These equity gaps are widest for interventions requiring access to health facilities 24/7. • Globally, coverage has increased more for the poor than for the rich, so the equity gap is shrinking. Coverage equity is improving in both absolute and relative terms but remains a pressing challenge in virtually every Countdown country. • Countries improve overall coverage when they focus on reducing inequity. Rapid progress in coverage came when countries effectively reached the poorest families.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Achieving high, equitable coverage requires financial investment, supportive policies and stronger health systems. • Donor funding has increased, but countries’ reliance on out-of-pocket spending is a concern. Aid for maternal, newborn and child health tripled from 2003 to 2012, and recent attention to neonatal survival has led to increased newborn health commitments. • Many countries have adopted supportive policies. More research is needed to better understand the strength of countries’ implementation after policies are adopted. • Most Countdown countries have a severe shortage of skilled health workers. Countdown countries have a median of 10.2 physicians, nurses and midwives per 10,000 people, and

three-quarters are below the World Health Organization benchmark of 22.8 per 10,000. More data are now available; more and better data are still needed. • More countries are conducting more frequent household surveys. Countries can use these data to support evidence-based decisionmaking about policies and programmes. • Better data are needed for assessing quality of care. Coverage data on service contacts such as antenatal and postnatal care visits need to be complemented with information on interventions provided during those contacts. The Countdown to 2015 experience offers important lessons that are relevant to the Sustainable Development Goals era.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Introduction

“Ten years from now, in 2015,” said the opening line of Countdown’s first report, “the governments of the world will meet to assess if we have achieved the Millennium Development Goals, the most widely ratified set of development goals ever, signed onto by every country in the world.”1 In that inaugural report the Countdown to 2015 partnership committed “to share new evidence and experience, to take stock of progress in preventing child deaths, to hold international and national level institutions accountable if the rate of progress is not satisfactory, to identify any major gaps in knowledge or existing processes that are hindering progress, to propose new actions as appropriate and to advocate for greater investment in child survival.” Countdown later expanded its mandate to include maternal survival and the continuum of care. This commitment aimed to ensure that the world’s assessment of its efforts to achieve Millennium Development Goals 4 and 5—to reduce child mortality and improve maternal health—would be accurate, meaningful and robust. That day of reckoning has come. It is human nature to look forward, and that inclination has played itself out in this pivotal year of 2015. Speculation, advocacy, planning and negotiation surrounding the world’s next set of goals—the Sustainable Development Goals—have claimed most of the attention in global health and development.2 This is by no means a bad thing: The Millennium Development Goals experience has shown that realistic, measureable goalsetting is a critically important step towards concerted action and lifesaving impact. But goals become truly meaningful only when performance is measured against them—that is, when those who wrote and signed on to those goals are held to account for their efforts to fulfil them and for the results of those efforts. Looking backward—identifying successes and failures and understanding how and why they occurred—is crucial. The Sustainable Development Goals that

pertain to reproductive, maternal, newborn, child and adolescent health as well as to other fields of health and development, are being built atop the foundation of the Millennium Development Goals. The promises made before 2015 to women and children do not just disappear, and they must not be allowed to. For Millennium Development Goals 4 and 5, the verdict is mixed. Since 2005, Countdown’s findings have always highlighted progress with unfinished business, lives saved with many lives still needlessly being lost. This mixed picture is the challenge ahead: how to convey powerful achievements that encourage other countries to do the same and to avoid the lure of complacency— that is, how to describe tragic failures in a way that stimulates a coordinated response rather than a crippling paralysis of “there’s nothing to be done.” As in past Countdown reports, the data tell the story. This is firstly a story of momentous achievement. The world has become a healthier place for women and children during the Millennium Development Goals era. Maternal and child mortality have both been nearly halved or halved, respectively, since 1990, and millions fewer mothers and children die each year. About half the 75 Countdown countries have “graduated” by moving below the mortality thresholds originally set for inclusion as a Countdown country. These advances reflect, in part, notable improvements in coverage for several key health interventions, particularly in areas that have received high and consistent attention and funding at the national and international levels, including malaria, HIV and immunization. Evidence-based policies and programmes are being adopted, and more countries are conducting population-based surveys—which are essential for tracking progress and provide much of the data for Countdown’s analyses—more often. However, the data also reveal a second, competing narrative, one in which a large majority of Countdown countries have not reached their

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Millennium Development Goal 4 and 5 targets. In many countries coverage of critical family planning, pregnancy, childbirth and treatment interventions for childhood diseases remains low. And even in countries that have made spectacular overall progress the poor and disadvantaged are being left behind to suffer and die from preventable and treatable illnesses. Both stories are true, and both are presented in this report. Together, they form the foreword to the story of the next 15 years under the Sustainable Development Goals, one hopefully full of small failures and great successes, of more women and children saved and fewer lives lost. These data-driven narratives are told by the figures and tables in the pages that follow and in the 75 country profiles that offer final report cards on the progress countries have made in improving equitable coverage and its policy, financial and health system determinants. Beneath these data and the stories they tell about country progress lies a deeper truth. Each percentage point of coverage represents hundreds or thousands of women, newborns or children who received the essential care they needed, as their human right to the best available standard of health care demands. Each percentage point short of universal coverage contains the stories

of hundreds or thousands forced to go without that lifesaving care: a woman who gave birth on a dirt floor and bled to death when there was no one around with the skills and tools to treat her, a newborn baby born too soon and too small whose mother received insufficient nutrition and inadequate antenatal care and who succumbed after only a few short hours or days of life, a toddler with diarrhoeal disease who died of dehydration because his family had neither safe drinking water nor access to the simple treatments that would have saved him, a teenager never taught how to prevent an unintended pregnancy who died from obstructed labour when the stillborn baby proved too big for her still-growing body. Fifteen years from now, the governments of the world will meet to assess whether the Sustainable Development Goals have been achieved. The global community must work together between now and then to hear and understand every story, happy and sad, and to remember that the numbers reported represent human lives. It must commit to counting every success, to understanding every failure, to valuing every life and to holding everyone fully accountable for keeping the promises. With this report, Countdownâ&#x20AC;&#x2122;s old work ends, and that new work begins.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survivalâ&#x20AC;&#x192; The 2015 Report

Countdown: The 2015 report

More than a decade ago the momentum generated by the Millennium Development Goals sparked those involved in the 2003 Lancet Child Survival Series to propose and launch Countdown to 2015— a global movement to track, stimulate and support country progress towards the health-related Millennium Development Goals, particularly goals 4 (reduce child mortality) and 5 (improve maternal health). Countdown is supra-institutional and includes academics, governments, international agencies, professional associations, donors, nongovernmental organizations and other members of civil society, with The Lancet as a key partner. The new initiative pledged to hold regular conferences, with the aim of “ensuring that there is an overall mechanism for improving accountability, re-energising commitment, and recognizing accomplishments in child survival.”3 Countdown compiled data to launch its first report in 2005, which was followed by five more reports launched at various high-level fora in 2008, 2010, 2012, 2013 and 2014.4 This is the final report in the series. From its original focus on child survival, Countdown expanded to track progress on reproductive, maternal, newborn and child health indicators across the continuum of care. At the heart of the Countdown reports are twopage country profiles, which summarize the most recent data on intervention coverage, maternal and child mortality, and nutrition. The country profiles also highlight socioeconomic inequalities in intervention coverage and two of the main drivers of coverage (health systems and policies, and financing). Countdown has evolved in many ways. It has grown from 11 to 43 institutional stakeholders. The number of countries monitored has increased from 60 to 75, to cover the countries where more than 95% of global deaths of mothers and children occur. And the number of indicators tracked has expanded from 35 to 73, as the scope has shifted beyond child survival and in response to new evidence. By including new, proven interventions

in its profiles even before data were available for many countries, Countdown helped raise their visibility and speed their scale-up. Countdown recognized the importance of engaging at the country level and in 2012 embarked on a set of case studies aimed at understanding how countries have achieved progress (box 1). Countdown is also the primary source of coverage information for monitoring the implementation of the recommendations of the Commission on Information and Accountability for Women’s and Children’s Health and the independent Expert Review Group reports.5 The number of reports on specific reproductive, maternal, newborn and child health issues has grown rapidly since Countdown’s inception. Countdown’s niches have been its action-oriented focus on intervention coverage and its user-friendly synthesis of information in the country profiles. Its principles have not changed: monitor the coverage of evidence-based, cost-effective interventions; maintain a country orientation; and build on existing goals and monitoring efforts.6 Countdown’s realization of these principles has helped increase the global visibility of women’s and children’s health and helped boost the unacceptably slow rate of progress in reducing maternal, newborn and child mortality during the 1990s.7 More information on Countdown, the explanatory framework guiding its work and its data sources and methods are included in annexes A–H and at www.countdown2015mnch. org. Countdown databases are publicly available at http://countdown2015mnch.org/about-countdown/ countdown-data.8 This final Countdown report begins with a summary of results from 2015 based on the data presented in the country profiles, building on a companion article published in The Lancet.9 It examines trends in mortality and nutrition; intervention coverage (including inequality); financial flows to reproductive, maternal, newborn and child health; and supportive policy and systems measures. Although some topics

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 1

Countdown country case studies Countdown in-depth country case studies use evidence to tell a story about country progress in adopting supportive policies, ensuring adequate funding for reproductive, maternal, newborn and child health, increasing equitable coverage and reducing maternal, newborn and child mortality. They focus on understanding how and why Millennium Development Goals 4 and 5 were achieved and on strengthening country-level capacity to lead monitoring efforts and use the results to improve their programmes. The portfolio of Countdown case studies includes Afghanistan, Bangladesh,1 China, Ethiopia, Kenya, Malawi, Niger,2 Pakistan, Peru and Tanzania,3 all at various stages of completion. Each case study is led by a country-based institution that is not directly involved with reproductive, maternal, newborn and child health programme implementation, supported by a multidisciplinary team. The analysis is guided by a common evaluation framework4 and spans Countdown’s four technical domains (coverage, equity, health systems and policies, and financing). The case studies culminate in a dissemination phase in which results are communicated using a variety of modes to inform national policymakers and civil society representatives and to increase the use of evidence in decisionmaking. The portfolio of countries represents a diverse set of contexts and experiences. Most countries present a mixed set of achievements across the continuum of care, and all face remaining challenges such as stubborn inequities and insufficient, unreliable financial flows to maternal, newborn and child health programmes. Afghanistan, Ethiopia, Malawi and Tanzania are highly donor dependent, calling into question the sustainability of the health gains achieved. All countries implemented reforms to increase access to health services (including pro-poor strategies), which were important in improving health overall, but equity gaps persist. Even in Peru, where great strides were made in reducing glaring inequalities the case study results show that coverage of a skilled attendant at delivery is 100% in the richest quintile but only 65% in the poorest quintile.5

and countries have seen considerable progress, important gaps remain that cannot be forgotten in the transition to the Sustainable Development Goals. The report then assesses changes in data availability and their implications for programme managers

Although a mosaic of context-specific factors shaped each case study country’s progress, several common themes emerged. For example, an important part of country plans to achieve Millennium Development Goal 4 included adopting multisectoral strategies to address childhood undernutrition and particularly high rates of stunting. Most countries also introduced integrated approaches to managing childhood illnesses at the facility and community levels. Similarly, improved maternal health outcomes across countries were associated with increased access to skilled attendants at delivery and emergency obstetric care, as well as such non–health sector changes as improved women’s access to education and income-earning strategies and better transportation. Strong political leadership and commitment were critical in directing resources to reproductive, maternal, newborn and child health programmes. Slower progress in newborn mortality than in child mortality, reported in all countries, was attributed in part to the lack of political prioritization of newborn health until the mid-2000s and in part to the fact that several effective, low-cost interventions (including community approaches to delivering services) were scaled up only in recent years. Further efforts are needed to improve the quality of intrapartum care in facilities in order to achieve needed reductions in maternal and newborn deaths and stillbirths. Countdown is planning to synthesize the lessons from the case studies once they have all been concluded at the end of 2015. Special attention will be given to the challenges of conducting the case studies in ways that expanded the capacity of local teams and country ownership of the data and results. These lessons should inform efforts to increase demand for and use of data by national decisionmakers in the Sustainable Development Goals era. Notes 1. El Arifeen and others 2014. 2. Amouzou, Habi and Bensaid 2012. 3. Afnan-Holmes and others 2015. 4. Bryce and others 2011. 5. Huicho and others forthcoming.

and decisionmakers. It concludes by turning a critical lens on the Sustainable Development Goals framework and future accountability efforts, drawing from Countdown’s 10 years of monitoring experience.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Progress towards Millennium Development Goals 4 and 5 Preventing the needless deaths of women and children depends on a collective ability to deliver high-quality services to those who need them and to improve the social determinants of health. The under-five mortality rate, the proportion of child deaths occurring during the neonatal period and the maternal mortality ratio are key indicators of women’s and children’s health and well-being. Mortality trends provide a reality check on how well the global community and countries are reaching their populations with equitable coverage of proven interventions across the reproductive, maternal, newborn and child continuum of care. This section reviews the 75 Countdown countries’ progress towards the mortality targets for Millennium Development Goals 4 and 5 and towards lower undernutrition rates, which are a key indicator for Millennium Development Goal 1 on poverty eradication. Laudable progress in reducing mortality—but more must be done Based on modelled estimates, the global maternal mortality ratio has fallen around 45% over the past two decades, and the number of maternal deaths has dropped from around 523,000 a year to 289,000.10 Although the reduction in mortality appears to have accelerated—75% of Countdown countries reduced maternal mortality faster over 2000–13 than over 1990–200011—very few Countdown countries will achieve Millennium Development Goal 5. Between 2003 and 2009 more than half of maternal deaths worldwide were due to haemorrhage, hypertensive disorders and sepsis—causes that are preventable by providing quality antenatal, childbirth and postnatal care.12 Recognition of the association between increasing use of contraception and declining maternal and newborn deaths has boosted resources for family planning programmes13 (box 2). Evidence of the importance of reaching adolescents with family planning and nutrition programmes to improve birth outcomes, as well as for their own health,

has also increased attention to this population group.14 Stillbirths were not visible as a public health problem when Countdown was launched. Improved estimates showing a major burden of 2.6 million third trimester stillbirths—1.2 million of them during the intrapartum period—and evidence of close links with maternal and newborn health led to the stillbirth rate being included in Countdown country profiles in 2010. Without a specific target, global visibility for stillbirths may remain limited in the Sustainable Development Goals era, and progress will remain slow unless all stakeholders act together and include stillbirths in the future programmatic and measurement agenda.15 The global under-five mortality rate has dropped 53% since 1990, from 91 deaths per 1,000 live births to 43 in 2015.16 The annual rate of reduction has accelerated steeply over time, suggesting that more progress can be expected in coming years. In 2000 there were 9.8 million deaths a year of children under age 5.17 Pooled estimates for 42 countries that included more than 90% of child deaths identified the leading causes as neonatal conditions (33%), diarrhoea (22%), pneumonia (21%), malaria (9%) and AIDS (3%).18 Estimates for 2015 suggest 5.9 million deaths a year,19 with a major shift in the causes: Preterm birth complications now cause 18% of deaths among children under age 5. Together preterm birth complications and other neonatal causes account for 45% of deaths among children under age 5. Deaths due to pneumonia (16%), diarrhoea (9%), malaria (5%) and AIDS (1%) have declined in relative terms—and even more so in absolute terms.20 The growing concentration of deaths in the newborn period, and improved understanding about causes of newborn deaths, has sparked the scale-up of long-existing interventions and the development of new ones, some of which are monitored by Countdown (see below). Some 25 of the 75 Countdown countries achieved the 4.4% annual rate of reduction in under-five

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 2

Family planning—reaching an unmet need There is an established body of evidence on the benefits of family planning on women’s, newborn’s and children’s health.1 Family planning can contribute to women’s empowerment, environmental sustainability (through a reduction in births) and economic prosperity for individuals, communities and countries.2 Although greater access to family planning has been a key development objective for about 50 years, efforts to help women prevent unintended pregnancies and unsafe abortions have historically been uneven, resulting in mixed progress across and within countries.3 Median coverage of demand for family planning satisfied (the proportion of women at risk of pregnancy who want to avoid or delay childbearing and who are using a modern method of contraception) in the 57 Countdown countries with available survey data from 2009 or later is only 55%, and coverage ranges widely, from 13% in South Sudan to 93% in Viet Nam (see table 2 in the main report). Use of family planning remains highly inequitable, with the wealthiest quintile having a higher demand for family planning satisfied than the poorest in all regions. This pattern is evident in almost all 41 Countdown countries with available disaggregated data (see figure), and the difference in coverage between the wealthiest and poorest quintile exceeds 5 percentage points in all but 6 of them. The gaps between wealth quintiles tend to decrease as national coverage increases. Viet Nam, with the highest coverage, shows almost no difference in demand for family planning satisfied between wealth quintiles. In contrast, Cameroon, Nigeria and other Sub-Saharan African countries where national coverage is below 50% show wide disparities.

in 2010. Unmet need (the proportion of women who are married or in union who want to delay or avoid a pregnancy but are not using a method of contraception) also varies widely across regions and between urban and rural areas, with women in rural areas and in the Lake and Western zones encountering frequent stockouts of methods and cultural barriers to using modern methods. In response, Tanzania revitalized its national family planning programme in 2010, and donor support for reproductive health increased.4 This example illustrates the importance of sustained political and financial support for family planning and the need for community-based and other approaches to improve demand for and acceptability of modern contraceptive methods, particularly among the underserved. There is reason to be optimistic for the future. The launch of Family Planning 2020 sparked renewed emphasis in the global community on accelerating progress in family planning. Considerable advocacy work is under way to ensure that sexual and reproductive health and rights remain at the forefront of the post-2015 global agenda. For example, the Sustainable Development Goals for health and gender reference reproductive health and explicitly mention the importance of family planning information and education.5 Technical work is also ongoing to improve measurement of demand for family planning satisfied in order to increase the comparability of data in low- and middle-income countries. Better means of monitoring trends along with continued global emphasis on making contraceptive services available will spur progress in the years ahead. Notes

An in-depth analysis of Tanzania’s slow progress towards Millennium Development Goal 5 found that family planning programmes introduced in the late 1980s and 1990s, although high on the political agenda, were weakly implemented, and consequently the national contraceptive prevalence rate rose only about 1 percentage point a year, from 7% in 1991 to 27%

1. Ahmed and others 2012; Glasier and others 2006; Cleland and others 2012. 2. UNFPA 2008; Singh, Darroch and Ashford 2014; Cleland and others 2006. 3. Darroch and Singh 2013; Fabic and others 2015. 4. Afnan-Holmes and others 2015. 5. United Nations 2015. (continued)

mortality that was required to reach Millennium Development Goal 4 in 2015, but the evidence suggests that only 6 countries achieved the 5.5% annual rate of reduction in maternal mortality needed to achieve Millennium Development Goal 5 (table 1). Four countries—Cambodia, Eritrea, Nepal and Rwanda—achieved the required annual rate of reductions for both goals.

Of the 60 countries selected in 2005 for monitoring by Countdown based on their high under-five mortality (either an under-five mortality rate of 90 or more deaths per 1,000 live births or 50,000 or more child deaths a year), 28 have “graduated” from Countdown by reducing child mortality below the threshold. In 2008 Countdown broadened its scope to include maternal mortality and set a threshold

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 2 (CONTINUED)

Family planning—reaching an unmet need

Use of family planning remains highly inequitable, with the wealthiest quintile having a higher demand for family planning satisfied than the poorest in most Countdown countries Demand for family planning satisfied for 41 Countdown countries with available data, by wealth quintile, 2009 or later (%) Poorest quintile

Viet Nam (2010)

Quintile 2

Peru (2012)

Quintile 3

Zimbabwe (2014)

Quintile 4 Richest quintile

Iraq (2011) Indonesia (2012) Swaziland (2010) Bangladesh (2011) Lao PDR (2011) Philippines (2013) Cambodia (2010) Rwanda (2010) Lesotho (2009) Nepal (2011) Malawi (2010) Pakistan (2012) Tanzania, U. Rep. (2010) Ghana (2011) Tajikistan (2012) Gabon (2012) Ethiopia (2011) Cameroon (2011) Haiti (2012) Nigeria (2013) Uganda (2011) Niger (2012) Senegal (2014) Congo, Dem. Rep. (2013) Burundi (2010) Côte d'Ivoire (2011) Sierra Leone (2013) Burkina Faso (2010) Liberia (2013) Comoros (2012) Togo (2013) Central African Rep. (2010) Mozambique (2011) Mali (2012) Benin (2011) Gambia (2013) Guinea (2012) Chad (2010) 0

100

Source: Re-analysis of Demographic and Health Survey and Multiple Indicator Cluster Survey data sets at the International Center for Equity in Health at the Federal University of Pelotas.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

TABLE 1

Countdown countries and graduation status based on original entry criteria Under-five mortality Average Rate annual (deaths rate of per 1,000 reduction live births) (%)

Maternal mortality Share of deaths Ratio Average occurring (deaths annual during the per rate of neonatal 100,000 reduction Number period (%) live births) (%) of deaths

1990–2015

2015

2013

1990–2013

2013

Country graduated from Countdown?

Afghanistan

2005

Under-five mortality rate and number of child deaths

91.1

2.7

94,261

38.4

400

4.7

4,200

Angola

2005

Under-five mortality rate and number of child deaths

156.9

1.5

169,310

31.4

460

4.9

4,400

Azerbaijan

2005

Under-five mortality rate

31.7

4.4

7,206

59.2

3.6

Yes

Bangladesh

2005

Number of child deaths

37.6

5.4

119,326

62.3

170

5.0

5,200

Benin

2005

Under-five mortality rate

99.5

2.4

37,092

32.2

340

2.4

1,300

Bolivia

2008

Maternal mortality ratio and number of maternal deaths

38.4

4.7

9,415

51.2

200

4.0

550

Yes

Botswana

2005

Under-five mortality rate

43.6

0.9

2,488

170

3.1

Yes

Brazil

2005

Number of child deaths

16.4

5.2

52,415

54.6

2.4

2,100

Burkina Faso

2005

Under-five mortality rate and number of child deaths

88.6

3.3

60,477

30.3

400

2.9

2,800

Burundi

2005

Under-five mortality rate and number of child deaths

81.7

3.0

36,970

35.8

740

2.3

3,400

Yes

Cambodia

2005

Under-five mortality rate and number of child deaths

28.7

5.6

10,257

51.5

170

8.1

670

Yes

Cameroon

2005

Under-five mortality rate and number of child deaths

87.9

1.8

71,348

29.5

590

0.9

4,900

Central African Rep.

2005

Under-five mortality rate

130.1

1.2

21,029

33.3

880

1.3

1,400

Chad

2005

Under-five mortality rate and number of child deaths

138.7

1.7

82,728

28.8

980

2.3

5,800

China

2005

Number of child deaths

10.7

6.5

181,574

51.5

4.7

5,900

Comoros

2012

73.5

2.1

1,897

46.9

350

2.6

Congo

2005

Under-five mortality rate

2.9

7,269

40.6

410

2.1

690

Yes No

Year entered Selection criteria used for inclusion Countdown as Countdown countrya

Country

2015

Number of deathsb

Congo, Dem. Rep.

2005

Under-five mortality rate and number of child deaths

98.3

2.6

304,558

30.9

730

1.5

21,000

Côte d'Ivoire

2005

Under-five mortality rate and number of child deaths

92.6

2.0

75,393

41.7

720

0.1

5,300

Djibouti

2005

Under-five mortality rate

65.3

2.4

1,429

51.6

230

2.4

Yes

Egypt

2005

Number of child deaths

5.1

65,775

54.5

4.1

860

Equatorial Guinea

2005

Under-five mortality rate

94.1

2.8

2,655

35.6

290

7.0

Eritrea

2008

Maternal mortality ratio and number of maternal deaths

46.5

4.7

7,764

39.4

380

6.2

880

Ethiopia

2005

Under-five mortality rate and number of child deaths

59.2

5.0

184,186

47.5

420

5.0

13,000

Gabon

2005

Under-five mortality rate

50.8

2.4

2,579

46.3

240

2.0

130

Yes

Gambia

2005

Under-five mortality rate

68.9

3.6

5,540

44.6

430

2.1

340

Yes

Ghana

2005

Under-five mortality rate and number of child deaths

61.6

2.9

54,061

380

2.9

3,100

Guatemala

2008

Maternal mortality ratio and number of maternal deaths

29.1

4.1

12,858

46.2

140

2.8

660

Yes

Guinea

2005

Under-five mortality rate and number of child deaths

93.7

3.7

42,073

650

2.2

2,800

Guinea-Bissau

2005

Under-five mortality rate

92.5

3.6

5,883

560

2.2

360

Haiti

2005

Under-five mortality rate

3.0

17,841

36.6

380

2.4

1,000

Yes

India

2005

Under-five mortality rate and number of child deaths

47.7

3.9

1,200,998

57.9

190

4.5

50,000

Indonesia

2005

Number of child deaths

27.2

4.5

147,162

50.2

190

3.5

8,800

Iraq

2005

Under-five mortality rate and number of child deaths

2.1

38,682

58.1

2.0

710

Yes

Kenya

2005

Under-five mortality rate and number of child deaths

49.4

2.9

74,429

45.3

400

0.8

6,300

Korea, Dem. People's Rep.

2008

Maternal mortality ratio and number of maternal deaths

24.9

2.2

9,271

54.9

–0.1

310

Yes

Kyrgyzstan

2012

21.3

4.5

3,644

54.5

0.5

110

Lao PDR

2008

Maternal mortality ratio

66.7

3.6

11,613

44.9

220

6.8

400

Yes

Lesotho

2008

Maternal mortality ratio

90.2

–0.1

5,570

36.7

490

1.7

280

Yes

Liberia

2005

Under-five mortality rate

69.9

5.2

10,509

34.7

640

2.8

980

Yes

Madagascar

2005

Under-five mortality rate and number of child deaths

49.6

4.7

40,075

40.4

440

2.3

3,500

Yes

Malawi

2005

Under-five mortality rate and number of child deaths

5.3

40,048

34.3

510

3.2

3,400

Yes

Mali

2005

Under-five mortality rate and number of child deaths

114.7

3.2

82,710

33.2

550

3.1

4,000

Mauritania

2005

Under-five mortality rate

84.7

1.3

11,050

42.5

320

2.9

430

Mexico

2005

Number of child deaths

13.2

5.0

31,278

53.1

2.5

1,100

Yes Yes

Morocco

2008

Maternal mortality ratio and number of maternal deaths

27.6

4.3

19,759

64.3

120

4.1

880

Mozambique

2005

Under-five mortality rate and number of child deaths

78.5

4.5

82,387

480

4.3

4,800

Myanmar

2005

Under-five mortality rate and number of child deaths

3.2

46,284

52.5

200

4.5

1,900

Yes

Nepal

2005

Under-five mortality rate and number of child deaths

35.8

5.5

19,900

61.6

190

6.0

1,100

Yes

Niger

2005

Under-five mortality rate and number of child deaths

95.5

4.9

87,967

630

2.0

5,600

(continued)

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

TABLE 1 (CONTINUED)

Countdown countries and graduation status based on original entry criteria Under-five mortality Average Rate annual (deaths rate of per 1,000 reduction live births) (%)

Year entered Selection criteria used for inclusion Countdown as Countdown countrya

Number of deathsb

Maternal mortality Share of deaths Ratio Average occurring (deaths annual during the per rate of neonatal 100,000 reduction Number period (%) live births) (%) of deaths

Country graduated from Countdown?

2015

1990–2015

2015

2013

1990–2013

2013

Nigeria

2005

Under-five mortality rate and number of child deaths

108.8

2.7

750,111

560

3.1

40,000

Pakistan

2005

Under-five mortality rate and number of child deaths

81.1

2.1

431,568

56.7

170

3.6

7,900

Yes

Country

Papua New Guinea

2005

Under-five mortality rate

57.3

1.8

11,963

42.9

220

3.3

460

Yes

Peru

2008

Maternal mortality ratio and number of maternal deaths

16.9

6.2

10,483

48.7

4.4

530

Yes

Philippines

2005

Number of child deaths

2.9

65,613

45.1

120

–0.6

3,000

Rwanda

2005

Under-five mortality rate and number of child deaths

41.7

5.2

14,207

44.3

320

6.1

1,300

Yes

São Tomé and Príncipe

2012

47.3

3.4

297

36.7

210

2.8

Senegal

2005

Under-five mortality rate and number of child deaths

47.2

4.4

27,059

44.6

320

2.2

1,700

Yes

Sierra Leone

2005

Under-five mortality rate and number of child deaths

120.4

3.1

26,466

28.8

1,100

3.3

2,400

Solomon Islands

2012

28.1

1.4

470

43.2

130

3.8

Somalia

2005

Under-five mortality rate and number of child deaths

136.8

1.1

60,537

29.2

850

1.8

3,900

South Africa

2005

Number of child deaths

40.5

1.6

41,930

26.6

140

0.4

1,500

Yes No

South Sudan

2012

92.6

4.0

39,487

43.1

730

3.0

3,000

Sudan

2005

Under-five mortality rate and number of child deaths

70.1

2.4

89,488

43.1

360

3.8

4,600

Swaziland

2005

Under-five mortality rate

60.7

0.8

2,221

23.4

310

2.5

120

Yes

Tajikistan

2005

Under-five mortality rate

44.8

3.5

11,799

46.6

1.9

120

Yes

Tanzania, United Rep.

2005

Under-five mortality rate and number of child deaths

48.7

4.9

98,180

39.3

410

3.5

7,900

Togo

2005

Under-five mortality rate

78.4

2.5

19,512

34.3

450

1.6

1,100

Yes

Turkmenistan

2005

Under-five mortality rate

51.4

2.3

5,868

0.3

Yes

Uganda

2005

Under-five mortality rate and number of child deaths

54.6

4.9

85,291

34.9

360

3.2

5,900

Uzbekistan

2012

39.1

2.4

26,205

52.1

2.6

220

Viet Nam

2012

21.7

3.4

34,191

52.4

4.4

690

Yemen

2005

Under-five mortality rate and number of child deaths

41.9

4.4

34,351

53.1

270

2.3

2,100

Yes

Zambia

2005

Under-five mortality rate and number of child deaths

4.4

38,990

33.8

280

3.1

1,800

Yes

Zimbabwe

2005

Under-five mortality rate and number of child deaths

70.7

0.3

38,087

33.7

470

0.4

2,100

Yes

Note: In 2008 eight countries were added when Countdown began to track progress in countries with high maternal mortality: Bolivia, Democratic People’s Republic of Korea, Eritrea, Guatemala, Lao People’s Democratic Republic, Lesotho, Morocco and Peru. a. Under-five mortality rate of 90 or more deaths per 1,000 live births in 2004, 50,000 or more child deaths a year in 2004, maternal mortality ratio of more than 550 maternal deaths per 100,000 live births in 2005, or maternal mortality ratio of more than 200 maternal deaths per 100,000 live births and 750 or more maternal deaths a year in 2005. b. The 2005 Countdown report includes the under-five mortality rate but not the absolute number of deaths. c. Added in 2012 to reconcile the Countdown and Global Strategy for Women’s and Children’s Health country lists. d. Added based on its high burden of child and maternal mortality after it was formed in 2012. Source: UN Inter-agency Group for Child Mortality Estimation 2015; Maternal Mortality Estimation Inter-agency Group 2014.

of more than 550 maternal deaths per 100,000 live births or more than 200 maternal deaths per 100,000 live births and 750 or more maternal deaths a year. Eight countries were added to the original 60, seven of which have “graduated” by reducing maternal mortality below the threshold. Seven other priority countries were added in 2008, to maintain consistency with the list of priority lowincome countries included in the Global Strategy for Women’s and Children’s Health. South Sudan was also added based on its high burden of child and maternal mortality after it was formed in 2012. Alternative estimates for maternal and child mortality are available from the Institute of Health

Metrics and Evaluation. Although its estimates for specific countries may differ from those presented in table 1, the overall conclusions are the same: Only a small minority of low- and middleincome countries will achieve either Millennium Development Goal 4 or 5. Nutrition is crucial—and far too many children are still hungry The past 10 years have also witnessed a growing understanding of the role of nutrition in mortality and human development.21 Undernutrition— including foetal growth restriction, stunting, wasting and deficiencies of vitamin A and zinc—

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 3

Breastfeeding: a life-saving practice with both short- and long-term health and development benefits The importance of breastfeeding in preventing deaths of children in low- and middle-income countries is well recognized,1 and scaling up breastfeeding could save about 800,000 deaths of children under age 5 a year.2 But this is only part of the story. Recent research suggests that breastfeeding has long-lasting effects that go well beyond infancy, including the prevention of obesity and diabetes,3 and of dental malocclusions.4 Women who breastfeed are less likely to develop type 2 diabetes or breast or ovarian cancer.5 Evidence from many countries also shows that breastfeeding results in an average increase of 3–4 points in intelligence scores,6 and a recent study from Brazil suggests that it also leads to better performance in school and higher incomes at age 30.7 Thus breastfeeding is crucial not only for women and children in low-income countries, but also for all women and children in other settings. Improved breastfeeding practices will help prevent noncommunicable diseases and boost intellectual development around the world. International organizations recommend that all children be exclusively breastfed for the first six months of life and continue to receive breast milk with appropriate complementary foods until at least age 2. Most countries are far from complying with these recommendations, and infant feeding indicators have shown little progress in the recent past. Exclusive breastfeeding at ages 0–5 months is increasing about 1 percentage point a year in Countdown countries (see table 3 in the main report), but the median coverage is still only 39% (see table 2 in the main report). Furthermore, most countries show reductions in the proportion of children who are still breastfed at ages 12–15 months and at ages 20–23 months. Breastfeeding is the only recommended behaviour tracked by the Countdown for which children from poor families do better than children from rich families (see figure), possibly because breastfeeding is regarded as “not modern” in many countries, and better-off families are switching to artificial feeding. The gaps are particularly wide for continued breastfeeding. Because of the important protection afforded by breast milk against child deaths, the results suggest that the poor–rich gap in under-five mortality would be even wider in the absence of breastfeeding.

Breastfeeding is the only recommended behaviour tracked by the Countdown for which children from poor families do better than children from rich families Mean prevalence of breastfeeding indicators for 43 Countdown countries with available data from national surveys, by wealth quintile, 2009 or later (%) Richest quintile Quintile 4 Quintile 2 Poorest quintile

Quintile 3

Exclusive breastfeeding, ages 0–5 months

Continued breasteeding, ages 12–15 months

Continued breastfeeding, ages 20–23 months 0

100

Source: Re-analysis of Demographic and Health Survey and Multiple Indicator Cluster Survey data sets at the International Center for Equity in Health at the Federal University of Pelotas.

International funding to promote breastfeeding has declined since the 1990s, in contrast to funding for other reproductive, maternal, newborn and child health interventions.8 Improved breastfeeding practices will contribute to the achievement of several Sustainable Development Goals, including those related to child mortality, noncommunicable diseases, nutrition, child development and economic growth. Protecting, promoting and supporting breastfeeding, particularly among the poor, deserve renewed investments and increased prioritization in the post2015 era. Notes 1. Sankar and others forthcoming. 2. Black and others 2013. 3. Horta, de Mola and Victora forthcoming b. 4. Peres and others forthcoming. 5. Chowdhury and others forthcoming. 6. Horta, de Mola and Victor forthcoming a. 7. Victora and others 2015. 8. Lutter and others 2011.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Reductions in stunting (inadequate length and height for age) and wasting (inadequate weight for height) are among the nutrition targets set by the World Health Assembly in 2012, and recent evidence shows that the world remains off track for reducing the number of children under ageÂ 5 who are stunted by 40% and childhood wasting to less than 5% by 2025. 24 Stunting is a

along with suboptimum breastfeeding (box 3) is an underlying cause of 45% of deaths of children under age 5,22 and as many as 20% of newborn deaths are among babies with low birthweight.23 Addressing undernutrition was critical to achieving the Millennium Development Goals and is embedded in the Sustainable Development Goals framework.

FIGURE 1

Stunting tends to be much more common in rural areas Prevalence of stunting among children under age 5 in countries with national prevalence of 30% or higher and data for 2009 or later, urban and rural areas (%) Burundi, 2010 Afghanistan, 2010 Urban areas

Lao PDR, 2011

Rural areas

Malawi, 2010 Pakistan, 2012 Congo, Dem. Rep., 2013 Ethiopia, 2011 Rwanda, 2010 Benin, 2011 Mozambique, 2011 Niger, 2012 Tanzania, U. Rep., 2010 Nigeria, 2013 Bangladesh, 2011 Central African Rep., 2010 Mali, 2012 Nepal, 2011 Cambodia, 2010 Chad, 2010 Sierra Leone, 2013 Cameroon, 2011 Lesotho, 2009 Burkina Faso, 2010 Guinea, 2012 Uganda, 2011 Liberia, 2013 Swaziland, 2010 Zimbabwe, 2010 Comoros, 2012 0

Source: Re-analysis of Demographic and Health Survey and Multiple Indicator Cluster Survey data sets at the International Center for Equity in Health at the Federal University of Pelotas.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survivalâ&#x20AC;&#x192; The 2015 Report

key indicator of the quality of a childâ&#x20AC;&#x2122;s life and reflects chronic exposure to an inadequate diet, possibly combined with repeat infections and poor child care. 25 The median prevalence of stunting in the 65 Countdown countries with data from 2009 or later is 32% and ranges from 9% in China to 58% in Burundi. Some 38 countries have a stunting prevalence of at least 30%.

Previous Countdown analyses have shown that stunting is concentrated among the poor and among children whose mothers have low levels of education.26 Stunting also tends to be much more common in rural areas (figure 1). Some 43Â Countdown countries have a wasting prevalence of 5% or higher, with a high of 23%. Wasting is a marker of acute malnutrition and can change rapidly by season and following catastrophic impacts such as natural or human-caused disasters.27

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survivalâ&#x20AC;&#x192; The 2015 Report

Intervention coverage is still too low for many interventions—and it matters! Tracking intervention coverage—the proportion of a population in need of an intervention that actually receives it—is central to accountability. It provides information on how well countries are successfully implementing policies and programmes aimed at improving women’s and children’s health. Low coverage of proven interventions and large disparities in coverage across population groups should spark immediate action.

Most high-impact interventions and service contacts monitored by Countdown show unacceptably low coverage, with enormous ranges across countries around the median for Countdown countries (figure 2, table 2).28 Even interventions for preventing malaria, which have shown greater accelerations in coverage than any other indicators in recent years, 29 are far from their full life-saving potential. In endemic countries

FIGURE 2

Coverage of interventions varies across the continuum of care Median national coverage of select interventions, 75 Countdown countries, most recent survey, 2009 or later (%) Prepregnancy

Pregnancy

Birth

Postnatal

Country reporting data

Infancy

Water and sanitation

Childhood

100

Improved sanitation facilities

Improved drinking water sources

Oral rehydration salts treatment

First-line antimalarial treatmenta

Careseeking for symptoms of pneumonia

Children sleeping under insecticide-treated netsa

Vitamin A supplementation (two doses)

Haemophilus influenzae type b immunization (three doses)

First dose measles immunization

Diphtheria-tetanus-pertussis immunization (three doses)

Introduction of solid, semisolid or soft foods

Exclusive breasteeding (< 6 months)

Early initiation of breastfeeding

Postnatal visit for babies

Postnatal visit for mothers

Skilled attendant at delivery

Neonatal tetanus protection

Intermittent preventive treatment of malaria for pregnant womena

Antenatal care (at least four visits)

Antenatal care (at least one visit)

Demand for family planning satisfied

Note: Figure excludes data on Rwanda for 2014–15. a. Analysis is restricted to countries where at least 75% of the population is at risk of malaria and where a substantial proportion (50% or more) of malaria cases is due to Plasmodium falciparum (n = 44) or where 50–74% of the population is at risk of malaria and where a substantial proportion (50% or more) of malaria cases is due to P. falciparum (n = 8). Source: Immunization rates, World Health Organization (WHO) and United Nations Children’s Fund (UNICEF); postnatal visit for mothers and postnatal visits for babies, Saving Newborn Lives analysis of Demographic and Health Surveys and Multiple Indicator Cluster Surveys; improved water and sanitation, WHO and UNICEF Joint Monitoring Programme for Water Supply and Sanitation; all other indicators, UNICEF global database, July 2015, based on Demographic and Health Surveys, Multiple Indicator Cluster Surveys and other national surveys.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

TABLE 2

National coverage of Countdown interventions, most recent data, 2009 or later Number of countries with data

Median coverage (%)

Range (%)

Low country

High country

13–93

South Sudan

Viet Nam

Antenatal care (at least one visit)

40–100

South Sudan

Democratic People's Republic of Korea

Antenatal care (at least four visits)

15–95

Afghanistan

Kyrgyzstan

Indicator Pre-pregnancy Demand for family planning satisfied Pregnancy

Intermittent preventive treatment of malaria for pregnant womena

0.1–73

Burundi

Zambia

Neonatal tetanus protection

0–96

South Sudan

Bangladesh

16–100

Ethiopia

China, Democratic People's Republic of Korea

Postnatal visit for mothers

9–98

Mauritania

Kyrgyzstan

Postnatal visit for babies

5–99

Rwanda

Kyrgyzstan

Early initiation of breastfeeding

17–95

Guinea

Malawi

Birth Skilled attendant at delivery Postnatal

Infancy Exclusive breastfeeding (< 6 months)

3–85

Chad

Rwanda

Introduction of solid, semisolid or soft foods

21–95

South Sudan

Mexico

Diphtheria-tetanus-pertussis (three doses)

24–99

Equatorial Guinea

China, Morocco, Rwanda, Uzbekistan

First dose measles immunization

22–99

South Sudan

China, Democratic People’s Republic of Korea, Morocco, Turkmenistan, United Republic of Tanzania, Uzbekistan

Haemophilus influenzae type b immunization (three doses)

0–99

China, South Sudan

Morocco, Rwanda, Uzbekistan

Pneumococcal conjugate vaccine (three doses) b

0–99

Kyrgyzstan

Rwanda

Rotavirus immunizationb

1–99

Philippines

Bolivia

Vitamin A supplementation (two doses)

0–99

Rwanda, Sudan

Benin, Burkina Faso, Cameroon, Côte d'Ivoire, Mauritania, Mozambique, Nepal, Senegal, Sierra Leone, Uzbekistan

Childhood Children sleeping under insecticide-treated netsa

10–74

Chad

Rwanda

Careseeking for symptoms of pneumonia

26–94

Chad

Djibouti

First-line antimalarial treatment a

3–92

Chad

Rwanda

Oral rehydration salts treatment

11–94

Mali

Djibouti

Oral rehydration therapy with continued feedingb

12–67

Sudan

Kyrgyzstan

Improved drinking water sources (total)

32–100

Somalia

Democratic People's Republic of Korea

Improved sanitation facilities (total)

7–100

South Sudan

Uzbekistan

31–89

South Sudan

Democratic People's Republic of Korea

Water and sanitation

Composite Coverage Index Composite Coverage Index b,c

a. Analysis is restricted to countries where at least 75% of the population is at risk of malaria and where a substantial proportion (50% or more) of malaria cases is due to Plasmodium falciparum (n = 44) or where 50–74% of the population is at risk of malaria and where a substantial proportion (50% or more) of malaria cases is due to P. falciparum (n = 8). b. Indicator is not included in figure 2. c. The Composite Coverage Index is a weighted average of eight interventions along the continuum of care that have been available in most countries for at least a decade. The interventions include demand for family planning satisfied, at least one antenatal care visit, skilled attendant at delivery, three immunization indicators (diphtheria-tetanus-pertussis, tuberculosis and first-dose measles), oral rehydration therapy for diarrhea and care-seeking for pneumonia. It is calculated as

(

)

SBA + ANCS 2DPT3 + MSL + BCG ORT + CPNM CCI = 1/4 FPS + + + . 2 4 2 This summary indicator used in Countdown’s routine reporting covers reproductive, maternal and newborn health, as well as both preventive and curative interventions. Note: Table excludes data on Rwanda for 2014–15. Bolded indicators are those recommended by the Commission on Information and Accountability for Women’s and Children’s Health. Source: Immunization rates, World Health Organization (WHO) and United Nations Children’s Fund (UNICEF); postnatal visit for mothers and postnatal visits for babies, Saving Newborn Lives analysis of Demographic and Health Surveys and Multiple Indicator Cluster Surveys; improved water and sanitation, WHO and UNICEF Joint Monitoring Programme for Water Supply and Sanitation; all other indicators, UNICEF global database, July 2015, based on Demographic and Health Surveys, Multiple Indicator Cluster Surveys and other national surveys.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

with available data, only 24% of women report receiving malaria prevention during pregnancy, and only 38% of children under age 5 were reported to be sleeping under an insecticidetreated net. Treatment interventions for the major killers of children are still reaching fewer than half of children with malaria or diarrhoea, and only 54% of children with symptoms of pneumonia are taken outside the home for care. Immunizations continue to be an exception, with median coverage generally above 85%, although these interventions —like all others—show high variation across countries. The coverage indicators tracked by Countdown have evolved in response to changes in clinical recommendations and advances in coverage measurement. For example, indicators for rotavirus vaccine and pneumococcal conjugate vaccine were added in 2014 because of increased data availability following rapid policy adoption. Antibiotic treatment for childhood pneumonia is no longer tracked because validation studies have shown that it cannot be accurately measured by household surveys.30 The indicator on oral rehydration therapy (oral rehydration solution or increased fluids and continued feeding) has been retained to allow the examination of trends and because it is a component of the Composite Coverage Index used by Countdown.31 However, World Health Organization (WHO)/United Nations Children’s Fund guidelines now recommend oral rehydration solution and zinc, so it will be important to track coverage for both going forward. In 2015, 37 countries had available data from population-based national surveys on the administration of zinc for treatment of childhood diarrhoea. The median coverage reported by these countries was 1%, with a high of 28% in Malawi.32 Figure 2 and table 2 reflect data from more countries than in previous years for all indicators measured through household surveys. The number of countries with population-based estimates of coverage for postnatal care visits for babies increased from 5 during 2000–06 33 to 35 during 2009–14. The rapid expansion of international household surveys during the Millennium Development Goals period has helped ensure that all countries have recent, high-quality data on coverage for high-impact interventions to guide their programmes and policies.34 Understanding country progress in reaching all population groups with needed services requires analysing changes in coverage over time. Trends in intervention coverage were featured in an earlier

Countdown publication35 and are updated in table 3 for countries with available data in both periods. Three broad patterns are evident: • Key malaria and HIV interventions began at low coverage and increased markedly. The three malaria interventions that started below 20% in the earlier period showed substantial increases. HIV interventions are not shown in table 3 because baseline data were not available due to methodological changes, but the prevention of mother-to-child transmission with antiretrovirals increased from near zero to 53% in the most recent period, with a range of 1% to more than 95% across countries with data. • Some interventions, which already showed high coverage by around 2000, increased modestly in absolute terms, partly because there was limited scope for increase. These include at least one antenatal care visit, access to an improved source of drinking water and the three vaccines (diphtheria-tetanus-pertussis, Haemophilus influenzae type B and first-dose measles). Nevertheless, a substantial proportion of the gap was closed for these interventions. • All other interventions studied had coverage below 60% before 2009 and increased 10 percentage points or less: family planning, four or more antenatal care visits, skilled attendant at delivery, access to an improved sanitation facility, exclusive breastfeeding and case management interventions for diarrhoea and pneumonia. These patterns suggest that rapid coverage increases are possible when interventions are prioritized and sufficiently funded, as for malaria or HIV. However, there was very limited progress for interventions that require multiple service contacts along the continuum of care or access to care 24/7, particularly during pregnancy and childbirth, and for the management of childhood diarrhoea and pneumonia. Interpreting these summary measures and trends and assessing whether countries are achieving meaningful coverage gains require consideration of uncertainty around the estimates. The Countdown Coverage Technical Working Group is undertaking analytical work on this topic as part of its efforts to improve coverage measurement and to communicate clear actionable messages to decisionmakers (box 4) Intervention coverage is closely related to maternal, newborn and child survival. Faster rates

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

TABLE 3

Changes in national coverage of Countdown interventions from 2000–2008 to 2009–2014 for countries with available data in both periods, by proportion of the coverage gap closed Median coveragea (%)

Number of countries with data

2000−2008

Haemophilus influenzae type b immunization (three doses) b

Diphtheria-tetanus-pertussis immunization (three doses) b

First dose measles immunizationb

Indicator

Change (percentage points)

Proportion of gap closed (%)

38 38

2009−2014

First-line antimalarial treatmentc

Antenatal care (at least one visit)

Children sleeping under insecticide treated netsc

Vitamin A supplementation (two doses)

Improved drinking water sourcesd

Demand for family planning satisfied

Skilled attendant at delivery

Intermittent preventive treatment of for malaria during pregnancyc

Exclusive breastfeeding (< 6 months)

Careseeking for symptoms of pneumonia

Antenatal care (at least four visits)

Oral rehydration salts treatment

Oral rehydration therapy with continued feeding

Improved sanitation facilities

42e

a. Data are for the most recent year available during the period specified. b. Data are for the midpoint of each period (2004 and 2012). c. Analysis is restricted to countries where at least 75% of the population is at risk of malaria and where a substantial proportion (50% or more) of malaria cases is due to Plasmodium falciparum (n = 44) or where 50–74% of the population is at risk of malaria and where a substantial proportion (50% or more) of malaria cases is due to P. falciparum (n = 8). d. Includes data for 2015. Note: Table includes only indicators for which trend data are available in the global data sets shared by the United Nations Children’s Fund (UNICEF), July 2015. Table excludes data on Rwanda for 2014–15. Source: Immunization rates, World Health Organization (WHO) and UNICEF; improved water and sanitation, WHO and UNICEF Joint Monitoring Programme for Water Supply and Sanitation; all other indicators, UNICEF global database, July 2015, based on Demographic and Health Surveys, Multiple Indicator Cluster Surveys and other national surveys.

of improvement in coverage have an impact on under-five mortality. For 29 countries with two or more surveys at least four years apart between 2000 and 2014 an annual increase of 1% in the Composite Coverage Index was associated with a decrease of 0.59% in the under-five mortality rate, after adjusting for changes in gross national product per capita and the baseline under-five mortality rate (95% confidence interval: 0.02%, 1.14%; P = 0.042; figure 3). Despite considerable progress, important gaps remain in the availability and frequency of coverage data collected through household surveys. For example, the results in figure 3 could be calculated for only 29 of the 75 Countdown countries. Among these, the fastest increases in the Composite Coverage Index were observed for Cambodia, Ethiopia, Rwanda and Burkina Faso, and the slowest for Mozambique, Cameroon,

Guinea and Benin. Box 5 shows the evolution of data availability, using coverage of skilled attendant at delivery as an example. There are also technical limitations in the methods used to measure intervention coverage. For example, there is no guarantee that women and children who report a service contact actually receive the full complement of lifesaving interventions that could and should be delivered during that contact. Reported coverage for antenatal care, postnatal care for mothers and babies, and skilled attendant at delivery therefore represent best case scenarios for actual coverage of interventions.36 Redoubled efforts are needed to ensure that all women and children are in contact with health services and that those services include the delivery of lifesaving interventions of sufficient quality. New secondary analyses of antenatal care patterns in

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 4

What constitutes a meaningful change in coverage of maternal, newborn and child health interventions? The Countdown Coverage Technical Working Group and the United Nations Children’s Fund Data and Analytics team are addressing whether changes in aggregate median estimates across countries over time are meaningful in public health terms and sufficiently robust to guide decisionmaking on policies, programmes and investments and whether there is a standardized way to present uncertainty around these estimates that will improve the scientific basis for their interpretation. They are conducting a set of analyses using average coverage rates instead of median coverage rates as a basis for developing confidence intervals around each estimate. Their work has yielded three features of data aggregation and assessment of change that should be considered when interpreting Countdown coverage estimates and trends: • Measures of uncertainty are essential. Changes in the coverage of health interventions are better interpreted with some measure of uncertainty around the estimates, generally represented by a 95% confidence interval. Without a confidence interval, it is impossible to determine whether observed changes reflect real improvements or are an artefact of the random sampling procedure. Fortunately, sampling errors decrease when averages are computed using data from many countries because the aggregate coverage estimate can be thought of as based on pooled independent samples from all countries, which results in a large sample size and therefore better precision. Figure 1 shows changes in average coverage for four key indicators monitored by Countdown in 44 countries for which data were available during 2003–08 and 2009–14.1 The confidence intervals are narrow for all four indicators, indicating that the estimates are very precise.2 The results also show statistically significant increases in coverage for each indicator. Between the two time periods, coverage of at least one antenatal care visit increased 6 percentage points, skilled attendant at delivery 11 percentage points, oral rehydration solution for diarrhoea treatment 7 percentage points and careseeking for symptoms of acute respiratory infection 4 percentage points. • Aggregate measures based on multiple countries are more likely to show significant change than those based on one country. Because aggregate measures are more efficient (smaller standard errors) than individual country estimates, it is possible to interpret

Figure 1. Narrow confidence intervals indicate that estimates are very precise Average coverage of selected maternal and child health interventions for 44 Countdown countries, 2003–08 and 2009–14 (%) and 95% confidence intervals 100

2003–08 2009–14 Confidence interval

0 Antenatal care (at least one visit)

Skilled attendant at delivery

Careseeking Oral for symptoms of rehydration acute respiratory salts infection

Source: United Nations Children’s Fund analysis of data from Multiple Indicator Cluster Surveys and Demographic and Health Surveys.

a change in an aggregate measure as statistically significant even when the majority of countries in the analysis show no statistically significant improvement in the indicator of interest. Of the 44 countries included in the analysis in figure 1, 21 showed no statistically significant change in coverage of at least one antenatal care visit, and 2 showed a significant decrease. For skilled attendant at delivery, 15 countries showed no significant change in coverage, and 1 country showed a significant decline. For oral rehydration solution and symptoms of acute respiratory infection, more than half the countries did not show a statistically significant increase in coverage. These results indicate that caution is needed when applying the findings of the aggregate analyses to what is happening in individual countries. • Trends in aggregate coverage can conceal dramatic changes in absolute numbers of women and children receiving interventions. To illustrate this point, the change in the number of annual births used to calculate coverage of at least one antenatal care visit and skilled attendant at delivery was estimated for the midyear of the two periods (2005 and 2011). Across the 44 countries in the analysis, the number of annual births increased from about 46 million in 2005 to 49 million in 2011 (figure 2). (continued)

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 4 (CONTINUED)

What constitutes a meaningful change in coverage of maternal, newborn and child health intervention?

Figure 2. Trends in aggregate coverage can conceal dramatic changes in absolute numbers of services provided Number of births (millions) 50

Antenatal care (at least one visit)

Skilled attendant at delivery

Increase in coverage due to the increased number of births between 2005 and 2011 Increase in coverage if the number of births in 2011 were the same as in 2005 Births with at least one antenatal care visit and skilled attendant at delivery in 2005

at least one antenatal care visit increased by about 5 million. Similarly, the number of women with a skilled attendant at delivery increased by 6.5 million, an accomplishment that is masked when progress is assessed only by looking at the modest 11 percentage point increase in coverage. These results emphasize that population change must be taken in to consideration when interpreting coverage values and highlight how increases in population add pressure to health systems. Given the welcome and increasing focus on accountability, the global community has a responsibility to inform policymakers about how to interpret and use statistical evidence. Tools like the Countdown country profiles should include confidence intervals where feasible and relevant and find ways to incorporate population dynamics in the interpretation of results. Notes 1. The analysis presented here is different from the results shown

Source: United Nations Children’s Fund analysis of data from Multiple

in table 3 on trends in coverage of health interventions along the

Indicator Cluster Surveys and Demographic and Health Surveys as

continuum of care because the analysis here is based on consecutive

well as data on births from UNDESA (2013).

periods of six years (2003–08 and 2009–14) and on average coverage instead of median coverage.

Thus, although average coverage of at least one antenatal care visit increased only 6 percentage points, the absolute number of women receiving

seven Countdown countries reflect an effort to dig deeper into available survey data to understand what interventions pregnant women are actually receiving and where dropoffs in attendance occur in different contexts (box 6). New approaches to measuring coverage for interventions that women are unable to accurately report on (that is, services provided around the time of birth when the majority of maternal and newborn deaths occur) during

2. 95% confidence intervals are based on sampling errors and do not incorporate any additional measurement error. The actual uncertainty around the coverage estimates may be wider.

household survey interviews are being developed and tested and should help increase available data and stimulate efforts to improve the quality of service delivery. 37 Efforts to link household surveys and health facility survey data are under way in order to generate the data on service quality needed to monitor progress in reaching women and children with the care they need. Countdown has also undertaken a programme of secondary analysis to increase the use of household survey data (box 7).

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

FIGURE 3

Increases in coverage of high-impact interventions are associated with decreases in under-five mortality Annual change in under-five mortality rate (%) 0 –2

Cameroon Guinea

–4

Benin

–6

Burkina Faso

Mozambique

Ethiopia

–8 Cambodia Rwanda

–10 –12 –1

Annual change in Composite Coverage Indexa (%) a. As calculated by the Countdown Equity Working Group. Note: Data are for countries with two or more surveys during 2000–14. The Composite Coverage Index is a weighted average of eight interventions along the continuum of care. Source: Re-analysis of Demographic and Health Survey and Multiple Indicator Cluster Survey data sets at the International Center for Equity in Health at the Federal University of Pelotas and estimates from the UN Inter-agency Group for Child Mortality Estimation.

