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A Multi-pronged Approach to Maternal Health in Lao PDR is Getting Results
– Reported, May 22, 2014
Traditional practices and large families contribute to maternal mortality.
In 2011, only 58 per cent of births in the country benefitted from skilled birth attendance. Several factors account for this lack of awareness about the importance of having assistance of a specially qualified health worker during childbirth, distrust in the competency of medical staff or facilities where they exist, a preference for traditional healers, or an inability to pay for or reach services. But this has changed a lot since 2005, when only 18 per cent of irths were attended by a skilled practitioner. According to the latest government data, about 38 per cent of births now take place at health facilities.
Giving birth early and often
According to the 2012 Lao Social Indicator Survey findings, more than 22 per cent of women marry by age 19 and become pregnant soon after. The use of contraceptives is low, at 50 per cent, due to lack of awareness or limited access. The 2012 LSIS also found that fewer than half of young people had access to any sexual or reproductive health education.
Other threats to women’s lives remain buried, but potentially lethal. The massive amount of unexploded ordnance from the 1970s war in Vietnam have created greater challenges for the government to address women’s health by impeding infrastructure development, such as roads and medical facilities. Human resources needed shoring up as well. A 2008 assessment of health workers found that fewer than 20 per cent could perform four basic life-saving skills for women or newborns.
The government sprang into action following a 2005 survey which estimated a high rate of maternal mortality 405 deaths of women per every 100,000 births. Although this marked an improvement from the previous figure of 650 deaths, it signaled that Lao PDR was off track for achieving the Millennium Development Goal on maternal health, which many consider to be the heart of the MDGs because of its impact on all the other goals.
Educating villagers on health
Community midwives visit patients.
UNFPA encouraged outreach by midwives and other clinic staff to educate villagers on family planning, health care and healthy behaviours, such as nutrition during pregnancy, and the benefits of exclusive breastfeeding. Midwives now provide a selection of free contraceptives, vaccinations, antenatal and postnatal care and, if need be, assistance for childbirth at home. However, they do encourage women to give birth in a health facility, where referral to a higher level of care can take place more efficiently if complications arise.
In the Manju health centre, painted in cheerful tones of green and yellow and stocked with delivery kits provided with UNFPA support, midwife Bouavone Sinethphone, 40, talks about the “big difference” between now and 2008. “Before, the husband didn’t touch the baby or even his pregnant wife,” she says. “Now the husband brings his wife for antenatal care and for delivery.” Making regular visits into communities has built the trust and ensuing traffic to her door.
Family planning is saving lives
“Contraception is saving women’s lives,” says Keng Ki village headman, Bounleu Saiyabong, 54, who regards it a duty to make sure all pregnant women in the village seek antenatal care and give birth in the Sepon district hospital (easily reached by river boat). He also says contraception, desired by most families in his village, is helping reduce poverty. “When there are so many children, it makes family life difficult. They can’t earn so much, they can’t feed the children and the mother can’t rest.” Smaller families, he says, means more children ultimately go to school and get a higher education.
The government, politicians and officials have made a similar connection. “I think if we can achieve MDG 5 we can increase GDP,” says Phonethep Pholsena, a member of parliament and president of the Cultural and Social Affairs Committee of the Lao National Assembly. However, he is concerned that the recent increases in the Health Ministry’s budget for maternal health aren’t enough to generated enough improvement to reach the MDG goal of 185 maternal deaths per 100,000 births by 2015, compared to the current rate of 357/100,00 (LSIS 2012).
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