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Maternal and newborn health

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This analytical profile on maternal and newborn health is structured as follows:

Contents

Analytical summary

The health care that a mother receives during pregnancy, at the time of delivery, and soon after delivery is important for the survival and well-being of both the mother and her baby. In Zambia, maternal and newborn health is among the national health priorities. The objectives in this area are aligned to the Millennium Development Goals and other global objectives and strategies relevant to maternal and newborn health.

Zambia is among the countries with the highest maternal and neonatal mortality rates in the world. However, over the past 10 years, the country has intensified its efforts towards strengthening of maternal and newborn health by scaling up high impact interventions.

As a result of these efforts, significant progress has been reported, leading to reductions in maternal, infant and under five mortality rates. According to the ZDHS 2007, maternal mortality ratio has reduced from 729 per 100000 live births in 2002 to 591 in 2007, infant mortality rate has decreased from 95 deaths per 1000 live births to 70 and under-five mortality from 168 per 1000 live births to 119, respectively.

Although there has been a reduction in neonatal mortality from 37 to 34, this reduction is considered insignificant. Neonatal deaths constitute approximately half the proportion of infants who die, leading to concerns of poor perinatal care in the country. While these reductions in mortalities are impressive, they are still considered high by regional and global standards, and require more efforts to bring them down to acceptable levels, in line with the Millennium Development Goal targets.


Disease burden

The health care that a mother receives during pregnancy, at the time of delivery, and soon after delivery is important for the survival and well-being of both the mother and her baby. In Zambia, maternal and newborn health is among the national health priorities. The objectives in this area are aligned to the MDGs and other global objectives and strategies relevant to maternal and newborn health.

Zambia is among the countries with the highest maternal and neonatal mortality rates in the world. However, over the past 10 years, the country has intensified its efforts towards strengthening of maternal and newborn health by scaling up high impact interventions. As a result of these efforts, significant progress has been reported, leading to reductions in maternal, infant and under five mortality rates. According to the ZDHS 2007, Maternal Mortality Ratio (MMR) has reduced from 729 per 100000 live births in 2002 to 591 in 2007, Infant Mortality Rate (IMR) has decreased from 95 deaths per 1000 live births to 70 and under-five mortality from 168 per 1000 live births to 119, respectivelly. Although there has been a reduction in neonatal mortality from 37 to 34, this reduction is considered insignificant. Neonatal deaths constitute approximately half the proportion of infants who die, leading to concerns of poor peri-natal care in the country. While these reductions in mortalities are impressive, they are still considered high by regional and global standards, and require more efforts to bring them down to acceptable levels, in line with the MDGs targets.


Risk factors/vulnerability

There are a number of factors that have an effect on the health situation of the mother and the newborn. These include the place of delivery, the birth weight, nutrition and fertility.

Fertility

In Zambia, the total fertility rate is high, at 6.2 births per woman in 2007, with an unmet need for family planning of 27% (ZDHS 2007).

Teenage pregnancy

In terms of adolescent health, teenage pregnancy is associated with higher morbidity and mortality for both the mother and child and also has adverse social consequences. According to the 2007 ZDHS, girls have earlier sex debuts than the boys and they are less likely to use condoms. It is estimated that 28% of young females aged 15 to 19 years have begun child bearing, 22% have had a child, while 6% are pregnant with their first child. Young females also test more (22%) for HIV than the males (10%).


Intervention coverage

Family planning

Knowledge of family planning in the country has been nearly universal since 1996. The ZDHS 2007 reported that 97% of women and 99% of men indicated that they knew about a contraceptive method. The pill, male condoms, and injectables were the most widely known methods. Estimates indicate that 70% of currently married women have used a family planning method, at least once in their lifetime; four in ten of currently married women are using any contraceptive method, and about three in ten reported using a modern method.

Antenatal care

The major objective of antenatal care is to achieve optimal health outcomes for the mother and baby. The key objectives include: early detection of complications and prompt treatment; prevention of diseases, through immunization and micro-nutrient supplementation; birth preparedness and complication readiness; and health promotion and disease prevention, by providing health messages and counseling to pregnant women. The following sections relate to how Zambia has faired with respect to the coverage of specific Antenatal care programmes.

Place of delivery

The place of delivery and assistance during childbirth are important factors that influence the birth outcome, as well as the health of both the mother and the baby. The skills and performance of the birth attendant determines whether or not he/she can manage complications and observe hygienic practices. Safe conditions and appropriate interventions during delivery contribute to the reduction of risks of complications and infections that may pose a danger to the mother and the baby. Over the period 2006-2008, there were mixed trends with regard to institutional and supervised deliveries. While supervised deliveries reduced from 62% in 2007 to 60% in 2008, institutional deliveries increased from 43% in 2006 to 45% in 2007.

Post-natal care

Zambia’s target for first postnatal attendance is 80%. Over the period 2006-2008, this target was not met, as first postnatal attendance nationally was recorded at 51%, 56% and 55% in 2006, 2007 and 2008, respectively.

ARV coverage in pregnant women living with HIV

The target for 2008 was to have 60% of HIV positive pregnant women on free ARV prophylaxis, to prevent Mother to Child Transmission (PMTCT). At the end of 2008, however, this target was not met, as only 53.2% of the targeted number (i.e. 45,000 out of 84,568) of the pregnant women were recorded as having received ARV treatment.


Equity

Policies

Systems

State of surveillance

Endnotes: sources, methods, abbreviations, etc.