BOX 5

Tracking progress in intervention coverage for reproductive, maternal, newborn and child health: more and better data The past two decades have witnessed steady improvements in the availability of country-specific data on service contacts and intervention coverage for reproductive, maternal, newborn and child health. The maps in this box provide an example using the service contact indicator for skilled attendant at delivery. They show the availability of data and coverage for three periods. Two points are clear: • More countries have available data than before 2000. Or, conversely, fewer countries have no data for the past decade on which to base assessments of progress. • There has been steady progress, if slower than desired, in moving from lower coverage to higher coverage.

Important challenges remain. Countries need help from the global measurement community to move beyond tracking service contacts to assessments of coverage for specific interventions delivered during those service contacts. This is particularly urgent for interventions that mothers cannot report on accurately in household survey interviews and will require innovative measurement approaches that link reports of where care was sought to assessments of the readiness and quality of care provided in those settings. The post-2015 landscape holds promise, focusing more attention and resources on ensuring that countries have the capacity to develop and implement sound measurement approaches and the commitment to use the resulting information to improve their programmes.

(continued)

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 5 (CONTINUED)

Tracking progress in intervention coverage for reproductive, maternal, newborn and child health: more and better data More countries have available data on skilled attendant at delivery than before 2000, and there has been steady progress in moving from lower coverage to higher coverage Coverage of skilled attendant at delivery in Countdown countries, 1999 and earlier, 2000–08, and 2009–14 (%)

1999 and earlier 80–100% 60–79% 40–59% 20–39% Less than 20% Countdown country; data unavailable

2000–08

2009–14

Note: Maps include data on Rwanda for 2014–15. Source: United Nations Children’s Fund global database, July 2015, based on Demographic and Health Surveys, Multiple Indicator Cluster Surveys and other national surveys.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 6

Unpacking coverage for antenatal care visits: capturing information on services actually provided Antenatal care is critical for improving maternal and newborn health.1 The World Health Organization recommends that pregnant women complete at least four antenatal care visits. 2 Countdown and other global monitoring efforts track the proportion of women who complete one or more visits to a skilled provider and four or more visits to any provider. This box discusses antenatal care use patterns in seven Countdown countries. It uses Demographic and Health Survey data to analyse the frequency of antenatal care use by provider and interventions received and by three dimensions of inequality (household wealth quintiles, women’s education and place of residence). It also uses multivariate analysis to identify determinants of use and reviews contextual data on antenatal care–related policies, guidelines and programmes.

women who had four or more visits than among women who reported one to three visits, but coverage was far from universal for the specific interventions examined, even in countries with high use. Analyses of country-specific inequalities indicated large disparities in antenatal care use by household wealth, women’s education and residence, except in Peru and Uganda. As the number of visits increases to four or more, the disparities within each dimension of inequality widen, albeit at a different pace in each country. The multivariate analysis results showed a strong, significant positive association between both woman’s education and seeking four or more antenatal care visits and between household wealth and seeking four or more antenatal care visits. Gestational age at first visit and parity were significantly negatively associated with seeking four or more visits.

Women generally reported at least one antenatal care visit to a skilled provider, except in Bangladesh and Nepal (see figure). A noticeable drop-off between three and four visits was visible in Senegal and Uganda.

Improving maternal and newborn health remains an important priority in the move to the post-2015 era. More concentrated efforts are needed to achieve full, equitable and sustained coverage of antenatal care. In-country quantitative and qualitative assessments are necessary to identify underserved women and the reasons behind low antenatal care use.

The content of visits—that is, the types of interventions or procedures women reported receiving (such as blood sample taken, blood pressure taken and being told about pregnancy complications)— was also examined. More content was reported among

Notes 1. USAID 2015. 2. WHO 2007b.

Wide variations across and within countries on the number of antenatal care visits women report completing Cumulative distribution of antenatal care visits by skilled and unskilled provider for the most recent birth (% of women who gave birth during the five years preceding the survey) Bangladesh

Unskilled provider Skilled provider Relative decline in coverage of visits

Cambodia

100

24%

10% 22% 28%

50 27% 34%

25 0

31%

Number of antenatal care visits

(continued)

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 6 (CONTINUED)

Unpacking use of antenatal care

Wide variations across and within countries on the number of antenatal care visits women report completing (continued) Unskilled provider Skilled provider Relative decline in coverage of visits

Cumulative distribution of antenatal care visits by skilled and unskilled provider for the most recent birth (% of women who gave birth during the five years preceding the survey) Nepal

Cameroon 100

100 7%

25%

19%

16% 25%

39%

25 0

Number of antenatal care visits

Peru

Senegal

100

100 7%

4% 12%

10%

14%

37%

65%

Number of antenatal care visits

Uganda 100

4% 13%

75 39%

50 57%

25 0

Number of antenatal care visits Source: Demographic and Health Surveys.

Number of antenatal care visits

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survivalâ&#x20AC;&#x192; The 2015 Report

BOX 7

Targeted secondary analysis for stronger programmes: an example from management of childhood diarrhoea Countdown strives to synthesize available data as a basis for promoting accountability and improving programmes. Too often, existing country datasets on intervention coverage are underused, with missed opportunities for programme-relevant analyses. Over the past two years, the Countdown Coverage Technical Working Group has engaged young investigators, including those from low- and middleincome countries, in secondary analyses projects focused on specific questions related to coverage of high-impact interventions. The priority analysis topics, arrived at through a consultative process involving all working group members, are antenatal care, led by researchers at the American University of Beirut (see box 6); family planning, led by the United Nations Population Fund and the Lives Saved Tool team based at Johns Hopkins University; and diarrhoea case management, led by the United Nations Children’s Fund and the Coverage Technical Working Group support team based at Johns Hopkins University. One aim of this work is to increase the engagement of young scientists in making full use of national household surveys, complemented by focused documentation efforts where appropriate. This box reports the results of the secondary analyses of diarrhoea case management, as an example: • Systematic reviews point to gaps in the evidence base. A systematic review of English language literature published since 1990 found numerous studies documenting the prevalence of harmful practices in diarrhoea case management, including the restriction of fluids and food during diarrhoea episodes. These practices can result in treatment failure, sustained nutritional deficits and increased mortality due to diarrhoea. This suggests that programme action is needed, but the evidence base is flawed by a lack of consistency in sampling, measurement and reporting across studies and over time.1 • Cross-country analyses highlight important needs for a broader programme focus. National survey data were used to quantify the extent of fluid curtailment in children with diarrhoea in six high– diarrhoea burden Countdown countries in Sub- Saharan Africa. The results were alarming. Fluid curtailment was reported by 55% of caregivers in Nigeria, 49% in Ethiopia, 44% in Uganda, 37% in Tanzania, 36% in the Democratic Republic of Congo

and 32% in Burkina Faso. Children whose fluids were curtailed were also 3.51 (95% confidence interval: 2.66, 4.64) times more likely to have food withheld during the diarrhoea episode. Particularly at risk were children whose mothers were poor or had little education, rural children, children taken to nongovernment providers for care and children who were breastfed.2 • Follow-up analyses provide information needed to target effective programmes. Since the first set of analyses showed that even children with diarrhoea who were taken for care to public health facilities were often unlikely to receive appropriate treatment, the set of countries was expanded from 6 to 12, and patterns of treatment were examined by type of provider. Case management practices were defined as “good,” “fair” or “poor” using World Health Organization/United Nations Children’s Fund guidelines (see table). Children with diarrhoea for whom no care was sought outside the home were also considered. Programme efforts related to diarrhoea case management in each country were documented in collaboration with United Nations Children’s Fund health staff. The reported prevalence of good diarrhoea management is low and variable across countries, ranging from 17% in Côte d’Ivoire to 67% in Sierra Leone. Even among children taken for care to health facilities, the median prevalence of good management was 52% (ranging from 34% to 64%). The odds of a child receiving good diarrhoea management were equivalent for community versus Definitions of “good”, “fair” and “poor” diarrhoea case management practices, as used in this analysis Oral rehydration salts or oral rehydration salts and zinc

Increased fluids

Continued feeding

Good

Yes

Good

Yes

Good

Yes

Fair

Yes

Faira

Yes

Practice

Faira

Yes

Poor

Yes

Poor

a. Defined as good practice for children ages 6 months and younger. (continued)

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 7 (CONTINUED)

Targeted secondary analysis for stronger programmes: an example from management of childhood diarrhoea facility providers in six countries and higher for community providers than for facility providers in Niger and Uganda. The figure shows summary results by type of provider. Diarrhoea has always been— and continues to be— an important cause of death among children under age 5. The programme of secondary analyses carried out by the Coverage Technical Working Group has provided new evidence that will help country programmes improve their supply-side efforts to train health workers, strengthen community case management where appropriate and ensure continuous availability of oral rehydration solutions and zinc and to complement these efforts with direct efforts to reduce harmful family practices and promote appropriate careseeking and management for childhood diarrhoea.

The reported prevalence of good diarrhoea management is low and variable across countries, even among children taken for care to health facilities Children ages 0–59 months with diarrhoea (%) 100

Fa cil Co ity m m un ity Tr ad iti on al N o ca re Fa cil Co ity m m un ity Tr ad iti on al N o ca re Fa cil Co ity m m un ity Tr ad iti on al N o ca re

More broadly, this work underscores the importance of making full use of available datasets to generate programme-relevant results. Building capacity for the analysis of coverage data among young scientists from low- and middle-income countries is an urgent priority.

Good management

Fair management

Poor management

Source: Re-analysis of Demographic and Health Surveys conducted

Notes

since 2009.

1. Carter and others 2015. 2. Perin and others 2015.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Equity—targeting the underserved

Equity was noticeably absent in the original formulation of the Millennium Development Goals.38 Since its first report, Countdown has provided original analyses of inequalities in intervention coverage by wealth, sex of the child, place of residence and other social determinants. These analyses consistently show systematic pro-rich inequalities for virtually all coverage indicators.39 The gaps are wider for interventions that require access to fixed health facilities or repeat contacts with a health provider(such as four or more antenatal care visits and skilled attendant at delivery) than for interventions that can be delivered through outreach strategies at the community level (such as immunization).40 The countries that have made rapid progress in coverage are those that effectively reached the poorest families.41 The Countdown Equity Technical Working Group prepares equity

profiles for each Countdown country (see www. countdown2015mnch.org). The growing number of countries with repeated surveys allows analyses of global trends in coverage not only at the national level, but also for the poorest and richest quintiles of mothers and children. Globally, the Composite Coverage Index42 increased for both the richest and poorest quintiles, but the increase was steeper among the poorest (1.0 percentage point per year; 95% confidence interval: 0.8, 1.1) than for the richest (0.3 percentage point; 95% confidence interval: 0.2, 0.4; left panel of figure 4). The rich–poor gap declined from 28 percentage points in 2000 to 19 in 2014, indicating an increase in coverage equity in both absolute and relative terms (both trends with P < 0.001; right panel of figure 4).

FIGURE 4

Greater data availability permits global tracking of declining inequalities Trends in the Composite Coverage Index, national and poorest and richest quintile, 47 Countdown countries

Trends in absolute and relative inequality in the Composite Coverage Index

Composite Coverage Index coverage (%)

National Poorest quintile Richest quintile

Absolute inequality (slope index of inequality) Relative inequality (concentration index)

0 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

Source: Re-analysis of Demographic and Health Survey and Multiple Indicator Cluster Survey data sets at the International Center for Equity in Health at the Federal University of Pelotas.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Like coverage, data availability for equity analyses has improved, but much scope for progress remains. Repeated surveys using consistent measurement of equity stratifiers, such as wealth, gender, residence or ethnicity, are required to identify priority groups and track subnational progress over time.

Despite the persistent coverage gap between rich and poor mothers and children, the gap has been closing, at least for the eight long-standing interventions that are part of the Composite Coverage Index (box 8).

BOX 8

How does equity change as coverage increases in Countdown countries? coverage had slow progress as well (Mali and Nepal). And countries with the lowest baseline coverage did not make progress at all (Chad and Ethiopia).

Focusing on coverage at the national level can mask large differences in access to services among different population groups within and across countries. Understanding country progress in reaching all population groups and determining strategies for improving coverage require exploring how inequalities in reproductive, maternal, newborn and child health interventions have changed over time.

Liberia achieved the biggest reductions in both absolute and relative inequalities by increasing the Composite Coverage Index value for all wealth quintiles, except for the richest, for whom coverage remained around 70% (figure 2). Bolivia presented a somewhat similar pattern, but with coverage for the richest just over 80%. In the other three countries the Composite Coverage Index value increased for all wealth quintiles but more rapidly for the poorer ones. In Cambodia (and in Sierra Leone to a lesser extent) top inequality (the richest have much higher coverage then the rest) at the baseline disappeared, while in Niger it remained.

Countries with higher average annual change on the Composite Coverage Index between 2000 and 2014 among the poorest quintile had national coverage around 50% at the baseline— Bolivia, Cambodia, Liberia, Rwanda and Sierra Leone (figure 1). Countries with high baseline national coverage are expected to make slower progress because they have less room for improvement. But several countries with lower baseline

Figure 1. Rapid increases in coverage among the poor were observed in several countries, particularly those with national baseline coverage around 50 percent Average annual change in Composite Coverage Index, poorest quintile (percentage points) 4

Nonsignificant change

Cambodia

Significant change

Sierra Leone Rwanda Nepal

Liberia

Bolivia

Niger

Mali

Ethiopia Chad

–1

100

Composite Coverage Index, national (%) Source: Re-analysis of Demographic and Health Survey and Multiple Indicator Cluster Survey data sets at the International Center for Equity in Health at the Federal University of Pelotas. (continued)

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 8 (CONTINUED)

How does equity change as coverage increases in Countdown countries? These examples indicate that rapid reductions in inequities in coverage are possible but that some countries are lagging behind and should be encouraged to introduce pro-poor strategies. Renewed efforts for increasing health intervention coverage should be based on locally designed equityoriented policies to avoid favouring the rich first and thus increasing inequalities. This is especially important in places where baseline inequalities are already high.

Figure 2. Reducing coverage inequalities is possible through targeting the poorest women and children Composite Coverage Index score for the five countries with biggest reduction in Composite Coverage Index inequality since 2000, by wealth quintile and in order of magnitude in reducing inequality Poorest quintile Quintile 2 Quintile 3 Quintile 4 Richest quintile 2007 2013 1994 1998 Bolivia 2003 2008 2000 Cambodia 2005 2010 1998 Niger 2006 2012 2008 Sierra Leone 2010 2013 Liberia

100

Source: Re-analysis of Demographic and Health Survey and Multiple Indicator Cluster Survey data sets at the International Center for Equity in Health at the Federal University of Pelotas.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survivalâ&#x20AC;&#x192; The 2015 Report

Determinants of coverage and equity—policies, systems and financing Countdown recognizes that country ability to achieve high and equitable coverage of proven interventions depends on sufficient financial investments in women’s and children’s health, supportive legislative frameworks and resilient health systems. Broader contextual factors such as progress in social and economic determinants of health and political stability also influence access to and use of health services. This section provides an update on country progress in adopting key policies and improving human resources for health, as well as trends in official development assistance for reproductive, maternal, newborn and child health. Progress depends on adopting key policies and strong health systems Supportive policy environments and functional health systems with adequate human resources are prerequisites for high and equitable coverage. The number of policy and systems indicators tracked in Countdown has increased, from 5 policies that promote child survival in the first report to 11 policies that cover the full reproductive, maternal, newborn and child health continuum of care in this year’s report, including four measures of systems that are critical to effective service delivery for women and children. These indicators are consistent with the WHO health system building block framework43 and the Essential Policies Compendium.44 Although further work is needed to develop comparable metrics for implementation strength at the national and subnational levels, Countdown has developed a set of tools that can be used to generate descriptions of relevant policies and aspects of reproductive, maternal, newborn and child health programme implementation across countries and over time (box 9). Notable progress in adopting supportive policies has occurred across the Countdown countries.45 The number of countries that adopted each of six policies for which trend data are available

increased markedly between 2008 and 2014 (figure 5). However, gaps remain, and more progress is needed, particularly for policies that are lagging. Two policies where uptake has been slow are maternity protection in accordance with Convention 183 of the International Labour Organization (which includes maternal leave and employment protection during pregnancy and the postnatal period) and adoption of the International Code of Marketing for Breastmilk Substitutes. Although the increase in adoption of policies on the notification of maternal deaths has been impressive, more effort is needed to strengthen country capacity to record and analyse the causes of maternal and perinatal deaths. Such information is critical for improving the quality of care in the Sustainable Development Goals era (box 10). Increased investment in information systems and a growing demand to understand the association between human resources and health have expanded available data on skilled health professionals.46 Three-quarters of Countdown countries have fewer than 22.8 physicians, nurses and midwives per 10,000 people, the threshold that the WHO considers necessary to achieve high coverage of essential health interventions in highburden countries.47 The most recent estimates show a median density of 10.2 skilled health professionals per 10,000 people in the Countdown countries, ranging from 1.6 in Madagascar and Niger to 142 in Uzbekistan. Ethiopia’s rapid expansion of its human resource capacity for health through the Health Extension Program introduced in 2003 shows that countries can successfully address shortfalls in their health workforce through intensive political commitment and investments.48 Although gaps remain in the country’s health workforce, in less than five years Ethiopia trained and deployed more than 30,000 health extension workers and substantially increased the number of nurses, physicians, health officers and midwives. However, more health workers is only one of several essential steps

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 9

What can systematic tools to track health systems and policy change contribute to understanding progress for ending preventable maternal, newborn and child deaths? Capturing information on adoption and implementation of policies and programmes is key to understanding how countries accelerate progress in maternal, newborn and child survival. However, few multicountry assessments on policy change and programme implementation have been undertaken, partly because of a lack of data and standardized methods for collecting and analysing this information. To address this gap, Countdown developed a tool set for use in country case studies to systematically analyse and compare national trends in policy adoption and programme implementation for reproductive, maternal, newborn and child health.

has experienced a complex policy and strategy environment since 1990. Child health has received consistent attention, with a focus on scaling up high-impact interventions at lower health system levels, such as the community level. Prioritization of maternal health started in the mid-1990s, with programmes and polices targeted at secondary and tertiary levels of the health system. Specific attention to newborn health started later in 2005, but programmes are being rapidly scaled up at the facility and community levels. Reproductive health lost momentum over 1990–2000s, with recent reinvestment.

The tool set builds on policy-tracking approaches developed for the Decade of Change for Newborn Survival series1 and inputs from more than 100 policymakers in Countdown countries2 to help in monitoring four phases of the policy process— agenda setting, policy formulation, policy implementation and evaluation. It will be available at www. countdown2015mnch.org in 2016 and includes four tools: the policy and programme timeline tool, the health policy tracer indicators dashboard, the health systems tracer indicators tool and the programme implementation assessment.

These tools can help tell the story of when changes in policies and programmes took place within and across countries, a starting point for understanding strategies adopted by countries to end preventable maternal, newborn and child deaths. They can also provide important lessons to guide countries in their efforts to achieve the post-2015 development goals. Further work is needed in developing standardized approaches to measure the strength of programme implementation that go beyond the Countdown tool set, which is critical for monitoring programme performance and impact on health outcomes.

Figure 1 shows the timeline developed for Tanzania spanning 1990–2015, 3 which identifies all major policy and systems changes related to reproductive, maternal, newborn and child health. Tanzania

Notes 1. Brewer and DeLeon 1983. 2. Moran and others 2012. 3. Afnan-Holmes and others 2015. (continued)

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 9 (CONTINUED)

What can systematic tools to track health systems and policy change contribute to understanding progress for ending preventable maternal, newborn and child mortality?

Tanzania’s timeline of major policy and systems changes related to reproductive, maternal, newborn and child health, 1990–2015

Decentralisation: introduced sector-wide capitation grants that gave districts financial resources (2000)

Growth and poverty reduction strategies

Health systems

H ealt h - care d ecen t ralisat io n st rat eg ies

H ealt h serv ices d ev elo p m en t p lan

Human resources for health strategic plan

H ealt h sect o r st rat eg ic p lan I

P lan II

P lan III

MN H ro ad m ap

Essential health and RCH interventions RMNCH

National policies and strategies that address RMNCH

Macro

National health, population and development policies

RCH strategic plan

P lan IV

MN CH st rat eg ic p lan I

Sh arp en ed p lan

RCH strategic plan

Adolescent-friendly policy

Pre-2000

Family planning

2000

2001

2002

2003

2005

2006

2007

Life saving skills programme (2000)

2010

2011

2012

2013

2014

2015

Post-2015

Guidelines revised (2012) EMOC assessment (2006) National MPDR programme (2006)

Guidelines revised MPDSR programme (2013)

Guidelines revision (2006)

PNC

Implentation study (INSIST) (2009 onwards)

Guidelines revision (2012)

National KMC programme (2008)

KMC

ENC and Resus

National ENC programme (2007) Pilot (2007)

National IMCI programme (2000)

EPI

National EPI programme (1975)

ITNs and drugs for malaria

ITN Pilot (1999)

PMTCT

2009

National focused ANC programme launched (2002)

MPDSR

IM(N)CI

2008

National family planning costed implementation plan (2010–15)

Pilot (2000)

EMOC

Policy formulation, implementation, and evaluation of key interventions

2004

Adolescent reproductive health strategic plan

National family planning programme (1989)

Focused ANC

Plan II

Programme revision to include the neonate (2006)

Evaluation (1999–2002)

EPI strategic plan (2002–07) Drug policy revision (2001)

Pilot nevirapine only (2000)

ORS and zinc

National ITN programme (2003)

National HBB programme (2009) Situation analysis of newborn health (2009)

EPI strategic plan (2006–10) National Drug policy ITN voucher revision scheme (2005) (2004) National PMTCT programme— azidothymidine included (2006)

Evaluation (2010) 2008—Under-5 catch-up campaign

EPI strategic plan (2010–15) National programme or policy pilot

2010—Aim for universal coverage

Programme revision— triple therapy Option A (2010) National ORS and zinc programme (2010)

National programme or policy formulation

National EMCT programme launched (2012) and option B+ (2013)

National programme or policy implementation National programme strategic or costed implementation plan National programme or policy evaluation Reproductive Maternal Newborn Child

Source: Afnan-Holmes and others 2015.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Countdown’s tracking of country progress in including key reproductive, maternal, newborn and child health commodities on the essential medicine list and in having costed national plans for women’s and children’s health is aligned with global efforts such as the Commission on Life-Saving Commodities to improve supply chain systems and the quality of care. The WHO is leading efforts to assess the feasibility of collecting data on selected tracer indicators for measuring quality of care for maternal, newborn and child health (box 11).

FIGURE 5

The number of countries that adopted each of six supportive policies for which trend data are available increased markedly between 2008 and 2014 Adoption of selected tracer policies at the macro and micro policy level for 68 Countdown countries, 2008 and 2014 (%)

Midwives authorized for specific tasks 2008 2014

Maternity protection (Convention 183)

Increases in funding are encouraging, but reliable financing for reproductive, maternal, newborn and child health remains a concern

Notification of maternal deaths

International code of marketing of breastmilk substitutes Community treatment of pneumonia with antibiotics Low-osmolarity oral rehydration salts and zinc for management of diarrhoea 0

100

Source: World Health Organization Global Maternal Newborn Child and Adolescent Health Policy Indicator Surveys.

for increasing service access, quality and use.49 The next steps in Ethiopia are to introduce health worker policies that will improve motivation and reduce turnover by ensuring a reasonable task load and supportive supervision, to strengthen the supply chain system in order to reduce stockouts of equipment and supplies, to develop a robust information system with a feedback loop in order to monitor the extent to which services are being delivered, and to improve the referral chain. The country is aiming to boost demand for services through its Health Development Army, whose tasks include disseminating health messages at the community level. Countdown has contributed to substantial increases in data availability on policies by helping shape the contents of the WHO’s biennial policy survey. More work is needed to overcome the limitations of using a survey-based approach in order to ensure more timely and accurate information and to explore associations between policy implementation and changes in coverage.

The establishment of the Millennium Development Goals framework led to a major upswing in political prioritization of women’s and children’s health,50 and official development assistance surged after the Millennium Development Goal summit in 2000.51 Although the growth in official development assistance slowed substantially following the economic crisis in 2007–08, official development assistance to maternal, newborn and child health in the Countdown countries tripled over 2003–12, from $2 billion to $6 billion.52 Most of the investment was for general health care (including health systems support), reproductive health, malaria programmes and immunization programmes. During the same period, official development assistance for projects that mention newborns grew exponentially, from $33 million to $1 billion, reflecting the greater visibility of newborn health.53 But these investments are far too little given that neonatal causes account for almost half of deaths among children under age 5. Government expenditures for reproductive, maternal, newborn and child health in Countdown countries increased approximately 31% between 2010 and 2013.54 Although the increased commitments and funding associated with the UN Every Woman Every Child Initiative are encouraging, further increases are needed to accelerate progress in reducing preventable maternal and child deaths. In particular, better targeting of resources to assist countries with the greatest burden and to support the scaleup of high-impact interventions would help narrow inequities between and within countries and promote the achievement of the next set of global goals. Box 12 outlines disbursements for reproductive, maternal, newborn and child health in 2013, describing the largest donors and how aid is targeted to the Countdown countries.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 10

Positive policy changes for maternal death notification—but more action is needed for stillbirths and neonatal deaths There is widespread acknowledgment of the need for more and better data on deaths of women and newborns around the time of birth. New guidelines and tools for maternal death surveillance are now available, and many countries have adopted policies related to maternal death notification. Figure 5 in the main report shows that of the 68 countries with available trend data, 47 (69%) reported having a policy on maternal death notification in 2013–14, up from 23 (34%) in 2008. Progress has been slower for policies requiring all stillbirths and neonatal deaths to be reviewed. Only 16 Countdown countries reported having such a policy for stillbirths, and only 30 reported having one for neonatal deaths, according to a 2013–14 World Health Organization Global Maternal, Newborn Child and Adolescent Health Policy Indicator Survey. Adoption of policies for maternal, stillbirth and neonatal death notification and review is only a first step; it must be followed by full implementation, which includes the scale-up of maternal and perinatal audits. As a complement to a country’s civil and vital registration system, maternal and perinatal mortality audits can provide essential evidence to guide programmatic changes, leading to better quality of care.1 However, many low- and middle-income countries lack a systematic approach for reviewing the causes and factors linked to maternal and perinatal deaths and “near-miss events” occurring in facilities and in the community. The large number of stillbirths

Each Countdown case study includes a detailed analysis of trends in financial flows to reproductive, maternal, newborn and child health and illustrates the complexity of the funding environment (see box 1). For example, the Peru55 and Ethiopia case studies both showed rapid growth in reproductive, maternal, newborn and child health expenditures over the past decade, which their authors suggest was an important contributor to accelerations in child survival. But the two countries used different resources and financing mechanisms to fund their programmes. Peru, an upper middle-income country, relied mostly on domestic funding, while Ethiopia, a low-income country, relied heavily on external funding. Both countries have high outof-pocket spending, which must be addressed to make health care more affordable to disadvantaged population groups (box 13).

and neonatal deaths, particularly in comparison to maternal deaths, presents a challenge to already weak health information systems that are not equipped to capture, let alone review, the quality of services provided to each baby who died. However, some countries are making an effort towards registering every birth and death and promoting review of select stillbirth and neonatal death cases in order to improve the quality of intrapartum care. To increase political prioritization of notification and review of stillbirths and neonatal deaths, the Every Newborn Action Plan includes a milestone for developing perinatal mortality audit guidelines. These guidelines will help clarify who is responsible for recording and reviewing stillbirths and neonatal deaths and how to use the information to improve health worker and health system performance. The benefit of audit and feedback is well recognized, and countries need to be supported in their efforts to adopt policies related to civil and vital registration and to implement both maternal and perinatal audits as critical actions towards preventing future deaths of mothers and their babies.2 Notes 1. Commission on Information and Accountability for Women’s and Children’s Health 2011b. 2. Mathai and others forthcoming.

The general consensus across the panoply of resource-tracking efforts is that official development assistance and domestic expenditures for reproductive, maternal, newborn and child health are increasing.56 Data on domestic spending on reproductive, maternal, newborn and child health are insufficient to estimate trends for the Countdown countries. The work of the Lancet Global Commission on Investing in Health, which emphasizes the centrality of reproductive, maternal, newborn, child and adolescent health for achieving global development, and the World Bank’s recently announced Global Financing Facility in support of Every Woman Every Child are signs that investments in reproductive, maternal, newborn, child and adolescent will continue to grow.57 Such investments will focus on child and adolescent development in addition to survival.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 11

Measuring quality of care: challenges and solutions Services for women and children must meet quality standards to be effective in saving lives. Assessing care quality and using the results to strengthen service delivery are urgent priorities. Numerous tools exist for these purposes, ranging from readiness assessments that determine whether trained personnel and system supports are available (such as the World Health Organization’s [WHO] Service Availability and Readiness Assessments and Demographic and Health Surveys Service Provision Assessments) to full observation-based evaluations of the care received (such as the Maternal and Child Health Integrated Program’s Rapid Health Facility Assessment, the World Health Organization’s Health Facility Survey for the Integrated Management of Childhood Illness and MEASURE Evaluation’s Quick Investigation of Quality). However, a remaining challenge is to define a standard set of core quality indicators and associated measurement tools that can produce comparable data across programmes and countries. Ideally, information on these indicators should be captured through existing systems and not through special studies or surveys. In 2013 the WHO convened a technical meeting that recommended 19 quality indicators across the continuum of care.1 The WHO is now assessing the feasibility of collecting comparable data on them in different settings. The potential of routine systems to generate needed data on quality was assessed through two efforts over 2012–14. Both the U.S. Agency for International Development–funded Maternal and Child Survival Program2 and the Centre for Maternal and Newborn Health at the Liverpool School of Tropical Medicine3 assessed the availability of relevant routine data on service quality in selected countries in Sub- Saharan African and South Asia. The Maternal and Child Survival Program focused on national health management and information systems, and the Centre

However, the very large number of goals and targets in the Sustainable Development Goals framework could detract from a sustained and accelerated focus on reproductive, maternal, newborn and child health, leaving many countries short of funds, particularly those that depend heavily on donors. The most important strategies in the coming years may be those that shore up the

for Maternal and Newborn Health focused on health facilities. The results were sobering and suggest that standalone tools will be needed to complement routine sources in order to generate data on service quality for some time, especially for newborn care. Even using specific tools, however, generating data to support measurement of the 19 indicators may not be feasible in most settings, as found in a recent exercise conducted by the World Council of Churches in 24 mostly second-level health care facilities in rural areas of five African countries.4 The exercise also found that some of the recommended child and newborn indicators may need to be reformulated so that the information collected is more useful for informing efforts to improve the performance of health worker systems. Strong leadership and a focused development programme will be needed to generate technical consensus on a limited number of quality indicators across the continuum of care that are feasible for measurement in low- and middle-income countries and to generate timely information useful for both programme monitoring and global reporting. The Sistema Informático Perinatal that has been implemented by the Latin American Perinatal Center in many countries of the region may provide a good model, especially because it illustrates the importance of tempering an aspirational list of indicators with concrete realities about the information actually available and able to be tracked routinely at the country level.5 Notes 1. WHO and Partnership for Maternal, Newborn and Child Health 2014. 2. Formerly the Maternal and Child Integrated Program. See www. mcsprogram.org and Dwivedi and others (2014). 3. Liverpool School of Tropical Medicine, Centre for Maternal and Newborn Health 2015. 4. Roos and others 2015. 5. PAHO 2010.

contribution of national sources to reproductive, maternal, newborn and child health. Country-level mechanisms such as concrete investment cases and accountability procedures that strengthen collaboration between citizens and governments can build more sustainable and efficient funding for reproductive, maternal, newborn and child health at the local level.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 12

Official development assistance: 2013 updates Tracking commitments and disbursements of official development assistance is valuable for holding donors to account for their commitments. This box presents data on flows of official development assistance disbursements in 2013 for reproductive, maternal, newborn and child health to the 75 Countdown countries. The term ODA+ is used to encompass disbursements from all donors reporting to the Organisation for Economic Co-operation and Development Creditor Reporting System, including official flows that are not official development assistance as well as private grants.1 All values are in 2013 U.S. dollars. ODA+ to health to all recipients was estimated at $25.8 billion in 2013, accounting for 12% of total ODA+ and up 13% in real terms from 2012. ODA+ to health among the Countdown countries was $17.4 billion, up 15% in real terms from 2012. Over 2003–13 ODA+ to health nearly tripled among all recipients and more than tripled in the Countdown countries (figure 1).2 An estimated $13.4 billion of ODA+ was disbursed to the Countdown countries for reproductive, maternal, newborn and child health in 2013, up 34% from $9.9 billion in 2012. The $13.4 billion included $2.5 billion for maternal and newborn health (19% of the total and up 28% from 2012), $6.4 billion for child health (48% of the total and up 35% from 2012) and $4.5 billion for reproductive health (including family planning, sexual health and sexually transmitted infections, including HIV; 33% of the total and up 38% from 2012). The 75 Countdown countries received 91.5% of the $14.6 billion in ODA+ for reproductive, Figure 1. Over 2003–13 ODA+ to health nearly tripled among all recipients and more than tripled in the Countdown countries Change in ODA+ to health from all donors, 2003–2013 (2013 $ billions) 30 All recipients 75 Countdown recipients

From whom? In 2013, as in previous years, more than half of ODA+ to reproductive, maternal, newborn and child health to the 75 Countdown came from bilateral agencies (58%), 14% came from multilateral agencies, 23% came from global health initiatives and 5% came from private foundations. The relative prominence of donor types varied across health areas: bilateral agencies provided three-quarters of funding to reproductive health, global health initiatives provided a third of funding to child health and multilateral agencies provided a quarter of funding to maternal and newborn health (figure 2). Global health initiatives and private foundations gave the majority of their reproductive, maternal, newborn and child health funding to child health projects (twothirds by global health initiatives and three-quarters by private foundations). Multilateral agencies gave just over half their reproductive, maternal, newborn and child health funding to child health and a third to maternal and newborn health, and bilateral agencies gave over two-fifths to reproductive health (figure 3). The largest donor to reproductive, maternal, newborn and child health in 2013 was the United States, providing 30% of the total ODA+ disbursed. The largest Figure 2. The relative prominence of donor types varied across health areas ODA+ to reproductive, maternal, newborn and child health from all donors to Countdown countries, by donor type and health area, 2013 (%) 100 75 50 25

maternal, newborn and child health disbursed in 2013 to 148 countries worldwide.

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Reproductive, Maternal, maternal, newborn and newborn and child health child health

Child health

Private foundations Global health initiatives

Maternal Reproductive and newborn health health

Multilateral Bilateral

Source: Organisation for Economic Co-operation and Development–

Development Assistance Committee Creditor Reporting System and

Aid Activities Database.

Aid Activities Database. (continued)

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 12 (CONTINUED)

Official development assistance: 2013 updates

Figure 3. Global health initiatives and private foundations gave the majority of their reproductive, maternal, newborn and child health funding to child health projects Distribution of the focus areas of ODA+ to reproductive, maternal, newborn and child health disbursements by type of donor (%) 100 75 50 25 0

Bilateral

Multilateral

Global health initiatives

Private foundations

Reproductive health Maternal and newborn health Child health

with smaller populations received more funding per capita. Kenya, Nigeria, South Africa and Tanzania received the most funding for reproductive health, with the 10 largest recipients receiving 63% of ODA+ to reproductive health (figure 4). Ethiopia, India and Pakistan received the most funding for maternal and newborn health, with the 10 largest recipients receiving 42% of ODA+ to maternal and newborn health. Nigeria, Ethiopia and the Democratic Republic of Congo received the most funding for child health, with the 10 largest recipients receiving 52% of ODA+ to child health. Figure 4. In 2013 the 10 largest recipients received 42% of all ODA+ to maternal and newborn health, 52% of all ODA+ to child health and 63% of all ODA+ to reproductive health Recipients of the largest disbursements of ODA+ to reproductive, maternal, newborn and child health from all donors to Countdown countries, by health area, 2013 (%)

Source: Organisation for Economic Co-operation and Development–

Reproductive health

Development Assistance Committee Creditor Reporting System and

100

Aid Activities Database.

Other

donors by health area were Gavi, the Vaccine Alliance, to child health (21%) and the United States to maternal and newborn health (15%) and to reproductive health (62%). The total proportion provided by the 10 largest donors in each health area varied from 69% of ODA+ to maternal and newborn health to 94% of ODA+ to reproductive health, and was 84% of ODA+ to reproductive, maternal, newborn and child health (see table). The increase in funding to reproductive, maternal, newborn and child health between 2012 and 2013 was driven primarily by increases in disbursements of 37% from the United States ($3.0 billion to $4.1 billion), 75% from the United Kingdom ($754 million to $1.3 billion) and 60% from Gavi, the Vaccine Alliance ($858 million to $1.4 billion), as well as by large increases from the Bill & Melinda Gates Foundation, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the International Development Association and Norway. As a proportion of national gross domestic product, the largest disbursements to reproductive, maternal, newborn and child health in 2013 came from Norway (0.07%), the United Kingdom (0.05%), Sweden (0.04%), Luxembourg (0.04%) and Canada (0.04%).3 To whom?

50 25

Zimbabwe Mozambique

India Zambia

Ethiopia Tanzania

Uganda South Africa Nigeria Kenya

0 Maternal and newborn health 100 75

Other Philippines

Mozambique Nigeria Bangladesh Pakistan

Congo, Dem. Rep. Afghanistan 25 Tanzania India 0

Ethiopia

Child health 100 Other

75 50

Kenya Afghanistan Tanzania

25 Congo, Dem. Rep. 0

Mozambique India Bangladesh Pakistan Ethiopia Nigeria

Source: Organisation for Economic Co-operation and Development–

As in previous years, in 2013 more-populous countries received greater absolute disbursements, and countries

Development Assistance Committee Creditor Reporting System and Aid Activities Database. (continued)

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 12 (CONTINUED)

Official development assistance: 2013 updates

ODA+ to maternal, newborn and child health per capita Across Countdown countries, ODA+ to reproductive, maternal, newborn and child health varies widely, even after adjusting for the size of the population. For example, the median ODA+ to maternal and newborn health per live birth was $6.34 for the 10 countries receiving the least and $158.47 for the 10 countries receiving the most (figure 5). The median ODA+ to child health per child under age 5 was $2.50 for the 10 countries receiving the least ODA+ and $54.68 for the 10 countries receiving the most (figure 6). Nigeria received the most ODA+ to child health in absolute terms ($697 million) but ranked 37th in ODA+ to child health per child under age 5 ($22.91). Conversely, São Tomé and Príncipe ranked 71st in total ODA+ to child health received (under $5 million) but had the highest disbursement per child under age 5 ($162.23).

Figure 6. Median ODA+ to child health per child under age 5 was $2.50 for the 10 countries receiving the least ODA+ and $54.68 for the 10 countries receiving the most Ten highest and ten lowest disbursements of ODA+ for child health per child under age 5 among Countdown countries ($) Indonesia Iraq Equatorial Guinea Mexico Philippines

Median: $2.50

Turkmenistan India Brazil Egypt China São Tomé and Príncipe Solomon Islands Lesotho

Figure 5. The median ODA+ to maternal and newborn health per live birth was $6.34 for the 10 countries receiving the least and $158.47 for the 10 countries receiving the most

Guinea-Bissau South Sudan

Median: $54.68

Liberia Zambia

Ten highest and ten lowest disbursements of ODA+ for maternal and newborn health per live birth among Countdown countries (%)

Malawi Gambia Afghanistan

Congo

Mexico

100

150

200

Source: Organisation for Economic Co-operation and Development–

Indonesia

Development Assistance Committee Creditor Reporting System and

Uzbekistan

Aid Activities Database.

Equatorial Guinea

Median: $6.34

Iraq

Funding by type of health activity

Turkmenistan India Egypt China São Tomé and Príncipe Solomon Islands Liberia Sierra Leone South Sudan

Median: $158.47

Papua New Guinea Lesotho Haiti Zimbabwe Guinea-Bissau 0

100

200

300

400

500

The largest share of ODA+ to child health supported immunization activities, excluding polio (27%, $1.7 billion), followed by generic malaria programming benefitting children (16%, $1.0 billion) and primary health care benefitting children (14%, $892 million). Maternal and neonatal health benefitted most from activities specifically focused on maternal and neonatal health (28%, $695 million), on maternal and child health spending (21%, $526 million), nutrition programming (13%, $327 million) and generic malaria programming (11%, $284 million). Disbursements for reproductive health were overwhelmingly for HIV programming (77%, $3.4 billion), followed by family planning (17%, $753 million).

Source: Organisation for Economic Co-operation and Development– Development Assistance Committee Creditor Reporting System and Aid Activities Database. (continued)

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 12 (CONTINUED)

Official development assistance: 2013 updates

Sources of 10 largest disbursement totals by health area, 2013 Reproductive, maternal, newborn and child health

$ millions

Share of ODA+ to reproductive, maternal, newborn and child health (%)

Maternal, newborn and child health

$ millions

Share of ODA+ to maternal, newborn and child health (%)

Maternal and newborn health

Child health

$ millions

Share of ODA+ to child health (%)

$ millions

Australia

Share of ODA+ to maternal and newborn health (%)

91.4

Bill & Melinda Gates Foundation

617.0

543.4

481.5

Canada

547.7

522.7

353.5

169.3

164.2

EU institutions Gavi, the Vaccine Alliance Germany

491.4

465.1

296.1

1,369.6

1,364.8

1,354.4

Reproductive health

$ millions

Share of ODA+ to repro ductive health (%)

49.4

73.5

312.3

251.5

154.1

97.3

60.8

Global Fund to Fight AIDS, Tuberculosis and Malaria

1,725.7

893.3

735.0

158.4

832.4

International Development Association

556.3

496.3

366.5

129.9

59.9

Japan

228.2

216.9

129.6

87.3

4 79.1

93.4

58.6

49.0

Netherlands Norway Sweden United Kingdom

1,322.2

1,159.7

816.5

343.3

162.4

United States

4,050.9

1,304.1

921.5

382.7

2746.8

Other donors

21,51.4

1,700.7

829.1

759.0

282.0

13,372.6

100

8,918.6

100

6,442.6

100

2,476.0

100

4,454.0

100

Total

Source: Organisation for Economic Co-operation and Development’s Development Assistance Committee.

Notes

included as ODA+ to reproductive, maternal, newborn and child health

1. The 2014 Countdown report used the same methodology, but the

in the present report, which includes projects outside those sector

term “ODA+” was not introduced until the publication of Arregoces

codes that benefitted reproductive, maternal, newborn and child

and others (2015). Prior to 2014, Countdown reports included only the

health and excludes some projects in those sector codes. However,

31 donors that had consistently reported to the Creditor Reporting

the vast majority of reproductive, maternal, newborn and child health

System for all years. The 2014 report and the present report include all

expenditure by value (94% in 2013) is from projects in those sector

donors.

codes.

2. ODA+ to health is the total disbursement reported to the Creditor

3. Based on 2013 GDP values from the Organisation for Economic

Reporting System under sector codes 120 (health) and 130 (population

Co‑operation and Development (https://data.oecd.org/gdp/gross

and reproductive health). It is not strictly a denominator for the projects

-domestic-product-gdp.htm).

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 13

Financing for women’s and children’s health in Ethiopia and Peru As part of Countdown’s efforts to better understand country progress towards Millennium Development Goals 4 and 5, analyses of domestic health care financing and official development assistance were completed for each country case study. These analyses documented trends in reproductive, maternal and child health expenditures, tracked government, external and out-of-pocket health expenditures and examined how health spending correlated with reproductive, maternal, newborn and child health outcomes. Below are summaries of the findings from Peru and Ethiopia, two countries that achieved Millennium Development Goal 4. Health financing in Peru Peru has made remarkable achievements in the last two decades to reduce under-five, maternal and neonatal mortality; these achievements were accompanied by increased health financing. Over the past 15 years total health expenditure more than doubled in real terms, boosting per capita health expenditure from $195 in 1995 to $333 in 2012.1 However, health expenditure as a percentage of GDP changed little, fluctuating around 4% to 5%, because of the country’s rapid economic growth.2 Peru experienced a similar increase for reproductive, maternal, newborn and child health financing: from $72 in 1999 to $2,135 in 2012.3 Reproductive, maternal and newborn health expenditure per pregnant woman rose from $828 in 2006 to $1,644 in 2012, and child health expenditure per child rose from $119 in 2006 to $319 in 2012. The increase in reproductive, maternal, newborn and child health expenditure was funded mainly domestically, as donor funding as a form of official development assistance averaged only 4% of total reproductive, maternal, newborn and child health expenditure between 2003 and 2012. Government expenditures grew from 24% of reproductive, maternal, newborn and child health expenditures in 2006 to 40% in 2012; however, household out-ofpocket spending remains high, at 26% in 2012. For child health in particular, Peru saw a rapid increase in government contributions, which rose from 24% of child health expenditures in 2006 to 47% in 2012. Consequently, the contribution of household out-ofpocket spending fell from 34% in 2006 to 23% in 2012.

Several main policies and movements can be linked to the rise in reproductive, maternal, newborn and child health spending in the past 15 years. During the 1990s increased focus on social assistance and family planning policies and programmes appears to have fuelled increases in reproductive, maternal, newborn and child health expenditure. In the 2000s stronger civil society advocacy further spurred political commitments on maternal and child health, leading to increased government expenditure on reproductive, maternal, newborn and child health interventions. From 2007 onwards, Peru also adopted results-based budgeting policies, which likely improved efficient spending with the potential to translate into better reproductive, maternal, newborn and child health outcomes now and in the future. Health spending in Ethiopia Although Ethiopia will not achieve Millennium Development Goal 5, the country achieved Millennium Development Goal 4 before the 2015 deadline. Over the past 15 years (1995/96–2010/11) Ethiopia has invested heavily in health. Total health expenditure as a percentage of GDP increased from 3.8% in 1995/96 to 5.2% in 2010/11.4 This led to an increase in per capita health expenditure of about 400%, from $4.09 in 1995/96 to $20.77 in 2010/11. Ethiopia’s spending on reproductive, maternal, newborn and child health experienced a similar increase from 2004/05 to 2010/11. Per capita reproductive and maternal health spending tripled (from $3.69 to $12), and per capita child health spending doubled (from $8 to $16) in nominal terms. The rapid growth in reproductive and maternal health funding between 2005 and 2011 was due mostly to continued high external support (outside sources accounted for 44% of total reproductive and maternal health expenditures in 2004/05 and 47% in 2010/11). The government’s contribution also increased from 19% in 2004/05 to 25% in 2010/11. These funding increases reduced household out-of-pocket spending for reproductive and maternal health 10 percentage points. By contrast, household out-of-pocket spending for child health increased, from 42% of total child health spending in 2004/05 to 48% in 2010/11, while contributions to child health from government and external resources stagnated or decreased.5 (continued)

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

BOX 13 (CONTINUED)

Financing for women’s and children’s health in Ethiopia and Peru Ethiopia mobilized more external resources for health (especially for reproductive and maternal health) through its harmonization initiative to enhance donor effectiveness. Acceleration in reproductive, maternal, newborn and child health funding between 2005 and 2011 enabled some health sectorwide changes, including the expansion of service delivery programmes such as the Health Extension Program and the community-based nutrition programme.

two countries’ development status. Peru, an upper middle-income country, relied mostly on domestic funding, while Ethiopia, a low-income country, relied heavily on external funding. Despite these differences, both countries have high out-of-pocket spending, which should be addressed to make health care more affordable to lower income groups and to improve the sustainability of health gains achieved. Notes

* * *

1. All dollar values in the discussion of Peru are in 2012 U.S. dollars. 2. WHO Global Health Expenditure Database.

The Peru and Ethiopia case studies show that both countries had strong political support for reproductive, maternal, newborn and child health and experienced rapid growth in total health expenditure and reproductive, maternal, newborn and child health expenditure in the past decade. Yet that growth resulted from different sources, perhaps related to the

3. Peru Ministry of Economy and Finance, Organisation for Economic Co-operation and Development Creditor Reporting System, Encuesta Nacional de Hogares andInstituto Nacional de Estadística e Informática (INEI). 4. All dollar values in the discussion of Ethiopia are in nominal U.S. dollars. 5. Ethiopian Public Health Institute 2015.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Monitoring and accountability: how the Countdown experience can inform the Sustainable Development Goals The Millennium Development Goals encouraged global political consensus, provided a focus for advocacy and visibility, improved the targeting and flow of aid and strengthened monitoring of process and outcome indicators.58 Within the context of the health Millennium Development Goals, Countdown played a unique role as a multistakeholder initiative aimed at monitoring and accountability. The country profiles and the global report linked to peer-reviewed journal articles in The Lancet, coupled with dissemination through a global event, represented Countdown’s persistent efforts to galvanize evidence-based advocacy for women’s and children’s health. Its success in advocacy and in country-level monitoring and accountability for Millennium Development Goals 4 and 5 was complemented by other initiatives, such as the independent Expert Review Group on Information and Accountability for Women’s and Children’s Health,59 that relied heavily on Countdown’s analysis and interpretation of data to push for global accountability. Countdown’s experience has inspired others. For example, advocates for the Non-Communicable Diseases Countdown 2025 wrote, “Lessons from Countdown to 2015 include the importance of collaboration and inclusiveness; adaptation of global targets to the national situation; regular measurement; transparent review and publication of progress on priority interventions and outcomes; strong engagement of academia and civil society; regular reports based on fairly simple summaries of country progress; and adequate resources. Countdown to 2015, while retaining a core of basic information, has evolved to include detailed country reports and shows the value of a strong and independent partnership for global health.”60 Leaders of global initiatives developed to track physical activity61 and nutrition62 also acknowledge that Countdown has inspired their work. This final Countdown report focuses on trends over the past 15 years. Intervention coverage

increased for most interventions, and particularly for interventions that received substantial donor investment, such as those against malaria and HIV.63 The gap in intervention coverage between rich and poor seems to be narrowing, at least for interventions that have been available in lowincome countries for many years, as well as for some interventions introduced more recently that benefit from strong political support and do not require functional health systems such as insecticide-treated nets and new vaccines (rotavirus and pneumococcal). More countries are adopting supportive policies, and financing for reproductive, maternal, newborn and child health has increased. But each of these positive statements about general trends must be qualified. Cost-effective interventions still fail to reach a large proportion of those who need them. Socioeconomic inequities in coverage remain rampant. Political conflict severely disrupts health service delivery in many Countdown countries. Most countries still lack essential policies and sufficient and equitably distributed human resources and commodities. And despite increased funding, there is still a huge shortfall of reliable, sustainable resources for reproductive, maternal, newborn, child and adolescent health, plus a tendency for donors and governments to favour a few types of interventions (such as vaccines and family planning) over others (such as promoting breastfeeding and managing diarrhoea and pneumonia). The Sustainable Development Goals are unquestionably much broader and more complex than the Millennium Development Goals—and will bring about substantive challenges to monitoring and accountability. This final section discusses how lessons from the Countdown process may be relevant to the Sustainable Development Goals era. • Establish clear, consistent baseline data. The Millennium Development Goals were launched

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

in 2000 with a baseline of 1990, a peculiar choice implying that signatory countries were accountable for trends in the intervening decade. In addition, the absence of consistent, comparable, timely data on births and deaths led to complex modelling procedures for estimating current and past maternal and child mortality in many countries. Reliance on these methods meant that historical trends were revised every time new data became available. Baseline values therefore kept changing, and countries seemed to be aiming at moving targets. Fortunately, the starting date for the Sustainable Development Goals is fixed in 2015, but substantial investments in data collection are urgently needed to provide valid and precise baseline values.64 • Solve the modelled mortality problem. Whereas child mortality estimates are modelled based on actual mortality data from censuses, surveys or civil registration, maternal mortality was, until 2015, modelled for most low- and middle-income countries based on predictor variables such as gross domestic product per capita, general fertility rate and coverage of skilled attendants at delivery due to lack of sufficient data points.65 The model only changed in 2015 to take better account of the gradually increasing number of data points from death registration systems, censuses and surveys. Despite important problems with the acceptability of modelled estimates in many countries, very few countries have invested in large-scale data collection efforts able to accurately measure maternal mortality,66 and even fewer countries have developed fullscale registration systems that yield reliable mortality statistics.67 Stillbirths should also not be forgotten—and must be included in efforts to collect better mortality data. • Improve measurement and data collection. In addition to dependence on modelled mortality estimates during the Millennium Development Goals era, coverage measurements were derived from infrequent household surveys and ad hoc systems for tracking policies, health system measures and funding flows. The Millennium Development Goals framework has also been justly criticized for its neglect of equity. The international community must invest now in improving measurement. Measuring effective coverage and quality of preventive and curative interventions deserves special attention. Regular surveys using consistent measurement of equity stratifiers, such as

wealth, residence or ethnicity, are also essential for tracking progress over time in reaching priority and disadvantaged groups with lifesaving interventions. Much more should be done to obtain subnational statistics, a major gap identified by countries. Doing so will likely involve a mix of population-based, facility-based and administrative data sources. • Ensure that common standards of measurement and reporting are used. Some of the larger Countdown countries (including China, Brazil, Mexico and South Africa) conducted their own surveys or substantially modified existing surveys such as Demographic and Health Surveys and Multiple Indicator Cluster Surveys. This has resulted in a lack of comparability of data from these countries on several core indicators. It is strongly recommend that countries measure and report on core indicators using international standards. • Set relative targets to complement fixed targets for assessing country progress. Countdown’s experience with monitoring progress towards the Millennium Development Goals shows the importance of setting targets as proportional improvements in outcomes over time that thus have universal relevance. For example, Millennium Development Goals 4 and 5 were clearly defined, with quantitative goals for relative mortality reductions. The corresponding Sustainable Development Goals (3.1 and 3.2) propose absolute targets of 25 deaths per 1,000 live births or less at the national level for underfive mortality, 12 deaths per 1,000 live births or less at the national level for neonatal mortality and 70 deaths per 100,000 live births or less at the global level for maternal mortality by 2030. According to 2015 estimates, 8 Countdown countries already meet the target for the underfive mortality rate below 25, and 11 meet the target for the maternal mortality ratio (see table 1). What type of progress, if any, should these countries be aiming for? Based on Countdown’s interaction with countries regarding progress towards global goals, the provisional Sustainable Development Goal targets must be urgently revisited and improved. The targets need to be more country-specific and to consider equity, so that progress can be assessed against baselines. • Set targets that are aspirational but also achievable. That only 25 Countdown countries will achieve Millennium Development Goal 4 and only 6 will achieve Millennium Development

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Goal 5 suggests that the original targets were too ambitious, particularly in view of the progress in financial flows to reproductive, maternal, newborn and child health and health system strengthening (such as addressing the human resource crisis and adopting and implementing supportive policies). Targets should still be set that push countries to strive to achieve them but that are realistic and take into consideration country contexts. • Track specific coverage indicators and a composite coverage index. The Countdown experience highlights the importance of focusing on interventions with an evidencebased impact on health status and of tracking how coverage for these interventions changed over time on a country-by-country basis. Although a huge task, monitoring 73 coverage indicators provides specific feedback on what needs to be improved and where. Such detail is essential but is complemented by a summary measure—the Composite Coverage Index. Rigorous tests have shown that it is robust, stable and highly associated with measures of mortality. In fact, the Composite Coverage Index provides a promising approach to measuring universal health coverage and includes a focus on equity, two pillars at the heart of the health Sustainable Development Goal. • Choose indicators carefully and balance focus with breadth. The large number of Sustainable Development Goal targets—recently estimated at 169—has brought about substantial criticism.68 Each target will require specific indicators, often two or more. The Countdown experience shows that an initial, short list of goals, targets and associated indicators can expand rapidly over time, as new interventions become available and as interest groups lobby —often with strong justification—for additional indicators. A rigorous technical process must be in place for ensuring the validity and reliability of new indicators, for ensuring that monitoring efforts stay coordinated and focused, for minimizing the reporting burden on countries and for ensuring that indicators are relevant to policymakers and program managers. Countdown’s niche has been country-level intervention coverage. This focus recognizes that

biomedical interventions are one of the most important pathways through which broader contextual and health systems factors affect women’s and children’s health. During the Sustainable Development Goals era, with its focus on a wider set of health challenges and emphasis on universal health care, tracking progress in social and environmental determinants—including understanding the multiple pathways through which these determinants impact health and development—will be just as important as tracking progress in coverage and health status. These efforts will likely face data availability challenges similar to those faced by Countdown. Several aspects of the Countdown experience may be relevant to similar initiatives in the Sustainable Development Goals era. Involving multiple stakeholders is essential for ensuring that data lead to action. Retaining scientific independence while forging a partnership of stakeholders with different interests and agendas is not always a smooth process, but Countdown achieved and maintained consensus about the indicators that should be monitored and disseminated based on the evidence. Positive pressure from stakeholders led to Countdown’s expansion from child survival in 2003 to the full reproductive, maternal, newborn and child health continuum of care. Balancing focus with breadth is not easy, and will likely be even harder in the Sustainable Development Goals era, both within the health goal and across all 17 Sustainable Development Goals. Regardless of what lies ahead, Countdown’s experience over the past 10 years has established the importance and feasibility of a vibrant multistakeholder initiative with independence and a strong technical component in accelerating progress for the world’s women and children. The launch and growth of Every Woman Every Child under the auspices of the UN Secretary-General, further supported by a new Global Financing Facility,69 increase the relevance of Countdown’s work, challenging it to rise to the occasion by continuing its independent monitoring role and innovative technical work at the global and country levels, with the ultimate aim of holding all to account for saving women’s and children’s lives over the next 15 years. Countdown stands ready to begin.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Country profiles

The information summarized in the profiles is intended to help policymakers and their partners assess progress, prioritize actions and ensure accountability for commitments to reduce maternal, newborn, and child mortality. The following section contains profiles for the 75 Countdown countries: Afghanistan Angola Azerbaijan Bangladesh Benin Bolivia Botswana Brazil Burkina Faso Burundi Cambodia Cameroon Central African Republic Chad China Comoros Congo Congo, Democratic Republic of the Côte d’Ivoire Djibouti Egypt Equatorial Guinea Eritrea Ethiopia Gabon Gambia, The Ghana Guatemala Guinea Guinea-Bissau Haiti India Indonesia

Iraq Kenya Korea, Democratic People’s Republic of Kyrgyzstan Lao People’s Democratic Republic Lesotho Liberia Madagascar Malawi Mali Mauritania Mexico Morocco Mozambique Myanmar Nepal Niger Nigeria Pakistan Papua New Guinea Peru Philippines Rwanda São Tomé and Príncipe Senegal Sierra Leone Solomon Islands Somalia South Africa South Sudan Sudan Swaziland Tajikistan Tanzania, United Republic of Togo Turkmenistan Uganda Uzbekistan Viet Nam Yemen Zambia Zimbabwe

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

The Countdown country profile: a tool for action

The Countdown country profiles present in one place the latest evidence to assess country progress in improving reproductive, maternal, newborn and child health. The two-page profiles in this report are updated every two years with new data and analyses. Countdown has also committed to annually updating the core indicators selected by the Commission on Information and Accountability for Women’s and Children’s Health.

