1. MDGs 5a:Decline maternal mortality ratio Group 2:Khouanchay(Laos) Qu Ji(Tibet,China) Mao Shengnan(China) Wang Shasha(China) 1

2. Contents  1.Background  2. Relevant Policies  3.Relevant Action  4.MMR in Laos  5.Causes and Interventions 2

3. Background 3

4. What is maternal mortality?  The maternal mortality is difined the death of a women while pregnant or within 42 days of termination of pregnancy,irrespective of the durationand site of the pregnancy,from cause relate to or aggravated by the pregnancy or its management but not from Accidental or incidental causes. 4

5. What is maternal mortality ratio?  Maternal mortality ratio is the number of women who die during pregnancy and childbirth, per 100,000 live births. The data are estimated with a regression model using information on fertility, birth attendants, and HIV prevalence. 5

6. Maternal mortality ratio in different countries 6

7. Maternal mortality ratio in China 7

8. Relevant Policies 8

9. 1.Law on Maternal and Infant HealthcareLaw on Maternal and Infant Healthcare 2.Law on the Protection of Women’ s Rights and InterestsLaw on the Protection of Women’ s Rights and Interests 3.Population and Family Planning LawPopulation and Family Planning Law 4.Management Regulations for Technical Services in Family Planning 5.Program for the Development of Chinese Women 9

10. Law on Maternal and Infant Healthcare  Since:1995.6.1  Substance:Ensure mother and infant health,Improve the birth population quality  Article21 ： Physicians and midwives shall strictly observe relevant operational procedures, improve the skills of midwifery and the quality of service, so as to prevent or reduce maternal injuries. 10

11.  Article 18: Intensive care, follow-up and health care services for high-risk pregnant women,Provide safety for maternal childbirth technology services. Law on the Protection of Women’ s Rights and Interests 11

12. Population and Family Planning Law  Article 30 ： Countries to establish a system for pre-marital health, maternal health, prevent or reduce birth defects, improve the born baby health.  Article33 ： Check married women who are in childbearing age, provide follow-up service work, care advice for family planning and reproductive health, guidance and technical services. 12

13. Relevant Action 13

14.  Focused on the remote and rural areas in mid-western which have a high or very high burden of maternal mortality Includes  Improving the quality of local obstetric healthcare services; developing an emergency system;  Reducing or waiving the cost of hospital deliveries;  Conducting health education;  Improving supervision and management of obstetric services. 1.“Subsidies for Rural Women Delivering in Hospitals in Key Central and Western Areas” project 14

15. 15

16. MMR in rural hospital delivery rates in rural hospital delivery rates M M R (1 /1 0 0, 0 0 0) 1990-2010 MMR and hospital delivery rates change tendency in Chinese rural resourse:Annals of the national maternal and child health system 16

17. 2.The"Reducing and Eliminating"intervention  2001-2010  Implemented in 1,200 priority counties in midwestern China  Beneficiaries:830,000,000  Financial investment:3,000,000,000  Result:hospital delivery rates 65.1% maternal mortality ratio 58.8% 17

18. 3.Three-tiered MCH service network  MCH:maternal and children health  Village, township and county  Strengthen the national monitoring system for maternal and child sanitation  It has also begun to submit annual statistical reports  Key indicators of health among migrant populations have been included in the annual MCH reports since 2003 18

19. 4.Incorporate maternal healthcare into basic national public health services  Since ： 2009  Today, all pregnant women are entitled to receive free antenatal care at least five times during their pregnancies, and postpartum women are entitled to two free postnatal visits. 19

20. 5.The new cooperative medical scheme in rural areas  Benefits 833 million people, or 94.2% of the rural population  Covers all the counties with rural population. 20

21. MMR in Laos 21

22. Background of the country PopulationSpecial characteristics Laos6.2 million (UNDP 2012) -A landlocked nation in Southeast Asia occupying the northwest portion of the Indochinese peninsula, Laos is surrounded by China, Vietnam, Cambodia, Thailand. - Laos is a mountainous country, especially in the north. - 45 per cent of the population are Ethics group. 22

23. Maternal Mortality Ratio Laos Target Indicators199020122015 1.Maternal mortality ratio (per 100,000 live birth) 750 357 260 2.Proportion of births attended by skilled health personnel 14% (1995) 41.5% 50% 23

