The World Bank has said that the maternal mortality ratios in four countries, including India, Nepal, Bangladesh and Pakistan are still 2 to 4 times higher than the millennium development goals (MDG) set for 2015, however, Sri Lank has shown an improved performance.
This was revealed in new report launched by the World Bank called Sparing lives - Better reproductive health for poor women in South Asia launched on Thursday simultaneously in Pakistan, Bangladesh, India, Nepal, and Sri Lanka.
According to the report the risk of dying during pregnancy for a woman in Sri Lanka is 1 in 430, Bangladesh 1 in 59, India 1 in 48, Pakistan 1 in 31 and Nepal 1 in 24.
The average risk of dying during pregnancy in these five countries of South Asia (1 in 43) is almost a hundred times greater than that of women in the industrialised countries (1 in 4000). The level of pregnancy and delivery cases in India and Pakistan as compared to other three countries is low (around 40 percent). Despite some improvement Pakistan faces significant challenges in improving reproductive health for poor women.
In Pakistan the total fertility rate has declined slowly and at 4.1 births per woman in 2005, Pakistan lags far behind its South Asian neighbours. The report stresses that reproductive health outcomes are poor and unequal in the region- poor women have substantially worse reproductive health than better off women. Low use of health services is a significant problem in South Asia.
Poor nutritional status is another key problem among females of all ages. The report highlights the need for improving poor womens reproductive health to break the cycle of poverty and achieve the Millennium Development Goals.
According to the report most of the differences between South Asian countries is due to low contraceptive prevalence rate, which has increased slowly since the mid-1990s. Contraceptive use is highly dependent on education and economic status; only 11 per cent of women in the poorest households use contraceptive as compared to 43 per cent among the richest.
A large gap in contraceptive use also exists between uneducated women and those with 10 or more years of schooling. Hence, services need to be made much more accessible to poor and illiterate women. In the presence of high fertility, maternal care is of paramount importance. Roughly two-thirds of the deliveries still take place at home. Maternal mortality rate is at 276 per 100,000 live births.
Infant mortality rates have declined steadi1y but there has been little change in neo-natal mortality levels so that neo-natal deaths now account for 57 percent of under-five deaths. Addressing neo-natal mortality also requires a greater focus on maternal services, including early post-partum care and promotion of institutional deliveries. Differentials in coverage of maternal services are similar to those in contraceptive use with much lower access of poor and/or uneducated women.
"Pakistan has done well in increasing the age at marriage of girls but low contraceptive use and high unmet need for family planning are key reasons for high fertility in the country" said Shahnaz Kazi, Senior Social Sector Economist of the World Bank while addressing the participants of the launching ceremony.
Shahnaz Kazi further said "Contraceptive use is highly dependent on mothers education and economic status and we will continue to support the government in improving maternal health and the education of poor women."
The report suggests that South Asian governments along with development partners need to strengthen and expand interventions to improve the reproductive health of poor women.
The World Bank report has highlighted that South Asian countries should increase the supply of reproductive heath services in an integrated manner. The report stresses decentralised action planning that can be used to improve reproductive health service delivery and outcomes.
It also says that the progress in poor womens reproductive health will depend greatly on improving quantum and quality of outreach care by frontline women workers. The report also cites best practices in reproductive health that provide models and lessons for improvements in South Asia.
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