Reviewing the information The first step in using the country profiles is to explore the range of data presented: demographics, mortality, coverage of evidencebased interventions, nutritional status and socioeconomic equity in coverage, and information on policies, health systems and financing. Key questions in reviewing the data include: • Are trends in mortality and nutritional status moving in the right direction? Is the country on track to achieve the health-related Millennium Development Goals? • How high is coverage for each intervention? Are trends moving in the right direction towards universal coverage? Are there gaps in coverage for specific interventions? • How equitable is coverage? Are certain interventions particularly inaccessible for the poorest segment of the population? • Are key policies and systems measures and adequate funding in place to bring coverage of key interventions to scale?

Identifying areas to accelerate progress The second step in using the country profiles is to identify opportunities to address coverage gaps and accelerate progress in improving coverage and health outcomes across the continuum of care. Questions to ask include:

• Are the coverage data consistent with the epidemiological situation? For example: • If pneumonia deaths are high, are policies in place to support community case management of pneumonia? Are coverage levels low for careseeking and antibiotic treatment for pneumonia, and what can be done to reach universal coverage? Are the rates of deaths due to diarrhoea consistent with the coverage levels and trends of improved water sources and sanitation facilities? • In priority countries for eliminating motherto-child transmission of HIV, are sufficient resources being targeted to preventing mother-to-child transmission? • Does lagging progress on reducing maternal mortality or high newborn mortality reflect low coverage of family planning, antenatal care, skilled attendant at delivery and postnatal care? • Do any patterns in the coverage data suggest clear action steps? For example, coverage for interventions involving treatment of an acute need (such as treatment of childhood diseases and childbirth services) is often lower than coverage for interventions delivered routinely through outreach or scheduled in advance (such as vaccinations). This gap suggests that health systems need to be strengthened, for example by training and deploying skilled health workers to increase access to care. • Do the gaps and inequities in coverage along the continuum of care suggest prioritizing specific interventions and increasing funding for reproductive, maternal, newborn and child health? For example, is universal access to labour, childbirth and immediate postnatal care being prioritized in countries with gaps in interventions delivered around the time of birth?

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Sample country profile Intervention coverage These charts show most recent coverage levels and trends for selected reproductive, maternal, newborn and child health interventions.

Key population characteristics These demographic indicators include the proportion of newborn deaths among all deaths of children under age 5, a Commission on Information and Accountability for Women’s and Children’s Health indicator.

Impact: under-5 mortality rate and maternal mortality ratio These charts display trends over time, reﬂecting progress towards reaching the Millennium Development Goal 4 and 5 targets.

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Benin

DEMOGRAPHICS

DEMOGRAPHICS (2015)

1,708

(2015)

388

(2015)

Birth registration (%) Total under-five deaths (000)

80 37

(2011-2012)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

32 64

(2015)

Total under-five population (000) Births (000)

Stillbirth rate (per 1000 total births)

(2015)

(2009)

1,300

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.7

(2015)

(2009)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

200

180

150 100

100

MDG Target: 60

50 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

700 600 600 500 400 300 200 100 0 1990

150

2000

2005

2010

Birth

Neonatal period

Percent

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

80 53

60 40 20

1996 DHS

2001 DHS

2006 DHS

2011-2012 DHS

2014 pMICS

>1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

Richest 20%

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Pneumonia treatment

Percent

70 70 70 63

Early initiation of breastfeeding

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

Measles

0 2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

60 32

31 23

20 2010

2014

(2014)

(2006)

1996 DHS

2001 DHS

2006 DHS

2011-2012 DHS

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100 Percent

Coverage levels are shown for the poorest 20% (red circles) and the richest 20% (orange circles). The longer the line between the two groups, the greater the inequality. These estimates may differ from other charts due to differences in data sources.

Percent

Source: DHS 2011-2012

100

20 0

39 20

40 20

2001 DHS

2006 DHS

2014 pMICS

2006 DHS

2011-2012 DHS

Yes Yes

Low osmolarity ORS and zinc for management of diarrhoea

(2014)

SYSTEMS

Postnatal visit for mother

(2014)

(2006)

C-section rate (total, urban, rural; %)

(within 2 days, %)

(within 2 days , %)

1996 DHS

2001 DHS

2006 DHS

100 80 60 40 20 0

2011-2012 DHS

2014 pMICS

Women with low body mass index (<18.5 kg/m2, %)

Malaria prevention and treatment Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

49 50 42

42 23

26 1996 DHS

33 23

2001 DHS

2006 DHS

2011-2012 DHS

13 (2014)

2 20

51 60

34 15

2015 Urban

1990

2015 Rural

2006 DHS

2011-2012 DHS

2014 pMICS

Source: WHO/UNICEF JMP 2015

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

8.3

(2008)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

34 (2011)

8 6 7

2015 Total

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

41 (2013)

Private sources

(2012)

26 52

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

16 7 10 7

36 20

1990

(2013)

External sources

25 53

60 79

General government expenditure on health as % of total government expenditure (%)

General government expenditure

100 80

Per capita total expenditure on health (Int$)

Available Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Reproductive health (X of 3) Maternal health (X of 3)

FINANCING

Improved sanitation coverage

20 5

2015 1990 Total

(2015)

Life Saving Commodities in Essential Medicine List:

National availability of Emergency Obstetric Care services

2001 DHS

1990

3 28

Yes

Costed national implementation plan(s) for: maternal, newborn and child health available

(% of recommended minimum)

100 80 60 40 20 0

2014 pMICS

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

2014 pMICS

Yes

Community treatment of pneumonia with antibiotics

(2014)

0 2001 DHS

(2011-2012)

Yes

International Code of Marketing of Breastmilk Substitutes

(2014)

10 1996 DHS

Antenatal corticosteroids as part of management of preterm labour

100

0 1996 DHS

Malaria during pregnancy - intermittent preventive treatment (%)

Yes Yes

(2014)

WATER AND SANITATION

100 80

(2011-2012)

Postnatal home visits in the first week after birth Kangaroo Mother Care in facilities for low birthweight/preterm newborns

5, 0, 0

Improved drinking water coverage Improved drinking water coverage

(2013)

Percent of infants <6 months exclusively breastfed

Exclusive breastfeeding

Percent

Careseeking for pneumonia

2014 pMICS

Early initiation of breastfeeding (within 1 hr of birth, %) 50 (2011-2012) Introduction of solid, semi-solid/soft foods (%) 59 (2011-2012) Vitamin A two dose coverage (%)

ORT & continued feeding

Antenatal care (4 or more visits, %)

Yes

Postnatal visit for baby

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80

Antenatal care (4+ visits)

Demand for family planning satisfied (%)

7 Yes

Maternal deaths notification

Neonatal tetanus vaccine

Diarrhoeal disease treatment

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

Skilled attendant at delivery

Source: WHO 2014

CHILD HEALTH

Percent

Poorest 20%

Indirect 29%

(Minimum target is 5% and maximum target is 15%)

Percent

Household wealth quintile: Demand for family planning satisfied Antenatal care (1+ visit)

20 2014

CHILD HEALTH

Socioeconomic inequities in coverage

3(R,F)

Maternity protection (Convention 183)

* See Annex/website for indicator definition

EQUITY

Partial

Legal status of abortion (X of 5 circumstances)

100

20 40 60 80 100

Antenatal care

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

Measles

Source: DHS, MICS, Other NS

Hypertension 16%

0% 11% Source: Malaria 12% Diarrhoea WHO/MCEE 2015 (provisional) Injuries 5% Measles 1% * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

2015

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Midwives authorized for specific tasks (X of 7 tasks)

Other direct 9%

Sepsis** 7%

53 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Haemorrhage 25%

Congenital 2%

HIV/AIDS 1%

Percent

Abortion 10%

Asphyxia* 8%

MDG Target

1995

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

MATERNAL AND NEWBORN HEALTH

Percent

Exclusive breastfeeding

Sepsis 10%

Other 2%

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

*Postnatal care

Neonatal death: 32%

340

Source: MMEIG 2014

Skilled attendant at delivery

Pre-pregnancy Pregnancy

Globally nearly half of child deaths are attributable to undernutrition

2% Preterm 11%

Other 25%

MATERNAL AND NEWBORN HEALTH 28

Pneumonia

13%

Note: MDG target calculated by Countdown to 2015.

Coverage along the continuum of care

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015

Deaths per 100,000 live births

Percent

10,880

Percent

Total population (000)

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Policies These indicators show whether needed policies are in place to support the introduction and scale-up of proven interventions.

Cause of death These charts provide information useful for interpreting the coverage measures and identifying programmatic priorities.

1990

2015

1990

Urban

2015 Rural

Source: WHO/UNICEF JMP 2015

Equity in coverage Socioeconomic inequities in coverage highlight the need for concerted eﬀorts to improve coverage among the poorest.

Nutrition Undernutrition contributes to nearly half of all deaths among children under age 5 globally.

Water and sanitation Water and sanitation from improved sources are essential for reducing transmission of infectious disease.

Health systems and ﬁnancing These indicators provide information on health system strength and available ﬁnancing for scaling up interventions.

Continuum of care Gaps in coverage along the continuum of care from pre-pregnancy and childbirth through childhood up to age 5 should serve as a call to action for a country to prioritize these interventions.

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Afghanistan DEMOGRAPHICS Total population (000)

32,527

(2015)

Total under-five population (000)

4,950

(2015)

Births (000)

1,081

(2015)

Birth registration (%) Total under-five deaths (000)

37 94

(2010-2011)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

36 66

(2015)

Stillbirth rate (per 1000 total births)

(2009)

4,200

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.7

(2015)

(2008)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

1400 1200 1200 1000 800 600 400 200 0 1990 1995

181

150 100

MDG Target: 60

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

400 300 MDG Target

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

*Postnatal care

Birth

Neonatal period

Exclusive breastfeeding Measles

Source: DHS, MICS, Other NS

6 4 2

20 40 60 80 100

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

1 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy 39

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2003 MICS

Percent

2008 Other NS

2010 DHS

2010-2011 MICS

<1 2005

<1 2008

2011

Source: UNICEF/UNAIDS/WHO 2015

1 2014

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100 80

75 75 66

80 Percent

Skilled attendant at delivery

Percent

100

Antenatal care (4+ visits)

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

Measles

2000

2005

ORT & continued feeding

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

(2013)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

Early initiation of breastfeeding (within 1 hr of birth, %) 54 Introduction of solid, semi-solid/soft foods (%) -

(2011)

Vitamin A two dose coverage (%)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

Percent

2010-2011 MICS

100

Percent

Source: MICS 2010-2011

Early initiation of breastfeeding

60 40

53 45

33 25

20 0

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

1997 MICS

2004 Other NS

2013 Other NS

No Data

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Afghanistan DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 12%

17%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 10%

Neonatal death: 38%

Sepsis 14%

Embolism 2%

Haemorrhage 30%

Abortion 6% Other direct 8%

Other 3%

Other 24%

Regional estimates for South Asia, 2013

Congenital 2% Sepsis** 8% HIV/AIDS 0%

12%

Source: WHO/MCEE 2015 Injuries 7% Measles 1% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis Malaria 0%

Hypertension 10%

Indirect 29%

Diarrhoea

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

(2010-2011)

4, 9, 2

(2010-2011)

(2014)

(2010)

Antenatal care (4 or more visits, %) Malaria during pregnancy - intermittent preventive treatment (%)

100

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby (within 2 days, %)

Postnatal visit for mother

(within 2 days , %)

2003 MICS

2008 Other NS

2010 DHS

2010-2011 MICS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

2003 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

36 31

21 1

1995

2015 1995 Total

Source: WHO/UNICEF JMP 2015

Percent of population by type of sanitation facility, 1995-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100 80

2015 Urban

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

20 5

1995

2015 Rural

33 43

(2015)

Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

4 3

(2015)

6.8

(2009)

143

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

22 12

1995

2015 Total

External sources

38 48 37

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

8 45

No Data

General government expenditure

16 0

Yes

Life Saving Commodities in Essential Medicine List:

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

40 37 20

Maternity protection (Convention 183)

Out of pocket expenditure as % of total expenditure on health(%)

2 20

General government expenditure on health as % of total government expenditure (%)

Percent

Midwives authorized for specific tasks (X of 7 tasks)

Per capita total expenditure on health (Int$)

Very limited risk

Percent of population by type of drinking water source, 1995-2015 Piped on premises Other improved Surface water Unimproved

FINANCING

2010-2011 MICS

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

Improved drinking water coverage

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1995

2015 Urban

1995

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Angola DEMOGRAPHICS Total population (000)

25,022

(2015)

Total under-five population (000)

4,718

(2015)

Births (000)

1,128

(2015)

36 169

(2001)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

49 96

(2015)

150

(2015)

100

Stillbirth rate (per 1000 total births)

(2009)

4,400

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

6.0

(2015)

Adolescent birth rate (per 1000 girls)

191

(2009)

Birth registration (%) Total under-five deaths (000)

Total maternal deaths

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

250

1500

226

1400

200 157 MDG Target: 75

1000 460

500

350

0 1990

1995

2000

2005

2010

0 1990

2015

Source: UN IGME 2015

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

Birth

*Postnatal care

Neonatal period

Exclusive breastfeeding Measles

1996 MICS

Percent

2006-2007 Other NS

40 20

20 40 60 80 100

Source: DHS, MICS, Other NS

100

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

45 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

3 2005

2008

Source: UNICEF/UNAIDS/WHO 2015

14 2011

2014

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

40 20

Early initiation of breastfeeding ITN use among children <5 yrs

85 80 80 61

Antenatal care (4+ visits)

No Data

1990

1995

2000

Source: WHO/UNICEF 2015

2005

2010

2014

NUTRITION

DTP3 Measles

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months) ORT & continued feeding

(2007)

(2000)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

Early initiation of breastfeeding (within 1 hr of birth, %) 55 Introduction of solid, semi-solid/soft foods (%) -

(2007)

Vitamin A two dose coverage (%)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100 80 Percent

Percent

60 40

37 16

20 0

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

No Data

Pneumonia treatment

1996 MICS

2007 Other NS

No Data

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Angola DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

15%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 10%

Asphyxia* 9%

Neonatal death: 31%

Sepsis 10%

Embolism 2%

Abortion 10%

Other 2%

Other 26%

Regional estimates for Sub-Saharan Africa, 2013

Haemorrhage 25%

Other direct 9%

Congenital 2% Sepsis** 6% 14%

HIV/AIDS 1%

Hypertension 16%

Source: Diarrhoea Malaria 6% WHO/MCEE 2015 Injuries 5% Measles 0% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

100

80 Percent

Antenatal care (4 or more visits, %)

(1996)

Malaria during pregnancy - intermittent preventive treatment (%)

(2011)

Demand for family planning satisfied (%)

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(within 2 days, %)

20 0

(within 2 days , %)

2006-2007 Other NS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Percent

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

No Data

77 (2011)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

1990

21 32

Source: WHO/UNICEF JMP 2015

26 2

2015 1990 Total

2015 Urban

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

1990

2015 Rural

30 64

2011 Other NS

(2015)

Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

18.3

(2009)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

(2015)

25 (2006)

2015 Total

(2013)

No Data

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

1990

52 22

(2013)

Private sources

89 14

(2013)

External sources

355

General government expenditure

1 10

60 40

Yes

Life Saving Commodities in Essential Medicine List:

General government expenditure on health as % of total government expenditure (%)

Percent of population by type of sanitation facility, 1990-2015 Unimproved facilities Improved and shared facilities Open defecation

FINANCING

100

40 20

Midwives authorized for specific tasks (X of 7 tasks)

Per capita total expenditure on health (Int$)

Improved sanitation coverage

Percent

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

Legal status of abortion (X of 5 circumstances)

National availability of Emergency Obstetric Care services

WATER AND SANITATION

(% of recommended minimum)

100 80 60 40 20 0

2006-2007 Other NS

100

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Azerbaijan DEMOGRAPHICS Total population (000)

9,754

(2015)

Total under-five population (000)

930

(2015)

Births (000)

193

(2015)

Birth registration (%) Total under-five deaths (000)

94 7

(2006)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

18 28

(2015)

Stillbirth rate (per 1000 total births)

(2009)

Total maternal deaths Lifetime risk of maternal death (1 in N) Total fertility rate (per woman) Adolescent birth rate (per 1000 girls)

(2015)

(2013)

1,800

(2013)

2.3

(2015)

(2013)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

100

120 95 100 80 60 40 20 0 1990

60 MDG Target: 32

1995

2000

2005

2010

2015

Source: UN IGME 2015

0 1990

1995

2000

2005

2010

MDG Target

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 77

*Postnatal care

Exclusive breastfeeding

100

Pre-pregnancy Pregnancy

Birth

Neonatal period

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

100

Percent

60 40 20

1990 Other NS

1998 Other NS

46 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

20 40 60 80 100

Source: DHS, MICS, Other NS

100

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2000 MICS

2006 DHS

2011 DHS

28 <1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

100 80

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months) ORT & continued feeding

(2013)

(2006)

Percent of children <5 years who are moderately or severely: underweight stunted

100

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 32 Introduction of solid, semi-solid/soft foods (%) 83

(2006)

Vitamin A two dose coverage (%)

(2013)

Percent of infants <6 months exclusively breastfed

100

40 20 0

Exclusive breastfeeding

28 9 1996 Other NS

2000 MICS

18 6 2001 Other NS

Percent

0 10 20 30 40 50 60 70 80 90 100

2000 MICS

2014

Underweight and stunting prevalence

Careseeking for pneumonia

Measles

ITN use among children <5 yrs

Source: DHS 2006

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

98 94 94 64

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

8 2006 DHS

18 5 2013 Other NS

40 20

2006 DHS

2013 Other NS

0 2000 MICS

(2006)

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Azerbaijan DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Globally nearly half of child deaths are attributable to undernutrition

Preterm 22%

Neonatal death: 59%

Sepsis 9%

Embolism 11%

Abortion 5%

Other direct 17%

Asphyxia* 12%

Other 20%

Regional estimates for Caucasus and Central Asia, 2013

Haemorrhage 23%

Other 4%

HIV/AIDS 0%

Congenital 10%

Malaria 0% Sepsis** 8%

Source: WHO/MCEE 2015 Measles 0% (provisional) Diarrhoea * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis Injuries 6%

Hypertension 15%

Indirect 22%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy 92

100

Percent

Demand for family planning satisfied (%)

(2006)

Antenatal care (4 or more visits, %)

(2011)

20, 25, 13

(2011)

Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby

(2011)

(2006)

(within 2 days, %)

Postnatal visit for mother

(within 2 days , %)

1997 MoH

2000 MICS

1996-2001 Other NS

2006 DHS

2011 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

10 2000 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2006 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2011 DHS

Percent

89 66

38 11

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

100 0 80 60

2015 Urban

1990

2015 Rural

5 6

Maternity protection (Convention 183)

Yes

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

2 -

(2015)

99.4

(2013)

957

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

Reproductive, maternal, newborn and child health expenditure by source

0 18

00 8

External sources

0 11 2

0 50

89 63

Private sources

ODA to child health per child (US$) ODA to maternal and neonatal health per live birth (US$)

No Data

General government expenditure

(R,F)

FINANCING

Percent of population by type of sanitation facility, 1995-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Midwives authorized for specific tasks (X of 7 tasks)

Per capita total expenditure on health (Int$)

Improved sanitation coverage

Percent

80 20

5 0 6

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 1 14

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

100 80 60 40 20 0

2000 MICS

Improved drinking water coverage 2

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

(2012)

Note: See annexes for additional information on the indicators above

75 49

1995

2015 Total

1995

2015 Urban

1995

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Bangladesh DEMOGRAPHICS Total population (000)

160,996

(2015)

15,331

(2015)

3,134

(2015)

31 119

(2011)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

23 31

(2015)

Stillbirth rate (per 1000 total births)

(2009)

5,200

(2013)

Lifetime risk of maternal death (1 in N)

250

(2013)

Total fertility rate (per woman)

2.1

(2015)

(2011)

Total under-five population (000) Births (000) Birth registration (%) Total under-five deaths (000)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

600

150

550

500

144

400 300

100 50 0 1990

1995

2000

2005

MDG Target: 48

200

100

2010

2015

Source: UN IGME 2015

170 140

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

*Postnatal care

Exclusive breastfeeding

Neonatal period

Measles

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

18 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

10 1993-94 1999-00 DHS DHS

2004 DHS

2007 DHS

2011 DHS

2014 pDHS

<1 2005

2008

Source: UNICEF/UNAIDS/WHO 2015

2011

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine 95 95 89

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100 80

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Measles

2014

(2014)

(2006)

1993-94 1999-00 DHS DHS

2007 DHS

2011 DHS

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

2004 DHS

0 10 20 30 40 50 60 70 80 90 100

100 80

Percent

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100 80

62 63 42

41 43

33 36

64 46

2004 DHS

2007 DHS

40 20

20 0

2014 pDHS

Early initiation of breastfeeding (within 1 hr of birth, %) 44 (2013) Introduction of solid, semi-solid/soft foods (%) 42 (2012-2013)

Percent

Careseeking for pneumonia

Vitamin A two dose coverage (%)

ORT & continued feeding

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

Source: DHS 2011

Pneumonia treatment

Percent

EQUITY

0 1989-90 1999-00 Other NS DHS

2004 DHS

2007 DHS

2011 DHS

2014 pDHS

1993-94 1999-00 DHS DHS

2011 DHS

2014 pDHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Bangladesh DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 19%

11%

Globally nearly half of child deaths are attributable to undernutrition

Neonatal death: 62%

Other 14%

Other 4%

Malaria 0%

Congenital 8% 6%

Measles 2%

Diarrhoea

* Intrapartum-related events

Haemorrhage 30%

Other direct 8%

Source: WHO/MCEE 2015 (provisional)

Sepsis** 13%

Embolism 2%

Abortion 6%

Asphyxia* 14%

HIV/AIDS 0%

Injuries 5%

Sepsis 14%

Regional estimates for South Asia, 2013

Hypertension 10%

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

80 Percent

Demand for family planning satisfied (%)

(2012-2013)

Antenatal care (4 or more visits, %)

(2014)

23, 38, 18

(2014)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2014)

Postnatal visit for mother

(2014)

Women with low body mass index

(2011)

Malaria during pregnancy - intermittent preventive treatment (%)

100 52

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

20 0

(within 2 days, %)

(within 2 days , %)

1993-94 1999-00 DHS DHS

2004 DHS

2007 DHS

2011 DHS

2014 pDHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2004 DHS

2011 DHS

55 86

20 0

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

1990

2015 Rural

1 10

40 20

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

2 3

(2015)

Density of doctors, nurses and midwives (per 10,000 population)

5.7

(2011)

National availability of Emergency Obstetric Care services

184 (2012)

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

80 26

Maternal deaths notification

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 2

General government expenditure on health as % of total government expenditure (%)

2014 pDHS

Improved drinking water coverage 0

Midwives authorized for specific tasks (X of 7 tasks)

(2015)

FINANCING

WATER AND SANITATION

100 6

Per capita total expenditure on health (Int$)

Very limited risk 2007 DHS

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

76 78

1993-94 1999-00 DHS DHS

Maternity protection (Convention 183)

** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Antenatal care

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

10 19

28 24

1990

2015 Total

(2013)

No Data

External sources

Private sources

ODA to child health per child (US$) ODA to maternal and neonatal health per live birth (US$)

(2013)

General government expenditure 2 8

0 12

(2012)

Note: See annexes for additional information on the indicators above

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Benin DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

10,880

(2015)

1,708

(2015)

388

(2015)

Birth registration (%) Total under-five deaths (000)

80 37

(2011-2012)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

32 64

(2015)

Stillbirth rate (per 1000 total births)

(2015)

(2009)

1,300

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.7

(2015)

(2009)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

700 600 600 500 400 300 200 100 0 1990

180

150 100

100

MDG Target: 60

50 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

340 150 MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 28

*Postnatal care

Exclusive breastfeeding

Birth

Neonatal period

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

100 80

40 20

20 40 60 80 100

Source: DHS, MICS, Other NS

Infancy

Measles

Percent

53 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

60 40 20

1996 DHS

2001 DHS

2006 DHS

2011-2012 DHS

2014 pMICS

2005

>1 2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100 80

70 70 70 63

80 Percent

Skilled attendant at delivery

Percent

100

Antenatal care (4+ visits)

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Measles

60 32

31 23

Early initiation of breastfeeding

2010

2014

(2014)

(2006)

1996 DHS

2001 DHS

2006 DHS

2011-2012 DHS

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

100 80

60 40

39 26

20 0

(2013)

Percent of infants <6 months exclusively breastfed

Percent

Source: DHS 2011-2012

Exclusive breastfeeding

39 22

Percent

Careseeking for pneumonia

2014 pMICS

Early initiation of breastfeeding (within 1 hr of birth, %) 50 (2011-2012) Introduction of solid, semi-solid/soft foods (%) 59 (2011-2012) Vitamin A two dose coverage (%)

ORT & continued feeding

Pneumonia treatment

40 20

0 1996 DHS

2001 DHS

2006 DHS

2014 pMICS

1996 DHS

2001 DHS

2006 DHS

2011-2012 DHS

2014 pMICS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Benin DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

13%

Globally nearly half of child deaths are attributable to undernutrition

2% Preterm 11%

Other 25%

Neonatal death: 32%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Asphyxia* 8%

Haemorrhage 25%

Other direct 9%

Other 2% Congenital 2%

HIV/AIDS 1%

Sepsis** 7%

Hypertension 16%

11%

Source: WHO/MCEE 2015 (provisional) Injuries 5% Measles 1% * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis Malaria 12%

Indirect 29%

Diarrhoea

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Demand for family planning satisfied (%)

(2011-2012)

Antenatal care (4 or more visits, %)

(2014)

Malaria during pregnancy - intermittent preventive treatment (%)

(2011-2012)

5, 0, 0

(2014)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2014)

Postnatal visit for mother

(2014)

(2006)

(within 2 days, %)

20 0

(within 2 days , %)

1996 DHS

2001 DHS

2006 DHS

2011-2012 DHS

2014 pMICS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

49 50 42

42 23

26 1996 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

33 23

2001 DHS

2006 DHS

2011-2012 DHS

13 (2014)

2 22

Percent

80 60 40

51 60

2006 DHS

2011-2012 DHS

2014 pMICS

1990

34 15

Source: WHO/UNICEF JMP 2015

2015 Urban

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

1990

2015 Rural

Maternity protection (Convention 183)

Yes

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Yes

Costed national implementation plan(s) for: maternal, newborn and child health available

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

8.3

(2008)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

34 (2011)

60 79 8

8 6 7

2015 Total

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

41 (2013)

Private sources

(2012)

26 52

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

16 7 10 7

1990

Per capita total expenditure on health (Int$)

External sources

General government expenditure

100

2015 1990 Total

Midwives authorized for specific tasks (X of 7 tasks)

Available Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

52 18

3 28

20 0

3(R,F)

FINANCING

2001 DHS

Percent

100

Legal status of abortion (X of 5 circumstances)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

Partial

(% of recommended minimum)

100 80 60 40 20 0

2014 pMICS

Improved drinking water coverage

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Bolivia DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

10,725

(2015)

1,186

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

150

600

253

(2015)

Birth registration (%) Total under-five deaths (000)

76 9

(2008)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

20 31

(2015)

MDG Target: 41

Stillbirth rate (per 1000 total births)

(2009)

550

(2013)

Lifetime risk of maternal death (1 in N)

140

(2013)

Total fertility rate (per woman)

2.9

(2015)

(2005)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

124

120

510

500 400

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

300

200

130

100 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 75

*Postnatal care

Exclusive breastfeeding

Birth

Neonatal period

Measles

100

Pre-pregnancy Pregnancy

100

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Infancy

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Percent

40 20

1989 DHS

56 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1994 DHS

1998 DHS

2003 DHS

2008 DHS

2012 Other NS

2005

2008

Source: UNICEF/UNAIDS/WHO 2015

2011

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months) ORT & continued feeding

2014

(2012)

(2008)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

1994 DHS

1998 DHS

2000 MICS

2003 DHS

2008 2011 DHS Other NS

Vitamin A two dose coverage (%)

(2013)

(2008)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100 80

(2008)

Early initiation of breastfeeding (within 1 hr of birth, %) 64 Introduction of solid, semi-solid/soft foods (%) 83

11 1989 DHS

1994 DHS

1998 DHS

2003 DHS

2008 DHS

Percent

Careseeking for pneumonia

62 40

Measles

ITN use among children <5 yrs

Source: DHS 2008

100

Early initiation of breastfeeding

94 95 94

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

1989 DHS

1994 DHS

1998 DHS

2003 DHS

2008 DHS

40 20 0

2012 Other NS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Bolivia DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

11%

Preterm 17% Asphyxia* 13%

Neonatal death: 51%

Other 25%

Globally nearly half of child deaths are attributable to undernutrition

Sepsis 8%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Latin America, 2013

Embolism 3%

Abortion 10%

Haemorrhage 23%

Other direct 15%

Other 4%

Sepsis** 7%

HIV/AIDS 0%

Source: WHO/MCEE 2015 Injuries 7% Measles 0% Diarrhoea (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis Malaria 0%

Hypertension 22%

Indirect 19%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

80 60

(2008)

Antenatal care (4 or more visits, %)

(2012)

27, 34, 13

(2012)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2008)

Postnatal visit for mother

(2008)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Demand for family planning satisfied (%)

Malaria during pregnancy - intermittent preventive treatment (%)

(within 2 days, %)

20 0

(within 2 days , %)

1989 DHS

1994 DHS

1998 DHS

2003 DHS

2008 DHS

2012 Other NS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

59 33

1994 DHS

1998 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2003 DHS

29 35

4 6

2008 DHS

2012 Other NS

0 1

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100 80

16 84

40 20

8 11

18 23

60 40 20

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

Yes

Postnatal home visits in the first week after birth

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

14.8

(2011)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

48 (2003)

1990

2015 Rural

17 46

61 50

1990

2015 Total

1990

2015 Urban

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

No Data

Private sources 46 72

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

2 11

General government expenditure on health as % of total government expenditure (%)

External sources

(2013)

General government expenditure

4 8

372

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

80 13

Partial

Maternal deaths notification

Per capita total expenditure on health (Int$)

Very limited risk

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 1

FINANCING

Improved drinking water coverage

Midwives authorized for specific tasks (X of 7 tasks)

(R)

(% of recommended minimum)

WATER AND SANITATION

100

National availability of Emergency Obstetric Care services

2000 MICS

Legal status of abortion (X of 5 circumstances)

Maternity protection (Convention 183)

Congenital 8%

Partial

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Botswana DEMOGRAPHICS Total population (000) Total under-five population (000)

2,262

(2015)

266

(2015)

Under-five mortality rate

Deaths per 100,000 live births

100

500

Births (000)

(2015)

Birth registration (%) Total under-five deaths (000)

72 2

(2007-2008)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

22 35

(2015)

Stillbirth rate (per 1000 total births)

(2009)

Total maternal deaths

(2015)

(2013)

Lifetime risk of maternal death (1 in N)

200

(2013)

Total fertility rate (per woman)

2.8

(2015)

(2011)

Adolescent birth rate (per 1000 girls)

Maternal mortality ratio

Deaths per 1000 live births

360

400

300 44

MDG Target: 18

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

200

170

100

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

*Postnatal care Exclusive breastfeeding

Birth

Neonatal period

Infancy

Measles

100

60 40 20

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

59 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1988 DHS

Percent

1996 Other NS

2000 MICS

2007 Other NS

2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100 80

No Data

60 40 14

20 0

0 1990

1995

Source: WHO/UNICEF 2015

2000

2005

2010

2000 MICS

2014

NUTRITION

Measles

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months) ORT & continued feeding

(2007)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

(2007)

Vitamin A two dose coverage (%)

(2013)

Percent of infants <6 months exclusively breastfed

100

Percent

60 35

40 20 0

Exclusive breastfeeding

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 40 Introduction of solid, semi-solid/soft foods (%) -

1996 Other NS

29 11

11 2000 MICS

2007 Other NS

Percent

DTP3

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding ITN use among children <5 yrs

97 96 95 82 81

Pneumonia treatment

Percent

EQUITY

60 40

34 20

20 0 2000 MICS

2007 Other NS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Botswana DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 19%

Globally nearly half of child deaths are attributable to undernutrition

Other 22%

Sepsis 10%

Embolism 2%

Abortion 10%

Asphyxia* 11%

Neonatal death: 51%

Regional estimates for Sub-Saharan Africa, 2013

Haemorrhage 25%

Other direct 9%

Other 3% Congenital 7%

HIV/AIDS 5% Malaria 0%

Hypertension 16%

Sepsis** 8%

Injuries 6% Measles 1%

* Intrapartum-related events

Source: WHO/MCEE 2015 Diarrhoea (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

100

(2007)

Malaria during pregnancy - intermittent preventive treatment (%)

C-section rate (total, urban, rural; %)

Antenatal care (4 or more visits, %)

80 Percent

Demand for family planning satisfied (%)

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(within 2 days, %)

20 0

(within 2 days , %)

1988 Other NS

2000 MICS

2007 Other NS

(<18.5 kg/m2, %)

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

WATER AND SANITATION Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

1 3

74 45

40 22

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100 80

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

2015 Urban

Yes

(2015)

Life Saving Commodities in Essential Medicine List: 1*

(2015)

3 3

(2015)

37.5

(2009)

851

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

1990

2015 Rural

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Maternity protection (Convention 183)

(2015)

FINANCING

2000 MICS

Per capita total expenditure on health (Int$)

Midwives authorized for specific tasks (X of 7 tasks)

(R,F)

(% of recommended minimum)

No Data

National availability of Emergency Obstetric Care services

Legal status of abortion (X of 5 circumstances)

Newborn health (X of 4) Child health (X of 3)

Diarrhoeal disease treatment

Yes

Reproductive health (X of 3) Maternal health (X of 3)

CHILD HEALTH

100 5

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

60 40 20

14 34

15 8

11 22

15 6

External sources Private sources 34

51 12

79 63

General government expenditure

20 6

No Data

ODA to child health per child (US$) ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

1990

2015 Total

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Brazil DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

207,848

(2015)

15,032

(2015)

3,016

(2015)

Birth registration (%) Total under-five deaths (000)

93 52

(2011)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

9 15

(2015)

Stillbirth rate (per 1000 total births)

(2015)

(2009)

2,100

(2013)

Lifetime risk of maternal death (1 in N)

780

(2013)

Total fertility rate (per woman)

1.8

(2015)

(2011)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

70 61 60 50 40 30 20 10 0 1990

Deaths per 100,000 live births

MDG Target: 20

1995

2000

2005

2010

2015

Source: UN IGME 2015

140 120 120 100 80 60 40 20 0 1990

69 30 MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 93 89 98

*Postnatal care Exclusive breastfeeding

Neonatal period

No Data

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Eligible HIV+ pregnant women receiving ART for their own health (%)

Infancy

Measles

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1996 DHS

Percent

2006 MoH

2012 MoH

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Skilled attendant at delivery Early initiation of breastfeeding

1990

1995

DTP3

NUTRITION

2005

2010

100

60 40

1996 DHS

2006 MoH

100 80

Percent of infants <6 months exclusively breastfed

Exclusive breastfeeding

Percent

2 (2006-2007) Early initiation of breastfeeding (within 1 hr of birth, %) 43 (2012) Introduction of solid, semi-solid/soft foods (%) 9 94 Vitamin A two dose coverage (%) n/a

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

2014

Underweight and stunting prevalence

Careseeking for pneumonia

Source: DHS 1996

2000

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

ORT & continued feeding

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Source: WHO/UNICEF 2015

Vitamin A (past 6 months)

Pneumonia treatment

ITN use among children <5 yrs

Measles

9795 92 93 93

100 80 60 40 20 0

Percent

Antenatal care (4+ visits)

Immunization

Percent

EQUITY

19 5 1989 Other NS

14 4

5 1996 DHS

2002-2003 Other NS

2 2006 MoH

40 20 0

2 1986 DHS

2006 MoH

(2006) (2006) -

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Brazil DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 17%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 8%

Neonatal death: 55%

Sepsis 8%

Regional estimates for Latin America, 2013

Embolism 3%

Abortion 10%

Haemorrhage 23%

Other 10%

Other 29%

Other direct 15%

Congenital 11%

HIV/AIDS 0%

Sepsis** 8% Source: WHO/MCEE 2015 (provisional) Diarrhoea ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Measles 0% * Intrapartum-related events

Hypertension 22%

Indirect 19%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

(2006)

Antenatal care (4 or more visits, %)

(2012)

56, 0, 0

(2012)

C-section rate (total, urban, rural; %)

Demand for family planning satisfied (%)

Malaria during pregnancy - intermittent preventive treatment (%)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(1996)

(within 2 days, %)

20 0

(within 2 days , %)

1986 DHS

1996 DHS

2003 MoH

2006 MoH

2009 MoH

(<18.5 kg/m2, %)

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Midwives authorized for specific tasks (X of 7 tasks)

(R)

Partial

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List:

Density of doctors, nurses and midwives (per 10,000 population) National availability of Emergency Obstetric Care services

(2015)

3 -

(2015)

94.9

(2013)

1,452

(2013)

(% of recommended minimum)

FINANCING 44

Per capita total expenditure on health (Int$)

Very limited risk

General government expenditure on health as % of total government expenditure (%)

1996 DHS

Out of pocket expenditure as % of total expenditure on health(%)

WATER AND SANITATION Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 8 10

0 0 2

0 4

98 70

92 38

20 0

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100 80

1990 Rural

2 14

17 15 1

6 14 1

11 1

External sources

13 48

60 83

No Data

General government expenditure

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

1 52

20 2015

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

4 0 2

100 4

Percent

Newborn health (X of 4) Child health (X of 3)

Diarrhoeal disease treatment

Legal status of abortion (X of 5 circumstances)

Reproductive health (X of 3) Maternal health (X of 3)

CHILD HEALTH

Yes

Maternity protection (Convention 183)

Malaria 0% Injuries 6%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Total

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Burkina Faso DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

18,106

(2015)

3,144

(2015)

Under-five mortality rate

Deaths per 100,000 live births

250

1000

717

(2015)

Birth registration (%) Total under-five deaths (000)

77 60

(2010)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

27 61

(2015)

150

(2015)

100

Stillbirth rate (per 1000 total births)

(2009)

2,800

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

5.4

(2015)

Adolescent birth rate (per 1000 girls)

136

(2008)

Total maternal deaths

(2015)

Maternal mortality ratio

Deaths per 1000 live births

202

200

770

800 600 89 MDG Target: 67

50 0 1990

1995

2000

2005

2010

190

200

MDG Target

0 1990

2015

Source: UN IGME 2015

400

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 32

*Postnatal care

Birth 72

Exclusive breastfeeding

Measles

Neonatal period

20 40 60 80 100 Percent

Source: DHS, MICS, Other NS

100

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

19 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

60 40

20 1993 DHS

1998-99 DHS

2003 DHS

2006 MICS

2010 DHS

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine 91 91 91

100 80

Skilled attendant at delivery

Percent

Antenatal care (4+ visits)

100 80

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

(2012)

(2010)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

1998-99 DHS

2003 DHS

2006 MICS

2010 DHS

Vitamin A two dose coverage (%)

(2013)

(2012)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80 41 30

46 34

42 26 35

20 0

1993 DHS

100

60 40

(2010)

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 42 Introduction of solid, semi-solid/soft foods (%) 57

Percent

ORT & continued feeding

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

0 1990

Measles

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

Source: DHS 2010

Pneumonia treatment

Percent

EQUITY

60 40 20

19 3

1993 DHS

1998-99 DHS

25 7

0 1993 DHS

1998-99 DHS

2003 DHS

2006 MICS

2009 2012 Other NS Other NS

2003 DHS

2006 MICS

2010 DHS

2014 Other NS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Burkina Faso DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

11%

Other 21%

Globally nearly half of child deaths are attributable to undernutrition

2% Preterm 9%

HIV/AIDS 1%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Haemorrhage 25%

Asphyxia* 8%

Neonatal death: 30%

Other direct 9%

Other 2%

Sepsis** 7%

Hypertension 16%

Diarrhoea

Source: WHO/MCEE 2015 (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Indirect 29%

Source: WHO 2014

Measles 2%

Injuries 5% * Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy 94

100

Percent

80 60

Demand for family planning satisfied (%)

(2014)

Antenatal care (4 or more visits, %)

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

(2014)

2, 6, 1

(2010)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2010)

Postnatal visit for mother

(2010)

Women with low body mass index

(2010)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

(within 2 days, %)

20 0

(within 2 days , %)

1993 DHS

1998-99 DHS

2003 DHS

2006 MICS

2010 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

1993 DHS

1998-99 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2003 DHS

2006 MICS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2010 DHS

28 (2014)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 3

Percent

70 74

20 0

42 8

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

100

2006 MICS

2010 DHS

2015 Urban

1990

2015 Rural

2014 Other NS

60 78 40

Yes

Maternal deaths notification

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Partial

Costed national implementation plan(s) for: maternal, newborn and child health available

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

6.1

(2010)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

16 (2011)

1990

2015 Total

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

General government expenditure External sources Private sources

36 89

()

(2013)

36 31

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

7 7 7

109

Available Reproductive, maternal, newborn and child health expenditure by source

9 5

Per capita total expenditure on health (Int$)

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Midwives authorized for specific tasks (X of 7 tasks)

FINANCING

Improved sanitation coverage

3 (R,F)

(% of recommended minimum)

100 80 60 40 20 0

2003 DHS

Percent

100

Legal status of abortion (X of 5 circumstances)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Yes

Maternity protection (Convention 183)

Congenital 2%

Malaria 21%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Urban

3 2

8 10 7

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Burundi DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

11,179

(2015)

2,062

(2015)

488

(2015)

Birth registration (%) Total under-five deaths (000)

75 37

(2010)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

29 54

(2015)

Stillbirth rate (per 1000 total births)

(2015)

(2009)

3,400

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

5.9

(2015)

(2008)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

1500

172

1300

1200

150

900

100

MDG Target: 57

0 1990

1995

2000

2005

2010

300

330

0 1990

2015

Source: UN IGME 2015

740

600

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

*Postnatal care

Exclusive breastfeeding

Birth

Neonatal period

Measles

100 34

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

27 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy 60

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1987 DHS

Percent

2000 MICS

2005 MICS

2010 DHS

2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Skilled attendant at delivery

96 95 95 95 94

100 80 60 40 20 0

Percent

Antenatal care (4+ visits)

Immunization

Early initiation of breastfeeding

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2005

2010

(2010)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

2000 MICS

2005 MICS

56 34

35 29

2010 DHS

(2010)

Vitamin A two dose coverage (%)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

20 0

100

60 40

Early initiation of breastfeeding (within 1 hr of birth, %) 74 Introduction of solid, semi-solid/soft foods (%) 70

Percent

2014

Underweight and stunting prevalence

Careseeking for pneumonia

Source: DHS 2010

2000

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

ORT & continued feeding

100

0 1995

ITN use among children <5 yrs

Vitamin A (past 6 months)

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

1990

Measles

Pneumonia treatment

Percent

Socioeconomic inequities in coverage

Percent

EQUITY

77 69

40 20 0

1987 DHS

2000 MICS

2005 Other NS

2010 DHS

1987 DHS

2000 MICS

2005 Other NS

2010 DHS

(2010)

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Burundi DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

14%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 11% Asphyxia* 11%

Neonatal death: 36%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Haemorrhage 25%

Other 2%

Other 26%

Other direct 9%

Congenital 3%

HIV/AIDS 1%

Hypertension 16%

Diarrhoea

Source: WHO/MCEE 2015 (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Malaria 6% Injuries 7% * Intrapartum-related events

Indirect 29%

Source: WHO 2014

Measles 0%

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

Percent

Demand for family planning satisfied (%)

(2010)

Antenatal care (4 or more visits, %)

(2010)

(2012)

4, 12, 3

(2010)

(2014)

(2010)

Postnatal visit for mother

(2010)

Women with low body mass index

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

100

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby (within 2 days, %)

20 0

(within 2 days , %)

1987 DHS

2000 MICS

2005 MICS

2010 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

2000 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2005 MICS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2010 DHS

69 (2012)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 10

13 13

66 49

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

2000 MICS

2005 MICS

1990

2015 Rural

2010 DHS

2012 Other NS

7 No

Maternal deaths notification

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

2.2

(2004)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

27 (2010)

1 41

2 16

1990

2015 Total

1990

2015 Urban

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

No Data

External sources

42 6

General government expenditure

Per capita total expenditure on health (Int$)

Reproductive, maternal, newborn and child health expenditure by source

1990

100

Midwives authorized for specific tasks (X of 7 tasks)

FINANCING

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

20 0

10 23

60 40

80 21 Percent

2 2

(% of recommended minimum)

100 80 60 40 20 0

Improved sanitation coverage

Percent

100

Legal status of abortion (X of 5 circumstances)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Maternity protection (Convention 183)

Sepsis** 7% 10%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Cambodia DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

15,578

(2015)

1,772

(2015)

371

(2015)

Birth registration (%) Total under-five deaths (000)

62 10

(2010)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

15 25

(2015)

Stillbirth rate (per 1000 total births)

(2009)

Total maternal deaths

670

(2013)

Lifetime risk of maternal death (1 in N)

180

(2013)

Total fertility rate (per woman)

2.6

(2015)

(2013)

Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

140 120 117 100 80 60 40 20 0 1990

1400 1200 1200 1000 800 600 400 200 0 1990 1995

MDG Target: 39

1995

2000

2005

2010

2015

Source: UN IGME 2015

170

300

MDG Target

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

*Postnatal care

Exclusive breastfeeding

100

Pre-pregnancy Pregnancy 89

Birth

Neonatal period

60 40

Infancy

100

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Percent

2000 DHS

2005 DHS

2010 DHS

2011 Other NS

40 0

2014 pDHS

60 28

20 1998 MoH

63 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine 97 97 94

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100 80

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

(2014)

(2010)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

2000 DHS

2005 DHS

2010 DHS

2014 pDHS

Vitamin A two dose coverage (%)

(2013)

(2010)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80 59 43

44 28

41 29

20 0

100

60 40

(2010)

Percent

64 48

Early initiation of breastfeeding (within 1 hr of birth, %) 66 Introduction of solid, semi-solid/soft foods (%) 88

Percent

ORT & continued feeding

0 1990

Vitamin A (past 6 months)

Measles

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

Source: DHS 2010

Pneumonia treatment

Percent

EQUITY

40 20

0 1996 Other NS

2000 DHS

2005 DHS

2010 DHS

2014 pDHS

2000 DHS

2005 DHS

2008 Other NS

2010 DHS

2014 pDHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Cambodia DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

14%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 15%

Asphyxia* 12%

Neonatal death: 51%

Sepsis 6%

Regional estimates for South-eastern Asia, 2013

Embolism 12%

Abortion 7%

Other direct 14%

Other 4% Other 20%

Haemorrhage 30%

Congenital 8%

HIV/AIDS 1%

Indirect 17%

Sepsis** 9%

Malaria 0% Injuries 7%

Source: WHO/MCEE 2015 (provisional) Diarrhoea ** Sepsis/ Tetanus/ Meningitis/ Encephalitis 0%

Measles 1%

* Intrapartum-related events

Hypertension 15%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100 80 Percent

(2014)

Antenatal care (4 or more visits, %)

(2014)

3, 0, 0

(2011)

(2014)

Postnatal visit for mother

(2010)

Women with low body mass index

(2010)

Malaria during pregnancy - intermittent preventive treatment (%) (Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

C-section rate (total, urban, rural; %)

Demand for family planning satisfied (%)

Postnatal visit for baby (within 2 days, %)

20 0

(within 2 days , %)

1998 MoH

2000 DHS

2005 DHS

2010 DHS

2014 pDHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

18 2000 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2005 DHS

2010 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2014 pDHS

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

60 42

55 21

1990

Source: WHO/UNICEF JMP 2015

2015 Urban

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

100

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

47 89 3 8

1990

2015 Rural

(2015)

Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

9.6

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

(2015)

33 (2008)

94 88

1990

2015 Total

3 7

1990

2015 Urban

(2013)

No Data

External sources

42 3

(2013)

Private sources

229

General government expenditure

3 0

Life Saving Commodities in Essential Medicine List:

General government expenditure on health as % of total government expenditure (%)

80 60

(R,F)

FINANCING

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

22 0

Midwives authorized for specific tasks (X of 7 tasks)

Per capita total expenditure on health (Int$)

Improved sanitation coverage

16 42

2015 1990 Total

40 20

(% of recommended minimum)

100 80 60 40 20 0

2005 DHS

Percent

Legal status of abortion (X of 5 circumstances)

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

Yes

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

6 0

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Cameroon DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

23,344

(2015)

3,738

(2015)

847

(2015)

Birth registration (%) Total under-five deaths (000)

61 71

(2011)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

26 57

(2015)

Stillbirth rate (per 1000 total births)

(2009)

4,900

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.6

(2015)

Adolescent birth rate (per 1000 girls)

128

(2008)

Total maternal deaths

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

800 138

150

720

600

100

MDG Target: 46

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

590

400 200

180

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 50

*Postnatal care

Birth

Exclusive breastfeeding

Neonatal period

80 60

Measles

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

100 80

Infancy

Percent

31 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

40 20

1991 DHS

1998 DHS

2000 MICS

2004 DHS

2006 MICS

2011 DHS

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

100 80

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months) ORT & continued feeding

2014

2010

(2011)

(2006)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

1991 DHS

1998 DHS

2000 MICS

2004 DHS

2006 MICS

2011 DHS

(2011)

Vitamin A two dose coverage (%)

(2013)

(2011)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

40 25

100

Early initiation of breastfeeding (within 1 hr of birth, %) 40 Introduction of solid, semi-solid/soft foods (%) 70

Percent

40 20

36 17

33 15

Percent

Measles

ITN use among children <5 yrs

Source: DHS 2011

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

87 87 80 87

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

60 40 20

2004 DHS

2006 MICS

2011 DHS

0 1991 DHS

1998 DHS

2004 DHS

2006 MICS

2011 DHS

1991 DHS

1998 DHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Cameroon DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 8%

13%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 9%

Neonatal death: 30%

Sepsis 10%

Embolism 2%

Abortion 10%

Haemorrhage 25%

Other 2% Congenital 2%

Other direct 9%

Sepsis** 6%

Diarrhoea

Hypertension 16%

Measles 0%

Source: WHO/MCEE 2015 Injuries 7% (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

HIV/AIDS 4% Malaria 10% * Intrapartum-related events

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Demand for family planning satisfied (%)

(2011)

Antenatal care (4 or more visits, %)

(2011)

Malaria during pregnancy - intermittent preventive treatment (%)

(2011)

4, 7, 2

(2011)

(2014)

(2011)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby (within 2 days, %)

Postnatal visit for mother

(within 2 days , %)

1991 DHS

1998 DHS

2000 MICS

2004 DHS

2006 MICS

2011 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

18 1991 DHS

1998 DHS

43 17

2000 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2004 DHS

22 13 2006 MICS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2011 DHS

26 (2011)

Percent

44 49

40 17

1990

2000 MICS

2004 DHS

13 2006 MICS

Source: WHO/UNICEF JMP 2015

2015 Urban

1990

2015 Rural

6 33

2011 DHS

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

5.2

(2009)

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

Reproductive, maternal, newborn and child health expenditure by source

(2015)

60 (2010)

1990

2015 Total

(2013)

No Data

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

Private sources

ODA to child health per child (US$)

40 40

(2013)

External sources 12

138

General government expenditure

32 2

2015 1990 Total

Yes

Postnatal home visits in the first week after birth

FINANCING

100 11

67 53

20 0

Partial

Maternal deaths notification

Per capita total expenditure on health (Int$)

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

35 59

4 1

(% of recommended minimum)

100 80 60 40 20 0

Improved sanitation coverage

Percent

100

Midwives authorized for specific tasks (X of 7 tasks)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

(R)

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

Legal status of abortion (X of 5 circumstances)

Maternity protection (Convention 183)

11%

Other 25%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Central African Republic DEMOGRAPHICS Total population (000)

4,900

(2015)

Total under-five population (000)

708

(2015)

Births (000)

164

(2015)

Birth registration (%) Total under-five deaths (000)

61 21

(2010)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

43 92

(2015)

Stillbirth rate (per 1000 total births)

(2009)

1,400

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.2

(2015)

Adolescent birth rate (per 1000 girls)

229

(2009)

Total maternal deaths

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

1400 1200 1200 1000 800 600 400 200 0 1990 1995

177

150

130

100 MDG Target: 59

50 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

880

300 MDG Target

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 36

*Postnatal care Exclusive breastfeeding

Neonatal period

Measles

Birth

100

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

Percent

13 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

60 20

1994-1995 DHS

2000 MICS

2006 MICS

2009 Other NS

2010 MICS

40 13

<1 2005

2008

Source: UNICEF/UNAIDS/WHO 2015

2011

2014

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80

Percent

49 47 47 47

40 20

Early initiation of breastfeeding

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

ORT & continued feeding

2014

(2010)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

20 0

32 30

1994-1995 DHS

2000 MICS

2006 MICS

2010 MICS

(2010)

Vitamin A two dose coverage (%)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100 80

60 40

Early initiation of breastfeeding (within 1 hr of birth, %) 44 Introduction of solid, semi-solid/soft foods (%) 60

Percent

40 20

42 24

45 22

41 24

Percent

Vitamin A (past 6 months)

Measles

Percent

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

Antenatal care (4+ visits)

Source: MICS 2010

Pneumonia treatment

20 0

1994-1995 DHS

2000 MICS

2006 MICS

2010 MICS

2000 MICS

2006 MICS

3 1994-1995 DHS

2010 MICS

(2010)

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Central African Republic DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

14%

Preterm 10%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 11%

Neonatal death: 33%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Haemorrhage 25%

Other 2%

Other 19%

Other direct 9%

Congenital 2% Sepsis** 6%

Measles 1%

Source: WHO/MCEE 2015 Malaria 15% Injuries 4% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Indirect 29%

Source: WHO 2014

Demand for family planning satisfied (%)

(2010)

Antenatal care (4 or more visits, %)

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

(2010)

5, 8, 2

(2010)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

(1994-1995)

(within 2 days, %)

20 0

(within 2 days , %)

1994-1995 DHS

2000 MICS

2006 MICS

2010 MICS

Women with low body mass index (<18.5 kg/m2, %)

Malaria prevention and treatment

47 28

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

38 16

2000 MICS

2006 MICS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2010 MICS

9 (2010)

Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 13

15 2 2006 MICS

2010 MICS

100 80

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

1990

2015 Rural

(2015)

Life Saving Commodities in Essential Medicine List: 2*

(2015)

3 -

(2015)

3.1

(2009)

Per capita total expenditure on health (Int$)

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

Private sources 46

1990

2015 Total

37 44

2015 Urban

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

3 7

1990

No Data

External sources

40 20

Yes

General government expenditure

Yes

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

20 0

FINANCING 36

Improved sanitation coverage

60 40

(% of recommended minimum)

100 80 60 40 20 0

2000 MICS

Percent

Partial

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Newborn health (X of 4) Child health (X of 3)