24. The Policies 1)Every woman will have access to a skilled professional attendant during pregnancy and delivery. 2) Every woman of child bearing age will receive iron and acid folic supplements. 3) Every district and provincial hospital will provide emergency obstetric care. 4)Every woman of child bearing age should receive the information & services on reproductive health. 5) All pregnant women should be immunized against tetanus. 24

25. Existing Problem  The Maternal Mortality Ratio is difficulty to estimate accurately, with out a strong vital registration system for birth and deaths.  while Maternal Mortality Ratio may have declined, especially in urban areas, a large disparity remains between urban and rural areas. This may be related to the high rate of home deliveries without skilled care in rural areas, also a cause of neonatal mortality. 25

26. Existing Problem  Most women deliver at home (49 percent), without a skilled birth attendant.  The highest risk of death for mother and child is during birth and the 24 hour after birth.  Slow progress has been made in ensuring the presence of SBAs at every birth in Lao PDR. During the period 1995-2005, the number of birth attended by SBAs increased from 14 percent to 23 percent 26

27. Recommendations  In spite of regular decline, the Maternal mortality ratio is unacceptably high. The proportion of births attended by skilled attendants increased by less than 1 percentage point per year. There are a high proportion of women with little or no access to reproductive health still.  Need more investment, particularly in the rural areas, in antenatal care, in the training of more birth attendants and in the promotion of maternal health at the community level. 27

28. Causes and Interventions 28

29. Causes of maternal deaths years 19961998200020032005 20082011 Obstetric hemorrhage 31.425.820.821.222.018.57.5 Pregnancy- induced hypertension disease 8.27.47.66.14.23.12.9 Amniotic fluid embolism 4.44.15.65.14.33.53.0 Pregnancy merge heart disease 5.26.94.34.94.63.12.7 Pregnancy with liver disease 2.42.22.62.02.21.51.3 the causes of maternal mortality from1996 to 2011 in China 29

30. Mortality Rate of Maternal in Surveillance Region 30

31.  treat anaemia before pregnancy,skilled attendent at birth,prevent bleeding with correct drugs,enough blood products.  detect before pergnancy,refer to doctor or hospital,treat eclampsia with appropriate anticonvulsive,for example magnesium sulfate  detection in time,referral for operative delivery. cure diseases with specific intervetions. 1 2 3 The intervention for maternal mortality 4 31

32.  It is very important for the government to estimate the efficacy of the intervention and make further modifications and also provide valuable experiences to achieve the MDG5 target. 32

33. percentage of Health Professionals By Age, Technical Position in 2011 33

34. Number of Medicine Graduates 34

35.  Service capacity of maternal and child health are not so good in the obvious disparity between urban and rural regions.  Service quality at the grass-roots level is not high.Population fluidity is big, maternal mortality is higher in vast rural areas due to lack of system management and health care services. challenges 35

36.  Parts of the maternal mortality rate, and other health indicators in project will occur soon after the rebound, they can't get continuous improvement.  the accelerated pace of industrialization and urbanization widened the economic gap between urban and rural areas. For example, women migrated from rural to big cities presented much higher maternal mortality rates than local residents. Health knowledge is one of the key factors enabling women to be aware of their rights and health status in order to seek appropriate health services. 36

37.  All regions have made progress but accelerated interventions are required in order meet the target. 37

38. Despite all kinds of difficulties, challenge and opportunity coexist. the future domestic situation international situation 38

39.  At present, China's maternal and child health cause is facing a rare opportunity for domestic and international development. From the domestic situation, we will deepen the reform of the pharmaceutical and health care system.It is one of the great opportunities to strengthen maternal and child health work. Maternal and child health as an important part of public health, will be taken seriously.Furthermore,financial investment will be more and more big. domestic sitution 39

40. the international situation  The international communities have pay more and more attention to women's and children's health.China's active participation has introduced the advanced management, service concept,appropriate technology. In the meantime we have raised the basic maternal and child health service capacity. 40

41.  International cooperation and exchanges in the field of maternal and child health,will deepen China's communication and understanding with the international communities.  China's maternal and child health development model and achievements will provide useful experience for the majority developing countries. 41

42. Therefore, as long as we seize opportunities from home and abroad aspects, mobilizing all social forces. I believe we will make more contributions to women's and children's health! 42

43. Thank you for your attention 43