Progress towards the MDGs in the Lao PDR

MDG 5: Improve Maternal Health

It is widely acknowledged that to reduce maternal mortality women need to have access to broader reproductive health services especially family planning, skilled assistance at birth and access to emergency obstetric and neonatal care for management of complications.

The Maternal Mortality Ratio, or MMR, is as difficult to estimate accurately, without a strong vital registration system for births and deaths, as it is to reduce in a short span of time. As revealed by the 1995 and 2005 population censuses, Lao PDR appears to have made progress in reducing maternal mortality - from a figure of 650 deaths per 100.000 live births in 1995, to 405 deaths per live births in 2005. Given the difficulties inherent in estimating MMR, it is not unexpected that the government’s estimate does not tally with the global estimate 660 with a range of uncertainty between 190 – 1600 per 100.000. Irrespective of estimated progress, the maternal mortality rate is one of the highest in the region, and it is doubtful if Lao PDR can reach the MDG 5 target given the current levels of investment for maternal health.

Reduction in maternal mortality does not take place in isolation. Rather, it is dependent upon a number of complex factors, and assessing progress on maternal mortality requires a review of these factors. Equally the MMR does not measure maternal health for behind every woman who dies due to complications during pregnancy or childbirth, 20 women survive but suffer from ill health or disability.

Most pregnancy-related deaths occur around the time of delivery, or soon after a termination. Increasing the proportion of births attended by skilled health personnel and with referral capacity to emergency obstetric and neonatal care will significantly reduce maternal and perinatal mortality. The MDG indicator on proportion of births attended by skilled birth health personnel increased by less than 5 percentage points between 1994 and 2005. Universal access to reproductive health is measured by indicators on access and usage of contraception, antenatal care and adolescent fertility. While there has been significant progress in the access and use of contraception, the percentage of births to women receiving antenatal care remain low at 28.5 % (LRHS 2005). Early marriage and pregnancy is still the norm in rural areas where access to life saving services in case of pregnancy related complications are limited.

Meeting the targets: The main priority inventions include family planning to reduce unwanted pregnancies, presence of skilled birth attendants at deliveries, and access to emergency obstetric and neonatal care. These interventions will only be effective if they reach out to women in rural and remote communities.

Improvement in the population’s health status is a central priority of the NSEDP. Some impressive achievements sit alongside limited progress in certain key areas. A 25% reduction in age-specific fertility rate and the doubling of the contraceptive prevalence rate from 1995 to 2005 are remarkable outcomes. On the other hand the slow increase in the number of births assisted by skilled attendants and the limited availability of emergency obstetric and neonatal care suggest weaknesses in health service provision that could threaten progress on MMR in the future.

In order to increase utilization of health services and provide the reproductive health care that is needed to improve the maternal and neonatal health, investment in training and capacity building for health personnel, especially skilled birth attendants, is required. Health systems must meet minimum standards in terms of human resources, infrastructure, supplies, and management. Consequently, recurrent budget expenditures for the health sector including reproductive health need to be increased, and sufficient revenue should be directed to the health sector in general.

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