Diarrhoeal disease treatment

1994-1995 DHS

Midwives authorized for specific tasks (X of 7 tasks)

Reproductive health (X of 3) Maternal health (X of 3)

CHILD HEALTH

100 80 60 40 20 0

Postnatal home visits in the first week after birth

MATERNAL AND NEWBORN HEALTH Antenatal care

Legal status of abortion (X of 5 circumstances)

Maternal deaths notification

Hypertension 16%

Diarrhoea

HIV/AIDS 3%

Maternity protection (Convention 183)

10%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Chad DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

14,037

(2015)

2,632

(2015)

Under-five mortality rate

Deaths per 100,000 live births

250

2000

630

(2015)

Birth registration (%) Total under-five deaths (000)

16 83

(2010)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

39 85

(2015)

150

(2015)

100

Stillbirth rate (per 1000 total births)

(2009)

5,800

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

6.1

(2015)

Adolescent birth rate (per 1000 girls)

203

(2009)

Total maternal deaths

(2015)

Maternal mortality ratio

Deaths per 1000 live births 215

200

1700

1500 139

980

1000 MDG Target: 72

50 0 1990

1995

2000

2005

2010

500 0 1990

2015

Source: UN IGME 2015

430 MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 15

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

Measles

40 15

1996-1997 DHS

2000 MICS

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

Percent

<1 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

10 2004 DHS

2010 MICS

<1 2005

2008

Source: UNICEF/UNAIDS/WHO 2015

2011

2014

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80

Percent

54 46 46

Percent

Skilled attendant at delivery

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

ORT & continued feeding

2014

(2010)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

1996-1997 DHS

2000 MICS

2004 DHS

2010 MICS

Vitamin A two dose coverage (%)

(2013)

(2010)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80 34

60 40 20

20 0

100

60 40

(2010)

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 29 Introduction of solid, semi-solid/soft foods (%) 46

Percent

Vitamin A (past 6 months)

Measles

Early initiation of breastfeeding

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

Antenatal care (4+ visits)

Source: MICS 2010

Pneumonia treatment

0 1996-1997 DHS

2000 MICS

2004 DHS

2010 MICS

10 2 1996-1997 DHS

2000 MICS

2004 DHS

2010 MICS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Chad DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

21%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 8% Asphyxia* 9%

Neonatal death: 29%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Haemorrhage 25%

Other 2% Other direct 9%

Congenital 2% Sepsis** 6% Other 23%

13%

Hypertension 16%

Diarrhoea

HIV/AIDS 2%

Source: WHO/MCEE 2015 Measles 0% Malaria 6% Injuries 5% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

(2010)

Antenatal care (4 or more visits, %)

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

(2010)

2, 4, 1

(2010)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

20 0

(2014)

Postnatal visit for baby

Postnatal visit for mother

(2004)

(within 2 days, %)

(within 2 days , %)

1996-1997 DHS

2000 MICS

2004 DHS

2010 MICS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

44 23

1996-1997 DHS

2000 MICS

2004 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2010 MICS

3 (2010)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 3

48 47 47

42 25

1990

Source: WHO/UNICEF JMP 2015

2015 1990 Total

2015 Urban

Midwives authorized for specific tasks (X of 7 tasks)

Maternity protection (Convention 183)

Maternal deaths notification

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

10 1

Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

2.3

(2006)

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

2010 MICS

100

1990

2015 Rural

Reproductive, maternal, newborn and child health expenditure by source

20 (2011)

64 42

19 5 12

1990

2015 Total

(2013)

No Data

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

18 10 3 8

External sources

(2015)

General government expenditure

(2015)

FINANCING

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Yes

Life Saving Commodities in Essential Medicine List:

Per capita total expenditure on health (Int$)

Improved sanitation coverage

60 46

2 (F)

(% of recommended minimum)

100 80 60 40 20 0

2000 MICS

Percent

Legal status of abortion (X of 5 circumstances)

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

12 21

31 1

1990

2015 Urban

2 4

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

China DEMOGRAPHICS Total population (000)

1,376,049

(2015)

Total under-five population (000)

83,186

(2015)

Births (000)

16,601

(2015)

182

(2015)

6 9

(2015)

(2009)

5,900

(2013)

1,800

(2013)

1.6

(2015)

(2009)

Birth registration (%) Total under-five deaths (000) Neonatal deaths (% of under-five deaths) Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births) Stillbirth rate (per 1000 total births) Total maternal deaths Lifetime risk of maternal death (1 in N) Total fertility rate (per woman) Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

120

100 80 60

MDG Target: 18

20 10 0 1990

1995

2000

2005

2010

20 0 1990

2015

Source: UN IGME 2015

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 97

*Postnatal care Exclusive breastfeeding

Birth

Neonatal period

100

Pre-pregnancy Pregnancy

100

Eligible HIV+ pregnant women receiving ART for their own health (%)

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

No Data

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

1990 MoH

1995 MoH

2000 MoH

2005 MoH

2010 MoH

2013 MoH

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

80 60

Percent

Skilled attendant at delivery

20 0

No Data

1990

1995

2000

Source: WHO/UNICEF 2015

2005

2014

2010

NUTRITION

DTP3 Measles

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

(2010)

Early initiation of breastfeeding (within 1 hr of birth, %) 41 Introduction of solid, semi-solid/soft foods (%) 60 Vitamin A two dose coverage (%)

ORT & continued feeding

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Percent of infants <6 months exclusively breastfed

100

Percent

60 40 20 0

n/a

Exclusive breastfeeding

Percent

Careseeking for pneumonia

No Data

Early initiation of breastfeeding ITN use among children <5 yrs

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

99 99

100

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

1990 Other NS

1995 Other NS

2000 Other NS

2005 Other NS

2010 Other NS

60 40

20 0 2008 Other NS

(2008) (2008) -

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

China DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Other 23%

HIV/AIDS 0%

Asphyxia* 14%

Injuries 14% Measles 0% 3% Diarrhoea

Abortion 1% Other direct 14%

Sepsis 3%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Eastern Asia, 2013

Embolism 12%

Preterm 17%

Neonatal death: 51%

Malaria 0%

Globally nearly half of child deaths are attributable to undernutrition

Other 5% Source: WHO/MCEE 2015 (provisional)

Congenital 9%

Hypertension 10%

Sepsis** 1% ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

100

Percent

(2001)

Antenatal care (4 or more visits, %)

Malaria during pregnancy - intermittent preventive treatment (%)

36, 47, 33

(2011)

Demand for family planning satisfied (%)

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy 96

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(within 2 days, %)

20 0

(within 2 days , %)

1992 MoH

1995 MoH

2000 MoH

2005 MoH

2010 MoH

2013 MoH

(<18.5 kg/m2, %)

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks (X of 7 tasks)

Maternal deaths notification

Postnatal home visits in the first week after birth

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Malaria prevention and treatment

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Partial

(2015)

Life Saving Commodities in Essential Medicine List: 1*

(2015)

31.5

(2011)

646

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

Newborn health (X of 4) Child health (X of 3)

Diarrhoeal disease treatment

Yes

Antenatal corticosteroids as part of management of preterm labour

Reproductive health (X of 3) Maternal health (X of 3)

CHILD HEALTH

(R,F)

Maternity protection (Convention 183)

Haemorrhage 36%

Indirect 25%

Density of doctors, nurses and midwives (per 10,000 population) National availability of Emergency Obstetric Care services

(% of recommended minimum)

FINANCING Per capita total expenditure on health (Int$)

Very limited risk

No Data

WATER AND SANITATION Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

100 7

4 22

20 11

39 73

28 11

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

1990

2015 Rural

100 7 80

40 20

1 2 19

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Percent

80 26

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

7 6

24 5

General government expenditure External sources 2

87 76

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

40 20

No Data

Note: See annexes for additional information on the indicators above

2 64

1990

2015 Total

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Comoros DEMOGRAPHICS Total population (000)

788

(2015)

Total under-five population (000)

119

(2015)

Births (000)

(2015)

Birth registration (%) Total under-five deaths (000)

87 2

(2012)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

34 55

(2015)

Stillbirth rate (per 1000 total births)

(2009)

Total maternal deaths

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.4

(2015)

(2010)

Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

140 125 120 100 80 60 40 20 0 1990

700 630 600 500 400 300 200 100 0 1990

74 MDG Target: 42

1995

2000

2005

2010

2015

Source: UN IGME 2015

350 160 MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 38

*Postnatal care

Exclusive breastfeeding

100

Pre-pregnancy Pregnancy

Birth

Neonatal period

No Data

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Eligible HIV+ pregnant women receiving ART for their own health (%)

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1996 DHS

Percent

2000 MICS

2012 DHS

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

100 80

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

56 38

Measles

ITN use among children <5 yrs

2014

(2012)

(2000)

1996 DHS

2000 MICS

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Percent of infants <6 months exclusively breastfed

100

Percent

60 39

40 20 0

Exclusive breastfeeding

40 21

Percent

Careseeking for pneumonia

2012 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 34 Introduction of solid, semi-solid/soft foods (%) 81 Vitamin A two dose coverage (%)

ORT & continued feeding

Source: DHS 2012

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

80 80 80

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

60 40 20 0

1991-1992 Other NS

1996 DHS

2000 MICS

2012 DHS

3 1996 DHS

2000 MICS

2012 DHS

(2012) (2012) -

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Comoros DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

13%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 18%

Neonatal death: 47%

Asphyxia* 11%

Other 19%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Other 3%

Haemorrhage 25%

Other direct 9%

Congenital 4% HIV/AIDS 1%

Sepsis** 8%

Malaria 8%

Hypertension 16%

Source: WHO/MCEE 2015 (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Injuries 5%

Indirect 29%

Diarrhoea

Measles 0% * Intrapartum-related events

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy 92

100

Percent

(2012)

Antenatal care (4 or more visits, %)

(2012)

Malaria during pregnancy - intermittent preventive treatment (%)

(2012)

10, 12, 9

(2012)

C-section rate (total, urban, rural; %)

Demand for family planning satisfied (%)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2012)

Postnatal visit for mother

(2012)

(within 2 days, %)

20 0

(within 2 days , %)

1996 DHS

2000 MICS

2004 Other NS

2012 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

54 38

1996 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2000 MICS

2012 DHS

16 (2012)

8 4

100 1

60 79

38 16

29 9

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

1990

2015 Rural

(2015)

Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

2 2

(2015)

8.9

(2004)

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

2012 DHS

Reproductive, maternal, newborn and child health expenditure by source

(2015)

33 (2005)

43 63

1990

2015 Total

2015 Urban

(2013)

No Data

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

2 12

1990

20 3

(2013)

External sources 1

General government expenditure

Yes

Life Saving Commodities in Essential Medicine List:

Per capita total expenditure on health (Int$)

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

31 52

Midwives authorized for specific tasks (X of 7 tasks)

FINANCING 41

Improved sanitation coverage

Percent

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 0

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

100 80 60 40 20 0

2000 MICS

Improved drinking water coverage

6 4

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Congo DEMOGRAPHICS Total population (000)

4,620

(2015)

Total under-five population (000)

759

(2015)

Births (000)

Under-five mortality rate

Deaths per 100,000 live births

150

800

167

(2015)

Birth registration (%) Total under-five deaths (000)

91 7

(2011-2012)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

18 33

(2015)

Stillbirth rate (per 1000 total births)

(2009)

690

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.8

(2015)

Adolescent birth rate (per 1000 girls)

147

(2009)

Total maternal deaths

(2015)

Maternal mortality ratio

Deaths per 1000 live births

120

670

600

410

400 45

MDG Target: 31

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

200

170

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 71

*Postnatal care

Exclusive breastfeeding

100

Pre-pregnancy Pregnancy

Birth

Neonatal period

40 30 20

2005 DHS

Percent

2011-2012 DHS

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

17 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

5 2005

2008

Source: UNICEF/UNAIDS/WHO 2015

2011

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100 80

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

2014

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

Source: DHS 2011-2012

Percent of infants <6 months exclusively breastfed

100 80

2011-2012 DHS

Exclusive breastfeeding

2005 DHS

30 16

1987 Other NS

25 12

2005 DHS

2011-2012 DHS

Percent

ORT & continued feeding

52 48

6 (2011-2012) Early initiation of breastfeeding (within 1 hr of birth, %) 24 (2011-2012) (2005) Introduction of solid, semi-solid/soft foods (%) 90 (2011-2012) Vitamin A two dose coverage (%) -

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Measles

Early initiation of breastfeeding

90 90 80 69 60

Pneumonia treatment

Percent

EQUITY

40 20

2005 DHS

2011-2012 DHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Congo DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

11%

Neonatal death: 41%

Preterm 14% Asphyxia* 10%

Globally nearly half of child deaths are attributable to undernutrition

Sepsis 10%

Embolism 2%

Abortion 10%

Haemorrhage 25%

Other 2% Congenital 6%

Other 23%

Other direct 9%

Sepsis** 6% 0%

HIV/AIDS 6%

Hypertension 16%

Diarrhoea

Source: WHO/MCEE 2015 Measles 1% (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Malaria 6%

Injuries 6% * Intrapartum-related events

Regional estimates for Sub-Saharan Africa, 2013

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy 93

100

Percent

Demand for family planning satisfied (%)

(2011-2012)

Antenatal care (4 or more visits, %)

(2011-2012)

Malaria during pregnancy - intermittent preventive treatment (%)

(2011-2012)

6, 8, 3

(2011-2012)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2011-2012)

Postnatal visit for mother

(2011-2012)

Women with low body mass index

(2011-2012)

(within 2 days, %)

20 0

(within 2 days , %)

2005 DHS

2011-2012 DHS

(<18.5 kg/m2, %)

Malaria prevention and treatment Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

18 2005 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2011-2012 DHS

57 (2012)

Percent of population by type of drinking water source, 2015 Piped on premises Other improved Surface water Unimproved

26 6

Total

Urban

2011-2012 DHS

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List:

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

Reproductive, maternal, newborn and child health expenditure by source

(2015)

3 3

(2015)

9.2

(2007)

(2015)

25 (2012)

(2013)

No Data

External sources

2 20 36

242

General government expenditure

Rural

80 Percent

Percent

Source: WHO/UNICEF JMP 2015

FINANCING

Percent of population by type of sanitation facility, 2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100

Maternity protection (Convention 183)

Per capita total expenditure on health (Int$)

Improved sanitation coverage

(% of recommended minimum)

100 80 60 40 20 0

2005 DHS

0 4

Midwives authorized for specific tasks (X of 7 tasks)

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

National availability of Emergency Obstetric Care services

WATER AND SANITATION

Legal status of abortion (X of 5 circumstances)

Newborn health (X of 4) Child health (X of 3)

Diarrhoeal disease treatment

100

Reproductive health (X of 3) Maternal health (X of 3)

CHILD HEALTH

100 80 60 40 20 0

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

30 15

9 6

Total

Urban

Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Congo,

Democratic Republic of the

DEMOGRAPHICS Total population (000)

77,267

(2015)

Total under-five population (000)

13,876

(2015)

3,217

(2015)

28 305

(2010)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

30 75

(2015)

Stillbirth rate (per 1000 total births)

(2009)

21,000

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

5.9

(2015)

Adolescent birth rate (per 1000 girls)

135

(2011)

Births (000) Birth registration (%) Total under-five deaths (000)

Total maternal deaths

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

1200

187

1000

150

800 98

100

MDG Target: 62

730

600 400

250

200

0 1990

1995

2000

2005

2010

0 1990

2015

Source: UN IGME 2015

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 42

*Postnatal care

Exclusive breastfeeding

Measles

Birth

Neonatal period

100 80

Infancy

40 20

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

11 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2001 MICS

Percent

2007 DHS

2010 MICS

2013-2014 DHS

2005

<1 2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

80 80 77 61

80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100 80

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

2014

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

2001 MICS

2007 DHS

2010 MICS

2013-2014 DHS

Percent of infants <6 months exclusively breastfed

80 51 31

44 34

20 0

100

60 40

Exclusive breastfeeding

Percent

Source: DHS 2013-2014

44 24

43 23

Percent

ORT & continued feeding

8 (2013-2014) Early initiation of breastfeeding (within 1 hr of birth, %) 52 (2013-2014) (2010) Introduction of solid, semi-solid/soft foods (%) 79 (2013-2014) Vitamin A two dose coverage (%) (2013) 98

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Measles

Early initiation of breastfeeding

Pneumonia treatment

Percent

EQUITY

60 40 20

1995 MICS

2001 MICS

2007 DHS

2010 MICS

0 1995 MICS

2001 MICS

2007 DHS

2010 MICS

2013-2014 DHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Congo,

Democratic Republic of the

DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 11%

13%

Neonatal death: 31%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 9%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Haemorrhage 25%

Other 2% Congenital 2%

Other 24%

Other direct 9%

Sepsis** 5%

Diarrhoea

HIV/AIDS 1%

Hypertension 16%

Measles 3%

Source: WHO/MCEE 2015 (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Malaria 12%

Indirect 29%

Injuries 5%

* Intrapartum-related events

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Demand for family planning satisfied (%)

(2013-2014)

Antenatal care (4 or more visits, %)

(2013-2014)

Malaria during pregnancy - intermittent preventive treatment (%)

(2013-2014)

5, 7, 4

(2013-2014)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby

(2014)

(2013-2014)

Postnatal visit for mother

(2013-2014)

Women with low body mass index

(2013-2014)

(within 2 days, %)

20 0

(within 2 days , %)

2001 MICS

2007 DHS

2010 MICS

2013-2014 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

42 17

2001 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2007 DHS

2010 MICS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2013-2014 DHS

19 (2013-2014)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

Percent

1 13

25 37

60 31

3 16

2001 MICS

2007 DHS

52 39

20 15

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

2010 MICS

24 1

1990

2015 Rural

2013-2014 DHS

5 No

Maternal deaths notification

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Yes

Costed national implementation plan(s) for: maternal, newborn and child health available

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

4 3

(2015)

6.4

(2004)

Per capita total expenditure on health (Int$)

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

Available Reproductive, maternal, newborn and child health expenditure by source

(2015)

1990

2015 Total

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

External sources

(2013)

General government expenditure

40 20

4 39

38 64

17 36

Midwives authorized for specific tasks (X of 7 tasks)

FINANCING

56 38

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100

(% of recommended minimum)

100 80 60 40 20 0

Improved sanitation coverage

Percent

100

Legal status of abortion (X of 5 circumstances)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Partial

Maternity protection (Convention 183)

10%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

13 7

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Côte d’Ivoire DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

22,702

(2015)

3,667

(2015)

838

(2015)

Birth registration (%) Total under-five deaths (000)

65 75

(2011-2012)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

38 67

(2015)

Stillbirth rate (per 1000 total births)

(2009)

5,300

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.9

(2015)

Adolescent birth rate (per 1000 girls)

125

(2009)

Total maternal deaths

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

900

740

153

150

720

600

100

300

MDG Target: 51

0 1990

1995

2000

2005

2010

190 MDG Target

0 1990

2015

Source: UN IGME 2015

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 45

*Postnatal care

Birth 70

Exclusive breastfeeding

Neonatal period

80 60 40

Infancy

Measles

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

100

Percent

20 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

60 20

1994 DHS

1998-99 DHS

2000 MICS

2005 Other NS

2006 MICS

2011-12 DHS

40 <1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100 80

67 67 63

80 Percent

60 40

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

Measles

2000

2005

2010

ORT & continued feeding

0 10 20 30 40 50 60 70 80 90 100

100

Percent

1994 DHS

1998-99 DHS

2000 MICS

2006 MICS

2011-12 DHS

Percent of infants <6 months exclusively breastfed

80 40

100

Exclusive breastfeeding

Percent

Percent of children <5 years who are moderately or severely: underweight stunted

Source: DHS 2011-2012

2014

Underweight and stunting prevalence

Careseeking for pneumonia

8 (2011-2012) Early initiation of breastfeeding (within 1 hr of birth, %) 31 (2011-2012) (2006) Introduction of solid, semi-solid/soft foods (%) 64 (2011-2012) Vitamin A two dose coverage (%) (2013) 99

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Early initiation of breastfeeding

32 18

39 29

Percent

Skilled attendant at delivery

Percent

100

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

60 40 20 0

1994 DHS

1998-99 DHS

2006 MICS

2007 Other NS

2011-12 DHS

1994 DHS

1998-99 DHS

10 2000 MICS

5 2003-04 Other NS

2006 MICS

2011-12 DHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Côte d’Ivoire DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

12%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 13% Asphyxia* 11%

Neonatal death: 42%

Other 16%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10% Haemorrhage 25%

Other 2% Other direct 9%

Congenital 3% Sepsis** 9% HIV/AIDS 2%

Hypertension 16%

Diarrhoea

Source: WHO/MCEE 2015 Measles 0% Injuries 4% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Indirect 29%

Malaria 17%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Demand for family planning satisfied (%)

(2011-2012)

Antenatal care (4 or more visits, %)

(2011-2012)

Malaria during pregnancy - intermittent preventive treatment (%)

(2011-2012)

3, 5, 1

(2011-2012)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2011-2012)

Postnatal visit for mother

(2011-2012)

(within 2 days, %)

20 0

(within 2 days , %)

1994 DHS

1998-99 DHS

2000 MICS

2005 Other NS

2006 MICS

2011-12 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

1994 DHS

1998-99 DHS

2000 MICS

2006 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2011-12 DHS

17 (2012)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

Percent

10 40

16 17

2000 MICS

2003-04 Other NS

2006 MICS

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

1990

2015 Rural

2011-12 DHS

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

6.3

(2008)

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

Reproductive, maternal, newborn and child health expenditure by source

(2015)

7 (2010)

1990

2015 Total

(2013)

No Data

General government expenditure External sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

172

Private sources 56

1990

80 36 60

Partial

FINANCING

100

Per capita total expenditure on health (Int$)

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Midwives authorized for specific tasks (X of 7 tasks)

(% of recommended minimum)

100 80 60 40 20 0

Improved sanitation coverage

Percent

80 14

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage 3

Legal status of abortion (X of 5 circumstances)

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100 10

Yes

Maternity protection (Convention 183)

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Urban

10 7

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Djibouti DEMOGRAPHICS Total population (000)

888

(2015)

Total under-five population (000)

102

(2015)

Births (000)

(2015)

Birth registration (%) Total under-five deaths (000)

92 1

(2006)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

33 54

(2015)

Stillbirth rate (per 1000 total births)

(2009)

Total maternal deaths

(2013)

Lifetime risk of maternal death (1 in N)

130

(2013)

Total fertility rate (per woman)

3.1

(2015)

(2010)

Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

140 119 120 100 80 60 40 20 0 1990

500

400

400 65 MDG Target: 40

1995

2000

2005

2010

2015

Source: UN IGME 2015

300

230

200 100

100

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

*Postnatal care Exclusive breastfeeding

Birth

Neonatal period

2003 MoH

Percent

2006 MICS

2012 Other NS

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

20 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

Infancy

Measles

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

8 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

No Data

100 80 60

40 20 0

0 1990

1995

2000

Source: WHO/UNICEF 2015

2005

2010

2014

2002 Other NS

2006 MICS

2012 Other NS

NUTRITION

Measles

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months) ORT & continued feeding

(2012)

(2006)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

(2006)

Vitamin A two dose coverage (%)

(2013)

Percent of infants <6 months exclusively breastfed

100

Percent

60 40 20 0

Exclusive breastfeeding

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 55 Introduction of solid, semi-solid/soft foods (%) 35

32 16

33 30

34 30

Percent

DTP3

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding ITN use among children <5 yrs

78 78 78 71

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

60 40 20

0 1989 Other NS

1996 Other NS

2002 Other NS

2006 MICS

2012 Other NS

2006 MICS

2012 Other NS

(2006)

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Djibouti DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 18%

Globally nearly half of child deaths are attributable to undernutrition

10%

Asphyxia* 13%

Neonatal death: 52%

Sepsis 10%

Embolism 2%

Abortion 10% Haemorrhage 25%

Other direct 9%

Other 19% Other 4% HIV/AIDS 3%

Regional estimates for Sub-Saharan Africa, 2013

Congenital 5%

Malaria 0%

Hypertension 16%

Sepsis** 8% Source: WHO/MCEE 2015 (provisional) Diarrhoea ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Injuries 5% Measles 4% * Intrapartum-related events

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent

(2012)

11, 0, 0

(2012)

Antenatal care (4 or more visits, %) Malaria during pregnancy - intermittent preventive treatment (%)

100

Demand for family planning satisfied (%)

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(within 2 days, %)

20 0

(within 2 days , %)

2003 MoH

2006 MICS

2012 Other NS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

100 80 60 40 20 0

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2006 MICS

2012 Other NS

22 (2009)

Percent

80 60

37 26

2 1

20 1

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

80 60

2009 Other NS

1990

2015 Rural

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 2

(2015)

10.3

(2008)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

50 (2004)

1990

2015 Total

2015 Urban

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

No Data

External sources

44 76

ODA to maternal and neonatal health per live birth (US$)

(2012)

233

(2012)

Note: See annexes for additional information on the indicators above

1990

General government expenditure on health as % of total government expenditure (%)

ODA to child health per child (US$)

(2013)

General government expenditure

7 5 73

247

Private sources

40 20

Reproductive, maternal, newborn and child health expenditure by source

9 12 6

66 26

100

Midwives authorized for specific tasks (X of 7 tasks)

FINANCING

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

40 20

Per capita total expenditure on health (Int$)

Improved sanitation coverage

Percent

100 2

Legal status of abortion (X of 5 circumstances)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

Partial

(% of recommended minimum)

100 80 60 40 20 0

2006 MICS

Improved drinking water coverage

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1 5

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Egypt DEMOGRAPHICS Total population (000)

91,508

(2015)

Total under-five population (000)

12,116

(2015)

Births (000)

Under-five mortality rate

Deaths per 100,000 live births

100

140 120 120 100 80 60 40 20 0 1990

2,488

(2015)

Birth registration (%) Total under-five deaths (000)

99 66

(2005)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

13 20

(2015)

Stillbirth rate (per 1000 total births)

(2009)

860

(2013)

Lifetime risk of maternal death (1 in N)

710

(2013)

Total fertility rate (per woman)

3.3

(2015)

(2012)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Maternal mortality ratio

Deaths per 1000 live births 86

MDG Target: 29

20 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

45 30 MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 82

*Postnatal care

Exclusive breastfeeding

Birth

Neonatal period

80 60

Infancy

Measles

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Percent

15 10

5 1988 DHS

8 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1995 DHS

2000 DHS

2005 DHS

2008 DHS

2014 DHS

2005

2008

Source: UNICEF/UNAIDS/WHO 2015

2 2011

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100 80

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

1992 DHS

1995 DHS

2000 DHS

2005 DHS

2008 DHS

2014 DHS

Measles

ITN use among children <5 yrs

(2014)

(2008)

Early initiation of breastfeeding (within 1 hr of birth, %) 56 Introduction of solid, semi-solid/soft foods (%) 69 Vitamin A two dose coverage (%)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

100 80

(2008)

Percent of infants <6 months exclusively breastfed

(2008)

Exclusive breastfeeding

31 8 1992 DHS

11 1995 DHS

2000 DHS

2005 DHS

2008 DHS

2014 DHS

Percent

ORT & continued feeding

Source: DHS 2008

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

94 94 93

Pneumonia treatment

Percent

EQUITY

56 45

53 40

40 20 0 1992 DHS

1995 DHS

2000 DHS

2005 DHS

2008 DHS

2014 DHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Egypt DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 21%

10%

Asphyxia* 10%

Neonatal death: 54%

Sepsis 6%

Globally nearly half of child deaths are attributable to undernutrition

Regional estimates for Northern Africa, 2013

Embolism 3%

Abortion 2% Other direct 17%

Other 6%

Haemorrhage 37%

Congenital 12% Sepsis** 4%

Other 26%

Indirect 18%

Source: Diarrhoea HIV/AIDS 0% WHO/MCEE 2015 Measles 0% (provisional) Injuries 5% Malaria 0% * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Hypertension 17%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

Percent

70 53

(2014)

Antenatal care (4 or more visits, %)

(2014)

52, 60, 48

(2014)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2014)

Postnatal visit for mother

(2014)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

53 39

Malaria during pregnancy - intermittent preventive treatment (%)

100

Demand for family planning satisfied (%)

(within 2 days, %)

20 0

(within 2 days , %)

1988 DHS

1995 DHS

2000 DHS

2005 DHS

2008 DHS

2014 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Midwives authorized for specific tasks (X of 7 tasks)

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

2 3

(2015)

63.5

(2009)

539

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

FINANCING 40

1992 DHS

1995 DHS

28 19

2000 DHS

2005 DHS

Per capita total expenditure on health (Int$)

Very limited risk

28 8

2008 DHS

General government expenditure on health as % of total government expenditure (%)

2014 DHS

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 0

00 0

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

100

0 0 5

100 9

0 0 1

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

80 4

2015 Urban

2015 Rural

1 3

0 0

60 40

95 73

1990

2015 Total

No Data

General government expenditure External sources 00 7

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

97 92

1990

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

100 25

Percent

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

Improved drinking water coverage

Partial

National availability of Emergency Obstetric Care services

WATER AND SANITATION

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Note: See annexes for additional information on the indicators above

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Equatorial Guinea DEMOGRAPHICS Total population (000)

845

(2015)

Total under-five population (000)

128

(2015)

Births (000)

(2015)

Birth registration (%) Total under-five deaths (000)

54 3

(2011)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

33 68

(2015)

Stillbirth rate (per 1000 total births)

(2009)

Total maternal deaths

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.7

(2015)

Adolescent birth rate (per 1000 girls)

177

(2008)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

240

2000 190

180

1600

1500

120

MDG Target: 63

0 1990

1995

2000

2005

2010

1000

0 1990

2015

Source: UN IGME 2015

290

500

400

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 27 67

*Postnatal care Exclusive breastfeeding

Birth

Neonatal period

Measles

60 40 20

20 40 60 80 100

Source: DHS, MICS, Other NS

100

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

42 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2000 MICS

Percent

2011 DHS

2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Skilled attendant at delivery

80 60

0 1990

1995

2000

Source: WHO/UNICEF 2015

2005

2010

40 20 0

2011 DHS

2014

NUTRITION

DTP3 Measles

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

(2011)

(2000)

Early initiation of breastfeeding (within 1 hr of birth, %) 21 Introduction of solid, semi-solid/soft foods (%) 76 Vitamin A two dose coverage (%)

ORT & continued feeding

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

Percent of infants <6 months exclusively breastfed

100 80

40 20

Exclusive breastfeeding

Percent

44 24 24

No Data

100

1997 Other NS

2000 MICS

35 26 11 2004 Other NS

Percent

ITN use among children <5 yrs

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

80 40

Early initiation of breastfeeding

Pneumonia treatment

100 60

Percent

Antenatal care (4+ visits)

Immunization

Percent

EQUITY

60 40 20

24 7

0 2011 DHS

2000 MICS

2011 DHS

(2011) (2011) -

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Equatorial Guinea DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

13%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 12% Asphyxia* 10%

Neonatal death: 36%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10% Haemorrhage 25%

Other 3%

Other 18%

Congenital 3%

Other direct 9%

Sepsis** 5% 7%

Source: WHO/MCEE 2015 Malaria 9% Injuries 4% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Indirect 29%

Source: WHO 2014

Percent

Demand for family planning satisfied (%)

(2011)

Antenatal care (4 or more visits, %)

(2011)

Malaria during pregnancy - intermittent preventive treatment (%)

(2011)

7, 9, 4

(2011)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(within 2 days, %)

20 0

(within 2 days , %)

1994 Other NS

2000 MICS

2011 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

53 36

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2000 MICS

2011 DHS

44 (2011)

23 1

40 20 0

1 22

41 10

1995

2015 1995 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

2011 DHS

1995

2015 Rural

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

8.4

(2004)

1,170

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

(2015)

6 9

13 8

3 5 11

3 6 11

5 7 7

External sources

5 18 6

Private sources

ODA to child health per child (US$) ODA to maternal and neonatal health per live birth (US$)

No Data

General government expenditure

60 40

Low osmolarity ORS and zinc for management of diarrhoea

General government expenditure on health as % of total government expenditure (%)

Percent of population by type of sanitation facility, 1995-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

FINANCING

100 4

Yes

Per capita total expenditure on health (Int$)

Improved sanitation coverage

Percent

Partial

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1995-2015 Piped on premises Other improved Surface water Unimproved

(% of recommended minimum)

100 80 60 40 20 0

2000 MICS

Improved drinking water coverage

Midwives authorized for specific tasks (X of 7 tasks)

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Postnatal home visits in the first week after birth

MATERNAL AND NEWBORN HEALTH Antenatal care

Legal status of abortion (X of 5 circumstances)

Maternal deaths notification

Hypertension 16%

Diarrhoea

Measles 9%

Yes

Maternity protection (Convention 183)

HIV/AIDS 4%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

(2012)

Note: See annexes for additional information on the indicators above

20 0

1995

2015 Total

1995

2015 Urban

1995

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Eritrea DEMOGRAPHICS Total population (000)

5,228

(2015)

Total under-five population (000)

815

(2015)

Births (000)

175

(2015)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

18 34

(2015)

Stillbirth rate (per 1000 total births)

(2009)

880

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.2

(2015)

(1999)

Birth registration (%) Total under-five deaths (000)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

2000 151

150

1700

1500

100

MDG Target: 50

50 0 1990

1995

2000

2005

2010

1000 430

0 1990

2015

Source: UN IGME 2015

380

500

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 22

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

Measles

20 40 60 80 100

Source: DHS, MICS, Other NS

100 34

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

52 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1995 DHS

Percent

2002 DHS

2010 Other NS

7 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

No Data

Measles

1990

1995

2000

Source: WHO/UNICEF 2015

2005

2010

ORT & continued feeding

(2010)

(2002)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

2002 DHS

2010 Other NS

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 93 Introduction of solid, semi-solid/soft foods (%) 40

(2010)

Vitamin A two dose coverage (%)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

60 37

40 20

100

Percent

2014

Underweight and stunting prevalence

Careseeking for pneumonia

NUTRITION Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

100

DTP3

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding ITN use among children <5 yrs

96 94 94

Pneumonia treatment

Percent

Socioeconomic inequities in coverage

Percent

EQUITY

0 1993 Other NS

1995 DHS

2002 DHS

2010 Other NS

1995 DHS

2002 DHS

2010 Other NS

(2002)

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Eritrea DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 9%

17%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 11%

Neonatal death: 39%

Sepsis 10%

Other 23%

Embolism 2%

Abortion 10%

Other 3%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

Haemorrhage 25%

Other direct 9%

Congenital 5% Sepsis** 9%

HIV/AIDS 1%

Hypertension 16%

9% Source: Diarrhoea Malaria 1% WHO/MCEE 2015 Injuries 8% Measles 2% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

(2002)

Antenatal care (4 or more visits, %)

(2010)

3, 6, 2

(2010)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Malaria during pregnancy - intermittent preventive treatment (%)

Demand for family planning satisfied (%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

(2002)

(within 2 days, %)

20 0

(within 2 days , %)

1995 DHS

2002 DHS

2010 Other NS

Women with low body mass index (<18.5 kg/m2, %)

Malaria prevention and treatment

54 45

1995 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2002 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2010 Other NS

5 (2008)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 15

20 0

0 27

1990

Source: WHO/UNICEF JMP 2015

44 0

2015 1990 Total

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

20 4 2008 Other NS

2010 Other NS

2015 Urban

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

1990

2015 Rural

(2015)

3 3

(2015)

6.3

(2004)

(2013)

(2015)

No Data

External sources Private sources

ODA to child health per child (US$) 100

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

40 20

(2015)

General government expenditure

100

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2015 Unimproved facilities Improved and shared facilities Open defecation

Yes

Life Saving Commodities in Essential Medicine List:

Per capita total expenditure on health (Int$)

Improved sanitation coverage

49 40

FINANCING 49

Maternity protection (Convention 183)

(% of recommended minimum)

100 80 60 40 20 0

2002 DHS

Percent

0 35

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

Midwives authorized for specific tasks (X of 7 tasks)

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

3 (R,F)

Newborn health (X of 4) Child health (X of 3)

Diarrhoeal disease treatment

100 80 60 40 20 0

Legal status of abortion (X of 5 circumstances)

Reproductive health (X of 3) Maternal health (X of 3)

CHILD HEALTH

Yes

1 9

1990

2015 Total

1990

2015 Urban

4 7

0 0

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Ethiopia DEMOGRAPHICS Total population (000)

99,391

(2015)

Total under-five population (000)

14,602

(2015)

3,176

(2015)

7 184

(2005)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

28 41

(2015)

150

(2015)

100

MDG Target: 68

Stillbirth rate (per 1000 total births)

(2009)

13,000

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.3

(2015)

(2013)

Births (000) Birth registration (%) Total under-five deaths (000)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

250

1500 205

200

1400

1000

0 1990

1995

2000

2005

2010

350

0 1990

2015

Source: UN IGME 2015

420

500

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

*Postnatal care

Birth

Exclusive breastfeeding

Neonatal period

Measles

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

100 80 16

20 40 60 80 100

Source: DHS, MICS, Other NS

Infancy

72 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

Percent

2000 DHS

2005 DHS

40 20

2011 DHS

2014 DHS

60 32 11

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

Skilled attendant at delivery

100 80

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

(2014)

(2005)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

67 42

51 35

44 29

40 25

20 0

2000 DHS

2005 DHS

2011 DHS

(2011)

Vitamin A two dose coverage (%)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

60 40

100

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 52 Introduction of solid, semi-solid/soft foods (%) 49

Percent

ORT & continued feeding

0 1990

Vitamin A (past 6 months)

Measles

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

Source: DHS 2011

77 76 70 63

Percent

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

40 20 0

1992 Other NS

2000 DHS

2005 DHS

2011 DHS

2014 DHS

2000 DHS

2005 DHS

2011 DHS

(2011)

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Ethiopia DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

13%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 11% Asphyxia* 14%

Neonatal death: 47%

Sepsis 10%

Embolism 2%

Abortion 10% Haemorrhage 25%

Other 2%

Other 18%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Sub-Saharan Africa, 2013

Other direct 9%

Congenital 5% Sepsis** 9%

HIV/AIDS 1% Malaria 1%

Hypertension 16%

Source: WHO/MCEE 2015 Injuries 7% Measles 4% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Indirect 29%

Diarrhoea

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

(2014)

Antenatal care (4 or more visits, %)

(2014)

(2005)

2, 11, 1

(2014)

Postnatal visit for mother

(2014)

Women with low body mass index

(2011)

Malaria during pregnancy - intermittent preventive treatment (%)

100

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(Minimum target is 5% and maximum target is 15%)

60 27

Neonatal tetanus vaccine

Postnatal visit for baby

(within 2 days, %)

20 0

(within 2 days , %)

2000 DHS

2005 DHS

2011 DHS

2014 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

2000 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2005 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2011 DHS

28 (2011)

100

2 2007 Other NS

2011 Other NS

74 45

12 1

1990

Source: WHO/UNICEF JMP 2015

43 3 0

2015 1990 Total

100

2015 Urban

1990

2015 Rural

20 0

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

2.8

(2009)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

11 (2008)

1 4

1990

2015 Total

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

No Data

External sources Private sources

Per capita total expenditure on health (Int$)

General government expenditure

6 29

20 0

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

60 40

Midwives authorized for specific tasks (X of 7 tasks)

FINANCING 33

Improved sanitation coverage

Percent

80 48

8 8

3(R,F)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

100 80 60 40 20 0

2005 DHS

Improved drinking water coverage

Yes

100 40

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

8 20

1990

2015 Urban

0 0 0

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Gabon DEMOGRAPHICS Total population (000)

1,725

(2015)

239

(2015)

Births (000)

(2015)

Birth registration (%) Total under-five deaths (000)

90 3

(2012)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

23 36

(2015)

Stillbirth rate (per 1000 total births)

(2009)

130

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

3.8

(2015)

Adolescent birth rate (per 1000 girls)

115

(2009)

Total under-five population (000)

Total maternal deaths

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

100

400

380

300 51 MDG Target: 31

20 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

240

200 100

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 54

*Postnatal care

Exclusive breastfeeding

100

Pre-pregnancy Pregnancy

Birth

Neonatal period

100

2000 DHS

Percent

40 0

2012 DHS

60 20

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

69 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

15 <1 2005

2008

Source: UNICEF/UNAIDS/WHO 2015

2011

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

68 48

Measles

ITN use among children <5 yrs

2014

(2012)

(2000)

2000 DHS

2012 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 32 Introduction of solid, semi-solid/soft foods (%) 82 Vitamin A two dose coverage (%)

ORT & continued feeding

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Percent of infants <6 months exclusively breastfed

100

40 20 0

Exclusive breastfeeding

Percent

Careseeking for pneumonia

Source: DHS 2012

100

Early initiation of breastfeeding

70 70

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

26 9

18 7

2000 DHS

40 20

2000 DHS

2012 DHS

0 2012 DHS

(2012) (2012) -

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Gabon DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 16%

11%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 12%

Neonatal death: 46%

Sepsis 10%

Embolism 2%

Abortion 10% Haemorrhage 25%

Other 3%

Other 18%

Regional estimates for Sub-Saharan Africa, 2013

Other direct 9%

Congenital 6%

Hypertension 16%

Source: WHO/MCEE 2015 Measles 3% Injuries 5% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis Diarrhoea

Malaria 6%

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

(2012)

Antenatal care (4 or more visits, %)

(2012)

10, 11, 6

(2012)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

Malaria during pregnancy - intermittent preventive treatment (%)

100

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2012)

Postnatal visit for mother

(2012)

(within 2 days, %)

20 0

(within 2 days , %)

2000 DHS

2012 DHS

Women with low body mass index (<18.5 kg/m2, %)

Malaria prevention and treatment Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

25 2000 DHS

2012 DHS

34 (2012)

72 29

1995

2015 1995 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

1995

2015 Rural

2 26

1 20

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

(2015)

Life Saving Commodities in Essential Medicine List:

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

(2015)

3 3

(2015)

53.1

(2004)

(2015)

123 (2001)

1995

2015 Total

1995

2015 Urban

1995

(2013)

No Data

External sources 4

735

General government expenditure

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

General government expenditure on health as % of total government expenditure (%)

Percent of population by type of sanitation facility, 1995-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

65 35

Yes

FINANCING

100 2

40 20

21 25

Yes

Postnatal home visits in the first week after birth

Per capita total expenditure on health (Int$)

Improved sanitation coverage

Percent

3 3

Partial

Maternal deaths notification

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1995-2015 Piped on premises Other improved Surface water Unimproved 2

(% of recommended minimum)

100 80 60 40 20 0

2012 DHS

Improved drinking water coverage

13 7

Midwives authorized for specific tasks (X of 7 tasks)

National availability of Emergency Obstetric Care services

WATER AND SANITATION

Newborn health (X of 4) Child health (X of 3)

Diarrhoeal disease treatment

100

Legal status of abortion (X of 5 circumstances)

Reproductive health (X of 3) Maternal health (X of 3)

CHILD HEALTH

100 80 60 40 20 0

Maternity protection (Convention 183)

Sepsis** 7% HIV/AIDS 5%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Private sources

ODA to child health per child (US$) ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Gambia DEMOGRAPHICS Total population (000)

1,991

(2015)

366

(2015)

Births (000)

(2015)

Birth registration (%) Total under-five deaths (000)

53 6

(2010)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

30 48

(2015)

Stillbirth rate (per 1000 total births)

(2009)

340

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

5.7

(2015)

(2011)

Total under-five population (000)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

800

170

150

600

100

400 69

MDG Target: 57

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

710 430

200

180

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 38

*Postnatal care

Birth 76

Exclusive breastfeeding

Neonatal period

100 80

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent

<1 (2014)

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

Measles

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2000 MICS

2005-2006 MICS

2010 MICS

2013 DHS

40 20

1990 Other NS

60 5

<1 2005

2008

Source: UNICEF/UNAIDS/WHO 2015

2011

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100 80

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2000 MICS

2005-2006 MICS

2010 MICS

2013 DHS

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Measles

ITN use among children <5 yrs

(2013)

(2010)

Early initiation of breastfeeding (within 1 hr of birth, %) 52 Introduction of solid, semi-solid/soft foods (%) 34 Vitamin A two dose coverage (%)

ORT & continued feeding

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Percent of infants <6 months exclusively breastfed

100

Percent

60 40 20 0

Exclusive breastfeeding

36 23

Percent

Careseeking for pneumonia

Source: DHS 2013

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

96 96 96 96 92

Pneumonia treatment

Percent

EQUITY

60 40 20

2005-2006 MICS

2010 MICS

0 1996 MICS

2000 MICS

2005-2006 MICS

2010 MICS

2013 DHS

2000 MICS

2013 DHS

(2010) (2010) -

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Gambia DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

11%

Preterm 13%

Neonatal death: 45%

Other 23%

Globally nearly half of child deaths are attributable to undernutrition

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Asphyxia* 13%

Haemorrhage 25%

Other direct 9%

Other 3% Congenital 4%

HIV/AIDS 2%

Hypertension 16%

Sepsis** 10%

Malaria 4% Measles 0%

Source: WHO/MCEE 2015 (provisional)

Injuries 7%

Diarrhoea

* Intrapartum-related events

Indirect 29%

Source: WHO 2014

** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy 91

100

(2010)

Antenatal care (4 or more visits, %)

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

(2013)

3, 5, 1

(2010)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2013)

Postnatal visit for mother

(2013)

Women with low body mass index

(2013)

(within 2 days, %)

20 0

(within 2 days , %)

2000 MICS

2005-2006 MICS

2010 MICS

2013 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

67 38

2000 MICS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2005-2006 MICS

2010 MICS

2013 DHS

37 (2013)

100 0

49 15 2005-2006 MICS

2010 MICS

2013 DHS

100 6 80

59 79

65 69 52 33 11

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

1990

2015 Rural

2 15

12 22

2 9

7 0 31

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

9.7

(2008)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

50 (2012)

Per capita total expenditure on health (Int$)

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

21 (2013)

General government expenditure

(2013)

20 13

External sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Private sources

Note: See annexes for additional information on the indicators above

40 20

Available Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1995-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

20 0

0 30

60 40

6 0

0 14

FINANCING

47 33

Improved sanitation coverage

Percent

10 0

Legal status of abortion (X of 5 circumstances) Midwives authorized for specific tasks (X of 7 tasks)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

Yes

(% of recommended minimum)

100 80 60 40 20 0

2000 MICS

Improved drinking water coverage

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1995

2015 Total

1995

2015 Urban

1995

2015 Rural

Source: WHO/UNICEF JMP 2015

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Ghana DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

27,410

(2015)

4,056

(2015)

884

(2015)

Birth registration (%) Total under-five deaths (000)

63 54

(2011)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

28 43

(2015)

Stillbirth rate (per 1000 total births)

(2009)

3,100

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.1

(2015)

(2013)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

140 127 120 100 80 60 40 20 0 1990 1995

800

760

600 62 MDG Target: 42

2000

2005

2010

2015

Source: UN IGME 2015

380

400 200

190 MDG Target

0 1990

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 44 87 68

*Postnatal care

Exclusive breastfeeding

Neonatal period

Measles

100 80

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Infancy

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

92 Percent

39 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

40 20

1988 DHS

1998 DHS

2003 DHS

2006 MICS

2008 DHS

2011 MICS

<1 2005

2008

Source: UNICEF/UNAIDS/WHO 2015

2011

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100 80

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months) ORT & continued feeding

2014

(2014)

(2011)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

20 0

53 41

1993 DHS

1998 DHS

2003 DHS

2008 DHS

2011 MICS

2014 pDHS

Vitamin A two dose coverage (%)

(2013)

(2011)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100 80

60 40

(2011)

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 46 Introduction of solid, semi-solid/soft foods (%) 75

43 25

31 20

Percent

Careseeking for pneumonia

Measles

ITN use among children <5 yrs

Source: MICS 2011

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

100

98 98 98 98 92

Pneumonia treatment

Percent

EQUITY

29 14

52 46

40 20

0 1988 DHS

1998 DHS

2003 DHS

2008 DHS

2011 MICS

2014 pDHS

1988 DHS

1998 DHS

2003 DHS

2008 DHS

2011 MICS

2014 pDHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Ghana DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Preterm 14%

Pneumonia

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 13%

Neonatal death: 47%

Other 19%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2% Haemorrhage 25%

Abortion 10%

Other 3% Other direct 9%

Congenital 5%

HIV/AIDS 1% Diarrhoea Source: WHO/MCEE

Injuries 5% * Intrapartum-related events

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Demand for family planning satisfied (%)

(2014)

Antenatal care (4 or more visits, %)

(2014)

Malaria during pregnancy - intermittent preventive treatment (%)

(2014)

11, 17, 7

(2011)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2011)

Postnatal visit for mother

(2014)

(2008)

(within 2 days, %)

20 0

(within 2 days , %)

1988 DHS

1998 DHS

2003 DHS

2006 MICS

2008 DHS

2011 MICS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

1993 DHS

1998 DHS

40 39

45 45

2003 DHS

2008 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2011 MICS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2014 pDHS

78 (2014)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 4 7

Percent

80 35 60 40

8 8

22 4 2006 MICS

2008 DHS

2011 MICS

2014 pDHS

40 41

1990 Total

2015 Urban

1990

2015 Rural

7 0

73 60

40 20

37 2

2015 1990

Source: WHO/UNICEF JMP 2015

100

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

1 2

(2015)

10.2

(2010)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

37 (2011)

1990

2015 Total

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

No Data

General government expenditure External sources 34

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

214

Private sources 29

29 7

Per capita total expenditure on health (Int$)

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Partial

FINANCING 47

Improved sanitation coverage

(% of recommended minimum)

100 80 60 40 20 0

2003 DHS

Percent

100

Midwives authorized for specific tasks (X of 7 tasks)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

3 (R,F)

Postnatal home visits in the first week after birth

Indirect 29%

2015 (provisional) Measles 0% ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Legal status of abortion (X of 5 circumstances)

Maternal deaths notification

Hypertension 16%

Yes

Maternity protection (Convention 183)

Sepsis** 9%

Malaria 11%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Urban

20 4

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

101

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Guatemala DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

16,343

(2015)

2,089

(2015)

Under-five mortality rate

Deaths per 100,000 live births

100

300

438

(2015)

Birth registration (%) Total under-five deaths (000)

97 13

(2008-2009)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

13 24

(2015)

Stillbirth rate (per 1000 total births)

(2009)

660

(2013)

Lifetime risk of maternal death (1 in N)

170

(2013)

Total fertility rate (per woman)

3.2

(2015)

(2011)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Maternal mortality ratio

Deaths per 1000 live births

270

250 200 150

20 0 1990

1995

2000

2005

100

MDG Target: 27

2010

2015

Source: UN IGME 2015

140 68

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 72

*Postnatal care Exclusive breastfeeding

Neonatal period

Measles

Infancy

20 40 60 80 100

Source: DHS, MICS, Other NS

52 41

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

60 40

Percent

23 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

20 10

1987 DHS

1995 DHS

1998-99 2002 2008-09 2013 DHS Other NS Other NS Other NS

4 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100 80

73 73 67 54 51

80 60

Percent

Skilled attendant at delivery

Percent

100

Antenatal care (4+ visits)

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2005

2010

ORT & continued feeding

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

2002 Other NS

Percent of infants <6 months exclusively breastfed

80 53

55 28

20 0

1998-99 DHS

Exclusive breastfeeding

60 40

1995 DHS

100

Percent

Source: Other NS 2008

1 (2008-2009) Early initiation of breastfeeding (within 1 hr of birth, %) 56 (2008-2009) 11 (2008-2009) Introduction of solid, semi-solid/soft foods (%) Vitamin A two dose coverage (%) (2013) 13

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

2014

1998-99 DHS

2002 Other NS

2008-09 Other NS

Percent

Measles

2000

0 1990

Early initiation of breastfeeding

102

Pneumonia treatment

60 40

2002 Other NS

2008-09 Other NS

20 0

1987 DHS

1995 DHS

1998-99 DHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Guatemala DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 12%

14%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 12%

Neonatal death: 46%

Sepsis 8%

Other direct 15%

Sepsis** 8%

Injuries 8%

Diarrhoea

Hypertension 22%

Indirect 19%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

100

Percent

80 60

(2008-2009)

Antenatal care (4 or more visits, %)

Malaria during pregnancy - intermittent preventive treatment (%)

16, 26, 11

(2008-2009)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Demand for family planning satisfied (%)

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

(2014)

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(2002)

(within 2 days, %)

20 0

(within 2 days , %)

1987 DHS

1995 DHS

1998-99 DHS

2002 Other NS

2008-09 Other NS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

1998-99 DHS

2002 Other NS

2008-09 Other NS

22 1995 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

100 11

3 8

2 0

17 16

100

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

1990

2015 Rural

5 Partial

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

18.3

(2009)

476

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

5 11 14

(2015)

No Data

General government expenditure 9

40 20

Midwives authorized for specific tasks (X of 7 tasks)

FINANCING

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

7 6

Per capita total expenditure on health (Int$)

Improved sanitation coverage

40 20

2 8

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

100 80 60 40 20 0

1999 MICS

Percent

80 12

Yes

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Maternity protection (Convention 183)

Source: WHO/MCEE 2015 Measles 0% (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

Haemorrhage 23%

Other 4%

Other 23%

Malaria 0%

Embolism 3%

Abortion 10%

Congenital 8%

HIV/AIDS 1%

Regional estimates for Latin America, 2013

External sources

ODA to child health per child (US$)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

8 49 31

1990

2015 Total

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

103

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Guinea DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

12,609

(2015)

2,046

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

250

1200

460

(2015)

Birth registration (%) Total under-five deaths (000)

58 42

(2012)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

31 61

(2015)

150

(2015)

100

Stillbirth rate (per 1000 total births)

(2009)

MDG Target: 79

2,800

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.9

(2015)

Adolescent birth rate (per 1000 girls)

154

(2010)

Total maternal deaths

(2015)

238

1100

1000

200

800

0 1990

1995

2000

2005

2010

400 280

200 0 1990

2015

Source: UN IGME 2015

650

600

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 29

*Postnatal care

Birth

Exclusive breastfeeding

Neonatal period

Measles

Infancy

No Data

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Percent

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1992 DHS

1999 DHS

2003 MICS

2005 DHS

2007 Other NS

2012 DHS

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80

52 51 51

Percent

60 40

Percent

Skilled attendant at delivery

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Measles

60 39

42 33

2014

(2012)

(2005)

1999 DHS

2003 MICS

2005 DHS

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Percent of infants <6 months exclusively breastfed

100

Percent

60 40 20 0

Exclusive breastfeeding

35 21

34 21

40 21

Percent

Careseeking for pneumonia

2012 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 17 Introduction of solid, semi-solid/soft foods (%) 43 Vitamin A two dose coverage (%)

ORT & continued feeding

Early initiation of breastfeeding

104

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

Antenatal care (4+ visits)

Source: DHS 2012

Pneumonia treatment

60 40 20

2003 MICS

2005 DHS

2012 DHS

0 1994-95 Other NS

1999 DHS

2005 DHS

2007-08 Other NS

2012 DHS

1999 DHS

(2012) (2012) -

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Guinea DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 9%

14%

Asphyxia* 10% Other 2%

Neonatal death: 34%

Other 18%

Globally nearly half of child deaths are attributable to undernutrition

Sepsis 10%

Embolism 2% Haemorrhage 25%

Abortion 10%

Other direct 9%

Congenital 2% Sepsis** 7%

Hypertension 16%

Diarrhoea

Measles 0%

Malaria 20%

Source: WHO/MCEE 2015 (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Indirect 29%

Injuries 4%

* Intrapartum-related events

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Demand for family planning satisfied (%)

(2005)

Antenatal care (4 or more visits, %)

(2012)

Malaria during pregnancy - intermittent preventive treatment (%)

(2012)

2, 6, 1

(2012)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2012)

Postnatal visit for mother

(2012)

Women with low body mass index

(2012)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

60 40

(within 2 days, %)

20 0

(within 2 days , %)

1992 DHS

1999 DHS

2003 MICS

2005 DHS

2007 Other NS

2012 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

25 1992 DHS

1999 DHS

2003 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2005 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2012 DHS

5 (2012)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

40 8

40 20 0

0 7

8 25

47 14

1990

Total Source: WHO/UNICEF JMP 2015

2015 Urban

26 1

2005 DHS

2007 Other NS

15 41

1990

2015 Rural

Partial

Maternal deaths notification

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS -

Costed national implementation plan(s) for: maternal, newborn and child health available

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

1.4

(2005)

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

2012 DHS

Reproductive, maternal, newborn and child health expenditure by source

0 21

(2015)

(2012-13)

45 55

1990

2015 Total

(2013)

No Data

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

37 34

(2013)

External sources 24

General government expenditure

60 40

(R,F)

FINANCING

20 9

39 0

2015 1990

Midwives authorized for specific tasks (X of 7 tasks)

Per capita total expenditure on health (Int$)

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100

(% of recommended minimum)

100 80 60 40 20 0

Improved sanitation coverage

Percent

7 7

Legal status of abortion (X of 5 circumstances)

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

Partial

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Maternity protection (Convention 183)

HIV/AIDS 1%

Regional estimates for Sub-Saharan Africa, 2013

9 3

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

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A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Guinea-Bissau DEMOGRAPHICS Total population (000)

1,844

(2015)

289

(2015)

Births (000)

(2015)

Birth registration (%) Total under-five deaths (000)

24 6

(2010)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

40 60

(2015)

150

(2015)

100

Total under-five population (000)

Stillbirth rate (per 1000 total births)

(2015)

(2009)

360

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.8

(2015)

Adolescent birth rate (per 1000 girls)

137

(2009)

Total maternal deaths

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

250

1000

229

930

800

200

600 93 MDG Target: 76

50 0 1990

1995

2000

2005

2010

230

200 0 1990

2015

Source: UN IGME 2015

560

400 MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

*Postnatal care

70 65

Exclusive breastfeeding

Neonatal period

Measles

20 40 60 80 100 Percent

60 40 20

1990-1995 Other NS

2000 MICS

2006 MICS

2010 MICS

20 0

100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

3 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2014 pMICS

22 4

<1 2005

2008

Source: UNICEF/UNAIDS/WHO 2015

2011

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

100 80

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

ORT & continued feeding

2014

(2014)

(2010)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

2000 MICS

2006 MICS

2010 MICS

2014 pMICS

Vitamin A two dose coverage (%)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80 48

100

(2010)

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 55 Introduction of solid, semi-solid/soft foods (%) 43

32 18

Percent

Vitamin A (past 6 months)

Measles

ITN use among children <5 yrs

Source: MICS 2006

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

106

80 80 69

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

60 40

53 38

37 16

20 0

2000 MICS

2006 MICS

2008 Other NS

2010 MICS

2014 pMICS

2000 MICS

2006 MICS

2010 MICS

2014 pMICS

(2010)

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Guinea-Bissau DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 11%

14%

Asphyxia* 13%

Neonatal death: 44%

Other 19%

Globally nearly half of child deaths are attributable to undernutrition

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2% Haemorrhage 25%

Abortion 10%

Other direct 9%

Other 3%

Sepsis** 10% 9%

Malaria 4% Injuries 5%

Indirect 29%

Source: WHO 2014

Measles 1% ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy 93

100

(2010)

Antenatal care (4 or more visits, %)

(2014)

Malaria during pregnancy - intermittent preventive treatment (%)

(2010)

4, 0, 0

(2014)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2014)

Postnatal visit for mother

(2014)

(Minimum target is 5% and maximum target is 15%)

Demand for family planning satisfied (%)

C-section rate (total, urban, rural; %)

80 Percent

(within 2 days, %)

20 0

(within 2 days , %)

2000 MICS

2006 MICS

2010 MICS

2014 pMICS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

53 23

25 23

2000 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2006 MICS

2010 MICS

2014 pMICS

47 (2014)

39 7

73 60

33 32 6

1990

Source: WHO/UNICEF JMP 2015

2015 Urban

17 40

2006 MICS

2010 MICS

2014 pMICS

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

1990

2015 Rural

Partial

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

1 -

(2015)

6.6

(2009)

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

Reproductive, maternal, newborn and child health expenditure by source

25 (2002)

1995

2015 Total

(2013)

No Data

ODA to child health per child (US$) ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

16 21

Private sources 33

(2013)

External sources

General government expenditure

20 8

2015 1990 Total

100 80

Postnatal home visits in the first week after birth

Per capita total expenditure on health (Int$)

Percent of population by type of sanitation facility, 1995-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

40 20

FINANCING

Improved sanitation coverage

Percent

1 0

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 0

Midwives authorized for specific tasks (X of 7 tasks)

(% of recommended minimum)

100 80 60 40 20 0

2000 MICS

Improved drinking water coverage

2 19

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100 4

Legal status of abortion (X of 5 circumstances)

Maternal deaths notification

Hypertension 16%

Source: WHO/MCEE 2015 (provisional)

Diarrhoea

Maternity protection (Convention 183)

Congenital 3% HIV/AIDS 4%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

34 2

1995

2015 Urban

4 8

1995

2015 Rural

Source: WHO/UNICEF JMP 2015

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A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Haiti DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

10,711

(2015)

1,238

(2015)

Under-five mortality rate

Deaths per 100,000 live births

250

800

200

600

263

(2015)

Birth registration (%) Total under-five deaths (000)

80 18

(2012)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

25 52

(2015)

150

(2015)

100

Stillbirth rate (per 1000 total births)

(2009)

1,000

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

3.0

(2015)

(2009)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Maternal mortality ratio

Deaths per 1000 live births

146

670 380

400 69

200

170

MDG Target: 49

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 49 67 37

*Postnatal care Exclusive breastfeeding

Neonatal period

Measles

1989 Other NS

1994-95 DHS

20 40 60 80 100 Percent

20 0

100 37

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

93 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

60 40 9

20 2000 DHS

2005-06 DHS

2012 DHS

2005

2008

Source: UNICEF/UNAIDS/WHO 2015

2011

2014

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80

Percent

53 48 48 40

40 20

Early initiation of breastfeeding

Percent

Skilled attendant at delivery

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

ORT & continued feeding

(2012)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

20 0

2000 DHS

2005-06 DHS

2012 DHS

Vitamin A two dose coverage (%)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100 80

60 40

1994-95 DHS

(2012)

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 47 Introduction of solid, semi-solid/soft foods (%) 87

40 24

1990 Other NS

37 24

1994-95 DHS

2000 DHS

Percent

Careseeking for pneumonia

0 1990

Vitamin A (past 6 months)

Measles

108

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

Antenatal care (4+ visits)

Source: DHS 2012

Pneumonia treatment

2005-06 DHS

22 12 2012 DHS

60 40 20 0

2005-06 DHS

2012 DHS

24 3 1994-95 DHS

2000 DHS

(2012)

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Haiti DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 12%

20%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 9%

Neonatal death: 37%

Sepsis 8%

Embolism 3%

Abortion 10%

Haemorrhage 23%

Other 3% Congenital 3%

Other direct 15%

Sepsis** 7%

Other 25%

Diarrhoea

Source: WHO/MCEE 2015 Injuries 7% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis HIV/AIDS 1%

Hypertension 22%

Indirect 19%

Measles 0%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Demand for family planning satisfied (%)

(2012)

Antenatal care (4 or more visits, %)

(2012)

6, 10, 3

(2012)

Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2012)

Postnatal visit for mother

(2012)

(within 2 days, %)

20 0

(within 2 days , %)

1984-89 Other NS

1994-95 DHS

2000 DHS

2005-06 DHS

2012 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

57 41

1994-95 DHS

2000 DHS

2005-06 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2012 DHS

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

100 19

80 48

1990

2015 Rural

Maternal deaths notification

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

(2015)

Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

2 -

(2015)

3.6

(1998)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

12 (2008)

18 28

1990

2015 Total

2015 Urban

(2013)

No Data

ODA to child health per child (US$) ODA to maternal and neonatal health per live birth (US$)

(2012)

106

(2012)

Note: See annexes for additional information on the indicators above

1990

(2013)

External sources

33 18

160

General government expenditure

Life Saving Commodities in Essential Medicine List:

General government expenditure on health as % of total government expenditure (%)

63 38

60 40

FINANCING

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

49 24

Midwives authorized for specific tasks (X of 7 tasks)

Per capita total expenditure on health (Int$)

Improved sanitation coverage

20 0

60 40

5 4

(% of recommended minimum)

100 80 60 40 20 0

2012 DHS

Percent

Legal status of abortion (X of 5 circumstances)

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Maternity protection (Convention 183)

10%

Malaria 0%

Regional estimates for Caribbean, 2013

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

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A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

India DEMOGRAPHICS Total population (000)

1,311,051

(2015)

123,711

(2015)

25,794

(2015)

84 1,201

(2011)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

28 38

(2015)

Stillbirth rate (per 1000 total births)

(2009)

50,000

(2013)

Lifetime risk of maternal death (1 in N)

190

(2013)

Total fertility rate (per woman)

2.4

(2015)

(2009)

Total under-five population (000) Births (000) Birth registration (%) Total under-five deaths (000)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

140 126 120 100 80 60 40 20 0 1990 1995

600

560

500 400 300 48 MDG Target: 42

2000

2005

2010

190

200

140

100

2015

Source: UN IGME 2015

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 73 45 52

*Postnatal care Exclusive breastfeeding

Neonatal period

Measles

Infancy

No Data

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

83 Percent

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1992-1993 1998-1999 NFHS NFHS

2000 MICS

2005-2006 2007-2008 NFHS Other NS

* See Annex/website for indicator definition

CHILD HEALTH

Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

83 83

80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months) ORT & continued feeding

2010

0 10 20 30 40 50 60 70 80 90 100

100

Percent

1992-1993 NFHS

1998-1999 NFHS

2005-2006 NFHS

2013-2014 Other NS

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

51 58

54 46

44 48

39 29

60 40

1992-1993 NFHS

1998-1999 NFHS

2005-2006 NFHS

110

100

Percent

77 69

15 (2013-2014) Early initiation of breastfeeding (within 1 hr of birth, %) 41 (2007-2008) 28 (2005-2006) Introduction of solid, semi-solid/soft foods (%) 56 (2005-2006) Vitamin A two dose coverage (%) (2013) 53

Percent of children <5 years who are moderately or severely: underweight stunted

Source: NFHS 2005-2006

2014

Underweight and stunting prevalence

Careseeking for pneumonia

100

Measles

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

Pneumonia treatment

Percent

Socioeconomic inequities in coverage

Percent

EQUITY

0 1992-1993 NFHS

1998-1999 NFHS

2005-2006 NFHS

2013-2014 Other NS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

India DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 25%

12%

Globally nearly half of child deaths are attributable to undernutrition

Neonatal death: 58%

Other 15%

Sepsis 14%

Regional estimates for South Asia, 2013

Embolism 2%

Haemorrhage 30%

Abortion 6%

Asphyxia* 11%

Other direct 8%

Other 3%

HIV/AIDS 0%

Congenital 6%

Malaria 1%

Sepsis** 9%

Injuries 3% Measles 2%

* Intrapartum-related events

Source: WHO/MCEE 2015 (provisional) Diarrhoea ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Hypertension 10%

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

(2007-2008)

Antenatal care (4 or more visits, %)

(2013-2014)

9, 17, 6

(2005-2006)

(2014)

Postnatal visit for mother

(2005-2006)

Women with low body mass index

(2005-2006)

Malaria during pregnancy - intermittent preventive treatment (%)

Demand for family planning satisfied (%)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby (within 2 days, %)

20 0

(within 2 days , %)

1992-1993 1998-1999 NFHS NFHS

2000 MICS

2005-2006 2013-2014 NFHS Other NS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

6 (2005-2006)

Midwives authorized for specific tasks (X of 7 tasks)

(R,F)

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

24.5

(2011)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

36 (2000)

FINANCING 18

1992-1993 NFHS

1998-1999 NFHS

Per capita total expenditure on health (Int$)

No Data

General government expenditure on health as % of total government expenditure (%)

2005-2006 NFHS

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 5

26 66

3 0

1 10

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

60 75

1990

2015 Rural

2015 Total

(2013)

No Data

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

6 5 2 16

1990

External sources

63 40

(2013)

Private sources

215

General government expenditure

10 6

40 3

20 5

100 80

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

32 77

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

100 3

Percent

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

Improved drinking water coverage

National availability of Emergency Obstetric Care services

WATER AND SANITATION

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

111

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Indonesia DEMOGRAPHICS Total population (000)

257,564

(2015)

24,864

(2015)

5,037

(2015)

67 147

(2012)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

14 23

(2015)

Stillbirth rate (per 1000 total births)

(2009)

8,800

(2013)

Lifetime risk of maternal death (1 in N)

220

(2013)

Total fertility rate (per woman)

2.4

(2015)

(2009)

Total under-five population (000) Births (000) Birth registration (%) Total under-five deaths (000)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

100

500

430

400 300 MDG Target: 28

20 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

190

200

110

100 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 84 84 87

*Postnatal care

Exclusive breastfeeding

100

Pre-pregnancy Pregnancy Birth

Neonatal period

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Percent

15 10

1997 DHS

2002-03 DHS

2007 DHS

2012 DHS

2013 Other NS

5 1991 DHS

8 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80

Percent

60 40

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

ORT & continued feeding

(2013)

(2007)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

2002-03 DHS

2007 DHS

2012 DHS

Vitamin A two dose coverage (%)

(2013)

(2012)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80 48 30

20 0

1994 DHS

100

60 40

1997 DHS

(2012)

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 49 Introduction of solid, semi-solid/soft foods (%) 91

42 23

40 19

Percent

Vitamin A (past 6 months)

2014

2010

Measles

Early initiation of breastfeeding

Percent

78 77

Skilled attendant at delivery

112

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

Antenatal care (4+ visits)

Source: DHS 2012

Pneumonia treatment

1994 DHS

1997 DHS

2002-03 DHS

20 0

1995 MICS

2001 2004 2007 2010 2013 Other NS Other NS Other NS Other NS Other NS

1991 DHS

2007 DHS

2012 DHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Indonesia DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 18%

14%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 11%

Neonatal death: 50%

Sepsis 6%

Abortion 7%

Embolism 12%

Other direct 14%

Other 3% Congenital 8%

Haemorrhage 30%

Other 18% Sepsis** 7% HIV/AIDS 1%

Malaria 1% Injuries 6%

Measles 3%

* Intrapartum-related events

Indirect 17%

Source: WHO/MCEE 2015 (provisional)

Diarrhoea

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for South-eastern Asia, 2013

Hypertension 15%

Source: WHO 2014

** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

(2012)

Antenatal care (4 or more visits, %)

(2013)

12, 17, 8

(2012)

Malaria during pregnancy - intermittent preventive treatment (%)

80 Percent

Demand for family planning satisfied (%)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2012)

Postnatal visit for mother

(2012)

(within 2 days, %)

20 0

(within 2 days , %)

1991 DHS

1997 DHS

2002-03 DHS

2007 DHS

2012 DHS

2013 Other NS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

61 43

1991 DHS

1997 DHS

2000 MICS

54 36

2002-03 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2007 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2012 DHS

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 2 11

6 0

1 10

20 0

3 18

2000 MICS

2007 DHS

80 40

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

1990

2015 Rural

8 11

19 12

13 5 10

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

15.9

(2012)

293

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

Reproductive, maternal, newborn and child health expenditure by source

(2015)

No Data

General government expenditure External sources Private sources 29

49 12 12

40 7 20

Maternity protection (Convention 183)

FINANCING

100

Per capita total expenditure on health (Int$)

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Midwives authorized for specific tasks (X of 7 tasks)

(% of recommended minimum)

100 80 60 40 20 0

Improved sanitation coverage

Percent

80 25

1(R,F)

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100 6

Legal status of abortion (X of 5 circumstances)

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

72 6

1990

2015 Total

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

113

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Iraq DEMOGRAPHICS Total population (000)

36,423

(2015)

Total under-five population (000)

5,727

(2015)

Births (000)

Under-five mortality rate

1,244

(2015)

Birth registration (%) Total under-five deaths (000)

99 39

(2011)

(2015)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

18 27

(2015)

(2009)

710

(2013)

Lifetime risk of maternal death (1 in N)

340

(2013)

Total fertility rate (per woman)

4.5

(2015)

(2006)

Stillbirth rate (per 1000 total births) Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

120

110

100 32

MDG Target: 18

10 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

60 40

20 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 87 50 91

*Postnatal care Exclusive breastfeeding

Neonatal period

100

Pre-pregnancy Pregnancy Birth

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

No Data

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Eligible HIV+ pregnant women receiving ART for their own health (%)

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

1989 Other NS

2000 MICS

2006 MICS

2006-2007 Other NS

2011 MICS

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80

64 64 57

Percent

60 40

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

Measles

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

(2011)

2000 MICS

2006 MICS

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Percent of infants <6 months exclusively breastfed

100

Percent

60 40 20 0

n/a

Exclusive breastfeeding

28 10 1991 Other NS

28 13 2000 MICS

10 2003 Other NS

Percent

Careseeking for pneumonia

2011 MICS

Early initiation of breastfeeding (within 1 hr of birth, %) 43 Introduction of solid, semi-solid/soft foods (%) 36 Vitamin A two dose coverage (%)

ORT & continued feeding

2014

2010

Early initiation of breastfeeding

Percent

Skilled attendant at delivery

114

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

Antenatal care (4+ visits)

Source: MICS 2011

Pneumonia treatment

28 7 2006 MICS

23 9 2011 MICS

60 40 20

0 2000 MICS

2006 MICS

2011 MICS

(2011) (2011) -

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Iraq DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Globally nearly half of child deaths are attributable to undernutrition

Preterm 20% Pneumonia

12%

Asphyxia* 13%

Neonatal death: 58%

Abortion 3%

Sepsis 5%

Embolism 9%

Other direct 16%

Other 4%

Haemorrhage 31%

Congenital 10% Other 19%

Regional estimates for Western Asia, 2013

Sepsis** 8%

HIV/AIDS 0% Malaria 0% Injuries 6%

Indirect 23%

Source: WHO/MCEE 2015 Measles 0% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Hypertension 13%

Diarrhoea

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

(2011)

Antenatal care (4 or more visits, %)

(2011)

22, 25, 16

(2011)

Malaria during pregnancy - intermittent preventive treatment (%)

Demand for family planning satisfied (%)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(within 2 days, %)

20 0

(within 2 days , %)

1996 Other NS

2000 MICS

2006 MICS

2011 MICS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2000 MICS

2006 MICS

15 7

10 12

5 1 11

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

Percent of population by type of sanitation facility, 1995-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100 6

23 13

60 40

4 10

0 7

3 0 11

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

6.1

(2010)

695

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

1990

2015 Rural

External sources

0 7 9

No Data

General government expenditure

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

95 75

7 46

60 40

Maternity protection (Convention 183)

Out of pocket expenditure as % of total expenditure on health(%)

Percent

General government expenditure on health as % of total government expenditure (%)

2011 MICS

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 2 3

Midwives authorized for specific tasks (X of 7 tasks)

FINANCING

Improved drinking water coverage

Per capita total expenditure on health (Int$)

WATER AND SANITATION

100

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

Very limited risk

Partial

National availability of Emergency Obstetric Care services

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1995

2015 Total

1995

2015 Urban

1995

2015 Rural

Source: WHO/UNICEF JMP 2015

115

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Kenya DEMOGRAPHICS Total population (000)

46,050

(2015)

Total under-five population (000)

7,166

(2015)

Births (000)

Under-five mortality rate

Deaths per 100,000 live births

150

600

1,571

(2015)

Birth registration (%) Total under-five deaths (000)

60 74

(2008-2009)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

22 36

(2015)

Stillbirth rate (per 1000 total births)

(2009)

6,300

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.3

(2015)

Adolescent birth rate (per 1000 girls)

101

(2013)

Total maternal deaths

(2015)

Maternal mortality ratio

Deaths per 1000 live births

102

120

490

500

400

400 300 49

MDG Target: 34

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

200 120

100 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 76 58 62

*Postnatal care Exclusive breastfeeding

Neonatal period

Measles

80 44

100

Percent

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

50 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

60 40 20

1989 DHS

1993 DHS

1998 DHS

2003 DHS

2008-09 DHS

2014 pDHS

48 <1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

40 20

Early initiation of breastfeeding

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

ORT & continued feeding

(2014)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Source: DHS 2008-2009

80 60

20 0

1993 DHS

1998 DHS

2003 DHS

2008-09 DHS

2014 pDHS

Early initiation of breastfeeding (within 1 hr of birth, %) 58 (2008-2009) 78

(2014)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100 80

8 (2008-2009) Introduction of solid, semi-solid/soft foods (%) Vitamin A two dose coverage (%)

Underweight and stunting prevalence

Careseeking for pneumonia

100

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Measles

116

81 81 81 79

Antenatal care (4+ visits)

Pneumonia treatment

Percent

Socioeconomic inequities in coverage

37 18

36 17

35 16

26 11

Percent

EQUITY

40 20

32 23

0 1993 DHS

1998 DHS

2000 MICS

2003 DHS

2008-09 DHS

2014 pDHS

1989 DHS

1993 DHS

1998 DHS

2003 DHS

2008-09 DHS

2014 pDHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Kenya DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

11%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 12% Asphyxia* 14%

Neonatal death: 45%

Sepsis 10%

Haemorrhage 25%

Abortion 10%

Other 3%

Other direct 9%

Congenital 6%

Other 19%

Embolism 2%

Regional estimates for Sub-Saharan Africa, 2013

Sepsis** 7% HIV/AIDS 6%

Hypertension 16%

Source: WHO/MCEE 2015 Measles 0% (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis Diarrhoea

Malaria 5% Injuries 6% * Intrapartum-related events

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

95 77

80 Percent

Demand for family planning satisfied (%)

(2014)

Antenatal care (4 or more visits, %)

(2014)

Malaria during pregnancy - intermittent preventive treatment (%)

(2014)

6, 11, 5

(2008-2009)

(2014)

Postnatal visit for mother

(2014)

Women with low body mass index

(2008-2009)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby (within 2 days, %)

20 0

(within 2 days , %)

1989 DHS

1993 DHS

1998 DHS

2003 DHS

2008-09 DHS

2014 pDHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

65 37

1993 DHS

1998 DHS

2000 MICS

33 29

2003 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2008-09 DHS

2014 pDHS

86 (2014)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

Percent

47 3

2000 MICS

2003 DHS

60 16

40 26

1990

Source: WHO/UNICEF JMP 2015

2015 Urban

2008-2009 2010 DHS Other NS

1990

2015 Rural

40 20

20 14

2015 1990 Total

15 19

Midwives authorized for specific tasks (X of 7 tasks)

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

4 -

(2015)

10.6

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

54 (2003)

FINANCING Per capita total expenditure on health (Int$)

2014 pDHS

General government expenditure on health as % of total government expenditure (%)

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100

5 13

(% of recommended minimum)

100 80 60 40 20 0

Improved sanitation coverage

Percent

Legal status of abortion (X of 5 circumstances)

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

Yes

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Total

16 27

1990

2015 Urban

(2013)

No Data

External sources

(2013)

General government expenditure

101

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

117

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Korea,

Democratic Peopleâ&#x20AC;&#x2122;s Republic of

DEMOGRAPHICS Total population (000)

25,155

(2015)

1,747

(2015)

Births (000)

360

(2015)

Birth registration (%) Total under-five deaths (000)

100 9

(2009)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

14 20

(2015)

Stillbirth rate (per 1000 total births)

(2009)

310

(2013)

Lifetime risk of maternal death (1 in N)

630

(2013)

Total fertility rate (per woman)

2.0

(2015)

(2008)

Total under-five population (000)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

80 60

40 25

MDG Target: 14

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

140 120 100 85 80 60 40 20 0 1990

21 MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 83 94

*Postnatal care Exclusive breastfeeding

Neonatal period

Measles

Birth

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

60 40

Infancy

No Data

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

100

Pre-pregnancy Pregnancy

100

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

2000 MICS

Percent

2004 Other NS

2009 MICS

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100

No Data

93 80

80 60 40 20 0

0 1990

1995

2000

Source: WHO/UNICEF 2015

2005

2010

2014

2004 Other NS

2009 MICS

NUTRITION Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Measles Vitamin A (past 6 months)

(2012)

(2009)

Underweight and stunting prevalence

ORT & continued feeding Careseeking for pneumonia

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

(2012)

Vitamin A two dose coverage (%)

(2013)

Percent

Percent of infants <6 months exclusively breastfed

100 56

51 25

20 0

Exclusive breastfeeding

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 28 Introduction of solid, semi-solid/soft foods (%) 66

43 21

32 15

Percent

DTP3

118

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding ITN use among children <5 yrs

99 93 93

Pneumonia treatment

Percent

EQUITY

2004 Other NS

2012 Other NS

40 20 0

1998 Other NS

2000 MICS

2004 Other NS

2009 MICS

2012 Other NS

(2012)

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Korea,

Democratic Peopleâ&#x20AC;&#x2122;s Republic of

DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 19%

12%

Globally nearly half of child deaths are attributable to undernutrition

Other 20%

Abortion 1%

Sepsis 3%

Regional estimates for Eastern Asia, 2013

Embolism 12%

Other direct 14%

Asphyxia* 12%

Neonatal death: 55%

Other 4% HIV/AIDS 0% Malaria 0%

Sepsis** 7%

Injuries 7%

Source: WHO/MCEE 2015 6% Measles 0% Diarrhoea (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis 0%

Hypertension 10%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

(2010)

Antenatal care (4 or more visits, %)

(2009)

13, 15, 9

(2009)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

Malaria during pregnancy - intermittent preventive treatment (%)

100

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(within 2 days, %)

20 0

(within 2 days , %)

2000 MICS

2009 MICS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2009 MICS

Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 0

Percent of population by type of sanitation facility, 1995-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100

100 80

80 Percent

Percent

60 100

1990

2015

1990

Total Source: WHO/UNICEF JMP 2015

2015 1990 Urban

2015 Rural

Maternal deaths notification

Postnatal home visits in the first week after birth

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

Newborn health (X of 4) Child health (X of 3)

74.1

(2003)

Per capita total expenditure on health (Int$)

General government expenditure on health as % of total government expenditure (%)

Out of pocket expenditure as % of total expenditure on health(%)

Density of doctors, nurses and midwives (per 10,000 population)

External sources Private sources

6 6

82 57

1995

2015 Total

No Data

General government expenditure

60 3

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Midwives authorized for specific tasks (X of 7 tasks)

FINANCING Very limited risk

5(R,F)

(% of recommended minimum)

WATER AND SANITATION

100

Legal status of abortion (X of 5 circumstances)

National availability of Emergency Obstetric Care services

Maternity protection (Convention 183)

Haemorrhage 36%

Indirect 25%

Congenital 10%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

73 48

1995

2015 Urban

1995

2015 Rural

Source: WHO/UNICEF JMP 2015

119

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Kyrgyzstan DEMOGRAPHICS Total population (000)

5,940

(2015)

Total under-five population (000)

780

(2015)

Births (000)

Under-five mortality rate

154

(2015)

Birth registration (%) Total under-five deaths (000)

98 4

(2012)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

12 19

(2015)

Stillbirth rate (per 1000 total births)

(2009)

110

(2013)

Lifetime risk of maternal death (1 in N)

390

(2013)

Total fertility rate (per woman)

3.1

(2015)

(2012)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

MDG Target: 22

15 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

140 120 100 85 80 60 40 20 0 1990

21 MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 67 95 98

*Postnatal care

Exclusive breastfeeding

Neonatal period

Infancy

Measles

<1 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

100

80 60

40 20

20 40 60 80 100

Source: DHS, MICS, Other NS

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1997 DHS

Percent

2006 MICS

2012 DHS

2014 MICS

5 2005

15 2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100 80

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

2006 MICS

2014 MICS

Measles

ITN use among children <5 yrs

(2014)

(2012)

1997 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 84 Introduction of solid, semi-solid/soft foods (%) 85 Vitamin A two dose coverage (%)

ORT & continued feeding

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Percent of infants <6 months exclusively breastfed

100

Percent

60 36

40 20 0

Exclusive breastfeeding

Percent

Careseeking for pneumonia

Source: DHS 2012

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

120

96 96 96

Pneumonia treatment

Percent

EQUITY

10 1997 DHS

18 3 2006 MICS

5 2009 Other NS

2012 DHS

2014 MICS

60 40 20

32 24

0 1997 DHS

2006 MICS

2012 DHS

2014 MICS

(2012) (2014) -

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Kyrgyzstan DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Asphyxia* 12% Other 4%

Preterm 16% Pneumonia

Globally nearly half of child deaths are attributable to undernutrition

11%

Neonatal death: 54%

Sepsis 9%

Embolism 11%

Abortion 5%

Other direct 17%

Congenital 12%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Caucasus and Central Asia, 2013

Haemorrhage 23%

Sepsis** 7%

Diarrhoea

HIV/AIDS 1% Malaria 0% * Intrapartum-related events

Source: WHO/MCEE 2015 Injuries 6% (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Hypertension 15%

Indirect 22%

Measles 0%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy 98

100

Percent

Demand for family planning satisfied (%)

(2012)

Antenatal care (4 or more visits, %)

(2014)

7, 0, 0

(2014)

Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby

(2014)

Postnatal visit for mother

(2014)

(2012)

(within 2 days, %)

20 0

(within 2 days , %)

1997 DHS

2006 MICS

2012 DHS

2014 MICS

Women with low body mass index (<18.5 kg/m2, %)

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2014 MICS

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

19 6

1 3

2 1 9

10 29

31 88

42 22

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

2015 Urban

Yes

(2015)

Life Saving Commodities in Essential Medicine List: 1*

(2015)

3 -

(2015)

81.9

(2013)

221

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

1990

2015 Rural

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100

Percent

Yes

Per capita total expenditure on health (Int$)

Very limited risk

Improved drinking water coverage

Yes

Postnatal home visits in the first week after birth

FINANCING

20 2012 DHS

Partial

Maternal deaths notification

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

(% of recommended minimum)

2006 MICS

63 40

1997 DHS

Midwives authorized for specific tasks (X of 7 tasks)

Newborn health (X of 4) Child health (X of 3)

Diarrhoeal disease treatment

5 (R,F)

Reproductive health (X of 3) Maternal health (X of 3)

CHILD HEALTH

100 80 60 40 20 0

Legal status of abortion (X of 5 circumstances)

Maternity protection (Convention 183)

Other 23%

Yes

3 4

5 4

4 7

6 3

No Data

General government expenditure External sources

01 3

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

20 0

1990

2015 Total

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

121

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Lao

Peopleâ&#x20AC;&#x2122;s Democratic Republic

DEMOGRAPHICS Total population (000)

6,802

(2015)

Total under-five population (000)

839

(2015)

Births (000)

179

(2015)

Birth registration (%) Total under-five deaths (000)

75 12

(2011-2012)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

30 51

(2015)

Stillbirth rate (per 1000 total births)

(2009)

400

(2013)

Lifetime risk of maternal death (1 in N)

130

(2013)

Total fertility rate (per woman)

2.9

(2015)

(2010)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

1200 162

1100

1000

150

800 600

100 50 0 1990

1995

2000

2005

400

MDG Target: 54

200

2010

0 1990

2015

Source: UN IGME 2015

220

280

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

*Postnatal care

Exclusive breastfeeding

Birth

Neonatal period

Measles

Source: DHS, MICS, Other NS

2005 Other NS

2006 MICS

2000 MICS

Percent

2011-2012 DHS/MICS

20 10

20 40 60 80 100

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

21 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

15 7

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

88 87 72

Antenatal care (4+ visits)

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100 80

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

2014

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

2011-2012 DHS/MICS

54 40

53 36

48 32

44 27

20 0

2006 MICS

100

60 40

2000 MICS

Percent of infants <6 months exclusively breastfed

Percent

Source: MICS 2011-2012

Exclusive breastfeeding

Percent

ORT & continued feeding

6 (2011-2012) Early initiation of breastfeeding (within 1 hr of birth, %) 39 (2011-2012) 15 (2011-2012) Introduction of solid, semi-solid/soft foods (%) 52 (2011-2012) Vitamin A two dose coverage (%) (2013) 87

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Measles

Early initiation of breastfeeding

122

Pneumonia treatment

Percent

EQUITY

60 40 20

40 23

2000 MICS

2006 MICS

0 1993 Other NS

1994 Other NS

2000 Other NS

2006 MICS

2011-2012 DHS/MICS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Lao

Peopleâ&#x20AC;&#x2122;s Democratic Republic

DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 12%

14%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 13%

Neonatal death: 45%

Abortion 7%

Sepsis 6%

Embolism 12%

Other direct 14%

Other 4%

Haemorrhage 30%

Congenital 4%

Other 22%

Sepsis** 8% HIV/AIDS 0%

Indirect 17%

11%

Source: WHO/MCEE 2015 Measles 0% (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Malaria 0%

Diarrhoea

Injuries 7% * Intrapartum-related events

Regional estimates for South-eastern Asia, 2013

Hypertension 15%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

(2012)

Antenatal care (4 or more visits, %)

(2011-2012)

(2006)

4, 10, 2

(2011-2012)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2012)

Postnatal visit for mother

(2012)

Malaria during pregnancy - intermittent preventive treatment (%)

100

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(Minimum target is 5% and maximum target is 15%)

60 40

(within 2 days, %)

20 0

(within 2 days , %)

2000 MICS

2005 Other NS

2006 MICS

2011-2012 DHS/MICS

Women with low body mass index (<18.5 kg/m2, %)

Malaria prevention and treatment

2000 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2006 MICS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2011-2012 DHS/MICS

11 (2011-2012)

Percent of population by type of drinking water source, 1995-2015 Piped on premises Other improved Surface water Unimproved

0 14

6 24

2015 1995

Source: WHO/UNICEF JMP 2015

2015 Urban

60 40 20

Total

1995

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

1995

2015 Rural

Partial

(2015)

Life Saving Commodities in Essential Medicine List:

Density of doctors, nurses and midwives (per 10,000 population)

Per capita total expenditure on health (Int$)

18 2006 MICS

2011-2012 DHS/MICS

General government expenditure on health as % of total government expenditure (%)

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1995-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100

64 32

Maternity protection (Convention 183)

(2015)

3 3

(2015)

10.6

(2012)

(2015)

46 (2011)

FINANCING 43

Improved sanitation coverage

40 20

(% of recommended minimum)

100 80 60 40 20 0

2000 MICS

Percent

Midwives authorized for specific tasks (X of 7 tasks)

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Legal status of abortion (X of 5 circumstances)

Newborn health (X of 4) Child health (X of 3)

Diarrhoeal disease treatment

Partial

Reproductive health (X of 3) Maternal health (X of 3)

CHILD HEALTH

100 80 60 40 20 0

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

23 3 3

(2013)

No Data

Private sources

External sources

5 2

94 10 1

(2013)

General government expenditure

1 1 4

9 3

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

10 0 12

1995

2015 Total

1995

2015 Urban

1995

2015 Rural

Source: WHO/UNICEF JMP 2015

123

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Lesotho DEMOGRAPHICS Total population (000)

2,135

(2015)

278

(2015)

Births (000)

(2015)

Birth registration (%) Total under-five deaths (000)

45 6

(2009)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

33 69

(2015)

Stillbirth rate (per 1000 total births)

(2009)

280

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

3.1

(2015)

(2013)

Total under-five population (000)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

150

800

120

600

720 490

400

MDG Target: 29

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

200

180

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 77

*Postnatal care

Exclusive breastfeeding

Measles

Birth

Neonatal period

20 0

20 40 60 80 100 Percent

>95

100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

72 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

60 40

20 1993 MoH

2000 MICS

2004 DHS

2009 DHS

2014 pDHS

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100 80

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

2009 DHS

2014 pDHS

Measles

ITN use among children <5 yrs

(2014)

(2009)

2000 MICS

2004 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 53 Introduction of solid, semi-solid/soft foods (%) 68 Vitamin A two dose coverage (%)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

80 53

100

(2009)

Percent of infants <6 months exclusively breastfed

Percent

(2009)

Exclusive breastfeeding

1993 Other NS

2000 MICS

2004 DHS

39 14

2009 DHS

33 10 2014 pDHS

Percent

ORT & continued feeding

Source: DHS 2009

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

124

96 96 92

Pneumonia treatment

Percent

EQUITY

60 40 20

36 16

1996 MICS

2000 MICS

0 2004 DHS

2009 DHS

2014 pDHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Lesotho DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

15%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 13%

Asphyxia* 11%

Neonatal death: 37%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Haemorrhage 25%

Other 2% Other direct 9%

Congenital 3%

Other 23%

Sepsis** 6% 9%

HIV/AIDS 10%

Hypertension 16%

Diarrhoea

Source: WHO/MCEE 2015 Malaria 0% Injuries 5% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis Measles 0%

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

80 Percent

Demand for family planning satisfied (%)

(2014)

Antenatal care (4 or more visits, %)

(2014)

7, 11, 5

(2009)

(2014)

(2009)

Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby (within 2 days, %)

Postnatal visit for mother

(within 2 days , %)

1993 1995 Other NS Other NS

2000 MICS

2004 DHS

2009 DHS

2014 pDHS

Women with low body mass index (<18.5 kg/m2, %)

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2000 MICS

2004 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2009 DHS

5 0

2014 pDHS

70 22

1990

Source: WHO/UNICEF JMP 2015

1 22

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

2015 Urban

Partial

(2015)

Life Saving Commodities in Essential Medicine List:

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

3 3

(2015)

6.7

(2003)

(2015)

29 (2004)

Percent of population by type of sanitation facility, 1995-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100 80 49

1990

2015 Rural

20 8

1995

2015 Total

2015 Urban

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

No Data

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

1995

Private sources

21 35

General government expenditure on health as % of total government expenditure (%)

External sources

(2013)

General government expenditure

60 40

297

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

2015 1990 Total

20 0

Maternity protection (Convention 183)

Per capita total expenditure on health (Int$)

Very limited risk

Percent

FINANCING

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

Midwives authorized for specific tasks (X of 7 tasks)

(% of recommended minimum)

Improved drinking water coverage

0 18

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100 2

Legal status of abortion (X of 5 circumstances)

Newborn health (X of 4) Child health (X of 3)

Diarrhoeal disease treatment

Partial

Reproductive health (X of 3) Maternal health (X of 3)

CHILD HEALTH

100 80 60 40 20 0

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1995

2015 Rural

Source: WHO/UNICEF JMP 2015

125

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Liberia DEMOGRAPHICS Total population (000)

4,503

(2015)

Total under-five population (000)

701

(2015)

Births (000)

Under-five mortality rate

Deaths per 100,000 live births

2000

156

(2015)

Birth registration (%) Total under-five deaths (000)

4 11

(2007)

300

(2015)

250

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

200

24 53

(2015)

150

Stillbirth rate (per 1000 total births)

(2009)

980

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.6

(2015)

Adolescent birth rate (per 1000 girls)

147

(2010)

Total maternal deaths

(2015)

Maternal mortality ratio

Deaths per 1000 live births 255

1200

1500 MDG Target: 85

100

50 0 1990

1995

2000

2005

2010

1000

300

0 1990

2015

Source: UN IGME 2015

640

500

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 39 78 61

*Postnatal care

Exclusive breastfeeding

Measles

Neonatal period

100

40 20

1986 DHS

Percent

1999-2000 DHS

2007 DHS

2013 DHS

40 20

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

52 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

<1 2005

2008

Source: UNICEF/UNAIDS/WHO 2015

2011

2014

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80

Percent

58 50 45

Percent

Skilled attendant at delivery

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

ORT & continued feeding

(2013)

(2007)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

(2013)

Vitamin A two dose coverage (%)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80 45

100

2013 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 61 Introduction of solid, semi-solid/soft foods (%) 46

Percent

2007 DHS

2014

39 20

Percent

Vitamin A (past 6 months)

2010

Measles

Early initiation of breastfeeding

126

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

Antenatal care (4+ visits)

Source: DHS 2013

Pneumonia treatment

60 35

40 20

0 1999-2000 Other NS

2007 DHS

2010 Other NS

2013 DHS

1986 DHS

1999-2000 Other NS

2007 DHS

2013 DHS

(2013)

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Liberia DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

14%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 10%

Asphyxia* 9% Other 2%

Neonatal death: 35%

Sepsis 10%

0% Source: WHO/MCEE 2015 (provisional)

Injuries 6%

* Intrapartum-related events

Hypertension 16%

Diarrhoea

Measles 1% Malaria 13%

Haemorrhage 25%

Other direct 9%

Sepsis** 8%

HIV/AIDS 1%

Embolism 2%

Abortion 10%

Congenital 3%

Other 22%

Regional estimates for Sub-Saharan Africa, 2013

Indirect 29%

Source: WHO 2014

** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy 96

100

Percent

Demand for family planning satisfied (%)

(2013)

Antenatal care (4 or more visits, %)

(2013)

Malaria during pregnancy - intermittent preventive treatment (%)

(2013)

4, 5, 3

(2013)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2013)

Postnatal visit for mother

(2013)

(within 2 days, %)

20 0

(within 2 days , %)

1986 DHS

1999-2000 DHS

2007 DHS

2013 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

7 1986 DHS

2007 DHS

2013 DHS

43 (2013)

Percent

80 39

2 9

2011 Other NS

2013 DHS

32 50

20 0

1995

2015 1995 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

1995

2015 Rural

60 40 20

49 4

60 40

Midwives authorized for specific tasks (X of 7 tasks)

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

2 3

(2015)

2.9

(2008)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

27 (2011)

1995

2015 Total

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

No Data

General government expenditure External sources Private sources

27 14

ODA to child health per child (US$) 68

17 28

1995

2015 Urban

ODA to maternal and neonatal health per live birth (US$)

(2012)

130

(2012)

Note: See annexes for additional information on the indicators above

Per capita total expenditure on health (Int$)

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1995-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100

3(R,F)

FINANCING 37

Improved sanitation coverage

Percent

100

Legal status of abortion (X of 5 circumstances)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Percent of population by type of drinking water source, 1995-2015 Piped on premises Other improved Surface water Unimproved

Partial

(% of recommended minimum)

100 80 60 40 20 0

2009 Other NS

Improved drinking water coverage

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

7 19

11 4

1995

2015 Rural

Source: WHO/UNICEF JMP 2015

127

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Madagascar DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

24,235

(2015)

3,770

(2015)

831

(2015)

Birth registration (%) Total under-five deaths (000)

83 40

(2012-2013)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

20 36

(2015)

Stillbirth rate (per 1000 total births)

(2009)

3,500

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.4

(2015)

Adolescent birth rate (per 1000 girls)

147

(2006)

Total maternal deaths

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

800 161

150

740

600

100

MDG Target: 54

50 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

440

400 200

190

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

*Postnatal care

Exclusive breastfeeding

68 51

Neonatal period

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent

Infancy

Measles

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

80 60

<1 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

15 10 5

1992 DHS

1997 DHS

2000 MICS

2003-04 2008-09 2012-13 DHS DHS Other NS

2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

73 73 72 64 50

80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100 80

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

2014

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

61 36

53 37

2000 MICS

2003-04 DHS

2008-09 DHS

2012-13 Other NS

Percent of infants <6 months exclusively breastfed

60 40

48 38

51 41

20 0

1997 DHS

60 40

100

Percent

Source: DHS 2008-2009

Exclusive breastfeeding

Percent

ORT & continued feeding

15 (2003-2004) Early initiation of breastfeeding (within 1 hr of birth, %) 66 (2012-2013) 16 (2008-2009) Introduction of solid, semi-solid/soft foods (%) 90 (2012-2013) Vitamin A two dose coverage (%) (2013) 94

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Measles

Early initiation of breastfeeding

128

Pneumonia treatment

Percent

EQUITY

0 1992 DHS

1995 MICS

1997 DHS

2003-04 DHS

2008-09 DHS

1992 DHS

1997 DHS

2000 MICS

2003-04 2008-09 2012-13 DHS DHS Other NS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Madagascar DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 11%

15%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 12%

Neonatal death: 40%

Sepsis 10%

Embolism 2%

Abortion 10%

Other 3%

Other 23%

Regional estimates for Sub-Saharan Africa, 2013

Haemorrhage 25%

Other direct 9%

Congenital 5%

Hypertension 16%

Diarrhoea

Source: WHO/MCEE 2015 (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Malaria 4%

Indirect 29%

Measles 0%

Injuries 8% * Intrapartum-related events

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Demand for family planning satisfied (%)

(2008-2009)

Antenatal care (4 or more visits, %)

(2012-2013)

Malaria during pregnancy - intermittent preventive treatment (%)

(2013)

2, 7, 1

(2012-2013)

(2014)

Postnatal visit for mother

(2008-2009)

Women with low body mass index

(2008-2009)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby (within 2 days, %)

20 0

(within 2 days , %)

1992 DHS

1997 DHS

2000 MICS

2003-04 2008-09 2012-13 DHS DHS Other NS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

14 1992 DHS

1997 DHS

2000 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2003-04 2008-09 2012-13 DHS DHS Other NS

11 (2013)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

100 22 44

62 46 0 2008-09 DHS

2011 Other NS

2013 Other NS

23 7

1990

30 22

2015 1990 Total

Source: WHO/UNICEF JMP 2015

40 27

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

2015 Urban

15 2

1990

20 14

Maternal deaths notification

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

4 3

(2015)

6.1

(2004)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

11 (2010)

1990

2015 Total

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

No Data

External sources Private sources

Per capita total expenditure on health (Int$)

General government expenditure

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

2015 Rural

24 40

60 40

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Midwives authorized for specific tasks (X of 7 tasks)

FINANCING

2000 MICS

Percent

(% of recommended minimum)

100 80 60 40 20 0

100

6 12

Legal status of abortion (X of 5 circumstances)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Maternity protection (Convention 183)

Sepsis** 7% HIV/AIDS 1%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Urban

11 8

13 9

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

129

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Malawi DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

17,215

(2015)

2,954

(2015)

Under-five mortality rate

Deaths per 100,000 live births

1200

665

(2015)

Birth registration (%) Total under-five deaths (000)

2 40

(2011)

300

(2015)

250

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

200

22 43

(2015)

150

Stillbirth rate (per 1000 total births)

(2009)

3,400

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

5.0

(2015)

Adolescent birth rate (per 1000 girls)

143

(2012)

Total maternal deaths

(2015)

Maternal mortality ratio

Deaths per 1000 live births

242

1100

1000 800 600

MDG Target: 81

100

50 0 1990

1995

2000

2005

2010

280

200 0 1990

2015

Source: UN IGME 2015

510

400

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 75 45 87

*Postnatal care

Exclusive breastfeeding

Measles

100

Pre-pregnancy Pregnancy Birth

Neonatal period

80 55

100 80

Infancy

20 0

20 40 60 80 100 Percent

64 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Source: DHS, MICS, Other NS

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

60 20

1992 DHS

2000 DHS

2004 DHS

2006 MICS

2010 DHS

2013-14 MICS

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100 80

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

20 0

2010 DHS

2013-14 MICS

1992 DHS

2000 DHS

2004 DHS

2006 MICS

(2010) (2014) (2013)

Percent of infants <6 months exclusively breastfed

100 56

60 40

Exclusive breastfeeding

Percent

4 (2013-2014) Early initiation of breastfeeding (within 1 hr of birth, %) 95 (2010) Introduction of solid, semi-solid/soft foods (%) 89 Vitamin A two dose coverage (%) 90

Underweight and stunting prevalence

Careseeking for pneumonia

70 52

53 18

48 14

42 17

Percent

ORT & continued feeding

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Measles

ITN use among children <5 yrs

Source: DHS 2010

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

130

91 91 87 85 83

Pneumonia treatment

Percent

EQUITY

2004 DHS

2006 MICS

2010 DHS

2013-14 MICS

40 20 0

1992 DHS

2000 DHS

2004 DHS

2006 MICS

2010 DHS

2013-14 MICS

2000 DHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Malawi DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Preterm 11%

Pneumonia

11%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 9% Other 2%

Neonatal death: 34%

Sepsis 10%

Haemorrhage 25%

Other direct 9%

Sepsis** 7% 0%

Hypertension 16%

Diarrhoea

Measles 1%

Source: WHO/MCEE 2015 Malaria 7% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis HIV/AIDS 8%

Embolism 2%

Abortion 10%

Congenital 3%

Other 25%

Regional estimates for Sub-Saharan Africa, 2013

Indirect 29%

Injuries 6%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy 92

100

(2013-2014)

Antenatal care (4 or more visits, %)

(2013-2014)

Malaria during pregnancy - intermittent preventive treatment (%)

(2014)

5, 9, 5

(2013-2014)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2013-2014)

Postnatal visit for mother

(2013-2014)

(2010)

(within 2 days, %)

20 0

(within 2 days , %)

1992 DHS

2000 DHS

2004 DHS

2006 MICS

2010 DHS

2013-14 MICS

Women with low body mass index (<18.5 kg/m2, %)

Malaria prevention and treatment

1992 DHS

2000 DHS

2004 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2006 MICS

2010 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2013-14 MICS

93 (2014)

Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 1

3 6

66 39 15

2004 DHS

2006 MICS

2010 DHS

2012 2013-14 Other NS MICS

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100

1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

1990

2015 Rural

4 29

4 14

1 15

31 36

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List:

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

4 3

(2015)

3.6

(2009)

(2015)

40 (2014)

FINANCING Per capita total expenditure on health (Int$)

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

External sources

No Data

General government expenditure

40 17 20

34 2

2015 1990

Percent

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

40 20

Midwives authorized for specific tasks (X of 7 tasks)

(% of recommended minimum)

100 80 60 40 20 0

2000 DHS

80 60 41

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Legal status of abortion (X of 5 circumstances)

Newborn health (X of 4) Child health (X of 3)

Diarrhoeal disease treatment

51 48

Partial

Reproductive health (X of 3) Maternal health (X of 3)

CHILD HEALTH

100 80 60 40 20 0

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

14 41

1990

2015 Total

40 27

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

131

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Mali DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

17,600

(2015)

3,271

(2015)

Under-five mortality rate

Deaths per 100,000 live births

1200

758

(2015)

Birth registration (%) Total under-five deaths (000)

81 83

(2010)

300

(2015)

250

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

200

38 75

(2015)

150

Stillbirth rate (per 1000 total births)

(2015)

(2009)

4,000

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

6.1

(2015)

Adolescent birth rate (per 1000 girls)

178

(2010)

Total maternal deaths

Maternal mortality ratio

Deaths per 1000 live births 254

1100

1000 800 115

100

MDG Target: 85

50 0 1990

1995

2000

2005

2010

400

280

200 0 1990

2015

Source: UN IGME 2015

550

600

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 28

*Postnatal care

Birth

Exclusive breastfeeding

Neonatal period

Measles

60 40

40 30

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

26 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1987 DHS

Percent

1995-1996 DHS

2001 DHS

2006 DHS

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

84 80 77 77

80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months) ORT & continued feeding

2010

(2006)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

132

2001 DHS

2006 DHS

1995-1996 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 46 Introduction of solid, semi-solid/soft foods (%) 30

(2006)

Vitamin A two dose coverage (%)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

43 30

20 0

100

60 40

Percent

Source: DHS 2012-2013

2014

Underweight and stunting prevalence

Careseeking for pneumonia

100

Measles

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

Pneumonia treatment

Percent

Socioeconomic inequities in coverage

Percent

EQUITY

40 20

25 9

1987 DHS

1995-1996 DHS

0 1987 DHS

1995-1996 DHS

2001 DHS

2006 DHS

2001 DHS

2006 DHS

(2006)

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Mali DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 10%

11%

Globally nearly half of child Asphyxia* 9%deaths are attributable to Other 2% undernutrition

Neonatal death: 33%

Other 17%

Abortion 10%

Haemorrhage 25%

Other direct 9%

Sepsis** 8%

Diarrhoea

Measles 1% Injuries 4%

Hypertension 16%

Source: WHO/MCEE 2015 (provisional)

Indirect 29%

Source: WHO 2014

** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

80 Percent

Demand for family planning satisfied (%)

(2012-2013)

Antenatal care (4 or more visits, %)

(2006)

2, 4, 1

(2006)

Malaria during pregnancy - intermittent preventive treatment (%)

100

60 40

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2012-2013)

Postnatal visit for mother

(2012-2013)

Women with low body mass index

(2012-2013)

(within 2 days, %)

20 0

(within 2 days , %)

1987 DHS

1995-1996 DHS

2001 DHS

2006 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

38 14

16 1995-1996 DHS

2001 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2006 DHS

80 Percent

1 22

62 37

1990

Source: WHO/UNICEF JMP 2015

2015 Urban

10 30

1990

2015 Rural

5 29

2 17

42 43

7 Yes

Maternal deaths notification

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

5.1

(2010)

122

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

(2015)

No Data

General government expenditure External sources 15

43 35

40 20

19 0

2015 1990 Total

100

60 65

Midwives authorized for specific tasks (X of 7 tasks)

FINANCING

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

1(R)

Per capita total expenditure on health (Int$)

Improved sanitation coverage

Percent

100 8

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

100 80 60 40 20 0

WATER AND SANITATION Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

Yes

National availability of Emergency Obstetric Care services

2006 DHS

Improved drinking water coverage

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Maternity protection (Convention 183)

HIV/AIDS 1%

* Intrapartum-related events

Embolism 2%

Congenital 2%

Malaria 24%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

23 13 25

1990

2015 Total

1990

2015 Urban

10 6 9

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

133

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Mauritania DEMOGRAPHICS Total population (000)

4,068

(2015)

Total under-five population (000)

601

(2015)

Births (000)

134

(2015)

Birth registration (%) Total under-five deaths (000)

59 11

(2011)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

36 65

(2015)

Stillbirth rate (per 1000 total births)

(2015)

(2009)

430

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.5

(2015)

(2011)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

140 118 120 100 80 60 40 20 0 1990

700 630 600 500 400 300 200 100 0 1990 1995

MDG Target: 39

1995

2000

2005

2010

2015

Source: UN IGME 2015

320 160 MDG Target

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 27

*Postnatal care

Birth

Exclusive breastfeeding

Neonatal period

Measles

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

Percent

11 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

15 5

1990-91 Other NS

2000-01 DHS

2007 MICS

2011 MICS

10 2

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

100

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2005

(2012)

(2011)

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

60 40 20 0

2000-01 DHS

2007 MICS

2011 MICS

Early initiation of breastfeeding (within 1 hr of birth, %) 56 Introduction of solid, semi-solid/soft foods (%) 48

(2011)

Vitamin A two dose coverage (%)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100

Percent

2014

2010

Underweight and stunting prevalence

Careseeking for pneumonia

Source: MICS 2011

2000

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

ORT & continued feeding

134

Vitamin A (past 6 months)

Early initiation of breastfeeding

Measles

100

Percent

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

84 84 84 84

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

Socioeconomic inequities in coverage

80 55

40 30

23 29

24 30

20 22

Percent

EQUITY

60 40 20

20 11

0 1990 1995-96 2000-01 Other NS MICS DHS

2007 MICS

2011 MICS

2012 Other NS

2000-01 DHS

2007 MICS

2011 MICS

(2011)

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Mauritania DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 17%

12%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 9%

Neonatal death: 42%

Sepsis 10%

Embolism 2%

Abortion 10%

Other 2%

Other 23%

Regional estimates for Sub-Saharan Africa, 2013

Haemorrhage 25%

Other direct 9%

Congenital 2%

Diarrhoea

Source: WHO/MCEE 2015 (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Malaria 4% Injuries 6%

Indirect 29%

Measles 1%

* Intrapartum-related events

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

80 60

Demand for family planning satisfied (%)

(2011)

Antenatal care (4 or more visits, %)

(2011)

Malaria during pregnancy - intermittent preventive treatment (%)

(2011)

10, 18, 4

(2011)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

(2011)

Women with low body mass index

(2000-2001)

(within 2 days, %)

20 0

(within 2 days , %)

1990-91 Other NS

2000-01 DHS

2007 MICS

2011 MICS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

9 2000-01 DHS

2007 MICS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2011 MICS

7 (2011)

60 65

100

20 23

33 15

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

66 36

19 2 2011 MICS

1990

2015 Rural

24 53

60 40

11 14

20 6 0

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

8.0

(2009)

Density of doctors, nurses and midwives (per 10,000 population)

37 (2011)

FINANCING

2015 Other NS

General government expenditure on health as % of total government expenditure (%)

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Partial

Postnatal home visits in the first week after birth

Per capita total expenditure on health (Int$)

Improved sanitation coverage

Percent

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 1

Midwives authorized for specific tasks (X of 7 tasks)

(% of recommended minimum)

100 80 60 40 20 0

2003-04 DHS

Improved drinking water coverage 1

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100 6

Legal status of abortion (X of 5 circumstances)

Maternal deaths notification

Hypertension 16%

10%

Maternity protection (Convention 183)

Sepsis** 10% HIV/AIDS 1%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Total

(2013)

No Data

External sources Private sources

(2013)

General government expenditure

138

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

12 5 14

17 3 6

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

135

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Mexico DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

127,017

(2015)

11,617

(2015)

Under-five mortality rate

2,346

(2015)

Birth registration (%) Total under-five deaths (000)

93 31

(2009)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

7 11

(2015)

Stillbirth rate (per 1000 total births)

(2015)

(2009)

1,100

(2013)

Lifetime risk of maternal death (1 in N)

900

(2013)

Total fertility rate (per woman)

2.2

(2015)

(2013)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

100

60 MDG Target: 16

10 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

40 22

20 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 88 93

*Postnatal care Exclusive breastfeeding

Birth

Neonatal period

100

Pre-pregnancy Pregnancy

Infancy

Measles

82 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

100

20 40 60 80 100

Source: DHS, MICS, Other NS

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

Percent

60 40 20

1990 Other NS

1997 Other NS

2006 2004-2009 2012 Other NS Other NS Other NS

2014

Source: UNICEF/UNAIDS/WHO 2015

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

80 60

Percent

Skilled attendant at delivery

20 0

No Data

1990

1995

2000

Source: WHO/UNICEF 2015

2005

2010

2014

NUTRITION

DTP3

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Measles Vitamin A (past 6 months)

(2012)

Early initiation of breastfeeding (within 1 hr of birth, %) 39 Introduction of solid, semi-solid/soft foods (%) 95 Vitamin A two dose coverage (%)

Underweight and stunting prevalence

ORT & continued feeding Careseeking for pneumonia

Percent of children <5 years who are moderately or severely: underweight stunted

100

Percent

Percent of infants <6 months exclusively breastfed

100

40 20 0

Exclusive breastfeeding

Percent

0 10 20 30 40 50 60 70 80 90 100

136

No Data

Early initiation of breastfeeding ITN use among children <5 yrs

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

97 94 87 85 87

100

Antenatal care (4+ visits)

Pneumonia treatment

1989 Other NS

1996 1998-1999 2006 Other NS Other NS Other NS

16 3

3 2012 Other NS

1999 Other NS

2012 Other NS

0 1987 DHS

(2012) (2012) -

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Mexico DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 PneumoniaPneumoniaPreterm 18%

Asphyxia* 7%

Globally nearly nearly Globally half of of child child half deaths are are deaths attributable to to attributable undernutrition undernutrition

Sepsis 8%

Regional estimates for Latin America, 2013

Embolism 3%

Abortion 10%

Haemorrhage 23%

Other 4%

Neonatal Neonatal death: death: 53% 53%

Congenital 13%

Other direct 15%

No Data HIV/AIDS 0% Injuries 7% * Intrapartum-related events

Hypertension 22%

Malaria 0%

Source: WHO/MCEE 2015 Measles 0% Source: WHO/CHERG 2014 (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Indirect 19%

Diarrhoea Diarrhoea

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

80 Percent

100

Demand for family planning satisfied (%)

(2009)

Antenatal care (4 or more visits, %)

(2012)

46, 49, 36

(2012)

Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(within 2 days, %)

20 0

(within 2 days , %)

1987 Other NS

1995 Other NS

2004-2009 Other NS

2012 Other NS

(<18.5 kg/m2, %)

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2012 Other NS

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

Percent

03 1

0 33

8 13

8 10

60 40

92 75

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100 80

1 4 10

22 4 8

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

2015 Rural

(2015)

Life Saving Commodities in Essential Medicine List: 1*

(2015)

2 -

(2015)

46.2

(2011)

1,061

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

10 74

No Data

External sources

1990

Partial

General government expenditure

4 11

2 0 10

10 2 9

20 0

Yes

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

Improved drinking water coverage

12 6 7

Yes

Postnatal home visits in the first week after birth

FINANCING Very limited risk

1996-1997 Other NS

Partial

Maternal deaths notification

Per capita total expenditure on health (Int$)

WATER AND SANITATION

(R,F)

(% of recommended minimum)

4 5 5

Midwives authorized for specific tasks (X of 7 tasks)

National availability of Emergency Obstetric Care services

4 0

Newborn health (X of 4) Child health (X of 3)

Diarrhoeal disease treatment

100

Legal status of abortion (X of 5 circumstances)

Reproductive health (X of 3) Maternal health (X of 3)

CHILD HEALTH

100 80 60 40 20 0

Yes

Maternity protection (Convention 183)

Sepsis** 8%

Other 28%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

1990

2015 Total

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

137

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Morocco DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

34,378

(2015)

3,421

(2015)

Under-five mortality rate

Deaths per 100,000 live births

100

350 310 300 250 200 150 100 50 0 1990 1995

699

(2015)

Birth registration (%) Total under-five deaths (000)

94 20

(2010-2011)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

18 18

(2013)

(2015)

Stillbirth rate (per 1000 total births)

(2015)

880

(2013)

Lifetime risk of maternal death (1 in N)

300

(2013)

Total fertility rate (per woman)

2.5

(2015)

(2008)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Maternal mortality ratio

Deaths per 1000 live births

MDG Target: 27

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

120 78 MDG Target

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 86

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

Measles

100

Percent

20 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

20 40 60 80 100

Source: DHS, MICS, Other NS

Infancy

52 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

20 1987 DHS

1992 DHS

1995 DHS

2003-04 DHS

2010-11 Other NS

5 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100 80

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

Measles

2000

2005

2010

ORT & continued feeding

2014

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

2003-04 DHS

2010-11 Other NS

80 35

1997 Other NS

100

1992 DHS

Percent of infants <6 months exclusively breastfed

Percent

Source: DHS 2003-2004

Exclusive breastfeeding

1987 DHS

30 8 1992 DHS

Percent

Careseeking for pneumonia

2 (2010-2011) Early initiation of breastfeeding (within 1 hr of birth, %) 52 (2003-2004) 15 (2003-2004) Introduction of solid, semi-solid/soft foods (%) 86 (2003-2004) Vitamin A two dose coverage (%) -

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Early initiation of breastfeeding

138

99 99 99 90 80

Pneumonia treatment

Percent

EQUITY

29 8 1996-97 Other NS

23 10 2003-04 DHS

2010-11 Other NS

60 40

50 25

2003-04 DHS

2010-11 Other NS

0 1987 DHS

1992 DHS

1995 DHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Morocco DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 22%

Globally nearly half of child deaths are attributable to undernutrition

Other direct 17%

Asphyxia* 14%

Neonatal death: 64%

Other 17%

Regional estimates for Northern Africa, 2013

Sepsis 6% Embolism 3% Abortion 2%

Haemorrhage 37%

Other 4%

HIV/AIDS 0% Malaria 0%

Congenital 10%

Injuries 6%

Indirect 18%

Source: WHO/MCEE 2015 (provisional) Diarrhoea * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis 4%

Measles 0%

Sepsis** 11%

Hypertension 17%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

(2011)

Antenatal care (4 or more visits, %)

(2010-2011)

16, 19, 11

(2007-2010)

Malaria during pregnancy - intermittent preventive treatment (%)

100 80 Percent

Demand for family planning satisfied (%)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(2003-2004)

(within 2 days, %)

20 0

C-section rate (total, urban, rural; %)

(within 2 days , %)

1987 DHS

1992 DHS

1995 DHS

1997 2003-04 2010-11 Other NS DHS Other NS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

14 1992 DHS

1995 DHS

Midwives authorized for specific tasks (X of 7 tasks)

Maternity protection (Convention 183)

Yes

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 1

(2015)

15.1

(2009)

Density of doctors, nurses and midwives (per 10,000 population)

2003-04 DHS

2010-11 Other NS

Per capita total expenditure on health (Int$)

Very limited risk

General government expenditure on health as % of total government expenditure (%) Out of pocket expenditure as % of total expenditure on health(%)

2 13

0 6

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100

1990

2015 Rural

9 2

80 38

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

100 3

Percent

(2015)

69 (2000)

FINANCING 46

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

Improved drinking water coverage

National availability of Emergency Obstetric Care services

WATER AND SANITATION

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

2 0 14

0 14

(2013)

No Data

General government expenditure External sources 23 3 8

2 8

40 20

438

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

2 3

1990

2015 Total

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

139

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Mozambique DEMOGRAPHICS Total population (000)

27,978

(2015)

Total under-five population (000)

4,816

(2015)

Births (000)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

1400 1300 1200 1000 800 600 400 200 0 1990 1995

1,087

(2015)

Birth registration (%) Total under-five deaths (000)

48 82

(2011)

300

(2015)

250

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

200

27 57

(2015)

150

MDG Target: 80

Stillbirth rate (per 1000 total births)

(2009)

100

4,800

(2013)

Total fertility rate (per woman)

5.3

(2015)

Adolescent birth rate (per 1000 girls)

166

(2009)

Total maternal deaths Lifetime risk of maternal death (1 in N)

(2015)

240

50 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

480 330 MDG Target

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 29

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

Measles

100

60 40

1997 DHS

Percent

2003 DHS

2008 MICS

2011 DHS

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

79 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

100 80

0 1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months) ORT & continued feeding

2014

2010

(2011)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

20 0

2003 DHS

2008 MICS

2011 DHS

Vitamin A two dose coverage (%)

(2013)

(2011)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100 80 60

60 40

1997 DHS

(2011)

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 77 Introduction of solid, semi-solid/soft foods (%) 90

49 24

47 21

44 18

Percent

Measles

ITN use among children <5 yrs

Source: DHS 2011

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

140

85 78 78 73

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

60 40

1997 DHS

2003 DHS

2011 DHS

2013 Other NS

20 0

1995 MICS

1997 2000-2001 2003 DHS Other NS DHS

2008 MICS

2011 DHS

2008 MICS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Mozambique DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 11%

12%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 9% Other 2%

Neonatal death: 35%

Sepsis 10%

Embolism 2%

Abortion 10%

Congenital 3%

Haemorrhage 25%

Other direct 9%

Sepsis** 8%

Other 20%

Regional estimates for Sub-Saharan Africa, 2013

Diarrhoea

HIV/AIDS 5%

Hypertension 16%

Measles 0%

Source: WHO/MCEE 2015 Injuries 6% (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Malaria 13% * Intrapartum-related events

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Demand for family planning satisfied (%)

(2011)

Antenatal care (4 or more visits, %)

(2011)

Malaria during pregnancy - intermittent preventive treatment (%)

(2011)

4, 9, 2

(2011)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(2011)

(within 2 days, %)

20 0

(within 2 days , %)

1997 DHS

2000 Other NS

2003 DHS

2008 MICS

2011 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

1997 DHS

2003 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2008 MICS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2011 DHS

60 (2011)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

100

23 7 2008 MICS

100 80

42 36

29 9

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

22 1

1990

2015 Rural

39 64

29 36

40 20

Midwives authorized for specific tasks (X of 7 tasks)

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

4.5

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

29 (2012)

FINANCING

2011 DHS

24 4

1990

2015 Total

2015 Urban

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

No Data

Private sources 52 75

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

36 23

2 10

1990

General government expenditure on health as % of total government expenditure (%)

External sources

(2013)

General government expenditure

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Per capita total expenditure on health (Int$)

Improved sanitation coverage

40 20

4 15

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

100 80 60 40 20 0

2007 Other NS

Percent

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

141

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Myanmar DEMOGRAPHICS Total population (000) Total under-five population (000)

53,897

(2015)

4,565

(2015)

Births (000)

Under-five mortality rate

Deaths per 100,000 live births

150

800

944

(2015)

Birth registration (%) Total under-five deaths (000)

72 46

(2009-2010)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

26 40

(2015)

Stillbirth rate (per 1000 total births)

(2009)

Total maternal deaths

(2015)

1,900

(2013)

Lifetime risk of maternal death (1 in N)

250

(2013)

Total fertility rate (per woman)

2.2

(2015)

(2006)

Adolescent birth rate (per 1000 girls)

Maternal mortality ratio

Deaths per 1000 live births

110

120

580

600 400 50

MDG Target: 37

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

200

150

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014

MATERNAL AND NEWBORN HEALTH 66

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

100

40 20

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

Measles Percent

39 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1991 Other NS

1997 Other NS

2001 Other NS

2007 2009-2010 Other NS MICS

75 48

50 25 0

27 <1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

60 40

No Data

60 40

2003 MICS

2009-2010 MICS

20 0

0 1990

1995

2000

Source: WHO/UNICEF 2015

2005

2010

2014

2000 MICS

NUTRITION

Measles

8 (2009-2010) Early initiation of breastfeeding (within 1 hr of birth, %) 76 (2009-2010) 9 (2009-2010) Introduction of solid, semi-solid/soft foods (%) 76 (2009-2010) Vitamin A two dose coverage (%) -

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months) ORT & continued feeding

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent of infants <6 months exclusively breastfed

100

80 Percent

Percent

Exclusive breastfeeding

60 37

41 28

20 0

35 23

Percent

DTP3

142

100

Early initiation of breastfeeding ITN use among children <5 yrs

86 75 75

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

60 40 20

24 11

0 1991 Other NS

1997 Other NS

2000 MICS

2003 MICS

2009-2010 MICS

2000 MICS

2009-2010 MICS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Myanmar DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Preterm 18%

Pneumonia

Asphyxia* 13%

13%

Globally nearly half of child deaths are attributable to undernutrition

Neonatal death: 53%

Sepsis 6%

No Data

Embolism 12%

Abortion 7% Other direct 14%

Other 4% Congenital 6%

Other 18%

Regional estimates for South-eastern Asia, 2013

Haemorrhage 30%

Sepsis** 8%

HIV/AIDS 1%

Indirect 17%

Malaria 1%

Source: WHO/MCEE 2015 Injuries 6% Measles 2% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis Diarrhoea Diarrhoea

Hypertension 15%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Demand for family planning satisfied (%)

(2001)

Antenatal care (4 or more visits, %)

(2007)

Malaria during pregnancy - intermittent preventive treatment (%)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(within 2 days, %)

20 0

(within 2 days , %)

1997 Other NS

2001 Other NS

2007 Other NS

2009-2010 MICS

(<18.5 kg/m2, %)

Malaria prevention and treatment

2000 MICS

2003 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2009-2010 MICS

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

18 71

50 8

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

2015 Urban

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

1990

2015 Rural

Reproductive, maternal, newborn and child health expenditure by source

(2015)

2 3

(2015)

16.2

(2012)

(2013)

(2015)

2 10 12

2 13

External sources 6 6 11

20 26

No Data

General government expenditure

60 8

(2015)

FINANCING

Percent of population by type of sanitation facility, 1995-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100

Partial

Life Saving Commodities in Essential Medicine List:

Per capita total expenditure on health (Int$)

Improved sanitation coverage

20 0

8 31

15 73

(% of recommended minimum)

100 80 60 40 20 0

2009-2010 Other NS

Percent

5 14

Midwives authorized for specific tasks (X of 7 tasks)

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Legal status of abortion (X of 5 circumstances)

Newborn health (X of 4) Child health (X of 3)

Diarrhoeal disease treatment

Partial

Reproductive health (X of 3) Maternal health (X of 3)

CHILD HEALTH

100 80 60 40 20 0

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

7 77

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

1995

2015 Total

1995

2015 Urban

1995

2015 Rural

Source: WHO/UNICEF JMP 2015

143

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Nepal DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

28,514

(2015)

2,807

(2015)

577

(2015)

Birth registration (%) Total under-five deaths (000)

42 20

(2011)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

22 29

(2015)

Stillbirth rate (per 1000 total births)

(2009)

1,100

(2013)

Lifetime risk of maternal death (1 in N)

200

(2013)

Total fertility rate (per woman)

2.2

(2015)

(2008)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Deaths per 100,000 live births

150

1000

141

(2015)

Maternal mortality ratio

Deaths per 1000 live births

790

800

100

600 MDG Target: 47

0 1990

1995

2000

2005

2010

400

0 1990

2015

Source: UN IGME 2015

190 200

200

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

*Postnatal care

Exclusive breastfeeding

Measles

Birth

Neonatal period

20 0

Percent

100

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

15 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1991 Other NS

80 Percent

Coverage along the continuum of care

60 40 20

1996 DHS

2001 DHS

2006 DHS

2011 DHS

2014 MICS

<1 2005

<1 2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine 92 92 88

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100 80

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

(2014)

(2011)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

60 40

2001 DHS

2006 DHS

2011 DHS

2014 MICS

(2011)

Vitamin A two dose coverage (%)

(2013)

(2011)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

61 43

49 29

40 20

20 0

1996 DHS

100

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 45 Introduction of solid, semi-solid/soft foods (%) 66

Percent

ORT & continued feeding

2014

2010

0 1990

Vitamin A (past 6 months)

Measles

144

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

Source: DHS 2011

Pneumonia treatment

Percent

EQUITY

0 1996 1997-1998 2001 DHS Other NS DHS

2006 DHS

2011 DHS

2014 MICS

1996 DHS

2001 DHS

2006 DHS

2011 DHS

2014 MICS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Nepal DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 19%

11%

Globally nearly half of child deaths are attributable to undernutrition

Neonatal death: 62%

Other 15%

Sepsis 14%

Embolism 2%

Haemorrhage 30%

Abortion 6%

Asphyxia* 14%

HIV/AIDS 0%

Regional estimates for South Asia, 2013

Other direct 8%

Injuries 6% 5%

Measles 1%

Sepsis** 12%

Source: WHO/MCEE 2015 (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis 0%

Hypertension 10%

Indirect 29%

Source: WHO 2014

Diarrhoea

* Intrapartum-related events

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

80 Percent

Demand for family planning satisfied (%)

(2011)

Antenatal care (4 or more visits, %)

(2014)

9, 19, 7

(2014)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2014)

Postnatal visit for mother

(2014)

Women with low body mass index

(2011)

Malaria during pregnancy - intermittent preventive treatment (%)

100 68 58

40 15

20 0

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

(within 2 days, %)

(within 2 days , %)

1991 Other NS

1996 DHS

2001 DHS

2006 DHS

2011 DHS

2014 MICS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

1996 DHS

37 29

2001 DHS

2006 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2011 DHS

Total Source: WHO/UNICEF JMP 2015

Urban

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

4 3

(2015)

6.7

(2004)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

46 (2007)

1990

2015 Rural

7 13

1990

2015 Total

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

No Data

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

General government expenditure on health as % of total government expenditure (%)

Private sources 37

56 46

6 2 4

(2013)

External sources

7 24

135

General government expenditure

6 1

2015

2015 1990

100

30 74

1990

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

20 0

60 40

Maternal deaths notification

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

80 27

Per capita total expenditure on health (Int$)

2014 MICS

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 1

Midwives authorized for specific tasks (X of 7 tasks)

(R,F)

FINANCING Very limited risk

Improved drinking water coverage

2 6

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100 7

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

47 39

Partial

Maternity protection (Convention 183)

Other 4% Congenital 8%

Malaria 0%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

145

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Niger DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

19,899

(2015)

4,145

(2015)

983

(2015)

Birth registration (%) Total under-five deaths (000)

64 88

(2012)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

27 57

(2015)

Stillbirth rate (per 1000 total births)

(2009)

5,600

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

7.6

(2015)

Adolescent birth rate (per 1000 girls)

210

(2009)

Total maternal deaths

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

400

1200 328

300

1000

1000 800

200

100

630

600

MDG Target: 109

400 250

200

0 1990

1995

2000

2005

2010

0 1990

2015

Source: UN IGME 2015

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 47

*Postnatal care

Birth

Exclusive breastfeeding

Neonatal period

60 40

20 40 60 80 100

Source: DHS, MICS, Other NS

1992 DHS

1998 DHS

2000 MICS

2006 DHS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

Measles

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

No Data

2012 DHS

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80

Percent

60 40

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2005

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months) ORT & continued feeding

(2012)

(2006)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

1998 DHS

2000 MICS

2006 DHS

2012 DHS

(2012)

Vitamin A two dose coverage (%)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80 41

47 51

54 44

60 40 20

20 0

1992 DHS

100

60 40

Early initiation of breastfeeding (within 1 hr of birth, %) 53 Introduction of solid, semi-solid/soft foods (%) -

Percent

2014

2010

Percent

Measles

2000

Early initiation of breastfeeding

Percent

72 68 68

Skilled attendant at delivery

146

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

Antenatal care (4+ visits)

Source: DHS 2012

Pneumonia treatment

0 1992 DHS

1998 DHS

2000 MICS

2006 DHS

2012 DHS

27 3

1992 DHS

2000 MICS

14 2006 DHS

4 2008 2010 Other NS Other NS

2012 DHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Niger DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Globally nearly Preterm 9% half of child deaths are attributable to Asphyxia* 8%undernutrition

19%

Neonatal death: 29%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Haemorrhage 25%

Other 2% Other direct 9%

Congenital 2% Sepsis** 6%

Other 24%

Hypertension 16%

Diarrhoea

HIV/AIDS 0% Malaria 11%

Source: WHO/MCEE 2015 (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

* Intrapartum-related events

Indirect 29%

Measles 0%

Injuries 6%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Demand for family planning satisfied (%)

(2012)

Antenatal care (4 or more visits, %)

(2012)

Malaria during pregnancy - intermittent preventive treatment (%)

(2012)

1, 5, 1

(2012)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2012)

Postnatal visit for mother

(2012)

Women with low body mass index

(2012)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

(within 2 days, %)

20 0

(within 2 days , %)

1992 DHS

1998 DHS

2000 MICS

2006 DHS

2012 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

43 20

10 1992 DHS

1998 DHS

2000 MICS

34 14

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

18 2006 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2012 DHS

83 (2012)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 3

Percent

80 60

20 1

2000 MICS

2006 DHS

2009 2010 Other NS Other NS

2012 DHS

68 39 49 41

30 9

1990

Source: WHO/UNICEF JMP 2015

2015 1990 Total

48 29

2015 Urban

100 80

1990

2015 Rural

Maternal deaths notification

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Yes

Costed national implementation plan(s) for: maternal, newborn and child health available

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

1.6

(2008)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

29 (2010)

9 7 11

7 4

1990

2015 Total

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

Private sources

()

(2012)

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

40 20

External sources

Per capita total expenditure on health (Int$)

General government expenditure

60 86

Partial

Available Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

FINANCING

64 43

40 20

0 0

Midwives authorized for specific tasks (X of 7 tasks)

(% of recommended minimum)

100 80 60 40 20 0

Improved sanitation coverage

Percent

100

3(F)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Yes

Legal status of abortion (X of 5 circumstances)

Maternity protection (Convention 183)

11%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

14 38 2

1990

2015 Urban

1 1

1990

6 3 5

2015 Rural

Source: WHO/UNICEF JMP 2015

147

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Nigeria DEMOGRAPHICS Total population (000)

182,202

(2015)

31,109

(2015)

7,133

(2015)

30 750

(2013)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

34 69

(2015)

150

(2015)

100

Stillbirth rate (per 1000 total births)

(2009)

40,000

(2013)

Total fertility rate (per woman)

5.6

(2015)

Adolescent birth rate (per 1000 girls)

123

(2010)

Total under-five population (000) Births (000) Birth registration (%) Total under-five deaths (000)

Total maternal deaths Lifetime risk of maternal death (1 in N)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

250

1400 1200 1200 1000 800 600 400 200 0 1990 1995

213

200

109 MDG Target: 71

50 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

560 300 MDG Target

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 43

Birth

*Postnatal care

Exclusive breastfeeding

Neonatal period

Measles

60 31

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

Percent

12 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

20 10

1990 DHS

1999 DHS

2003 DHS

2008 DHS

2011 MICS

2013 DHS

11 <1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80

66 66 51

Percent

60 40

Percent

Skilled attendant at delivery

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

ORT & continued feeding

2014

(2014)

(2011)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

2008 DHS

2011 MICS

2013 DHS

Vitamin A two dose coverage (%)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80 51 35

44 35

20 0

2003 DHS

100

60 40

1990 DHS

(2013)

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 33 Introduction of solid, semi-solid/soft foods (%) 67

41 27

36 24

33 20

Percent

Vitamin A (past 6 months)

Measles

Early initiation of breastfeeding

148

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

Antenatal care (4+ visits)

Source: DHS 2013

Pneumonia treatment

60 40 20 0

1990 DHS

1993 Other NS

2003 DHS

2008 DHS

2011 MICS

2014 Other NS

1999 DHS

2003 DHS

2008 DHS

2011 MICS

1 1990 DHS

2013 DHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Nigeria DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 10%

15%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 10% Other 2%

Neonatal death: 32%

Sepsis 10%

Embolism 2%

Abortion 10%

Congenital 2%

Haemorrhage 25%

Other direct 9%

Sepsis** 6%

Other 19%

Regional estimates for Sub-Saharan Africa, 2013

10%

Hypertension 16%

Diarrhoea

HIV/AIDS 3% Measles 1%

Source: WHO/MCEE 2015 Injuries 5% (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Malaria 14% * Intrapartum-related events

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

(2011)

Antenatal care (4 or more visits, %)

(2013)

Malaria during pregnancy - intermittent preventive treatment (%)

(2013)

2, 4, 1

(2013)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2013)

Postnatal visit for mother

(2013)

Women with low body mass index

(2013)

C-section rate (total, urban, rural; %)

Demand for family planning satisfied (%)

(Minimum target is 5% and maximum target is 15%)

(within 2 days, %)

20 0

(within 2 days , %)

1986 DHS

1990 DHS

1999 DHS

2003 DHS

2008 DHS

2013 DHS

(<18.5 kg/m2, %)

Malaria prevention and treatment

1990 DHS

1999 DHS

2003 DHS

25 26 2008 DHS

28 26

2011 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

29 34

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2013 DHS

11 (2011)

Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

Percent

40 20 0

3 16

6 18

16 50

28 32 12

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

29 1

2003 DHS

2008 DHS

2015 Urban

100 80 60

1990

2015 Rural

2010 2011 Other NS MICS

7 12

15 14

25 17 2013 DHS

2014 Other NS

(2015)

Life Saving Commodities in Essential Medicine List:

Density of doctors, nurses and midwives (per 10,000 population)

43 38

24 38

1990

2015 Total

Per capita total expenditure on health (Int$)

(2015)

4 3

(2015)

20.1

(2008)

(2015)

194 (2003)

217

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

Reproductive, maternal, newborn and child health expenditure by source

No Data

General government expenditure External sources Private sources

40 20

22 3

Yes

FINANCING

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Midwives authorized for specific tasks (X of 7 tasks)

(% of recommended minimum)

100 80 60 40 20 0

Improved sanitation coverage

Percent

80 37

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Legal status of abortion (X of 5 circumstances)

Newborn health (X of 4) Child health (X of 3)

Diarrhoeal disease treatment

Partial

Reproductive health (X of 3) Maternal health (X of 3)

CHILD HEALTH

100 80 60 40 20 0

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

11 38

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

149

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Pakistan DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

188,925

(2015)

24,664

(2015)

5,451

(2015)

34 432

(2012-2013)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

46 66

(2015)

Stillbirth rate (per 1000 total births)

(2009)

Birth registration (%) Total under-five deaths (000)

Total maternal deaths

(2015)

7,900

Lifetime risk of maternal death (1 in N)

170

(2013)

Total fertility rate (per woman)

3.6

(2015)

(2010)

Maternal mortality ratio

Deaths per 100,000 live births

150

500

139

(2015)

(2013)

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Deaths per 1000 live births

400

400 100

300 200

MDG Target: 46

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

170 100

100 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 64 37 52

*Postnatal care Exclusive breastfeeding

Neonatal period

Measles

40 19

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

Percent

<1 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

20 Percent

Coverage along the continuum of care

15 10 5

1990-91 1996-97 2001-02 2006-07 2010-11 2012-13 DHS Other NS Other NS DHS Other NS DHS

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100 80

73 68 63

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

ORT & continued feeding

2010

2014

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

60 40

1990-91 DHS

2006-07 DHS

2012-13 DHS

Percent of infants <6 months exclusively breastfed

100 80

63 44

55 34

31 42 31 43 32

60 40 20

20 0

Exclusive breastfeeding

Percent

Source: DHS 2012-2013

11 (2012-2013) Early initiation of breastfeeding (within 1 hr of birth, %) 18 32 (2006-2007) Introduction of solid, semi-solid/soft foods (%) 66 Vitamin A two dose coverage (%) -

Percent

Vitamin A (past 6 months)

Measles

Early initiation of breastfeeding

150

Pneumonia treatment

Percent

EQUITY

2006-07 DHS

2012-13 DHS

0 1985-87 1990-91 Other NS DHS

1995 MICS

2001 2011 2012-13 Other NS Other NS DHS

1990-91 DHS

(2013) (2013) -

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Pakistan DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

11%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 22%

Other 17%

Neonatal death: 57%

Sepsis 14%

Embolism 2%

Haemorrhage 30%

Abortion 6%

Asphyxia* 12%

HIV/AIDS 0%

Regional estimates for South Asia, 2013

Other direct 8%

Other 4%

Malaria 0%

Congenital 3%

Injuries 5%

Source: WHO/MCEE 2015 1% (provisional) Diarrhoea * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis Measles 1%

Sepsis** 12%

Hypertension 10%

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

(2012-2013)

Antenatal care (4 or more visits, %)

(2012-2013)

14, 24, 10

(2012-2013)

Malaria during pregnancy - intermittent preventive treatment (%)

100

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(Minimum target is 5% and maximum target is 15%)

20 0

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2012-2013)

Postnatal visit for mother

(2012-2013)

Women with low body mass index

(2012-2013)

(within 2 days, %)

(within 2 days , %)

1990-91 1996-97 2001 2004-05 2006-07 2012-13 DHS Other NS Other NS Other NS DHS DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks (X of 7 tasks)

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

2 3

(2015)

14.0

(2010)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

45 (1999)

(% of recommended minimum)

FINANCING 37

1990-91 DHS

2006-07 DHS

Per capita total expenditure on health (Int$)

Very limited risk

General government expenditure on health as % of total government expenditure (%)

2012-13 DHS

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 7

6 0

1 3

80 52

11 7

65 73

40 20

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100 80

1990

2015 Rural

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

100 8

Percent

National availability of Emergency Obstetric Care services

WATER AND SANITATION

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

13 49

14 9

60 40 20

9 7

18 10

25 64

66 1

1990

2015 Total

1990

2015 Urban

(2013)

No Data

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

(2013)

Note: See annexes for additional information on the indicators above

External sources 21

(2013)

General government expenditure

126

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

151

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Papua New Guinea DEMOGRAPHICS Total population (000)

7,619

(2015)

Total under-five population (000)

996

(2015)

Births (000)

Under-five mortality rate

Deaths per 100,000 live births

100

500

215

(2015)

Birth registration (%) Total under-five deaths (000)

(2015)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

25 45

(2015)

Stillbirth rate (per 1000 total births)

(2009)

460

(2013)

Lifetime risk of maternal death (1 in N)

120

(2013)

Total fertility rate (per woman)

3.7

(2015)

(2004)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Maternal mortality ratio

Deaths per 1000 live births 89

470

400

80 57 MDG Target: 30

20 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

300

220

200 100

120

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 54

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

Measles

100 80

40 20

1996 DHS

Percent

2006 DHS

40 20

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

47 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

<1 2005

2008

Source: UNICEF/UNAIDS/WHO 2015

15 2011

2014

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

65 62 62

1990

Measles

1995

Source: WHO/UNICEF 2015

2000

2005

2010

2014

1996 DHS

2006 DHS

NUTRITION 14 (2009-2011) Early initiation of breastfeeding (within 1 hr of birth, %) (2005) Introduction of solid, semi-solid/soft foods (%) 11

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

No Data

Early initiation of breastfeeding

Vitamin A two dose coverage (%)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent of infants <6 months exclusively breastfed

100

80 Percent

Percent

Exclusive breastfeeding

40 20 0

44 18

Percent

ORT & continued feeding

152

100 80

Skilled attendant at delivery

DTP3

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

Antenatal care (4+ visits)

ITN use among children <5 yrs

Pneumonia treatment

1996 DHS

2006 DHS

40 20 0

1982-1983 Other NS

2005 Other NS

2009-2011 Other NS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Papua New Guinea DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 14%

14%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 12%

Neonatal death: 43%

Other 18%

Sepsis 5% Embolism 15%

Abortion 7% Other direct 12%

Other 3%

Sepsis** 7%

Haemorrhage 30%

Indirect 17%

Source: WHO/MCEE 2015 Injuries 5% Measles 1% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Hypertension 14%

Diarrhoea

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Demand for family planning satisfied (%)

(2006)

Antenatal care (4 or more visits, %)

(2006)

Malaria during pregnancy - intermittent preventive treatment (%)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(within 2 days, %)

20 0

(within 2 days , %)

1996 DHS

2006 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Yes

Legal status of abortion (X of 5 circumstances)

Midwives authorized for specific tasks (X of 7 tasks)

6 Partial

Maternity protection (Convention 183)

Congenital 5% HIV/AIDS 1% Malaria 12%

Regional estimates for Oceania, 2013

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

6.2

(2010)

114

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

Density of doctors, nurses and midwives (per 10,000 population) National availability of Emergency Obstetric Care services

(2015)

(% of recommended minimum)

FINANCING Per capita total expenditure on health (Int$)

No Data

WATER AND SANITATION Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 6 7

Percent

80 43

100

20 0

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

1990

2015 Rural

60 40

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Percent

100

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

General government expenditure External sources 13

25 31 10

40 20 4

1990

2015 Total

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

56 3

No Data

3 13

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

153

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Peru DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

31,377

(2015)

3,020

(2015)

Under-five mortality rate

Deaths per 100,000 live births

100

300

615

(2015)

Birth registration (%) Total under-five deaths (000)

96 10

(2012)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

8 13

(2015)

Stillbirth rate (per 1000 total births)

(2009)

530

(2013)

Lifetime risk of maternal death (1 in N)

440

(2013)

Total fertility rate (per woman)

2.4

(2015)

(2011)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Maternal mortality ratio

Deaths per 1000 live births

250

250 200 150 MDG Target: 27

20 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

100

50 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

*Postnatal care

89 95

Exclusive breastfeeding

Measles

100

Pre-pregnancy Pregnancy Birth

Neonatal period

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

100

20 0

20 40 60 80 100 Percent

Infancy

60 40

20 1992 DHS

1996 DHS

2000 DHS

43 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

Source: DHS, MICS, Other NS

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2004 DHS

2009 DHS

2014 DHS

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100 80

20 1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Measles

2004-06 DHS

2009 DHS

2014

(2013)

(2011)

1992 DHS

1996 DHS

2000 DHS

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

n/a

100

(2010)

Percent of infants <6 months exclusively breastfed

Percent

(2013)

Exclusive breastfeeding

1992 DHS

1996 DHS

2000 DHS

30 5 2004-06 DHS

Percent

Careseeking for pneumonia

2014 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 56 Introduction of solid, semi-solid/soft foods (%) 82 Vitamin A two dose coverage (%)

ORT & continued feeding

ITN use among children <5 yrs

Source: DHS 2012

88 88 86 86

Early initiation of breastfeeding

154

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

24 4 2009 DHS

18 4 2013 DHS

60 40

2009 DHS

2014 DHS

20 0 1992 DHS

1996 DHS

2000 DHS

2004 DHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Peru DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 19%

Globally nearly half of child deaths are attributable to undernutrition

Neonatal death: 49%

Sepsis 8%

Regional estimates for Latin America, 2013

Embolism 3%

Abortion 10%

Haemorrhage 23%

Asphyxia* 6% Other 5%

Other 29%

Other direct 15%

HIV/AIDS 0%

Sepsis** 5% Source: WHO/MCEE 2015 Diarrhoea (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Measles 0% * Intrapartum-related events

Hypertension 22%

Indirect 19%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

(2013)

Antenatal care (4 or more visits, %)

(2014)

29, 36, 12

(2014)

(2012)

C-section rate (total, urban, rural; %)

Demand for family planning satisfied (%)

Malaria during pregnancy - intermittent preventive treatment (%)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby (within 2 days, %)

Postnatal visit for mother

(within 2 days , %)

1992 DHS

1996 DHS

2000 DHS

2004 DHS

2009 DHS

2014 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

1992 DHS

2000 DHS

2004-06 DHS

2009 DHS

Very limited risk

8 5

11 15

28 28

48 13

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100 80

40 20

2015 Urban

1990

2015 Rural

Partial

Maternal deaths notification

Postnatal home visits in the first week after birth

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

2 -

(2015)

26.5

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

45 (2000)

5 10

7 10

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

External sources

20 74

82 70

Private sources

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

11 1

No Data

General government expenditure

4 76

(2013)

ODA to child health per child (US$)

8 6

40 20

15 6 9

626

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

80 17

Per capita total expenditure on health (Int$)

2014 DHS

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 1

Midwives authorized for specific tasks (X of 7 tasks)

FINANCING

Improved drinking water coverage

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100 9

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

1996 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Partial

Maternity protection (Convention 183)

Congenital 12%

Malaria 0% Injuries 9%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Total

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

155

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Philippines DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

100,699

(2015)

11,255

(2015)

2,349

(2015)

Birth registration (%) Total under-five deaths (000)

90 66

(2010)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

13 22

(2015)

Stillbirth rate (per 1000 total births)

(2009)

3,000

(2013)

Lifetime risk of maternal death (1 in N)

250

(2013)

Total fertility rate (per woman)

2.9

(2015)

(2011)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

70 60 58 50 40 30 20 10 0 1990

Deaths per 100,000 live births

28 MDG Target: 19

1995

2000

2005

2010

2015

Source: UN IGME 2015

140 110 120 100 80 60 40 20 0 1990

120

28 MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 76 84 73

*Postnatal care

Exclusive breastfeeding

Neonatal period

No Data

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

Measles

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

1993 DHS

1998 DHS

2000 MICS

2003 DHS

2008 DHS

2013 DHS

* See Annex/website for indicator definition

CHILD HEALTH

Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

100 80

Skilled attendant at delivery

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2005

20 0

1998 DHS

2003 DHS

64 50

1993 DHS

2008 DHS

2013 DHS

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100 80

60 40

80 Percent

8 (2013-2014) Early initiation of breastfeeding (within 1 hr of birth, %) 50 (2008) Introduction of solid, semi-solid/soft foods (%) 90 Vitamin A two dose coverage (%) 89

100

Percent

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

2014

2010

Underweight and stunting prevalence

Careseeking for pneumonia

Source: DHS 2013

2000

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

ORT & continued feeding

88 79

Vitamin A (past 6 months)

100

Measles

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

156

Percent

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

Socioeconomic inequities in coverage

45 29

39 26

34 21

Percent

EQUITY

60 40

1998 DHS

2003 DHS

2008 DHS

20 0

1987 1993 1998 2003 2008 2013-14 Other NS Other NS Other NS Other NS Other NS Other NS

1993 DHS

(2013) (2008) (2013)

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Philippines DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

16%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 15%

Neonatal death: 45%

Abortion 7%

Embolism 12%

Other direct 14%

Asphyxia* 10%

Other 23%

Sepsis 6%

Haemorrhage 30%

Other 3% Congenital 7%

HIV/AIDS 0%

Indirect 17%

Sepsis** 6%

Malaria 0%

Source: WHO/MCEE 2015 Measles 0% Diarrhoea (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis 0%

Injuries 8%

Regional estimates for South-eastern Asia, 2013

Hypertension 15%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

(2013)

Antenatal care (4 or more visits, %)

(2013)

9, 11, 8

(2013)

Malaria during pregnancy - intermittent preventive treatment (%)

Demand for family planning satisfied (%)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2013)

Postnatal visit for mother

(2013)

(within 2 days, %)

20 0

(within 2 days , %)

1993 DHS

1998 DHS

2000 MICS

2003 DHS

2008 DHS

2013 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

76 43

1993 DHS

1998 DHS

2003 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2011 Other NS

35 49

1990

Source: WHO/UNICEF JMP 2015

2015 Urban

1990

2015 Rural

7 17

0 19

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

71.5

(2004)

287

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

External sources

12 74

No Data

General government expenditure

10 1 18

23 19

2015 1990 Total

100

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

68 43

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Maternity protection (Convention 183)

Out of pocket expenditure as % of total expenditure on health(%)

General government expenditure on health as % of total government expenditure (%)

Percent

6 0

Midwives authorized for specific tasks (X of 7 tasks)

Per capita total expenditure on health (Int$)

2013 DHS

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 2

FINANCING

53 49

Improved drinking water coverage 3

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

WATER AND SANITATION

100 4

Partial

National availability of Emergency Obstetric Care services

No Data 2008 DHS

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

71 46

1990

2015 Total

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

157

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Rwanda DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

11,610

(2015)

1,695

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

363

(2015)

Birth registration (%) Total under-five deaths (000)

63 14

(2010)

Neonatal deaths (% of under-five deaths)

(2015)

240

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

19 31

(2015)

180

(2015)

Stillbirth rate (per 1000 total births)

120

(2009)

MDG Target: 51

1,300

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

3.8

(2015)

(2008)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

1600

300

1400

1200

152

800

0 1990

1995

2000

2005

2010

350

0 1990

2015

Source: UN IGME 2015

320

400

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

*Postnatal care

Exclusive breastfeeding

Birth

Neonatal period

Measles

100

Pre-pregnancy Pregnancy 91

Percent

>95

100

40 20

1992 DHS

2000 DHS

2005 DHS

>95

20 40 60 80 100

Source: DHS, MICS, Other NS

Infancy

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

>95 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2007-08 DHS

2010 DHS

2014-15 pDHS

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100 80

0 1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

ORT & continued feeding

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

80 57

20 0

45 20

1992 DHS

2000 MICS

2005 DHS

2007-08 DHS

2010 DHS

2014-15 pDHS

38 9

(2010) (2010) (2013)

Percent of infants <6 months exclusively breastfed

100

60 40

Exclusive breastfeeding

Percent

2 (2014-2015) Early initiation of breastfeeding (within 1 hr of birth, %) 71 (2010) Introduction of solid, semi-solid/soft foods (%) 7 79 Vitamin A two dose coverage (%) 0

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

2014

2010

Percent

Measles

ITN use among children <5 yrs

Source: DHS 2010

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

158

98 99 99 99 98

Pneumonia treatment

Percent

EQUITY

1992 DHS

2000 DHS

2005 DHS

2010 DHS

2014-15 pDHS

60 40 20 0

1992 DHS

1996 Other NS

2000 DHS

2005 DHS

2010 DHS

2014-15 pDHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Rwanda DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 12%

11%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 12%

Neonatal death: 44%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Haemorrhage 25%

Abortion 10%

Other 3% Other direct 9%

Congenital 6% Other 25%

Sepsis** 8%

HIV/AIDS 1% Malaria 4% Injuries 8% * Intrapartum-related events

Hypertension 16%

Source: WHO/MCEE 2015 Measles 0% (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Indirect 29%

Diarrhoea

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

(2010)

Antenatal care (4 or more visits, %)

(2014-2015)

Malaria during pregnancy - intermittent preventive treatment (%)

(2007-2008)

15, 0, 0

(2013)

(2014)

(2010)

(2015)

(2010)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby (within 2 days, %)

Postnatal visit for mother

(within 2 days , %)

1992 DHS

2000 MICS

2005 DHS

2007-08 DHS

2010 DHS

2014-15 pDHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

20 14

1992 DHS

2000 DHS

2005 DHS

21 29

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2007-08 DHS

2010 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2014-15 pDHS

92 (2013)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 9

Percent

9 6

56 13

2005 DHS

2007-08 DHS

2010 DHS

1990

Source: WHO/UNICEF JMP 2015

2015 1990 Total

2015 Urban

1990

2015 Rural

11 25

2013 2014-15 Other NS pDHS

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

7.5

(2010)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

35 (2007)

162

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

Reproductive, maternal, newborn and child health expenditure by source

External sources 2

27 56

No Data

General government expenditure

2 23 55

100 7 80

Midwives authorized for specific tasks (X of 7 tasks)

Per capita total expenditure on health (Int$)

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

FINANCING

Improved sanitation coverage

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

100 80 60 40 20 0

2000 DHS

Percent

100

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

5 62

63 32

1990

2015 Total

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

159

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

São Tomé and Príncipe DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

190

(2015)

Under-five mortality rate

Deaths per 100,000 live births

500

(2015)

Birth registration (%) Total under-five deaths (000)

75 0

(2008-2009)

120

(2015)

100

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

17 35

(2015)

Stillbirth rate (per 1000 total births)

(2009)

Total maternal deaths

(2013)

Lifetime risk of maternal death (1 in N)

100

(2013)

Total fertility rate (per woman)

4.5

(2015)

Adolescent birth rate (per 1000 girls)

110

(2006)

(2015)

Maternal mortality ratio

Deaths per 1000 live births 111

410

400 300 47

MDG Target: 37

20 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

210

200 100

100

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 51

*Postnatal care

Exclusive breastfeeding

Neonatal period

Measles

Birth

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

No Data

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

2000 MICS

Percent

2006 MICS

2008-2009 DHS

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Source: DHS 2008-2009

Percent of infants <6 months exclusively breastfed

100

40 20 0

2008-2009 DHS

Exclusive breastfeeding

32 10

1986 Other NS

2000 MICS

29 14 8 2006 MICS

Percent

Careseeking for pneumonia

2000 MICS

2014

11 (2008-2009) Early initiation of breastfeeding (within 1 hr of birth, %) 45 (2008-2009) 10 (2008-2009) Introduction of solid, semi-solid/soft foods (%) 74 (2008-2009) Vitamin A two dose coverage (%) (2013) 67

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

ORT & continued feeding

0 1990

Vitamin A (past 6 months)

Measles

Early initiation of breastfeeding

160

95 95 95 92

Pneumonia treatment

Percent

EQUITY

2000 MICS

2006 MICS

2008-2009 DHS

40 20 0

2008-2009 DHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

São Tomé and Príncipe DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 11%

10%

Asphyxia* 9% Other 2%

Neonatal death: 37%

Other 21%

Globally nearly half of child deaths are attributable to undernutrition

Sepsis 10%

Embolism 2%

Haemorrhage 25%

Abortion 10%

Congenital 5%

Other direct 9%

Sepsis** 7% 0%

HIV/AIDS 0%

Regional estimates for Sub-Saharan Africa, 2013

Hypertension 16%

Diarrhoea

Measles 1%

Source: WHO/MCEE 2015 Injuries 6% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis Malaria 17%

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

(2008-2009)

Antenatal care (4 or more visits, %)

(2008-2009)

Malaria during pregnancy - intermittent preventive treatment (%)

(2008-2009)

5, 7, 4

(2008-2009)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby

(2008-2009)

(within 2 days, %)

Postnatal visit for mother

(within 2 days , %)

2000 MICS

2006 MICS

2008-2009 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

49 31

2000 MICS

2006 MICS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2008-2009 DHS

43 (2008-2009)

Percent of population by type of drinking water source, 1995-2015 Piped on premises Other improved Surface water Unimproved 19 7

60 40

12 5

1995

Source: WHO/UNICEF JMP 2015

2015 1995 Total

2015 Urban

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

2006 MICS

2008-2009 DHS

(2015)

Newborn health (X of 4) Child health (X of 3)

3 -

(2015)

23.6

(2004)

203

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

1995

2015 Rural

No Data

External sources Private sources

54 74 6 5

General government expenditure

100

(2015)

Reproductive health (X of 3) Maternal health (X of 3)

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1995-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Yes

Life Saving Commodities in Essential Medicine List:

Per capita total expenditure on health (Int$)

Improved sanitation coverage

Midwives authorized for specific tasks (X of 7 tasks)

FINANCING

56 42

54 54

(% of recommended minimum)

100 80 60 40 20 0

2000 MICS

Percent

Legal status of abortion (X of 5 circumstances)

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

3 5

1995

2015 Total

ODA to child health per child (US$)

48 68

80 5 6

2015 Urban

(2012)

113

(2012)

Note: See annexes for additional information on the indicators above

4 7

3 4

1995

ODA to maternal and neonatal health per live birth (US$)

1995

2015 Rural

Source: WHO/UNICEF JMP 2015

161

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Senegal DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

15,129

(2015)

2,601

(2015)

567

(2015)

Birth registration (%) Total under-five deaths (000)

73 27

(2012-2013)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

21 42

(2015)

Stillbirth rate (per 1000 total births)

(2009)

1,700

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

5.0

(2015)

(2011)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

600

150

530

500

140

400

320

300

100 50

47 MDG Target: 47

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

200

130

100

MDG Target

0 1990

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 38

*Postnatal care

Birth

Exclusive breastfeeding

Neonatal period

Measles

100

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

Percent

53 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

40 20

1992-93 DHS

1997 DHS

2000 MICS

2005 DHS

2010-11 DHS

2014 DHS

26 <1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

100 80

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

ORT & continued feeding

2014

2010

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

20 0

1992-93 DHS

2000 MICS

2005 DHS

2010-11 2012-13 DHS DHS

2014 DHS

100 80

60 40

Percent of infants <6 months exclusively breastfed

Percent

Exclusive breastfeeding

34 20

30 15 20

19 29

Percent

Careseeking for pneumonia

(2014) Early initiation of breastfeeding (within 1 hr of birth, %) 48 (2010-2011) 6 19 (2010-2011) Introduction of solid, semi-solid/soft foods (%) 67 (2010-2011) Vitamin A two dose coverage (%) (2013) 99

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Measles

ITN use among children <5 yrs

Source: DHS 2014

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

162

89 89 81 80

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

60 34

40 20

1986 DHS

1992-93 DHS

1997 DHS

0 1992-93 DHS

1996 MICS

2000 MICS

2005 DHS

2010-11 DHS

2014 DHS

2005 DHS

2010-11 DHS

2014 DHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Senegal DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

12%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 13%

Other 22%

Asphyxia* 11%

Neonatal death: 45%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2% Haemorrhage 25%

Abortion 10%

Other direct 9%

Other 3%

Malaria 4%

Hypertension 16%

Sepsis** 10%

Injuries 7%

Source: WHO/MCEE 2015 (provisional) Diarrhoea ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Measles 1% * Intrapartum-related events

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Demand for family planning satisfied (%)

(2012-2013)

Antenatal care (4 or more visits, %)

(2014)

Malaria during pregnancy - intermittent preventive treatment (%)

(2014)

4, 7, 2

(2014)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2013)

Postnatal visit for mother

(2013)

Women with low body mass index

(2010-2011)

(within 2 days, %)

20 0

(within 2 days , %)

1992-93 DHS

1997 DHS

2000 MICS

2005 DHS

2010-11 DHS

2014 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

7 1992-93 DHS

1997 DHS

2000 MICS

2005 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2010-11 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2014 DHS

10 (2014)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

Percent

80 39

13 42

2005 DHS

2008-09 Other NS

2010-11 DHS

2014 DHS

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100 80

14 23

2015 Urban

1990

2015 Rural

60 16 40 20

Partial

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

4.8

(2008)

Density of doctors, nurses and midwives (per 10,000 population)

Per capita total expenditure on health (Int$) General government expenditure on health as % of total government expenditure (%)

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

(2015)

36 (2013)

FINANCING

60 40

7 0

Midwives authorized for specific tasks (X of 7 tasks)

(% of recommended minimum)

100 80 60 40 20 0

2000 MICS

Percent

0 11

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

Legal status of abortion (X of 5 circumstances)

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100 1

Yes

Maternity protection (Convention 183)

Congenital 5%

HIV/AIDS 1%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

8 14

56 34

1990

2015 Total

2015 Urban

(2013)

No Data

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

5 21

1990

External sources

(2013)

General government expenditure

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

163

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Sierra Leone DEMOGRAPHICS Total population (000)

6,453

(2015)

Total under-five population (000)

1,004

(2015)

Births (000)

Under-five mortality rate

Deaths per 100,000 live births

3000

229

(2015)

Birth registration (%) Total under-five deaths (000)

78 26

(2010)

300

(2015)

250

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

200

35 87

(2015)

150

Stillbirth rate (per 1000 total births)

(2009)

2,400

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.5

(2015)

Adolescent birth rate (per 1000 girls)

131

(2011)

Total maternal deaths

(2015)

Maternal mortality ratio

Deaths per 1000 live births 264

2300

2500 2000 120

100

MDG Target: 88

50 0 1990

1995

2000

2005

2010

1500

580

500

MDG Target

0 1990

2015

Source: UN IGME 2015

1100

1000

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 40 76 60

*Postnatal care

Exclusive breastfeeding

Neonatal period

Infancy

No Data

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Measles Percent

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

2000 MICS

2005 MICS

2008 DHS

2010 MICS

2013 DHS

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

83 83 83 78 53

80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100 80

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

2014

(2013)

(2010)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

2005 MICS

2008 DHS

2010 MICS

2013 DHS

Vitamin A two dose coverage (%)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80 47

41 25

20 0

2000 MICS

100

60 40

(2013)

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 54 Introduction of solid, semi-solid/soft foods (%) 63

38 25

37 21

38 18

Percent

ORT & continued feeding

0 1990

Vitamin A (past 6 months)

Measles

164

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

Source: DHS 2013

Pneumonia treatment

Percent

EQUITY

60 40 20 0

1990 Other NS

2000 MICS

2005 MICS

2008 DHS

2010 MICS

2013 DHS

2000 MICS

2005 MICS

2010 MICS

2013 DHS

2008 DHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Sierra Leone DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 9% Asphyxia* 8%

12%

Globally nearly half of child deaths are attributable to undernutrition

Other 2%

Neonatal death: 29%

Haemorrhage 25%

Abortion 10%

Other direct 9%

10%

Embolism 2%

Sepsis 10%

Congenital 2% Sepsis** 7%

Other 21%

Regional estimates for Sub-Saharan Africa, 2013

Diarrhoea

Measles 2%

HIV/AIDS 0%

Hypertension 16%

Source: WHO/MCEE 2015 Injuries 5% (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Malaria 20% * Intrapartum-related events

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

80 Percent

100

Demand for family planning satisfied (%)

(2013)

Antenatal care (4 or more visits, %)

(2013)

Malaria during pregnancy - intermittent preventive treatment (%)

(61.7)

3, 5, 2

(2013)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2013)

Postnatal visit for mother

(2013)

(within 2 days, %)

20 0

(within 2 days , %)

2000 MICS

2005 MICS

2008 DHS

2010 MICS

2013 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

54 39

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

73 58

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2000 MICS

2005 MICS

2008 DHS

2010 MICS

2013 DHS

77 (2013)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

100

26 2

2000 MICS

2005 MICS

2008 DHS

2010 MICS

2013 DHS

60 40

22 23 58

24 47

20 31 0

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

2015 Rural

1 24

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

1.9

(2010)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

24 (2008)

1990

2015 Total

1990

2015 Urban

228

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

No Data

External sources Private sources

8 36

Per capita total expenditure on health (Int$)

General government expenditure

40 20

1990

Midwives authorized for specific tasks (X of 7 tasks)

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

FINANCING 49

Improved sanitation coverage

Percent

80 40

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

100 80 60 40 20 0

100

6 9

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

14 5

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

165

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Solomon Islands DEMOGRAPHICS Total population (000)

584

(2015)

Total under-five population (000)

(2015)

Births (000)

(2015)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

12 24

(2015)

Stillbirth rate (per 1000 total births)

(2009)

Total maternal deaths

(2013)

Lifetime risk of maternal death (1 in N)

180

(2013)

Total fertility rate (per woman)

3.9

(2015)

(2008)

Birth registration (%) Total under-five deaths (000)

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

50 40

28 MDG Target: 13

10 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

350 320 300 250 200 150 100 50 0 1990

130 80 MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 76

*Postnatal care Exclusive breastfeeding

Birth

Neonatal period

Measles

100

Pre-pregnancy Pregnancy

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

60 40

Infancy

No Data

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Eligible HIV+ pregnant women receiving ART for their own health (%)

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1994 Other NS

Percent

1999 Other NS

2007 DHS

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

1995

2000

Source: WHO/UNICEF 2015

2005

2010

2014

2007 DHS

NUTRITION Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

0 1990

No Data

Measles

(2007)

Early initiation of breastfeeding (within 1 hr of birth, %) 75 Introduction of solid, semi-solid/soft foods (%) Vitamin A two dose coverage (%)

ORT & continued feeding

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

Percent of infants <6 months exclusively breastfed

100 80

20 0

40 16

n/a

Exclusive breastfeeding

Percent

166

100

Percent

DTP3

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding ITN use among children <5 yrs

93 88 88

Pneumonia treatment

Percent

EQUITY

60 40 20 0

1989 Other NS

2007 DHS

(2007) -

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Solomon Islands DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

16%

Preterm 13% Asphyxia* 11%

Neonatal death: 43%

Globally nearly half of child deaths are attributable to undernutrition

Abortion 7%

Sepsis 5%

Embolism 15%

Regional estimates for Oceania, 2013

Other direct 12%

Other 3%

Other 25%

Congenital 8% HIV/AIDS 0%

Indirect 17%

Sepsis** 6%

Malaria 1% Injuries 8%

Source: WHO/MCEE 2015 Measles 0% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis 7%

Haemorrhage 30%

Hypertension 14%

Diarrhoea

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

(2006-2007)

Antenatal care (4 or more visits, %)

(2006-2007)

6, 8, 6

(2006-2007)

Malaria during pregnancy - intermittent preventive treatment (%)

100 74

80 Percent

Demand for family planning satisfied (%)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(within 2 days, %)

20 0

(within 2 days , %)

2007 DHS

(<18.5 kg/m2, %)

Malaria prevention and treatment Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

76 Percent

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2007 DHS

1 6 32

100

Maternal deaths notification

Postnatal home visits in the first week after birth

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

40 20

Urban

Rural

(2015)

Life Saving Commodities in Essential Medicine List:

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

Reproductive, maternal, newborn and child health expenditure by source

(2015)

2 3

(2015)

22.8

(2009)

(2015)

100 (2015)

106

(2013)

No Data

General government expenditure External sources Private sources

9 10

ODA to child health per child (US$) 66

Total

Per capita total expenditure on health (Int$)

Percent of population by type of sanitation facility, 2015 Unimproved facilities Improved and shared facilities Open defecation

Source: WHO/UNICEF JMP 2015

Maternity protection (Convention 183)

FINANCING 40

Improved sanitation coverage

Percent

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 2015 Piped on premises Other improved Surface water Unimproved 7

Midwives authorized for specific tasks (X of 7 tasks)

(% of recommended minimum)

100 80 60 40 20 0

2007 DHS

Improved drinking water coverage

National availability of Emergency Obstetric Care services

WATER AND SANITATION

Legal status of abortion (X of 5 circumstances)

Newborn health (X of 4) Child health (X of 3)

Diarrhoeal disease treatment

100

Reproductive health (X of 3) Maternal health (X of 3)

CHILD HEALTH

100 80 60 40 20 0

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

ODA to maternal and neonatal health per live birth (US$)

(2012)

147

(2012)

Note: See annexes for additional information on the indicators above

81 19

Total

Urban

Rural

Source: WHO/UNICEF JMP 2015

167

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Somalia DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

10,787

(2015)

1,971

(2015)

471

(2015)

Birth registration (%) Total under-five deaths (000)

3 61

(2006)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

40 85

(2015)

Stillbirth rate (per 1000 total births)

(2009)

3,900

(2013)

Total fertility rate (per woman)

6.4

(2015)

Adolescent birth rate (per 1000 girls)

123

(2005)

Total maternal deaths Lifetime risk of maternal death (1 in N)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

1500

180

150

1300

1200

137

850

900

100

600

MDG Target: 60

300

0 1990

1995

2000

2005

2010

0 1990

2015

Source: UN IGME 2015

330 MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

Measles

10 33

6 4 2

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

3 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

1999 MICS

Percent

2002 Other NS

2006 MICS

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

100 80

Percent

46 42 42

40 20

Early initiation of breastfeeding

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

40 13

2006 MICS

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Measles

Percent

Skilled attendant at delivery

(2009)

Early initiation of breastfeeding (within 1 hr of birth, %) 26 Introduction of solid, semi-solid/soft foods (%) 16 Vitamin A two dose coverage (%)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

Percent of infants <6 months exclusively breastfed

100

Percent

60 33

40 20 0

Exclusive breastfeeding

Percent

ORT & continued feeding

168

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

Antenatal care (4+ visits)

Source: MICS 2006

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

60 40 20

9 5

0 1999 MICS

2006 MICS

2009 Other NS

1999 MICS

2006 MICS

2009 Other NS

(2006) (2006) -

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Somalia DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

22%

Globally nearly half of child deaths are attributable to undernutrition

3% Preterm 7%

Neonatal death: 29%

Other 23%

Sepsis 10%

Embolism 2%

Abortion 10%

Asphyxia* 11%

Regional estimates for Sub-Saharan Africa, 2013

Haemorrhage 25%

Other direct 9%

Other 2%

Sepsis** 5% 14%

Malaria 1%

Hypertension 16%

Source: WHO/MCEE 2015 (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Indirect 29%

Diarrhoea

Injuries 6% Measles 5% * Intrapartum-related events

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100 80 Percent

Demand for family planning satisfied (%)

Antenatal care (4 or more visits, %)

(2006)

Malaria during pregnancy - intermittent preventive treatment (%)

(2006)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine 32

(2014)

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(within 2 days, %)

(within 2 days , %)

1999 MICS

2006 MICS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

30 13

7 1999 MICS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2006 MICS

10 (2006)

Percent of population by type of drinking water source, 2010 Piped on premises Other improved Surface water Unimproved

100

17 42

40 20

Total Source: WHO/UNICEF JMP 2015

Urban

60 40

Rural

Maternal deaths notification

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

1.5

(2006)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

56 (2005)

30 83

General government expenditure on health as % of total government expenditure (%)

Out of pocket expenditure as % of total expenditure on health(%)

No Data

General government expenditure External sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

52 5 6 6

Total

Note: See annexes for additional information on the indicators above

9 15

Per capita total expenditure on health (Int$)

Private sources

3 15

20 9 0

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 2010 Improved facilities Shared facilities Open defecation Unimproved facilities

Midwives authorized for specific tasks (X of 7 tasks)

FINANCING

Improved sanitation coverage

Percent

(% of recommended minimum)

100 80 60 40 20 0

2006 MICS

4 27

Legal status of abortion (X of 5 circumstances)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Maternity protection (Convention 183)

Congenital 2% HIV/AIDS 1%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Urban

Rural

Source: WHO/UNICEF JMP 2015

169

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

South Africa DEMOGRAPHICS Total population (000)

54,490

(2015)

Total under-five population (000)

5,370

(2015)

Births (000)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

100

200

1,111

(2015)

Birth registration (%) Total under-five deaths (000)

85 42

(2012)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

11 34

(2015)

Stillbirth rate (per 1000 total births)

(2009)

1,500

(2013)

MDG Target: 20

Lifetime risk of maternal death (1 in N)

300

(2013)

Total fertility rate (per woman)

2.3

(2015)

(2007)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

150

0 1990

1995

2000

2005

2010

140

100 50

0 1990

2015

Source: UN IGME 2015

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 81

*Postnatal care Exclusive breastfeeding

Birth

Neonatal period

100

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

70 Percent

1998 DHS

2003 DHS

40 0

2008 Other NS

>95

60 20

1995 Other NS

>95 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

Infancy

Measles

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2005

2008

Source: UNICEF/UNAIDS/WHO 2015

2011

2014

* See Annex/website for indicator definition

EQUITY

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

100 80

72 70 70 70 65

Percent

60 40 20

Early initiation of breastfeeding

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

ORT & continued feeding

(2008)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

(2003)

Vitamin A two dose coverage (%)

(2013)

Percent

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

2003 DHS

100

1998 DHS

Early initiation of breastfeeding (within 1 hr of birth, %) 61 Introduction of solid, semi-solid/soft foods (%) -

Percent

29 8 1994-1995 Other NS

10 1999 Other NS

2003 DHS

24 9 2008 Other NS

Percent

Vitamin A (past 6 months)

2014

2010

Measles

Percent

Skilled attendant at delivery

170

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

Antenatal care (4+ visits)

Source: DHS 1998

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

60 40 20

1998 DHS

2003 DHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

South Africa DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 9%

15%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 6% Other 4%

Neonatal death: 27%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Haemorrhage 25%

Congenital 2% Sepsis** 4%

Other direct 9%

Diarrhoea

Other 31%

Hypertension 16%

Measles 1% Source: WHO/MCEE 2015 Malaria 0% (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis Injuries 9%

HIV/AIDS 8% * Intrapartum-related events

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

(2003)

Antenatal care (4 or more visits, %)

(2008)

21, 24, 15

(2003)

Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(within 2 days, %)

20 0

(within 2 days , %)

1994-1995 Other NS

1998 DHS

2003 DHS

2008 Other NS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

1998 DHS

4 20

0 0 8

02 12

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100

43 92

56 38

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 -

(2015)

58.9

(2013)

1,121

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

2015 Urban

1990

2015 Rural

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

(R,F)

Maternity protection (Convention 183)

Out of pocket expenditure as % of total expenditure on health(%)

General government expenditure on health as % of total government expenditure (%)

2003 DHS

Midwives authorized for specific tasks (X of 7 tasks)

Per capita total expenditure on health (Int$)

Very limited risk

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 13 4

FINANCING 40

Improved drinking water coverage

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

Yes

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

4 8

14 18

General government expenditure External sources 8

40 20

2 10

66 51

No Data

Private sources

ODA to child health per child (US$) ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

61 38

1990

2015 Total

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

171

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

South Sudan DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

12,340

(2015)

1,956

(2015)

Under-five mortality rate

Deaths per 100,000 live births

2000

446

(2015)

Birth registration (%) Total under-five deaths (000)

35 39

(2010)

300

(2015)

250

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

200

39 60

(2015)

150

3,000

(2013)

Total fertility rate (per woman)

4.9

(2015)

Adolescent birth rate (per 1000 girls)

158

(2008)

Stillbirth rate (per 1000 total births) Total maternal deaths Lifetime risk of maternal death (1 in N)

(2015)

Maternal mortality ratio

Deaths per 1000 live births 253

1800

1500 1000

100

MDG Target: 84

0 1990

1995

2000

2005

2010

730

500

450

0 1990

2015

Source: UN IGME 2015

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 13

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

Measles

40 19

30 18

20 10

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

7 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2006 MICS

Percent

2010 MICS

<1 2005

<1 2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Skilled attendant at delivery

100

39 22

0 1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

ORT & continued feeding

(2010)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

(2010)

Vitamin A two dose coverage (%)

(2013)

Percent of infants <6 months exclusively breastfed

100 80

60 40

40 20

20 0

Exclusive breastfeeding

Percent

2010 MICS

Early initiation of breastfeeding (within 1 hr of birth, %) 48 Introduction of solid, semi-solid/soft foods (%) 21

Percent

Vitamin A (past 6 months)

2014

2010

40 20

Measles

172

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

Source: MICS 2010

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

Antenatal care (4+ visits)

Immunization

Percent

EQUITY

0 2006 MICS

2010 MICS

(2010)

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

South Sudan DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

17%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 11% Asphyxia* 15%

Neonatal death: 43%

Sepsis 10%

Haemorrhage 25%

Other direct 9%

Congenital 3%

Other 16%

Embolism 2%

Abortion 10%

Other 2%

Regional estimates for Sub-Saharan Africa, 2013

Sepsis** 7% HIV/AIDS 4%

Diarrhoea

Malaria 7% Injuries 5% * Intrapartum-related events

Measles 1%

Hypertension 16%

Source: WHO/MCEE 2015 (provisional)

Indirect 29%

Source: WHO 2014

** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100 62

Percent

60 40 26

(2010)

Antenatal care (4 or more visits, %)

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

(2013)

1, 1, 0

(2010)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

Postnatal visit for mother

Women with low body mass index

(Minimum target is 5% and maximum target is 15%)

(within 2 days, %)

20 0

C-section rate (total, urban, rural; %)

Demand for family planning satisfied (%)

(within 2 days , %)

2006 MICS

2010 MICS

2013 Other NS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

39 23 2010 MICS

100 80 60 40 20 0

8 (2010)

40 57

20 0

2009 Other NS

2013 Other NS

Maternity protection (Convention 183)

Maternal deaths notification

Postnatal home visits in the first week after birth

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Percent of population by type of sanitation facility, 2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Total

Urban

Rural

50 74

Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

1 2

(2015)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

22 (2013)

Per capita total expenditure on health (Int$) General government expenditure on health as % of total government expenditure (%)

(2013)

No Data

General government expenditure External sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

40 20

(2015)

Private sources

Life Saving Commodities in Essential Medicine List:

Reproductive, maternal, newborn and child health expenditure by source

100

Source: WHO/UNICEF JMP 2015

Midwives authorized for specific tasks (X of 7 tasks)

FINANCING 46

Improved sanitation coverage

Percent

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 2015 Piped on premises Other improved Surface water Unimproved 24

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

2006 MICS

Improved drinking water coverage

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

24 15

4 7

15 2 4

Total

Urban

Rural

Source: WHO/UNICEF JMP 2015

173

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Sudan DEMOGRAPHICS Total population (000)

40,235

(2015)

Total under-five population (000)

5,952

(2015)

Births (000)

Under-five mortality rate

Deaths per 100,000 live births

150

800

1,319

(2015)

Birth registration (%) Total under-five deaths (000)

59 89

(2010)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

30 48

(2015)

Stillbirth rate (per 1000 total births)

(2009)

4,600

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.3

(2015)

Adolescent birth rate (per 1000 girls)

102

(2010)

Total maternal deaths

(2015)

Maternal mortality ratio

Deaths per 1000 live births 128

120

720

600 400

70 MDG Target: 43

30 0 1990

1995

2000

2005

2010

360

200

180

0 1990

2015

Source: UN IGME 2015

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 24

*Postnatal care

Birth

Exclusive breastfeeding

Neonatal period

Measles

15 10 5

20 40 60 80 100

Source: DHS, MICS, Other NS

86 0

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

5 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2006 MICS

Percent

2010 MICS

<1 2005

2008

Source: UNICEF/UNAIDS/WHO 2015

2 2011

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

100 60

Percent

Skilled attendant at delivery

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

2014

(2014)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

Vitamin A two dose coverage (%)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80 38

60 40

55 41

20 0

2014 MICS

100

60 40

2010 MICS

(2010)

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 73 Introduction of solid, semi-solid/soft foods (%) 51

Percent

ORT & continued feeding

Vitamin A (past 6 months)

Measles

174

100

Early initiation of breastfeeding

Source: MICS 2010

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

97 94 94 86

Antenatal care (4+ visits)

Pneumonia treatment

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

EQUITY

0 2006 MICS

2010 MICS

2014 MICS

2010 MICS

2014 MICS

(2010)

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Sudan DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 12%

14%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 12%

Neonatal death: 43%

Sepsis 10%

Embolism 2%

Abortion 10%

Other 2%

Haemorrhage 25%

Sepsis** 9%

HIV/AIDS 0% Malaria 1%

Hypertension 16%

10%

Source: WHO/MCEE 2015 Measles 2% (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis Diarrhoea

Injuries 8% * Intrapartum-related events

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

80 Percent

Demand for family planning satisfied (%)

(2010)

Antenatal care (4 or more visits, %)

(2014)

(2010)

9, 0, 0

(2014)

Malaria during pregnancy - intermittent preventive treatment (%)

100 79

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2014)

Postnatal visit for mother

(2014)

(within 2 days, %)

20 0

(within 2 days , %)

2006 MICS

2010 MICS

2014 MICS

Women with low body mass index (<18.5 kg/m2, %)

Malaria prevention and treatment Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2000 MICS

2006 MICS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

12 22 2010 MICS

2014 MICS

33 (2010)

Percent of population by type of drinking water source, 1990-2010 Piped on premises Other improved Surface water Unimproved

Percent

1990

Source: WHO/UNICEF JMP 2015

2010 Urban

1990

2010 Rural

60 40 20

2010 1990 Total

100 80 38

20 35

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List:

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

3 3

(2015)

11.2

(2008)

(2015)

35 (2005)

FINANCING

1990

2010 Total

1990

2010 Urban

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

No Data

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

4 13

29 52

External sources

General government expenditure on health as % of total government expenditure (%)

Private sources

(2013)

General government expenditure

20 28

221

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2010 Improved facilities Shared facilities Open defecation Unimproved facilities

60 40

Maternity protection (Convention 183)

Per capita total expenditure on health (Int$)

Improved sanitation coverage

Percent

2 12

(% of recommended minimum)

100 80 60 40 20 0

2006 MICS

Improved drinking water coverage

80 25

1 (R,F)

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100 8

Legal status of abortion (X of 5 circumstances)

Newborn health (X of 4) Child health (X of 3)

Diarrhoeal disease treatment

Partial

Reproductive health (X of 3) Maternal health (X of 3)

CHILD HEALTH

100 80 60 40 20 0

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Midwives authorized for specific tasks (X of 7 tasks)

Other direct 9%

Congenital 4% Other 22%

Regional estimates for Sub-Saharan Africa, 2013

1990

2010 Rural

Source: WHO/UNICEF JMP 2015

175

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Swaziland DEMOGRAPHICS Total population (000)

1,287

(2015)

173

(2015)

Births (000)

(2015)

Birth registration (%) Total under-five deaths (000)

50 2

(2010)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

14 45

(2015)

Stillbirth rate (per 1000 total births)

(2009)

120

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

3.2

(2015)

(2009)

Total under-five population (000)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

150

600

120

500 75

550

400 61

MDG Target: 25

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

310

300 200

140

100 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 83 77 82

*Postnatal care

Exclusive breastfeeding

Neonatal period

Measles

100

Pre-pregnancy Pregnancy Birth

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

100

Infancy

20 0

Percent

>95

20 40 60 80 100

Source: DHS, MICS, Other NS

66 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

60 40 20

1994 Other NS

2000 MICS

2002 2006-07 Other NS DHS

2010 MICS

2014 MICS

<1 2005

<1 2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100 80

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

(2014)

(2010)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

2010 MICS

2014 MICS

Vitamin A two dose coverage (%)

(2013)

(2010)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100 80

2006-2007 DHS

(2010)

2000 MICS

Early initiation of breastfeeding (within 1 hr of birth, %) 55 Introduction of solid, semi-solid/soft foods (%) 66

9 2000 MICS

30 6

2006-2007 2008 DHS Other NS

6 2010 MICS

26 6 2014 MICS

Percent

ORT & continued feeding

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Measles

73 60

ITN use among children <5 yrs

Source: MICS 2010

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

176

98 98 86 67

Pneumonia treatment

Percent

EQUITY

40 20

64 32

0 2000 MICS

2006-2007 2008 DHS Other NS

2010 MICS

2014 MICS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Swaziland DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 8% Asphyxia* 6%

15%

Globally nearly half of child deaths are attributable to undernutrition

Other 2%

Neonatal death: 23%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Congenital 3%

Haemorrhage 25%

Sepsis** 4% Other direct 9%

10%

Diarrhoea

Other 32%

Measles 0%

Hypertension 16%

Injuries 8%

HIV/AIDS 12% * Intrapartum-related events

Source: WHO/MCEE 2015 Malaria 0% (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

(2010)

Antenatal care (4 or more visits, %)

(2010)

12, 12, 13

(2010)

(2014)

(2006-2007)

Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby (within 2 days, %)

Postnatal visit for mother

(within 2 days , %)

2000 MICS

2002 2006-2007 Other NS DHS

2010 MICS

2014 MICS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

86 66 48 25

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2000 MICS

2006-2007 DHS

2010 MICS

2014 MICS

18 (2010)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

Percent

12 45

8 6 19

3 19

14 57

18 21

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

1990

2015 Rural

2000 MICS

2006-2007 DHS

2010 MICS

14 8

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

17.7

(2009)

564

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

Reproductive, maternal, newborn and child health expenditure by source

7 1

6 29

(2015)

External sources

1990

2015 Total

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

15 63

No Data

General government expenditure

31 10

40 20

Midwives authorized for specific tasks (X of 7 tasks)

(F)

FINANCING

100

Per capita total expenditure on health (Int$)

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

100 80 60 40 20 0

Improved sanitation coverage

Percent

100

Partial

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Note: See annexes for additional information on the indicators above

56 44

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

177

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Tajikistan DEMOGRAPHICS Total population (000)

8,482

(2015)

Total under-five population (000)

1,176

(2015)

Births (000)

Under-five mortality rate

Deaths per 100,000 live births

150

140

256

(2015)

Birth registration (%) Total under-five deaths (000)

88 12

(2012)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

21 39

(2015)

Stillbirth rate (per 1000 total births)

(2009)

120

(2013)

Lifetime risk of maternal death (1 in N)

530

(2013)

Total fertility rate (per woman)

3.5

(2015)

(2010)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

(2015)

Maternal mortality ratio

Deaths per 1000 live births

108

120

110 68

80 45

MDG Target: 36

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

20 -10 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 55

*Postnatal care

Exclusive breastfeeding

100

Pre-pregnancy Pregnancy

Birth

Neonatal period

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

100

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent

1991 Other NS

1996 MoH

2000 MICS

2005 MICS

20 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

Infancy

Measles

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2010 Other NS

25 0

2012 DHS

50 7

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

98 97 97

80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100 80

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

2014

(2012)

(2005)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

2000 MICS

2005 MICS

2012 DHS

Vitamin A two dose coverage (%)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

100 80 42

33 15

20 0

(2012)

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 50 Introduction of solid, semi-solid/soft foods (%) 49

Percent

ORT & continued feeding

0 1990

Vitamin A (past 6 months)

Measles

178

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

Source: DHS 2012

Pneumonia treatment

Percent

EQUITY

60 40 20

0 1999 Other NS

2003 Other NS

2005 MICS

2007 Other NS

2012 DHS

2000 MICS

2005 MICS

2012 DHS

(2012)

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Tajikistan DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 14%

15%

Asphyxia* 12%

Neonatal death: 47%

Sepsis 9%

Globally nearly half of child deaths are attributable to undernutrition

Embolism 11%

Abortion 5%

Other direct 17%

Other 4%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Caucasus and Central Asia, 2013

Legal status of abortion (X of 5 circumstances)

Maternity protection (Convention 183)

Sepsis** 7%

HIV/AIDS 0% Malaria 0%

Source: WHO/MCEE 2015 Injuries 7% Measles 0% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Hypertension 15%

Indirect 22%

Diarrhoea

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100 71

Percent

Demand for family planning satisfied (%)

(2012)

Antenatal care (4 or more visits, %)

(2012)

4, 6, 4

(2012)

Malaria during pregnancy - intermittent preventive treatment (%) C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby

(2012)

Postnatal visit for mother

(2012)

(within 2 days, %)

20 0

(within 2 days , %)

2000 MICS

2005 MICS

2007 Other NS

2012 DHS

Women with low body mass index (<18.5 kg/m2, %)

Malaria prevention and treatment

100 80 60 40 20 0

48 29

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2000 MICS

2005 MICS

2009 Other NS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2012 DHS

11 (2005)

40 20

1995

2015 1995 Total

Source: WHO/UNICEF JMP 2015

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

(2015)

Life Saving Commodities in Essential Medicine List:

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

2 -

(2015)

69.4

(2013)

86 (2005)

Reproductive, maternal, newborn and child health expenditure by source

6 3

2 0 3

1 2 5

10 5

(2013)

No Data

General government expenditure External sources 0 3 2

2 8 2

170

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

Yes

General government expenditure on health as % of total government expenditure (%)

Antenatal corticosteroids as part of management of preterm labour

FINANCING

Percent of population by type of sanitation facility, 1995-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100

5 2 10

4 4 15

5 11

Per capita total expenditure on health (Int$)

Improved sanitation coverage

Percent

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1995-2015 Piped on premises Other improved Surface water Unimproved

Yes

(% of recommended minimum)

100 80 60 40 20 0

WATER AND SANITATION

100

Yes

National availability of Emergency Obstetric Care services

2005 MICS

Improved drinking water coverage

Partial

Postnatal home visits in the first week after birth

Reproductive health (X of 3) Maternal health (X of 3)

CHILD HEALTH

Maternal deaths notification

Newborn health (X of 4) Child health (X of 3)

Diarrhoeal disease treatment

5 (R,F)

Midwives authorized for specific tasks (X of 7 tasks)

Haemorrhage 23%

Congenital 7% Other 24%

Yes

2015 Urban

1995

2015 Rural

20 0

1995

2015 Total

1995

2015 Urban

1995

2015 Rural

Source: WHO/UNICEF JMP 2015

179

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Tanzania, United Republic of DEMOGRAPHICS Total population (000)

53,470

(2015)

Total under-five population (000)

9,398

(2015)

Births (000)

2,064

(2015)

Birth registration (%) Total under-five deaths (000)

16 98

(2010)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

19 35

(2015)

Stillbirth rate (per 1000 total births)

(2015)

(2009)

7,900

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

5.1

(2015)

Adolescent birth rate (per 1000 girls)

128

(2007)

Total maternal deaths

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

1000

165

910

800

150

600

100

MDG Target: 55

50 0 1990

1995

2000

2005

2010

230

200

MDG Target

0 1990

2015

Source: UN IGME 2015

410

400

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 58

*Postnatal care

Exclusive breastfeeding

Birth

Neonatal period

No Data

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

Measles Percent

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1991-92 DHS

1996 DHS

1999 Other NS

2004-05 DHS

2010 DHS

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine 99 97 97 97 93

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100 80

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

(2014)

(2010)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

1999 DHS

2004-05 DHS

2010 DHS

Vitamin A two dose coverage (%)

(2013)

(2010)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

80 50 25

50 27

20 0

1996 DHS

100

60 40

1991-92 DHS

(2010)

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 49 Introduction of solid, semi-solid/soft foods (%) 92

44 17

43 16

35 13

Percent

ORT & continued feeding

ITN use among children <5 yrs

Vitamin A (past 6 months)

Measles

180

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

Source: DHS 2010

Pneumonia treatment

Percent

EQUITY

60 40 20

29 23

0 1991-92 DHS

1996 DHS

1999 DHS

2004-05 DHS

2010 DHS

2014 Other NS

1991-92 DHS

1996 DHS

1999 2004-05 Other NS DHS

2010 DHS

2014 Other NS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Tanzania, United Republic of DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Preterm 10%

Pneumonia

Asphyxia* 11%

12%

Globally nearly half of child deaths are attributable to undernutrition

Other 2%

Neonatal death: 39%

Sepsis 10%

Embolism 2%

Abortion 10%

Haemorrhage 25%

Other direct 9%

Congenital 5%

Other 24%

Regional estimates for Sub-Saharan Africa, 2013

Sepsis** 8% 0%

HIV/AIDS 3%

Hypertension 16%

Diarrhoea

Source: WHO/MCEE 2015 Measles 0% (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Malaria 5% Injuries 8% * Intrapartum-related events

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

80 Percent

(2010)

Antenatal care (4 or more visits, %)

(2010)

Malaria during pregnancy - intermittent preventive treatment (%)

(2011-2012)

5, 10, 3

(2010)

(2014)

Postnatal visit for mother

(2010)

Women with low body mass index

(2010)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby (within 2 days, %)

20 0

Demand for family planning satisfied (%)

(within 2 days , %)

1991-92 DHS

1996 DHS

1999 DHS

2004-05 2007-08 DHS Other NS

2010 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

1991-92 DHS

1996 DHS

1999 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2004-05 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2010 DHS

61 (2011-2012)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 14

Percent

80 60

3 5

2004-05 DHS

2007-08 Other NS

2010 DHS

2011-12 Other NS

1990

Source: WHO/UNICEF JMP 2015

2015 Urban

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Yes

Costed national implementation plan(s) for: maternal, newborn and child health available

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

4.7

(2012)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

21 (2005)

100 9

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

External sources 17

126

General government expenditure

36 80

FINANCING

Private sources

(2012)

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

20 0

2015 1990 Total

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Midwives authorized for specific tasks (X of 7 tasks)

Available Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Per capita total expenditure on health (Int$)

3 20

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

100 80 60 40 20 0

1999 DHS

Percent

100

Yes

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Rural

1990

2015 Total

6 6

1990

2015 Urban

4 8

3 7

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

181

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Togo DEMOGRAPHICS Total population (000)

7,305

(2015)

Total under-five population (000)

1,160

(2015)

Births (000)

256

(2015)

Birth registration (%) Total under-five deaths (000)

78 20

(2010)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

27 52

(2015)

Stillbirth rate (per 1000 total births)

(2015)

(2009)

1,100

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.5

(2015)

(2011)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

200

800 146

150

660

600

100

MDG Target: 49

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

450

400 200

170

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 37

*Postnatal care

Birth

Exclusive breastfeeding

Neonatal period

Measles

100

Infancy

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

82 Percent

22 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

40 20

1998 DHS

2000 MICS

2003 Other NS

2006 MICS

2010 MICS

2013-14 DHS

60 17

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

35 34

40 20

Early initiation of breastfeeding

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100 80

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

20 0

2006 MICS

2010 MICS

2013-14 DHS

Percent of infants <6 months exclusively breastfed

100 80

60 40

2000 MICS

Exclusive breastfeeding

Percent

Source: DHS 2013-2014

7 (2013-2014) Early initiation of breastfeeding (within 1 hr of birth, %) 61 (2013-2014) (2010) Introduction of solid, semi-solid/soft foods (%) 67 (2013-2014) Vitamin A two dose coverage (%) (2013) 61

Underweight and stunting prevalence

Careseeking for pneumonia

1998 DHS

41 22

22 28

21 27

30 17

28 16

Percent

ORT & continued feeding

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

0 1990

Measles

182

87 87 82

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

60 40 20

2010 MICS

2013-14 DHS

0 1988 DHS

1998 DHS

2006 MICS

2008 Other NS

2010 MICS

2013-14 DHS

1988 DHS

1998 DHS

2000 MICS

2006 MICS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Togo DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 10%

13%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 10%

Neonatal death: 34%

Other 20%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Haemorrhage 25%

Other 2%

Hypertension 16%

Diarrhoea

Malaria 18%

Source: WHO/MCEE 2015 Measles 0% (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Injuries 5% * Intrapartum-related events

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

80 Percent

Demand for family planning satisfied (%)

(2013-2014)

Antenatal care (4 or more visits, %)

(2013-2014)

Malaria during pregnancy - intermittent preventive treatment (%)

(2013-2014)

7, 12, 3

(2013-2014)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2013-2014)

Postnatal visit for mother

(2013-2014)

(within 2 days, %)

20 0

(within 2 days , %)

1988 DHS

1998 DHS

2000 MICS

2006 MICS

2010 MICS

2013-14 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

17 1998 DHS

2000 MICS

2006 MICS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

33 19

2010 MICS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2013-14 DHS

50 (2013-2014)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 17

Percent

2006 MICS

2010 MICS

2013-14 DHS

60 31

40 20

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities 25

80 29

44 35 5

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

1990

20 24

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Partial

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Yes

Costed national implementation plan(s) for: maternal, newborn and child health available

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 2

(2015)

3.3

(2008)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

52 (2013)

1990

2015 Total

2015

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

41 (2013)

ODA to maternal and neonatal health per live birth (US$)

(2010)

9 4

(2012)

Note: See annexes for additional information on the indicators above

4 15 7

Urban

ODA to child health per child (US$) 74

1990

General government expenditure on health as % of total government expenditure (%)

Private sources

(2013)

External sources

119

General government expenditure

60 13

2015 Rural

Yes

Postnatal home visits in the first week after birth

Available Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Maternal deaths notification

Per capita total expenditure on health (Int$)

Partial

FINANCING

57 38

100

8 1

(% of recommended minimum)

100 80 60 40 20 0

2000 MICS

Percent

100

2 (R,F)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Legal status of abortion (X of 5 circumstances)

Maternity protection (Convention 183)

Sepsis** 7% HIV/AIDS 1%

Partial

Midwives authorized for specific tasks (X of 7 tasks)

Other direct 9%

Congenital 3%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

17 6

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

183

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Turkmenistan DEMOGRAPHICS Total population (000)

5,374

(2015)

Total under-five population (000)

528

(2015)

Births (000)

112

(2015)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

23 44

(2015)

Stillbirth rate (per 1000 total births)

(2009)

Total maternal deaths

(2013)

Lifetime risk of maternal death (1 in N)

640

(2013)

Total fertility rate (per woman)

2.3

(2015)

(2006)

Birth registration (%) Total under-five deaths (000)

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

100

80 51 MDG Target: 30

20 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

60 40 20

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 83

*Postnatal care Exclusive breastfeeding

Birth

Neonatal period

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

No Data

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Infancy

Measles

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1996 MoH

Percent

2000 DHS

2006 MICS

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Skilled attendant at delivery

98 97

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

No Data

80 60

40 20 0

0 1990

1995

2000

Source: WHO/UNICEF 2015

2005

2010

2014

2000 DHS

2006 MICS

NUTRITION

DTP3 Measles

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

(2006)

(2011)

Early initiation of breastfeeding (within 1 hr of birth, %) 18 Introduction of solid, semi-solid/soft foods (%) Vitamin A two dose coverage (%)

ORT & continued feeding

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

Percent of infants <6 months exclusively breastfed

100

40 20 0

Exclusive breastfeeding

Percent

Careseeking for pneumonia

184

Pneumonia treatment

Early initiation of breastfeeding ITN use among children <5 yrs

100

Percent

Antenatal care (4+ visits)

Immunization

Percent

EQUITY

28 11 2000 DHS

40 20

2000 DHS

2006 MICS

0 2006 MICS

(2000) -

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Turkmenistan DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

14%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 15%

Neonatal death: 44%

Sepsis 9%

Embolism 11%

Abortion 5%

Asphyxia* 11%

Other direct 17%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for Caucasus and Central Asia, 2013

Legal status of abortion (X of 5 circumstances)

Sepsis** 6%

Malaria 0%

Injuries 6%

Measles 0%

* Intrapartum-related events

Source: WHO/MCEE 2015 (provisional)

Diarrhoea

Hypertension 15%

Indirect 22%

Source: WHO 2014

** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

(2000)

Antenatal care (4 or more visits, %)

(2000)

3, 4, 2

(2000)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

Malaria during pregnancy - intermittent preventive treatment (%)

100

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby

Postnatal visit for mother

(2000)

(within 2 days, %)

20 0

(within 2 days , %)

2000 DHS

2006 MICS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2000 DHS

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

2 -

(2015)

132.2

(2002)

276

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

Per capita total expenditure on health (Int$)

Very limited risk

General government expenditure on health as % of total government expenditure (%)

2006 MICS

Out of pocket expenditure as % of total expenditure on health(%)

1 10 8

Percent of population by type of sanitation facility, 2005 Unimproved facilities Improved and shared facilities Open defecation

100 80 45

23 47

No Data

General government expenditure External sources Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

29 7

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

40 20

FINANCING 47

Percent of population by type of drinking water source, 2005 Piped on premises Other improved Surface water Unimproved

Postnatal home visits in the first week after birth

(% of recommended minimum)

Improved drinking water coverage

Maternal deaths notification

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Maternity protection (Convention 183)

Congenital 6% HIV/AIDS 0%

5 (R,F)

Midwives authorized for specific tasks (X of 7 tasks)

Haemorrhage 23%

Other 3%

Other 27%

77 50

20 0

Total Source: WHO/UNICEF JMP 2015

Urban

Rural

Total

Urban

Rural

Source: WHO/UNICEF JMP 2015

185

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Uganda DEMOGRAPHICS Total population (000)

39,032

(2015)

Total under-five population (000)

7,278

(2015)

Births (000)

Under-five mortality rate

Deaths per 100,000 live births

250

1000

1,665

(2015)

Birth registration (%) Total under-five deaths (000)

30 85

(2011)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

19 38

(2015)

150

(2015)

100

Stillbirth rate (per 1000 total births)

(2009)

5,900

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

5.7

(2015)

Adolescent birth rate (per 1000 girls)

140

(2013)

Total maternal deaths

(2015)

Maternal mortality ratio

Deaths per 1000 live births

187

200

780

800 600 MDG Target: 62

50 0 1990

1995

2000

2005

2010

200

0 1990

2015

Source: UN IGME 2015

360

400

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 44

*Postnatal care

Birth

Exclusive breastfeeding

Neonatal period

Measles

100

Percent

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

91 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

60 40 20

1988-1989 DHS

1995 DHS

2000-2001 DHS

2006 DHS

2011 DHS

2005

<1 2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

100 80

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

2011 DHS

(2011) (2011) (2013)

Percent of infants <6 months exclusively breastfed

80 48

2006 DHS

100

2000-2001 DHS

Exclusive breastfeeding

Percent

1995 DHS

46 21

39 16

34 12

Percent

ORT & continued feeding

2014

4 (2011-2012) Early initiation of breastfeeding (within 1 hr of birth, %) 53 (2011) Introduction of solid, semi-solid/soft foods (%) 67 Vitamin A two dose coverage (%) 65

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Measles

ITN use among children <5 yrs

Source: DHS 2011

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

186

82 78 78 50

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

1995 DHS

2000-2001 DHS

2006 DHS

2011 DHS

40 20 0

1988-1989 DHS

1995 DHS

2000-2001 DHS

2006 DHS

2011-2012 Other NS

1988-1989 DHS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Uganda DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

14%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 10%

Asphyxia* 10%

Neonatal death: 35%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Haemorrhage 25%

Other 2%

Other 23%

Sepsis** 7% 0%

Hypertension 16%

Diarrhoea

HIV/AIDS 6%

Source: WHO/MCEE 2015 Injuries 7% (provisional) * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis Measles 0%

Malaria 7%

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Demand for family planning satisfied (%)

(2014)

Antenatal care (4 or more visits, %)

(2011)

Malaria during pregnancy - intermittent preventive treatment (%)

(2011)

5, 14, 4

(2011)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2011)

Postnatal visit for mother

(2011)

Women with low body mass index

(2011)

(within 2 days, %)

20 0

(within 2 days , %)

1988-1989 DHS

1995 DHS

2000-2001 DHS

2006 DHS

2011 DHS

(<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

1995 DHS

2000-2001 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

2006 DHS

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2011 DHS

69 (2011)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

Percent

18 73

60 36 74

40 20 0

10 0

Source: WHO/UNICEF JMP 2015

2015 Urban

2006 DHS

2009 Other NS

2011 DHS

1990

2015 Rural

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Yes

Costed national implementation plan(s) for: maternal, newborn and child health available

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

14.2

(2005)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

34 (2003)

1990

2015 Total

1990

2015 Urban

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

(2012)

24 53

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

(2013)

External sources 8

60 57

146

General government expenditure

Available Reproductive, maternal, newborn and child health expenditure by source

2 27

20 10

36 0

2015 1990 Total

Maternity protection (Convention 183)

Per capita total expenditure on health (Int$)

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

100

FINANCING

Improved sanitation coverage

1990

3 (R,F)

(% of recommended minimum)

100 80 60 40 20 0

2000-2001 DHS

Percent

100

Legal status of abortion (X of 5 circumstances)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Partial

Midwives authorized for specific tasks (X of 7 tasks)

Other direct 9%

Congenital 4%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

6 11

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

187

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Uzbekistan DEMOGRAPHICS Total population (000)

29,893

(2015)

3,195

(2015)

Births (000)

667

(2015)

Birth registration (%) Total under-five deaths (000)

100 26

(2006)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

20 34

(2015)

(2009)

220

(2013)

1,100

(2013)

2.4

(2015)

(2006)

Total under-five population (000)

Stillbirth rate (per 1000 total births) Total maternal deaths Lifetime risk of maternal death (1 in N) Total fertility rate (per woman) Adolescent birth rate (per 1000 girls)

(2015)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

100

100 72

60 39 MDG Target: 24

20 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

40 20

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH Coverage along the continuum of care 80

100

*Postnatal care Exclusive breastfeeding

Birth

Neonatal period

No Data

20 0

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Infancy

Measles

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

1996 DHS

Percent

2000 MICS

2006 MICS

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

99 99 99

100 Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

(2006)

Percent of children <5 years who are moderately or severely: underweight stunted

100

Percent

(2006)

Vitamin A two dose coverage (%)

(2013)

Percent of infants <6 months exclusively breastfed

100 80

60 40

40 20 0

Exclusive breastfeeding

Percent

2006 MICS

Early initiation of breastfeeding (within 1 hr of birth, %) 67 Introduction of solid, semi-solid/soft foods (%) 47

Percent

0 10 20 30 40 50 60 70 80 90 100

1996 DHS

2014

Underweight and stunting prevalence

Careseeking for pneumonia

0 1995

ITN use among children <5 yrs

ORT & continued feeding

20 1990

Vitamin A (past 6 months)

Measles

188

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

Source: MICS 2006

Pneumonia treatment

Percent

EQUITY

25 13 1996 DHS

20 4

2002 DHS

60 40 20 0

2006 MICS

2000 MICS

2002 DHS

3 1996 DHS

2006 MICS

(2006)

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Uzbekistan DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 18%

12%

Globally nearly half of child deaths are attributable to undernutrition

Neonatal death: 52%

Embolism 11%

Abortion 5%

Asphyxia* 12%

Other 24%

Regional estimates for Caucasus and Central Asia, 2013

Sepsis 9%

Other direct 17%

Haemorrhage 23%

Other 4%

Sepsis** 7%

Injuries 6%

Source: WHO/MCEE 2015 Diarrhoea (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Measles 0% * Intrapartum-related events

Hypertension 15%

Indirect 22%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

(1996)

Antenatal care (4 or more visits, %)

(1996)

3, 5, 2

(1996)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

Malaria during pregnancy - intermittent preventive treatment (%)

100

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

Postnatal visit for baby

Postnatal visit for mother

(1996)

(within 2 days, %)

20 0

(within 2 days , %)

1996 DHS

2000 MICS

2006 MICS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Midwives authorized for specific tasks (X of 7 tasks)

(R,F)

Partial

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

2 -

(2015)

144.7

(2013)

330

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

(% of recommended minimum)

FINANCING 31

1996 DHS

2000 MICS

Per capita total expenditure on health (Int$)

Very limited risk

2006 MICS

Improved drinking water coverage

Percent of population by type of drinking water source, 1990-2010 Piped on premises Other improved Surface water Unimproved

100 5

3 10

1 11

11 13

5 14

7 8

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent of population by type of sanitation facility, 1990-2015 Unimproved facilities Improved and shared facilities Open defecation

100 0

0 24

60 86

40 57

20 0

1990

2010 1990 Total

Source: WHO/UNICEF JMP 2015

2010 Urban

1990

2010 Rural

No Data

General government expenditure External sources

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Percent

Legal status of abortion (X of 5 circumstances)

National availability of Emergency Obstetric Care services

WATER AND SANITATION

Yes

Maternity protection (Convention 183)

Congenital 8%

HIV/AIDS 0% Malaria 0%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

100

Note: See annexes for additional information on the indicators above

20 0

1990

2015 Total

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

189

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Viet Nam DEMOGRAPHICS Total population (000)

93,448

(2015)

Total under-five population (000)

7,741

(2015)

Births (000)

Under-five mortality rate

1,582

(2015)

Birth registration (%) Total under-five deaths (000)

95 34

(2011)

(2015)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

11 17

(2015)

Stillbirth rate (per 1000 total births)

(2009)

690

(2013)

1,100

(2013)

2.0

(2015)

(2013)

Total maternal deaths Lifetime risk of maternal death (1 in N) Total fertility rate (per woman) Adolescent birth rate (per 1000 girls)

(2015)

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

150

140

100 22

MDG Target: 17

10 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 93 74 94

*Postnatal care

Exclusive breastfeeding

Neonatal period

100

Percent

60 40 20

1997 DHS

2000 MICS

2002 DHS

2006 MICS

37 (2014)

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

20 40 60 80 100

Source: DHS, MICS, Other NS

Infancy

Measles

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2011 MICS

2014 MICS

1 2005

25 2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine 97 95 95

100 80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100 80

1990

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

81 73

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Measles

83 71

Early initiation of breastfeeding

(2013)

(2011)

1997 DHS

2000 MICS

2002 DHS

2006 MICS

2011 MICS

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

80 61 41

41 27

20 0

100

60 40

(2014)

Percent of infants <6 months exclusively breastfed

Percent

Source: MICS 2010-2011

(2011)

Exclusive breastfeeding

20 31

Percent

Careseeking for pneumonia

2014 MICS

Early initiation of breastfeeding (within 1 hr of birth, %) 40 Introduction of solid, semi-solid/soft foods (%) 91 Vitamin A two dose coverage (%)

ORT & continued feeding

190

Pneumonia treatment

Percent

EQUITY

60 40 20

1997 DHS

2002 DHS

2006 MICS

2011 MICS

0 1987-89 1994 Other NS Other NS

2000 MICS

2004 2008 2013 Other NS Other NS Other NS

2005 Other NS

2014 MICS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Viet Nam DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Globally nearly half of child deaths are attributable to undernutrition

10%

Preterm 21% Other 27%

Embolism 12%

Abortion 7%

Other direct 14%

Neonatal death: 52% Asphyxia* 7%

Haemorrhage 30%

Other 4%

HIV/AIDS 0%

Indirect 17%

Congenital 12%

Malaria 0% Injuries 4%

Source: WHO/MCEE 2015 (provisional) Diarrhoea * Intrapartum-related events ** Sepsis/ Tetanus/ Meningitis/ Encephalitis Sepsis** 4%

Measles 1%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

Regional estimates for South-eastern Asia, 2013

Sepsis 6%

Hypertension 15%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

Percent

Demand for family planning satisfied (%)

(2014)

Antenatal care (4 or more visits, %)

(2014)

(2006)

28, 43, 21

(2014)

Malaria during pregnancy - intermittent preventive treatment (%)

C-section rate (total, urban, rural; %)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2014)

Postnatal visit for mother

(2014)

(within 2 days, %)

20 0

(within 2 days , %)

1997 DHS

2000 MICS

2002 DHS

2006 MICS

2011 MICS

2014 MICS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

65 40

57 47

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

11 1997 DHS

2000 MICS

2002 DHS

2006 MICS

2011 MICS

2014 MICS

42 (2011)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 1 1

0 1

6 4

61 43

20 0

100 80

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

1990

2015 Rural

1 16

2005 Other NS

Maternal deaths notification

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Yes

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Partial

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

24.3

(2013)

308

(2013)

Density of doctors, nurses and midwives (per 10,000 population)

General government expenditure on health as % of total government expenditure (%)

2011 MICS

Reproductive, maternal, newborn and child health expenditure by source

0 1 5

(2015)

94 78

External sources Private sources

25 4

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

No Data

General government expenditure

1 43

7 4

40 2 20

Maternity protection (Convention 183)

FINANCING

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Percent

Per capita total expenditure on health (Int$)

Improved sanitation coverage

Midwives authorized for specific tasks (X of 7 tasks)

(% of recommended minimum)

100 80 60 40 20 0

2000 MICS

80 21

5 (R,F)

National availability of Emergency Obstetric Care services

WATER AND SANITATION

100

Legal status of abortion (X of 5 circumstances)

Out of pocket expenditure as % of total expenditure on health(%)

Improved drinking water coverage

Yes

1990

2015 Total

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

191

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Yemen DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

26,832

(2015)

3,925

(2015)

856

(2015)

Birth registration (%) Total under-five deaths (000)

17 34

(2012)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

22 34

(2015)

Stillbirth rate (per 1000 total births)

(2015)

(2009)

2,100

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

4.0

(2015)

(2012)

Total maternal deaths

Adolescent birth rate (per 1000 girls)

Under-five mortality rate

Maternal mortality ratio

Deaths per 1000 live births

Deaths per 100,000 live births

140 126 120 100 80 60 40 20 0 1990

500

460

400 300

270

200 42

MDG Target: 42

1995

2000

2005

2010

2015

Source: UN IGME 2015

120

100 0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 54

Birth

*Postnatal care Exclusive breastfeeding

Neonatal period

Measles

20 40 60 80 100 Percent

Source: DHS, MICS, Other NS

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

Infancy

9 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

15 10 5

1991-1992 DHS

1997 DHS

2003 Other NS

2006 MICS

2013 DHS

2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100

88 88 88 75 72

80 60

Percent

Antenatal care (4+ visits) Skilled attendant at delivery

100 80

1995

ITN use among children <5 yrs

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

2014

(2011)

(2010)

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

1997 DHS

2003 Other NS

2006 MICS

2013 DHS

(2006)

Vitamin A two dose coverage (%)

(2013)

Exclusive breastfeeding Percent of infants <6 months exclusively breastfed

60 40 20

20 0

1991-1992 DHS

60 40

100

Percent

Early initiation of breastfeeding (within 1 hr of birth, %) 30 Introduction of solid, semi-solid/soft foods (%) -

Percent

ORT & continued feeding

0 1990

Vitamin A (past 6 months)

Measles

192

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

Source: MICS 2006

Pneumonia treatment

Percent

EQUITY

1991-1992 DHS

1997 DHS

2003 Other NS

2013 DHS

0 1991-1992 Other NS

1996 MICS

1997 DHS

2003 Other NS

2011 Other NS

Improve

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Yemen DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

12%

Globally nearly half of child deaths are attributable to undernutrition

Preterm 17%

Asphyxia* 13%

Neonatal death: 53%

Other 19%

Abortion 3%

Sepsis 5%

Regional estimates for Western Asia, 2013

Embolism 9%

Other direct 16% Haemorrhage 31%

Other 4%

Sepsis** 9%

Injuries 8%

Measles 0%

Diarrhoea

* Intrapartum-related events

Indirect 23%

Source: WHO/MCEE 2015 (provisional)

Hypertension 13%

Source: WHO 2014

** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

(2013)

Antenatal care (4 or more visits, %)

(2013)

5, 10, 3

(2013)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

Malaria during pregnancy - intermittent preventive treatment (%)

100

(Minimum target is 5% and maximum target is 15%)

60 40

Neonatal tetanus vaccine

34 26

20 0

(2014)

Postnatal visit for baby

Postnatal visit for mother

(1997)

(within 2 days, %)

(within 2 days , %)

1991-1992 DHS

1997 DHS

2003 Other NS

2006 MICS

2013 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Midwives authorized for specific tasks (X of 7 tasks)

7 No

Maternal deaths notification

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

8.7

(2010)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

14 (2005)

FINANCING 48

1991-1992 DHS

1997 DHS

2006 MICS

Per capita total expenditure on health (Int$)

No Data

General government expenditure on health as % of total government expenditure (%)

2013 DHS

Out of pocket expenditure as % of total expenditure on health(%)

Percent of population by type of drinking water source, 1990-2010 Piped on premises Other improved Surface water Unimproved 4

80 28

1 3 12

1990

2010 1990 Total

Source: WHO/UNICEF JMP 2015

100

2010 Urban

1990

2010 Rural

22 22

60 40 20

2 3 2

80 44

60 39

Percent of population by type of sanitation facility, 1990-2010 Improved facilities Shared facilities Open defecation Unimproved facilities

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

Percent

100 6

Percent

(% of recommended minimum)

Improved drinking water coverage

Legal status of abortion (X of 5 circumstances)

National availability of Emergency Obstetric Care services

WATER AND SANITATION

Partial

Maternity protection (Convention 183)

Congenital 6% HIV/AIDS 0% Malaria 1%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

23 1

31 1

2010 Total

1990

2010 Urban

(2013)

No Data

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

1 12

1990

(2013)

Private sources

External sources 31

(2013)

General government expenditure

200

1990

2010 Rural

Source: WHO/UNICEF JMP 2015

193

A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Zambia DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

16,212

(2015)

2,851

(2015)

Under-five mortality rate

Deaths per 100,000 live births

250

800

645

(2015)

Birth registration (%) Total under-five deaths (000)

14 39

(2007)

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

21 43

(2015)

150

(2015)

100

Stillbirth rate (per 1000 total births)

(2009)

1,800

(2013)

Total fertility rate (per woman)

5.3

(2015)

Adolescent birth rate (per 1000 girls)

145

(2012)

Total maternal deaths Lifetime risk of maternal death (1 in N)

(2015)

Maternal mortality ratio

Deaths per 1000 live births

191

200

580

600 400

280

MDG Target: 64

0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

200

150

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 70

*Postnatal care

Birth

Exclusive breastfeeding

Neonatal period

Measles

80 60

Infancy

Percent

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

100

>95

20 40 60 80 100

Source: DHS, MICS, Other NS

66 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

40 20

1992 DHS

1996 DHS

1999 MICS

2001-02 DHS

2007 DHS

2013-14 DHS

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

100 60

Percent

Skilled attendant at delivery

100 80

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

Percent of children <5 years who are moderately or severely: underweight stunted

0 10 20 30 40 50 60 70 80 90 100

100

Percent

1996 DHS

2001-02 DHS

2007 DHS

2013-14 DHS

Percent of infants <6 months exclusively breastfed

1992 DHS

100

Exclusive breastfeeding

Percent

6 (2013-2014) Early initiation of breastfeeding (within 1 hr of birth, %) 66 (2013-2014) (2007) Introduction of solid, semi-solid/soft foods (%) 82 (2013-2014) Vitamin A two dose coverage (%) (2013) 93

Underweight and stunting prevalence

Careseeking for pneumonia

53 23

46 15

40 15

Percent

ORT & continued feeding

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Measles

ITN use among children <5 yrs

Source: DHS 2007

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

Early initiation of breastfeeding

194

86 86 85 77 73

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

60 40

40 20

0 1992 DHS

1996 DHS

1999 MICS

2001-02 DHS

2007 DHS

2013-14 DHS

1992 DHS

1996 DHS

1999 MICS

2001-02 DHS

2007 DHS

2013-14 DHS

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A Decade of Tracking Progress for Maternal, Newborn and Child Survival The 2015 Report

Zambia DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 9%

13%

Globally nearly half of child deaths are attributable to undernutrition

Other 23%

Asphyxia* 10%

Neonatal death: 34%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Haemorrhage 25%

Other 2% Other direct 9%

Congenital 3%

Hypertension 16%

Diarrhoea

Source: WHO/MCEE 2015 Measles 0% (provisional) ** Sepsis/ Tetanus/ Meningitis/ Encephalitis

Malaria 7% Injuries 7% * Intrapartum-related events

Indirect 29%

Source: WHO 2014

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

100

(2013-2014)

Antenatal care (4 or more visits, %)

(2013-2014)

Malaria during pregnancy - intermittent preventive treatment (%)

(2013-2014)

4, 7, 3

(2013-2014)

C-section rate (total, urban, rural; %)

80 Percent

Demand for family planning satisfied (%)

(Minimum target is 5% and maximum target is 15%)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2013-2014)

Postnatal visit for mother

(2013-2014)

(within 2 days, %)

20 0

(within 2 days , %)

1992 DHS

1996 DHS

1999 MICS

2001-02 DHS

2007 DHS

2013-14 DHS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

1992 DHS

1996 DHS

2001-2002 DHS

2007 DHS

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

2013-2014 DHS

90 (2013-2014)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved 12

Percent

80 60 40

2001-02 DHS

2007 DHS

2010 2012 2013-14 Other NS Other NS DHS

23 41

50 44

49 30 19

1990

Source: WHO/UNICEF JMP 2015

14 27

2015 Urban

1990

2015 Rural

11 27

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

International Code of Marketing of Breastmilk Substitutes

Community treatment of pneumonia with antibiotics

Yes

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

8.5

(2010)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

41 (2005)

1990

2015 Total

34 23

7 56

2015 Urban

(2013)

General government expenditure on health as % of total government expenditure (%)

(2013)

Out of pocket expenditure as % of total expenditure on health(%)

(2013)

No Data

Private sources

ODA to child health per child (US$)

(2012)

ODA to maternal and neonatal health per live birth (US$)

(2012)

Note: See annexes for additional information on the indicators above

1990

192

External sources 22

Per capita total expenditure on health (Int$)

General government expenditure

40 20

23 1

2015 1990 Total

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

Partial

Maternal deaths notification

Reproductive, maternal, newborn and child health expenditure by source

Improved sanitation coverage

FINANCING

100

Midwives authorized for specific tasks (X of 7 tasks)

(% of recommended minimum)

100 80 60 40 20 0

1999 MICS

Percent

100

4(R,F)

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Partial

Legal status of abortion (X of 5 circumstances)

Maternity protection (Convention 183)

Sepsis** 6% HIV/AIDS 6%

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

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Zimbabwe DEMOGRAPHICS Total population (000) Total under-five population (000) Births (000)

15,603

(2015)

2,505

(2015)

Under-five mortality rate

Deaths per 100,000 live births

800

539

(2015)

Birth registration (%) Total under-five deaths (000)

49 38

(2010-2011)

120

(2015)

100

Neonatal deaths (% of under-five deaths)

(2015)

Neonatal mortality rate (per 1000 live births) Infant mortality rate (per 1000 live births)

24 47

(2015)

Stillbirth rate (per 1000 total births)

(2009)

2,100

(2013)

Lifetime risk of maternal death (1 in N)

(2013)

Total fertility rate (per woman)

3.9

(2015)

Adolescent birth rate (per 1000 girls)

120

(2013)

Total maternal deaths

(2015)

Maternal mortality ratio

Deaths per 1000 live births

600

76 71

MDG Target: 25

20 0 1990

1995

2000

2005

2010

2015

Source: UN IGME 2015

520 470

400 200

130

0 1990

MDG Target

1995

2000

2005

2010

2015

Source: MMEIG 2014 Note: MDG target calculated by Countdown to 2015.

MATERNAL AND NEWBORN HEALTH 87 70 80

*Postnatal care

Exclusive breastfeeding

Neonatal period

Infancy

Measles

Percent HIV+ pregnant women receiving ARVs for PMTCT Uncertainty range around the estimate

100

20 40 60 80 100

Source: DHS, MICS, Other NS

Percent

40 20

1988 DHS

1994 DHS

1999 DHS

2005-06 2010-11 DHS DHS

74 (2014)

Eligible HIV+ pregnant women receiving ART for their own health (%)

100

Pre-pregnancy Pregnancy Birth

Prevention of mother-to-child transmission of HIV

Percent live births attended by skilled health personnel

Percent

Demand for family planning satisfied Antenatal care (4+ visits) Skilled attendant at delivery

Skilled attendant at delivery

Percent

Coverage along the continuum of care

2014 MICS

<1 2005

2008

2011

Source: UNICEF/UNAIDS/WHO 2015

2014

* See Annex/website for indicator definition

CHILD HEALTH

Socioeconomic inequities in coverage Household wealth quintile:

Poorest 20%

Richest 20%

Demand for family planning satisfied Antenatal care (1+ visit)

Immunization

Percent of children immunized: against measles with 3 doses DTP with 3 doses Hib with rotavirus vaccine with 3 doses pneumococcal conjugate vaccine

Percent

1990

1995

Source: WHO/UNICEF 2015

DTP3

NUTRITION

2000

2005

Underweight and stunting prevalence

Percent of children <5 years who are moderately or severely: underweight stunted

Careseeking for pneumonia 0 10 20 30 40 50 60 70 80 90 100

100

Percent

2009 MICS

2010-11 DHS

2014 MICS

(2014) (2014) (2013)

Percent of infants <6 months exclusively breastfed

2005-06 DHS

100

Exclusive breastfeeding

Percent

(2014) Early initiation of breastfeeding (within 1 hr of birth, %) 59 3 11 (2010-2011) Introduction of solid, semi-solid/soft foods (%) 87 Vitamin A two dose coverage (%) 34

8 1988 DHS

29 12 1994 DHS

12 1999 DHS

36 14

32 10

2005-06 2010-11 DHS DHS

28 11

Percent

ORT & continued feeding

2014

2010

Wasting prevalence (moderate and severe, %) Low birthweight prevalence (%)

Vitamin A (past 6 months)

Measles

ITN use among children <5 yrs

Source: MICS 2014

100

Early initiation of breastfeeding

196

91 91 91

Skilled attendant at delivery

Percent of children <5 years with symptoms of pneumonia taken to appropriate health provider

100

Antenatal care (4+ visits)

Pneumonia treatment

Percent

EQUITY

60 40

0 2014 MICS

1999 DHS

2005-2006 2009 2010-2011 DHS Other NS DHS

2014 MICS

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Zimbabwe DEMOGRAPHICS

POLICIES Causes of maternal deaths, 2013

Causes of under-five deaths, 2015 Pneumonia

Preterm 12%

12%

Globally nearly half of child deaths are attributable to undernutrition

Asphyxia* 10%

Neonatal death: 34%

Other 26%

Sepsis 10%

Regional estimates for Sub-Saharan Africa, 2013

Embolism 2%

Abortion 10%

Other 2%

Haemorrhage 25%

Other direct 9%

Congenital 3% Sepsis** 5%

Malaria 2%

Diarrhoea

Measles 0%

Injuries 7%

* Intrapartum-related events

Hypertension 16%

HIV/AIDS 9%

Source: WHO/MCEE 2015 (provisional)

Indirect 29%

Source: WHO 2014

** Sepsis/ Tetanus/ Meningitis/ Encephalitis

MATERNAL AND NEWBORN HEALTH Antenatal care

Percent women aged 15-49 years attended at least once by a skilled health provider during pregnancy

Percent

100

Demand for family planning satisfied (%)

(2014)

Antenatal care (4 or more visits, %)

(2014)

Malaria during pregnancy - intermittent preventive treatment (%)

(2014)

6, 11, 4

(2014)

C-section rate (total, urban, rural; %)

Neonatal tetanus vaccine

(2014)

Postnatal visit for baby

(2014)

Postnatal visit for mother

(2014)

(2010-2011)

(Minimum target is 5% and maximum target is 15%)

(within 2 days, %)

20 0

(within 2 days , %)

1988 DHS

1994 DHS

1999 DHS

2005-06 2010-11 DHS DHS

2014 MICS

Women with low body mass index (<18.5 kg/m2, %)

CHILD HEALTH Diarrhoeal disease treatment

Malaria prevention and treatment

100 80 60 40 20 0

Percent children receiving first line treatment among those receiving any antimalarial Percent children < 5 years sleeping under ITNs

35 32

43 21

Percent

Percent of children <5 years with diarrhoea: receiving oral rehydration therapy/increased fluids with continued feeding treated with ORS

6 2005-06 DHS

2009 Other NS

2010-11 DHS

2014 MICS

79 (2014)

Percent of population by type of drinking water source, 1990-2015 Piped on premises Other improved Surface water Unimproved

Percent

80 60

0 0

2009 Other NS

2010-11 DHS

2014 MICS

74 33

9 24

1990

2015 1990 Total

Source: WHO/UNICEF JMP 2015

2015 Urban

1990

2015 Rural

1 0 33

Maternity protection (Convention 183)

Maternal deaths notification

Yes

Postnatal home visits in the first week after birth

Yes

Kangaroo Mother Care in facilities for low birthweight/preterm newborns

Antenatal corticosteroids as part of management of preterm labour

Yes

International Code of Marketing of Breastmilk Substitutes

Yes

Community treatment of pneumonia with antibiotics

Low osmolarity ORS and zinc for management of diarrhoea

Yes

SYSTEMS Costed national implementation plan(s) for: maternal, newborn and child health available

Yes

(2015)

Life Saving Commodities in Essential Medicine List: Reproductive health (X of 3) Maternal health (X of 3)

(2015)

Newborn health (X of 4) Child health (X of 3)

3 3

(2015)

14.2

(2011)

Per capita total expenditure on health (Int$)

General government expenditure on health as % of total government expenditure (%)

Out of pocket expenditure as % of total expenditure on health(%)

Density of doctors, nurses and midwives (per 10,000 population)

(2015)

Private sources 46

ODA to child health per child (US$)

ODA to maternal and neonatal health per live birth (US$)

1990

2015 Total

(2012)

181

(2012)

Note: See annexes for additional information on the indicators above

49 31

External sources

19 52

No Data

General government expenditure

4 2

40 20

Midwives authorized for specific tasks (X of 7 tasks)

Reproductive, maternal, newborn and child health expenditure by source

Percent of population by type of sanitation facility, 1990-2015 Improved facilities Shared facilities Open defecation Unimproved facilities

2 (R,F)

FINANCING

Improved sanitation coverage 100

40 20

Legal status of abortion (X of 5 circumstances)

(% of recommended minimum)

100 80 60 40 20 0

2005-06 DHS

Percent

100 8

National availability of Emergency Obstetric Care services

WATER AND SANITATION Improved drinking water coverage

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

1990

2015 Urban

1990

2015 Rural

Source: WHO/UNICEF JMP 2015

197

Annex A About Countdown to 2015 for Maternal, Newborn and Child Survival Countdown to 2015 for Maternal, Newborn and Child Survival is a global movement to track, stimulate and support country progress towards achieving the health-related Millennium Development Goals, particularly goals 4 (reduce child mortality) and 5 (improve maternal health). Established in 2003,70 Countdown includes academics, governments, international agencies, professional associations, donors, nongovernmental organizations and other members of civil society, with The Lancet as a key partner. Members of the Countdown community share a common goal of using data to increase accountability for women’s and children’s health. Countdown specifically focuses on tracking coverage of a core set of evidence-based interventions proven to reduce maternal, newborn and child mortality.

What Countdown does Countdown produces periodic publications, reports and other materials on key aspects of reproductive, maternal, newborn and child health, using data to hold stakeholders to account for global and national action.71 At the core of Countdown reporting are two-page country profiles, updated approximately every two years, that present key demographic, nutritional status and mortality statistics; coverage levels and trends for proven reproductive, maternal, newborn and child health interventions; and policy, health system, financial and equity indicators to enable assessment of country progress in improving reproductive, maternal, newborn and child health. Countdown plays a central role in the follow-up to the UN Secretary-General’s Global Strategy for Women’s and Children’s Health by annually updating onepage profiles showcasing the 11 indicators selected by the Commission on Information and Accountability for Women’s and Children’s Health.72 Countdown also prepares equity profiles highlighting disparities in coverage in each of the 75 priority countries. Countdown analyses are guided by a conceptual model (figure A1) consistent with the results-based evaluation framework for health systems strengthening that was developed by a working group of members from Countdown, the World Health Organization, the World Bank, the GAVI Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria.73 The model shows the range of indicators included in Countdown’s four linked datasets on coverage, equity, policies and systems, and financial flows and illustrates possible pathways through which policy, systems and financing measures in a given context impact levels and trends in coverage of proven reproductive, maternal, newborn and child health interventions. Countdown recognizes the paramount role of social, political, economic, cultural and environmental determinants in shaping population health. Many of these broader determinants influence health outcomes by increasing access, utilization and coverage with available life-saving interventions. Intervention coverage is thus the specific niche occupied by Countdown in the array of initiatives aimed at monitoring the Millennium Development Goals. Countdown harnesses the global learning potential of its datasets through cross-cutting research and country case studies that allow for an in-depth exploration of the “how” and “why” of progress in reproductive, maternal, newborn and child health. These have been completed to date in Niger for child survival74 and in Bangladesh for maternal survival,75 with additional work nearing completion in Afghanistan, Pakistan, Ethiopia, Tanzania, Malawi and Peru.

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FIGURE A1

Summary impact model guiding Countdown work

Supportive policies

Health systems and financing

For example, maternal protection, community health workers and midwives authorized to provide essential services, vital registration, adoption of new interventions

For example, human resources, functioning emergency obstetric care, referral and supply chain systems, quality of health services, financial resources for reproductive, maternal, newborn and child health, user fees

Increased and equitable intervention coverage Pre-pregnancy

Pregnancy

Birth

Family planning Womenâ&#x20AC;&#x2122;s nutrition

Antenatal care Skilled attendant Intermittent preventive at delivery treatment for malaria Caesarean section Prevention of mother-to-child and emergency transmission of HIV obstetric care Tetanus vaccines

Postnatal

Childhood

Postnatal care for mother and baby Infant and young child feeding

Case management of childhood illness Vaccines Malaria prevention (insecticide-treated nets and indoor residual spraying)

Increased survival and improved health and nutrition for women and children Political, economic, social, technological and environmental factors

Countdown to 2015: A Decade of Tracking Progress for Maternal, Newborn and Child Survivalâ&#x20AC;&#x192; The 2015 Report

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Annex B Summary of Countdown data sources and analysis methods

Data sources Most Countdown coverage, equity and nutrition data are from standardized, nationally representative household surveys, primarily Demographic and Health Surveys and Multiple Indicator Cluster Surveys. For national coverage estimates, Countdown reviews databases provided by stakeholder organizations, particularly the United Nations Children’s Fund but also the United Nations Population Division and Save the Children, and extracts the data for the 75 Countdown countries. Cause of death profiles are abstracted from World Health Organization statistical databases based on work by the Child Health Epidemiology Reference Group. As in past Countdown reports, the child mortality estimates are based on the work of the UN Inter-agency Group for Child Mortality Estimation—led by the United Nations Children’s Fund and including the World Health Organization, the World Bank, the Population Division of the United Nations Department of Economic and Social Affairs and the United Nations Economic Commission for Latin America and the Caribbean Population Division—and are the official UN estimates for measuring progress towards Millennium Development Goal 4. The maternal mortality estimates are based on the work of an interagency group comprising the World Health Organization, the United Nations Children’s Fund, the United Nations Population Fund and the World Bank. Data for the Countdown health systems and policies indicators are abstracted from global databases maintained by the World Health Organization and other groups such as the International Labour Organization, routine monitoring data from UN organizations, national service delivery surveys (for emergency obstetric care data) and surveys administered to government authorities by the World Health Organization with responses validated by UN agencies at the country level. Countdown financing data are abstracted from datasets maintained by the Development Assistance Committee of the Organisation for Economic Co-operation and Development.

Analysis methods Countdown assesses progress at the country level, so it uses the country as the unit of analysis when summarizing results across databases. The summary measure used for the coverage indicators is the median, which gives each of the 75 Countdown countries equal weight, and the range, which illustrates the extent of variation across countries. Countdown coverage data are compiled and analysed by the Institute for International Programs at the Johns Hopkins University in collaboration with the Countdown Coverage Working Group and the United Nations Children’s Fund. Summary estimates of coverage for 2015 include Countdown countries with available estimates for 2009–2014. To track coverage trends, subsets of countries with at least two data points for each indicator, one from 2000–2008 and one from 2009–2014, were used. The difference between the two summary point estimates were calculated for each indicator, as well as the proportion of the gap closed between the earlier estimate and 100% coverage. Countdown tracks coverage (“the proportion of women and children in need of interventions who actually receive them”) in preference to measures of “effective coverage” that include estimates of intervention effectiveness, access, use and service quality. Effective coverage metrics are difficult to use in global monitoring because they typically require data that are rarely available in Countdown countries and sometimes rely on modelling procedures that must then be unpacked to guide decisionmaking. Two summary metrics of coverage are used in presenting the results. The first, the Composite Coverage Index, is a weighted average of eight interventions and reflects the performance of each Countdown country in achieving coverage along the continuum of care.76 The second, the co-coverage index, reflects the extent to which individual women and their children are receiving eight well established preventive interventions. These interventions have been available in most if not all countries—even the poorest—for at least a decade.77

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The equity analyses require that indicators be estimated for subgroups of the country population. Results are presented for selected individual coverage indicators as well as the two summary indices stratified by wealth quintiles.78 Equity analyses are conducted by the International Center for Equity in Health at the University of Pelotas, Brazil, in collaboration with the Countdown Equity Technical Working Group. Information on country-specific policies and systems indicators related to maternal and newborn health is reviewed and confirmed by technical staff at World Health Organization headquarters and country offices and maintained by the World Health Organization with inputs from the Countdown Health Systems and Policies Technical Working Group. The data on financial flows are compiled and analysed by a team at the London School of Hygiene and Tropical Medicine in collaboration with the Countdown Financial Flows Technical Working Group.

Additional information Further detail on Countdownâ&#x20AC;&#x2122;s data sources and methods are available in the published literature79 and on the Countdown website (www.countdown2015mnch.org). Countdown databases are publicly available for free through the Countdown website (http://countdown2015mnch.org/about-countdown/countdown-data).

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Annex C Country profile indicators and data sources Indicator

Data source

Global database

Demographics Demographics

Child mortality

Maternal mortality

Total population

United Nations Population Division

Total under-five population

United Nations Population Division

Births

United Nations Population Division

Birth registration

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, other national household surveys, censuses and vital registration systems

United Nations Children’s Fund

Total fertility rate

United Nations Population Division

Adolescent birth rate

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, Reproductive Health Surveys, other national surveys, civil registration systems and censuses

United Nations Population Division, United Nations Population Fund

Total under-five deaths

The UN Inter-agency Group for Child Mortality Estimation (United Nations Children’s Fund, World Health Organization, United Nations Population Division, World Bank)

Neonatal deaths as a share of all under-five deaths*

The UN Inter-agency Group for Child Mortality Estimation (United Nations Children’s Fund, World Health Organization, United Nations Population Division, World Bank)

Neonatal mortality rate

The UN Inter-agency Group for Child Mortality Estimation (United Nations Children’s Fund, World Health Organization, United Nations Population Division, World Bank)

Infant mortality rate

The UN Inter-agency Group for Child Mortality Estimation (United Nations Children’s Fund, World Health Organization, United Nations Population Division, World Bank)

Under-five mortality rate*

The UN Inter-agency Group for Child Mortality Estimation (United Nations Children’s Fund, World Health Organization, United Nations Population Division, World Bank)

Causes of under-five deaths

World Health Organization, Child Health Epidemiology Reference Group

World Health Organization, Maternal and Child Health Estimation

Stillbirth rate

Cousens and others 2011

Total maternal deaths

Maternal Mortality Estimation Inter-agency Group (World Health Organization, United Nations Children’s Fund, United Nations Population Fund, World Bank)

Lifetime risk of maternal death Maternal Mortality Estimation Inter-agency Group (World Health Organization, United Nations Children’s Fund, United Nations Population Fund, World Bank)

Maternal Mortality Estimation Inter-agency Group (World Health Organization, United Nations Children’s Fund, United Nations Population Fund, World Bank)

Maternal mortality ratio (adjusted)*

Maternal Mortality Estimation Inter-agency Group (World Health Organization, United Nations Children’s Fund, United Nations Population Fund, World Bank)

Causes of maternal deaths (regional)

World Health Organization

Maternal and newborn health Delivery care

Skilled attendant at delivery*

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, Reproductive Health Surveys, other national surveys

United Nations Children’s Fund

AIDS

Pregnant women living with HIV receiving antiretroviral therapy for their own health*

Country reporting through the Global AIDS Response Progress Report and Universal Access joint reporting process by the World Health Organization, the United Nations Children’s Fund and the Joint United Nations Programme on HIV/AIDS and UNAIDS Spectrum estimates

Joint United Nations Programme on HIV/AIDS, United Nations Children’s Fund, World Health Organization

Pregnant women living with HIV receiving antiretroviral drugs for prevention of mother-to-child transmission*

United Nations Children’s Fund

Antenatal care (at least one visit)

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, Reproductive Health Surveys, other national surveys

United Nations Children’s Fund

Antenatal care (four or more Multiple Indicator Cluster Surveys, Demographic and visits)* Health Surveys, Reproductive Health Surveys, other national surveys Demographic and Health Surveys, Reproductive Health Survey, other national surveys

United Nations Children’s Fund

Antenatal care

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Indicator Demand for family planning satisfied

Data source Demand for family planning Multiple Indicator Cluster Surveys, Demographic and satisfied* Health Surveys, Reproductive Health Surveys, other national surveys

Global database United Nations Population Fund

Intermittent preventive Intermittent preventive treatment of malaria treatment of malaria during during pregnancy pregnancy

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, Malaria Indicator Surveys, other national surveys

United Nations Children’s Fund

Caesarean section

Caesarian section rate

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, Reproductive Health Survey, other national surveys

United Nations Children’s Fund

Neonatal tetanus protection

Neonatal tetanus vaccine

Multiple Indicator Cluster Surveys, Demographic and Health Surveys

United Nations Children’s Fund, World Health Organization

Postnatal care

Postnatal visit for babies*

Multiple Indicator Cluster Surveys, Demographic and Health Surveys

Special data analysis by Saving Newborn Lives

Postnatal care

Postnatal visit for mothers* Multiple Indicator Cluster Surveys, Demographic and Health Surveys

Special data analysis by Saving Newborn Lives

Demand for family planning Multiple Indicator Cluster Surveys, Demographic and satisfied* Health Surveys

Special data analysis by Federal University of Pelotas, Brazil

Antenatal care (at least one visit)

Multiple Indicator Cluster Surveys, Demographic and Health Surveys

Special data analysis by Federal University of Pelotas, Brazil

Antenatal care (four or more Multiple Indicator Cluster Surveys, Demographic and visits)* Health Surveys

Special data analysis by Federal University of Pelotas, Brazil

Skilled attendant at delivery*

Multiple Indicator Cluster Surveys, Demographic and Health Surveys

Special data analysis by Federal University of Pelotas, Brazil

Early initiation of breastfeeding Multiple Indicator Cluster Surveys, Demographic and Health Surveys

Special data analysis by Federal University of Pelotas, Brazil

Insecticide-treated net use among children under age 5

Multiple Indicator Cluster Surveys, Demographic and Health Surveys

Special data analysis by Federal University of Pelotas, Brazil

Three doses of combined diphtheria/tetanus/ pertussis vaccine immunization coverage*

Multiple Indicator Cluster Surveys, Demographic and Health Surveys

Special data analysis by Federal University of Pelotas, Brazil

Measles immunization coverage

Multiple Indicator Cluster Surveys, Demographic and Health Surveys

Special data analysis by Federal University of Pelotas, Brazil

Vitamin A (past 6 months)

Multiple Indicator Cluster Surveys, Demographic and Health Surveys

Special data analysis by Federal University of Pelotas, Brazil

Oral rehydration therapy and continued feeding

Multiple Indicator Cluster Surveys, Demographic and Health Surveys

Special data analysis by Federal University of Pelotas, Brazil

Careseeking for pneumonia

Multiple Indicator Cluster Surveys, Demographic and Health Surveys

Special data analysis by Federal University of Pelotas, Brazil

Measles immunization coverage

World Health Organization and United Nations Children’s Fund estimates of national immunization coverage

Three doses of combined diphtheria/tetanus/ pertussis vaccine immunization coverage*

World Health Organization and United Nations Children’s Fund estimates of national immunization coverage

Haemophilus influenzae type B immunization coverage

World Health Organization and United Nations Children’s Fund estimates of national immunization coverage

Rotavirus vaccine coverage

World Health Organization and United Nations Children’s Fund estimates of national immunization coverage

Pneumococcal conjugate vaccine coverage

World Health Organization and United Nations Children’s Fund estimates of national immunization coverage

Careseeking for symptoms of pneumonia

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, other national surveys

United Nations Children’s Fund

Antibiotic treatment for symptoms of pneumonia*

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, other national surveys

United Nations Children’s Fund

Oral rehydration therapy and continued feeding

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, other national surveys

United Nations Children’s Fund

Oral rehydration salts

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, other national surveys

United Nations Children’s Fund

Zinc treatment for diarrhoea

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, other national surveys

United Nations Children’s Fund

Equity

Child Health Immunization

Pneumonia treatment

Diarrhoeal disease treatment

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203

Indicator

Data source

Global database

Malaria prevention and Children receiving first-line treatment treatment among those receiving any antimalarial

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, Malaria Indicator Surveys, other national surveys

United Nations Children’s Fund

Insecticide-treated net use

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, Malaria Indicator Surveys, other national surveys

United Nations Children’s Fund

Underweight prevalence

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, other national surveys

United Nations Children’s Fund, World Health Organization, World Bank

Stunting prevalence*

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, other national surveys

United Nations Children’s Fund, World Health Organization, World Bank

Wasting prevalence

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, other national surveys

United Nations Children’s Fund, World Health Organization, World Bank

Nutrition Anthropometry

Infant feeding

Early initiation of breastfeeding Multiple Indicator Cluster Surveys, Demographic and Health Surveys, other national surveys

United Nations Children’s Fund

Exclusive breastfeeding rate (< 6 months)*

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, other national surveys

United Nations Children’s Fund

Introduction of solid, semisolid and soft foods (ages 6–8 months)

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, other national surveys

United Nations Children’s Fund

Low birthweight

Low birthweight incidence

Multiple Indicator Cluster Surveys, Demographic and Health Surveys, other national surveys, routine reporting

United Nations Children’s Fund

Micronutrient supplementation

Vitamin A two dose coverage

United Nations Children’s Fund

Body mass index

Women with low body mass index

Demographic and Health Surveys

Demographic and Health Surveys, STATCompiler (accessed March 2014)

Water

Improved drinking water coverage

Joint Monitoring Programme for Water Supply and Sanitation (World Health Organization and United Nations Children’s Fund)

Sanitation

Improved sanitation coverage

Joint Monitoring Programme for Water Supply and Sanitation (World Health Organization and United Nations Children’s Fund)

Laws or regulations that allow adolescents to access contraceptives without parental or spousal consent

World Health Organization

Global Maternal Newborn Child and Adolescent Health Policy Indicator Survey 2013 by the World Health Organization Department of Maternal Child and Adolescent Health

Legal status of abortion

United Nations Population Division policy database

United Nations Population Division policy database http://esa.un.org/poppolicy/about_database.aspx (Accessed January 2014)

Midwives authorized for specific tasks

World Health Organization

Global Maternal Newborn Child and Adolescent Health Policy Indicator Survey 2013 by the World Health Organization Department of Maternal Child and Adolescent Health

Maternity protection (Convention 183)

International Labour Organization

International Labour Organization, NORMLEX Information System on International Labour Standards, at: https://www.ilo.org/dyn/normlex/en (Accessed March 2014)

Maternal deaths notification

World Health Organization

Global Maternal Newborn Child and Adolescent Health Policy Indicator Survey 2013 by the World Health Organization Department of Maternal Child and Adolescent Health

Postnatal home visits in first week after birth

World Health Organization

Global Maternal Newborn Child and Adolescent Health Policy Indicator Survey 2013 by the World Health Organization Department of Maternal Child and Adolescent Health

Kangaroo mother care in facilities for low-birthweight and preterm newborns

World Health Organization

Global Maternal Newborn Child and Adolescent Health Policy Indicator Survey 2013 by the World Health Organization Department of Maternal Child and Adolescent Health

Antenatal corticosteroids as World Health Organization part of management of preterm labour

Global Maternal Newborn Child and Adolescent Health Policy Indicator Survey 2013 by the World Health Organization Department of Maternal Child and Adolescent Health

International Code of Marketing of Breastmilk Substitutes

World Health Organization and United Nations Children’s Fund special data compilation

Water and sanitation

Policies, systems and financing Policies

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Indicator

Systems

Financing

Data source

Global database

Community treatment of pneumonia with antibiotics

World Health Organization

Global Maternal Newborn Child and Adolescent Health Policy Indicator Survey 2013 by the World Health Organization Department of Maternal Child and Adolescent Health

Low-osmolarity oral rehydration salts and zinc for management of diarrhoea

World Health Organization

Global Maternal Newborn Child and Adolescent Health Policy Indicator Survey 2013 by the World Health Organization Department of Maternal Child and Adolescent Health

Costed national implementation World Health Organization plans for maternal, newborn and child health available

Global Maternal Newborn Child and Adolescent Health Policy Indicator Survey 2013 by the World Health Organization Department of Maternal Child and Adolescent Health

Reproductive lifesaving commodities in essential medicines list: emergency contraceptives, implants and female condoms

U.S. Agency for International Development Deliver Project and World Health Organization

Emergency contraceptives and implants information: U.S. Agency for International Development Deliver Project, http://deliver.jsi.com/dhome/whatwedo/ commsecurity/csmeasuring/csindicators/ csindicatordashboards (Accessed March 2014) Female condoms information: World Health Organization EML database www.who.int/medicines/ publications/essentialmedicines (Accessed March 2014)

Maternal lifesaving commodities in essential medicines list: oxytocin, misoprostol and magnesium sulfate

World Health Organization

Global Maternal Newborn Child and Adolescent Health Policy Indicator Survey 2013 by the World Health Organization Department of Maternal Child and Adolescent Health

Newborn lifesaving commodities in essential medicines list: injectable antibiotics, antenatal corticosteroids, chlorhexidine and resuscitation equipment

World Health Organization and the Chlorhexidine Working Group

Global Maternal Newborn Child and Adolescent Health Policy Indicator Survey 2013 by the World Health Organization Department of Maternal Child and Adolescent Health and the Chlorhexidine Working Group

Child lifesaving commodities in essential medicines list: amoxicillin, oral rehydration salts and zinc

World Health Organization

Global Maternal Newborn Child and Adolescent Health Policy Indicator Survey 2013 by the World Health Organization Department of Maternal Child and Adolescent Health

Density of doctors, nurses and midwives

World Health Organization

Global Health Observatory 2013

National availability of emergency obstetric care services

Averting Maternal Death and Disability, United Nations Averting Maternal Death and Disability, United Nations Children’s Fund, United Nations Population Fund Children’s Fund, United Nations Population Fund special data compilation

Per capita total expenditure on health

World Health Organization

Global Health Expenditure Database http://apps.who.int/gho/data/node.main.484?lang=en (Accessed February 2014)

General government expenditure on health as share of total government expenditure

World Health Organization

Global Health Expenditure Database http://apps.who.int/gho/data/node.main.484?lang=en (Accessed February 2014)

Out-of-pocket expenditure as share of total expenditure on health

World Health Organization

Global Health Expenditure Database http://apps.who.int/gho/data/node.main.484?lang=en (Accessed February 2014)

Reproductive, maternal, newborn and child health expenditure by source

World Health Organization

Official development assistance Organisation for Economic Co-operation and to child health per child Development’s Development Assistance Committee

London School of Health and Tropical Medicine

Official development assistance Organisation for Economic Co-operation and to maternal and neonatal Development’s Development Assistance Committee health per live birth

London School of Health and Tropical Medicine

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Annex D Definitions of Countdown coverage indicators Intervention

Indicator definition

Numerator

Denominator

Percentage of live births attended by skilled health personnel

Number of women ages 15–49 with a Total number of women ages 15–49 with live birth in the X years prior to the survey a live birth in the X years preceding the who were attended during delivery by survey skilled health personnel

Maternal and newborn health Skilled attendant at delivery*

Treatment of pregnant women living Percentage of eligible pregnant women with HIV* with HIV who received antiretroviral therapy

Number of pregnant women living with HIV who are receiving lifelong antiretroviral therapy

Estimated number of pregnant women living with HIVa

Prevention of mother-to-child transmission of HIV*

Percentage of pregnant women living with HIV who received most efficacious regimens of antiretrovirals to prevent mother-to-child transmission of HIV

Number of pregnant women living with HIV who received most efficacious regimens of antiretrovirals to prevent mother-to-child transmission of HIV

Estimated number of pregnant women living with HIVa

Antenatal care (at least one visit)

Percentage of women attended at least once during pregnancy by skilled health personnel

Number of women ages 15–49 who were attended at least once during the pregnancy that led to their last birth in the X years preceding the survey by skilled health personnel

Total number of women ages 15–49 with a live birth in the X years preceding the survey

Antenatal care (four or more visits)*

Percentage of women attended four or more times during pregnancy by any provider

Number of women ages 15–49 who were Total number of women ages 15–49 with attended four or more times during the a live birth in the X years preceding the pregnancy that led to their last birth in survey the X years preceding the survey by any provider

Demand for family planning satisfied*

Percentage of women ages 15–49, either Women who are married or in union married or in union, who have their need and currently using any method of for family planning satisfied contraception

Intermittent preventive treatment for malaria during pregnancy

Percentage of women who received intermittent preventive treatment for malaria during their last pregnancy

Number of women ages 15–49 at risk Total number of women ages 15–49 with for malaria who received two or more a live birth in the X years preceding the doses of a sulfadoxine-pyrimethamine survey (Fansidar™), at least one of which was received during antenatal care, to prevent malaria during their last pregnancy that led to a live birth

Caesarean section rate

Percentage of live births delivered by Caesarean section

Number of women ages 15–49 with a live Total number of women ages 15–49 with birth in the X years preceding the survey a live birth in the X years preceding the delivered by caesarean section survey

Neonatal tetanus protection

Percentage of newborns protected against tetanus

Number of live births in the year who are Number of live births in the year protected from tetanus at birth

Postnatal care for mothers*b

Percentage of mothers who received postnatal care within two days of childbirth

Number of women ages 15–49 who received a health check while in a facility or at home following delivery or a postnatal care visit within two days of delivery of their most recent live birth in the X years prior to the survey

Postnatal care for babies*

Percentage of babies who received Number of last live births in the X years Total number of live births in the X years postnatal care within two days of childbirth prior to the survey who received a health prior to the survey check while in a facility or at home following delivery or a postnatal care visit within two days of delivery

Women who are married or in union and who are currently using any method of contraception or who are fecund, not using any method of contraception but report wanting to space their next birth or stop childbearing altogether

Total number of women ages 15–49 with a last live birth in the x years prior to the survey (regardless of place of delivery)

Child health First-dose measles immunization coverage

Percentage of infants immunized with a first dose of measles-containing vaccine

Number of surviving infants who receive the first dose of measlescontaining vaccine by their first birthday (or as recommended in the national immunization schedule)

Total number of surviving infants

Three doses of combined diphtheria with tetanus toxoid and pertussis containing vaccine coverage*

Percentage of infants who received three Number of surviving infants receiving doses of diphtheria with tetanus toxoid three doses of diphtheria with tetanus and pertussis containing vaccine toxoid and pertussis containing vaccine

Total number of surviving infants

Three doses of Haemophilus influenzae type B immunization coverage

Percentage of infants who received three Number of surviving infants receiving doses of Haemophilus influenzae type B three doses of Haemophilus influenzae vaccine type B vaccine

Total number of surviving infants

Careseeking for symptoms of pneumonia Percentage of children ages 0–59 months Number of children ages 0–59 months with symptoms of pneumonia taken to an with symptoms of pneumonia (cough with appropriate health provider fast breathing due to problem in the chest or problem in the chest and blocked nose) in the two weeks prior to the survey who were taken to an appropriate health provider

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Total number of children ages 0–59 months with symptoms of pneumonia (cough with fast breathing due to problem in the chest or problem in the chest and blocked nose) in the two weeks prior to the survey

Intervention

Indicator definition

Zinc treatment for diarrhoea

Percentage of children ages 0–59 months Number of children ages 0–59 months with diarrhoea receiving zinc treatment with diarrhoea in the two weeks prior to the survey receiving zinc

Numerator

Denominator

Oral rehydration therapy and continued feeding

Percentage of children ages 0–59 months Number of children ages 0–59 months Total number of children ages 0–59 with diarrhoea receiving oral rehydration with diarrhoea in the previous two weeks months with diarrhoea in the previous therapy and continued feeding receiving oral rehydration therapy (oral two weeks rehydration salts packet, pre-packaged oral rehydration salts fluid, recommended homemade fluid or increased fluids) and continued feeding

Oral rehydration salts treatment

Percentage of children ages 0–59 months Number of children ages 0–59 months with diarrhoea receiving oral rehydration with diarrhoea in the two weeks prior salts to the survey receiving oral rehydration salts

Total number of children ages 0–59 months with diarrhoea in the two weeks prior to the survey

First-line antimalarial treatment

Percentage of children ages 0–59 months Number of children ages 0–59 months receiving first-line antimalarial treatment who had a fever in the two weeks prior to the survey who received first line treatment according to national policy

Total number of children ages 0–59 months who had a fever in the two weeks prior to the survey who received any antimalarial drugs

Insecticide-treated net use

Percentage of children ages 0–59 months Number of children ages 0–59 months sleeping under an insecticide-treated sleeping under an insecticide-treated mosquito net mosquito net the night before the survey

Total number of children ages 0–59 months surveyed

Total number of children ages 0–59 months with diarrhoea in the two weeks prior to the survey

Nutrition Early initiation of breastfeeding

Percentage of newborns put to the breast Number of women with a live birth in the Total number of women with a live birth within one hour of birth X years prior to the survey who put the in the X years prior to the survey newborn infant to the breast within one hour of birth

Exclusive breastfeeding (< 6 months)*

Percentage of infants ages 0–5 months who are exclusively breastfed

Number of infants ages 0–5 months who Total number of infants ages 0–5 months were exclusively breastfed during the surveyed previous day

Introduction of solid, semi-solid and soft foods (ages 6–8 months)

Percentage of infants ages 6–8 months who receive solid, semi-solid or soft foods

Number of infants ages 6–8 months who Total number of infants ages 6–8 months received solid, semi-solid or soft foods surveyed during the previous day

Vitamin A supplementation

Percentage of children ages 6–59 months Estimated number of children ages 6–59 who received two doses of vitamin A months who received two doses of during the calendar year vitamin A during the calendar year

Total number of children ages 6–59 months

Use of improved drinking water sources

Percentage of the population using improved drinking water sources

Number of household members using improved drinking water sources (including piped on premises, public standpipe, borehole, protected dug well, protected spring, rainwater collection)

Total number of household members

Use of improved sanitation facilities

Percentage of the population using improved sanitation facilities

Number of household members using Total number of household members improved sanitation facilities (including connection to a public sewer, connection to a septic system, pour-flush latrine, simple pit latrine or a ventilated improved pit latrine) not shared with other households

Water and sanitation

* Indicators in bold are those recommended by the Commission on Information and Accountability for Women’s and Children’s Health. The commission indicator for under-five mortality includes the proportion of neonatal deaths, also tracked by Countdown. Note: The indicator definitions use “in the X years prior to the survey” to indicate the different time periods for which Demographic and Health Surveys and Multiple Indicator Cluster Surveys collect information on births occurring prior to the survey. a. More details on the HIV estimates methodology can be found at www.unaids.org. b. As used for postnatal care in the graph on coverage along the continuum of care on the first page of each country profile.

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Annex E Definitions of health policies, systems and finance indicators Indicator

Definition

Criteria for ranking

Policy indicators Family planning for adolescents

Laws or regulations allow adolescents (married or Yes = legislation is available that allows adolescents to access unmarried) to access contraception without parental or contraception without parental or spousal consent. spousal consent. Partial = legislation is available that allows either married adolescents to access contraception without spousal consent or allows unmarried adolescents to access contraception without parental consent. No = no legislation is available that allows adolescents to access contraception without parental or spousal consent.

Legal status of abortion

Legal grounds under which abortion is allowed.

Abortion allowed on the following grounds: I = to save a woman’s life. II = to preserve physical health and above. III = to preserve mental health and above. IV = for economic and social reason and the above. V = on request and above. R = in case of rape or incest. F = in case of foetal impairment. — = data are not available.

Midwives authorized for specific tasks

Midwifery personnel are authorized to deliver basic emergency obstetric and newborn care.

Number of the seven lifesaving interventions tasks authorized: • Parental antibiotics. • Parenteral oxytocin. • Parental anticonvulsants. • Manual removal of placenta. • Removal of retained products of conception. • Assisted vaginal delivery. • Newborn resuscitation.

Maternity protection (Convention 183)

Country has ratified International Labour Organization Convention 183 or has passed national legislation that is in compliance with the three key provisions of the convention (14 weeks of maternity leave, paid at 66% of previous earnings by social security or general revenue)

Yes = International Labour Organization Convention 183 ratified (maternity leave of at least 14 weeks with cash benefits of previous earnings paid by social security or public funds). Partial = International Labour Organization Convention 183 not ratified but previous maternity convention ratified (maternity leave of at least 12 weeks with cash benefits of previous earnings paid by social security or public funds). No = no ratification of any maternal protection convention.

Maternal deaths notification

National policy has been adopted requiring health professionals to notify any maternal death to a responsible national body.

Yes = national policy adopted and implemented. Partial = national policy adopted but no systematic implementation. No = no national policy adopted.

Postnatal home visits in the first week after birth

National policy recommending home visits to mother and newborn in the first week after childbirth by a trained provider have been adopted and implemented.

Kangaroo mother care for low birthweight newborns

National policy recommends kangaroo mother care for low-birthweight newborns.

Yes = national policy or guidelines recommending postnatal home visits adopted and implemented. No = no national policy or guidelines on postnatal home visits adopted. Yes = national policy recommends kangaroo mother care for lowbirthweight newborns. No = national policy does not recommend kangaroo mother care for low-birthweight newborns.

Antenatal corticosteroids for preterm labour

National policy recommends antenatal corticosteroids for preterm labour.

Yes = national policy recommends use of antenatal corticosteroids for preterm labour. No = national policy does not recommend use of antenatal corticosteroids for preterm labour.

International Code of Marketing of Breastmilk Substitutes

National policy has been adopted on all provisions stipulated in International Code of Marketing of Breastmilk Substitutes.

Yes = all provisions stipulated in International Code of Marketing of Breastmilk Substitutes adopted in legislation. Partial = voluntary agreements or some provisions stipulated in International Code of Marketing of Breastmilk Substitutes adopted in legislation. No = no legislation and no voluntary agreements adopted in relation to the International Code of Marketing of Breastmilk Substitutes.

Community treatment of pneumonia with antibiotics

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National policy or guidelines authorizing case management of pneumonia in the community by a trained provider has been adopted and implemented.

Yes = national policy or guidelines adopted on the identification and treatment of pneumonia by trained providers in the community. No = no national policy or guidelines on the identification and treatment of pneumonia by trained providers.

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Indicator

Definition

Criteria for ranking

Low-osmolarity oral rehydration salts and zinc for management of diarrhoea

National policy on management of diarrhoea with low osmolality oral rehydration salts and zinc has been adopted and implemented.

Yes = national policy or guidelines adopted on use of low osmolality oral rehydration salts and zinc for management of diarrhoea.

National plan for scaling up maternal, newborn and child health interventions is available and costed.

Yes = costed plan or plans to scale up maternal, newborn and child health interventions available at the national level.

No = no national policy or guidelines adopted on use of low osmolality oral rehydration salts and zinc for management of diarrhoea

Systems indicators Costed national implementation plan for maternal, newborn and child health

Partial = costed plan available for either maternal and newborn health or child health. No = no costed implementation plan for maternal, newborn and child health available. Reproductive lifesaving commodities in essential medicines list

Emergency contraceptives, implants and female condoms are in the essential medicines list.

Maternal lifesaving commodities in essential medicines list

Oxytocin, misoprostol and magnesium sulfate are in the Number of the three listed commodities that are included in the essential medicines list. essential medicines list.

Newborn lifesaving commodities in essential medicines list

Injectable antibiotics, antenatal corticosteroids, chlorhexidine and resuscitation equipment are in the essential medicines list.

Child lifesaving commodities in essential Amoxicillin, oral rehydration salts and zinc are in the medicines list essential medicines list.

Number of the three listed commodities that are included in the essential medicines list.

Number of the four listed commodities that are included in the essential medicines list. Number of the three listed commodities that are included in the essential medicines list.

Density of health workers

Proportion of physicians, nurses and midwives who are Percentage available per 10,000 population.

National availability of emergency obstetric care services

At least five emergency obstetric care facilities per 500,000 people, including one comprehensive and four basic emergency obstetric care facilities. (The breakdown of comprehensive and basic by population and geographic area is available in country assessment reports but not included in the Countdown.)

Availability is expressed as a percentage of the minimum acceptable number of emergency obstetric care facilities. The minimum acceptable number of emergency obstetric care facilities (comprehensive and basic) is calculated by dividing the population by 500,000 and multiplying by 5. The percentage of recommended minimum number of emergency obstetric care facilities is calculated by dividing the number of functioning emergency obstetric care facilities by the recommended number and multiplying by 100. To qualify as a fully functioning basic or comprehensive emergency obstetric care facility, a facility must provide a standard set of signal functions

Finance indicators Per capita total expenditure on health

Numerical

General government expenditure on health as a share of total government expenditure

Numerical

Out-of-pocket expenditure as a share of total expenditure on health

Numerical

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Annex F Technical annex for the Health Systems and Policies Technical Working Group and the Financing Technical Working Group

Health systems and policies indicators Most of the policy indicators compiled by the Countdown Health Systems and Policies Technical Working Group are the result of a biannual survey implemented by the World Health Organization’s Department of Maternal, Newborn, Child and Adolescent Health. Indicators are developed as a composite measure summarizing the presence and implementation of a given policy. If a policy is endorsed and implemented, the value of the indicator is marked as “Yes”. If the policy is not endorsed, the value of the indicator is marked as “No”. If the policy is endorsed but lacks implementation, the value of the indicator is marked as “Partial”. For policies such as midwifery personnel authorized to deliver basic emergency obstetric and newborn care or reproductive, maternal, newborn and child health lifesaving commodities in essential list of medicines, the value of the indicator is the number of policy components endorsed or present in the policy document. Respondents to the survey are ministry of health officials responsible for maternal, newborn, child and adolescent health in their country. The information reported is independently validated by the World Health Organization country office and at least one other UN organization that operates in the country. Data analysis and compilation are done by the World Health Organization. Data reported are collected from the 2013–14 survey. The legal status of abortion indicator is a result of the analysis of legal grounds under which abortion is legally allowed, as per the information reported in the United Nations Population Division policy database. The Health Systems and Policies Technical Working Group regularly reviews the evidence base for all the systems and policy measures that Countdown tracks. For example, a small working group has been formed to review the competencies related to the indicator on emergency obstetric care, including on care for newborns. Financing Technical Working Group

Financing indicators The Countdown Financing Working Group analysed 2013 official development assistance disbursements, as well as non–official development assistance official flows and private grants, reported to the Organisation for Economic Co-operation and Development’s Development Assistance Committee’s Creditor Reporting System aid activities database, using previously implemented methods.80 Data were downloaded on 12 January 2015 and included 231,398 records of aid disbursement. Researchers reviewed all records and manually coded them against a framework defining reproductive, maternal, newborn and child health activities. Broadly, maternal and newborn health activities were defined as those that aim to restore, improve or maintain the health of women and their newborn during pregnancy, childbirth and the postnatal period. Child health activities were defined as those that aim to restore, improve or maintain the health of children ages 1 month to 5 years. Additional activities considered as reproductive health include family planning and those related to sexual health and sexually transmitted infections, including HIV. Based on the codes assigned, a proportion of each record from 0% to 100% was allocated to child health, maternal and newborn health and reproductive health. These proportions were established after reviewing the literature and current estimates of health care financing (for example, general government expenditure on health as a percentage of total government expenditure), epidemiology (for example, percentage of a population group with HIV) and population structure (for example, percentage of population under age 5). The analysis included official development assistance and other official aid flows and private grants from 31 bilateral donors; 30 multilateral organizations GAVI, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and the Bill & Melinda Gates Foundation.81 The Institute for Health Metrics and Evaluation estimated total development assistance to maternal, newborn and child health to all countries at $9.7 billion in 2013, with 69% going to newborn and child health ($6.7 billion) and the remaining 31% going to newborn health ($3.0 billion).82 It also estimated an 8.7% increase in funding to maternal, newborn and child health relative to 2012. However, these estimates

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are preliminary based on early reports to the Creditor Reporting System; where data were incomplete, projections were made based on trends over time and commitments. The estimates do not include investments in malaria. The Countdown Financing Technical Working Group estimates are $9.8 billion for maternal, newborn and child health in 2013, $2.8 billion for maternal and newborn health and $7.1 billion for child health, covering 148 recipient countries. This is a 17% increase on the $8.4 billion estimated for maternal, newborn and child health in 2012 ($2.4 billion for maternal and newborn health and $6.0 billion for child health). The most recent Partnership for Maternal, Newborn and Child Health estimates of total official development assistance to reproductive, maternal, newborn and child health among the 75 priority countries is $12.1 billion.83 This compares to the Countdown Financing Technical Working Group’s estimate of $13.4 billion in ODA+ to reproductive, maternal, newborn and child health. Some variation between the estimation exercises is not surprising, given differences in the methods used. The main differences are summarized in table F1.

TABLE F1

Overview of key differences in methods to resource tracking among Countdown, the Institute for Health Metrics and Evaluation and the Partnership for Maternal, Newborn and Child Health Institute for Health Metrics and Evaluation

Partnership for Maternal, Newborn and Child Health

Source of variation

Countdown

Values tracked

Official development assistance Development assistance for health disbursements, other official aid flows and disbursements and commitments private grants

Official development assistance disbursements and commitments

Recipients

All countries and 75 Countdown countries

Low- and middle-income countries, as classified by the World Bank

49 target countries for the Global Strategy for Women’s and Children’s Health and 75 Countdown countries

Data sources

All Organisation for Economic Cooperation and Development–Development Assistance Committee Creditor Reporting System disbursement data, including from within health, population, humanitarian, and all other sectors

Organisation for Economic Co-operation and Development–Development Assistance Committee Creditor Reporting System data on official development assistance within health and population sectors, donor and nongovernmental organization databases, and communication with donors

Organisation for Economic Co-operation and Development–Development Assistance Committee Creditor Reporting System data within health, population, and water sectors, and general budget support

Health areas tracked

Reproductive, maternal, newborn and child health; child health; maternal and newborn health; maternal, newborn and child health; and reproductive health

Eight health areas: maternal health, Reproductive, maternal, newborn and child child and newborn health, HIV/AIDS, health only tuberculosis, malaria, noncommunicable diseases, sectorwide approaches and health sector support, and other infectious diseases

Coding approach

Researchers assign one of 27 activitybased codes to each disbursement record by reading project descriptions, Creditor Reporting System purpose codes and donor names

Automated, using theme-based key term searching and channel-specific rules

Use existing Creditor Reporting System purpose codes

How codes are used to generate estimates

A proportion of the value of records within each activity-based code is assigned to child health, maternal and newborn health or reproductive health; in some cases they are based on recipient country–specific data; in others the same allocation factor is used for all recipients.

The full value of a record containing a key term is allocated to the associated health area; if a record contains key terms for more than one health area, the value is divided across health areas according to the number of key terms.

Allocate a fixed proportion of the value of funding within each Creditor Reporting System purpose code to maternal, newborn and child health

Disease-specific spending

Allocates a proportion of disease-specific funding to maternal, newborn and child health

Excludes HIV, tuberculosis and malaria from the maternal, newborn and child health estimate

Allocates a proportion of each purpose code, including those specific to malaria, HIV and tuberculosis, to maternal, newborn and child health

Budget support and health systems funding

Allocates a proportion of budget support and health systems support to maternal, newborn and child health

Excludes health sector support from estimates

Allocates a proportion of budget support to maternal, newborn and child health

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Annex G Countdown countries prioritized for malaria intervention coverage analysis and Countdown countries considered vitamin A priority countries Table G1 organizes the Countdown countries according to a set of criteria related to malaria transmission risk: • The left column includes 44 countries where at least 75% of the total population is at risk of malaria transmission and where a substantial proportion (50% or more) of malaria cases is due to Plasmodium falciparum. Only the countries meeting these criteria were included in the analyses for the malaria indicators in this report. • The right column includes 8 countries where 50–74% of the population is at risk of malaria transmission and where a substantial proportion (50% or more) of malaria cases is due to Plasmodium falciparum. When available, malaria intervention coverage data are included in the Countdown profiles. Table G2 identifies the Countdown countries considered priority countries for vitamin A.

TABLE G1

Countdown countries by malaria transmission risk Countries where at least 75% of the population is at risk of malaria and where a substantial proportion (50% or more) of malaria cases is due to Plasmodium falciparum (N = 44) Angola Benin Burkina Faso Burundi Cameroon Central African Republic Chad Comoros Congo Congo, Dem. Rep. Côte d’Ivoire Equatorial Guinea Eritrea Gabon Gambia Ghana Guinea Guinea-Bissau Haiti India Kenya Liberia

Countries where 50–74% of the population is at risk of malaria and where a substantial proportion (50% or more) of malaria cases is due to Plasmodium falciparum (N = 8)

Madagascar Malawi Mali Mauritania Mozambique Niger Nigeria Papua New Guinea Philippines Rwanda Saõ Tomé and Príncipe Senegal Sierra Leone Solomon Islands Somalia South Sudan Sudan Tanzania, United Republic Togo Uganda Yemen Zambia

Botswana Cambodia Djibouti Ethiopia Indonesia Lao People’s Democratic Republic Myanmar Zimbabwe

Source: WHO 2014b.

TABLE G2

Countdown countries considered priority countries for Vitamin A Afghanistan Angola Azerbaijan Bangladesh Benin Bolivia Botswana Burkina Faso Burundi Cambodia Cameroon Central African Republic Chad Comoros

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Congo Congo, Dem. Rep. Côte d’Ivoire Djibouti Egypt Equatorial Guinea Eritrea Ethiopia Gabon Gambia Ghana Guatemala Guinea Guinea-Bissau

Haiti India Indonesia Kenya Kyrgyzstan Korea, Dem. People’s Rep. Lao People’s Dem. Rep. Lesotho Liberia Madagascar Malawi Mali Mauritania Mexico

Morocco Mozambique Myanmar Nepal Niger Nigeria Pakistan Papua New Guinea Philippines Rwanda São Tomé and Príncipe Senegal Sierra Leone Somalia

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South Africa South Sudan Sudan Swaziland Tajikistan Tanzania, U. Rep. Togo Turkmenistan Uganda Uzbekistan Viet Nam Yemen Zambia Zimbabwe

Annex H Details on estimates produced by interagency groups used in the Countdown report— mortality, immunization, and water and sanitation

Mortality Countdown to 2015 aims to stimulate progress towards Millennium Development Goals 4 and 5, so it relies on UN interagency estimates on child and maternal mortality that are produced for official Millennium Development Goal reporting. These estimates are used to monitor progress at the global level because they are made comparable across countries and over time by applying standard methods to generate country, regional and global estimates. The UN mortality estimates are generated based on national data but may not always correspond precisely to the results from the most recent available data source or to country official estimates due to differences in the methods applied. Child mortality. The child mortality estimates in this report (neonatal mortality rate, infant mortality rate, under-5 mortality rate and under-5 deaths) are based on the work of the UN Inter-agency Group for Child Mortality Estimation (UN IGME), which includes the United Nations Children’s Fund, the World Health Organization, the United Nations Population Division and the World Bank. The UN IGME estimates are the official UN estimates for measuring progress towards Millennium Development Goal 4 (reduce child mortality). The UN IGME compiles available data from all possible nationally representative sources for a country, including household surveys, censuses and vital registration systems, and uses a model to fit a regression line to the data to produce the mortality estimates. Estimates are updated every year after a detailed review of all newly available data points. The review may result in adjustments to previously reported estimates as new data become available and provide more information on past trends. The data inputs, methods and full time series of the UN IGME estimates for all countries are available at www.data.unicef.org and www.childmortality.org. Maternal mortality. Maternal mortality estimates for 1990–2013 are based on the work of the Maternal Mortality Estimation Inter‑agency Group, which comprises the World Health Organization, the United Nations Children’s Fund, the United Nations Population Fund and the World Bank. Maternal mortality data—more sparse than child mortality data—are from sources such as vital registration systems, surveys and censuses. Maternal mortality estimates from these sources are subject to serious misclassification and underreporting. These data are therefore adjusted to account for these errors, and multilevel regression models are fit to predict levels and trends in maternal mortality between 1990 and 2013. Covariates used in the models include gross domestic product per capita, general fertility rate and skilled birth attendance. For more information, see Maternal Mortality Estimation Inter-agency Group (2014).

Immunization The immunization data published in this report are based on the work of the World Health Organization and the United Nations Children’s Fund. The estimates should not be confused with other sources of information, such as Demographic and Health Surveys, Multiple Indicator Cluster Surveys or administratively reported data from ministries of health. The World Health Organization and United Nations Children’s Fund use data reported by national immunization programmes as well as surveys and other sources to obtain estimates of national immunization coverage each year. A draft report is sent to each country for review and comment. Final reports are published in July with coverage estimates for the preceding calendar year. All new evidence, such as final survey reports received after publication, are taken into consideration during production of the following year’s estimates. For each country’s final report for 2015 as well as methods, data sources and brief description of trends, see www.data.unicef.org.

Water and sanitation The drinking water and sanitation coverage estimates are produced by the World Health Organization– United Nations Children’s Fund Joint Monitoring Programme for Water Supply and Sanitation. The estimates are the official UN estimates for measuring progress towards the Millennium Development Goal

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targets for drinking water and sanitation. They use a standard classification of what constitutes coverage. The Joint Monitoring Programme does not report the findings of the latest nationally representative household survey or census. Instead, it estimates coverage using a linear regression line that is based on coverage data from all available household sample surveys and censuses. For specific country data, see www.childinfo.org and www.wssinfo.org.

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Notes

1. 2. 3. 4. 5. 6. 7.

8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27.

28.

29. 30. 31.

Countdown to 2015 2005. https://sustainabledevelopment.un.org/topics/ sustainabledevelopmentgoals. The Bellagio Study Group on Child Survival 2003. Countdown to 2015 2005, 2008, 2010, 2012, 2013, 2014. Independent Expert Review Group 2015. The Bellagio Study Group on Child Survival 2003. The Bellagio Study Group on Child Survival 2003; Black and others 2008; Lawn, Cousens and Zupan 2005; Ronsmans and Graham 2006. Requejo, Victora and Bryce 2014. Victor and others forthcoming. Maternal Mortality Estimation Inter-agency Group 2014. Requejo and others 2015. Say and others 2014. Ahmed and others 2012. Dean and others 2014; Mason and others 2014. Lawn and others 2011. UN Inter-agency Group for Child Mortality Estimation 2015; You and others 2015. UN Inter-agency Group for Child Mortality Estimation 2015. Black, Morris and Bryce 2003. You and others 2015; UN Inter-agency Group for Child Mortality Estimation 2015. Liu and others 2015. Black and others 2008, 2013. Black and others 2013; Liu and others 2015. Lawn and others 2014. IFPRI 2015; WHO 2012. Black and others 2013. Countdown to 2015 2013, 2014. Summary data on stunting and wasting prevalence in the Countdown countries are available in the web appendix at www.countdown2015mnch.org. A league table and summary measures for HIV, caesarean-section and zinc treatment tracked by Countdown are available in the web appendix at www. countdown2015mnch.org. Walker and others 2013. Hazir and others 2013. The Composite Coverage Index is a weighted average of eight interventions along the continuum of care that have been available in most countries for at least a decade. The interventions include demand for family planning satisfied,

at least one antenatal care visit, skilled attendant at delivery, three immunization indicators (diphtheria-tetanus-pertussis, tuberculosis and first-dose measles), oral rehydration therapy for diarrhea and care-seeking for pneumonia. It is calculated as ANCS + 2DPT3 + MSL + BCG + ORT + CPNM . CCI = 1/4 FPS + SBA +2 4 2

(

32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45.

46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56.

)

This summary indicator used in Countdown’s routine reporting covers reproductive, maternal and newborn health, as well as both preventive and curative interventions. Data are available in the web appendix at www. countdown2015mnch.org. Countdown to 2015 2008. Hazir and others 2013; Requejo, Newby and Bryce 2013. Walker and others 2013. UNICEF 2014, 2015. Bryce and others 2013. UNICEF 2015. Victora and others 2003, 2012. Barros and others 2012. Victora and others 2012. WHO 2007a. See note 31 for the definition of the Composite Coverage Index. Partnership for Maternal, Newborn and Child Health 2014. See the web appendix at www.countdown2015mnch. org for adoption rates of 10 essential policies tracked by Countdown, based on a 2013–14 WHO survey developed in consultation with Countdown technical experts, as well as the latest available data on the legal status of abortion in the Countdown countries. Global Health Workforce Alliance and WHO 2014. Global Health Workforce Alliance and WHO 2014. Ethiopian Public Health Institute 2015. Miller and others 2014. Waage and others 2010. Waage and others 2010; Arregoces and others 2015. Arregoces and others 2015. Arregoces and others 2015. Partnership for Maternal, Newborn and Child Health 2015. Huicho and others forthcoming. Arregoces and others 2015; Partnership for Maternal, Newborn and Child Health 2015; Dieleman and others 2015. See annex F for a description of the different methods

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57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69.

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used by Countdown, the Institute for Health Metrics and Evaluation and the Partnership for Maternal, Newborn and Child Health and a discussion of the new Organisation for Economic Co-operation and Development policy marker. Desalegn, Solberg and Kim 2015. Jamison and others 2015. Independent Expert Review Group 2015. Beaglehole and others 2014. Personal communication with P.C. Hallal. Personal communication with L. Haddad. Countdown 2008 Equity Analysis Group 2008; Dieleman and others 2015. Handley and others 2015. UN Inter-agency Group for Child Mortality Estimation 2015; Maternal Mortality Estimation Inter-agency Group 2014. El Arifeen 2014. WHO 2014a. Stokstad 2015; The Economist 2015. Desalegn, Solberg and Kim 2015.

70. The Bellagio Study Group on Child Survival 2003. 71. Bhutta and others 2010. 72. Commission on Information and Accountability for Women’s and Children’s Health 2011a. 73. Monitoring and Evaluation Working Group of the International Health Partnership and Related Initiatives n.d.; Bryce and others 2011. 74. Amouzou, Habi and Bensaïd 2012. 75. El Arifeen and others 2014. 76. Barros and Victora 2013. 77. Victora and others 2001. 78. Filmer and Pritchett 2001. 79. Requejo, Victora and Bryce 2014. 80. Arregoces and others 2015. 81. See www.oecd.org/dac/stats/methodology.htm for notes on the methodology used to calculate these values. 82. In 2013 prices. Dieleman and others 2015. 83. In 2013 prices. Partnership for Maternal, Newborn and Child Health 2015.

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