index A African Region(continued) low uptake of professional birth care 86 maternal deaths 62 aftercare xv. xxi. 44. 51 52 neonatal deaths 9. 82 complications 51-52 reversal or stagnation of mortality 13, 82 legal aspects xxi, 52 insafe abortions 50 51 see also sub-Saharan Africa alcohol see lifestyles, unhealthy unsafe x,xx,x,10,13,44,50-51 Americas( Region of the child mortality 8-9 abortion services xv. 51. 52 immunization coverage 26 neonatal mortality 82 adolescents 49 anaemia 45. 63 arriers 26. 48.86 Angola, expenditure on child health 117 district approach 32 antenatal care entitlement 4.5. 7 35 arriers to access 48 inancial barriers xvii, xXi, 86, 137, 139 Latin America 130 coverage Xx, 48 limited 53 ncreased uptake 11, 12, 42-4 effective interventions 47-48 maternal, neonatal and child health 132, 137-140, 141, 143 effect on neonatal mortality 88 opportunity xiv-XV, XX, 42-48, 86 efugees 51 see also pregnan eproductive health xiv, 6, 49, 125 antenatal screening 47, 69 antibiotics 108. 113 third-party authorization 53 antimalarials 44. 108. 113 universal xiv, xvi-xix, xxii-Xxii, 6, 32, 68, 88-98, 125 APGAR test 84 37-141,143 see also exclusion neonatal deaths 9 acute lower respiratory infections, as cause of death 106 safe abortions 50 51 safe abortion 51 take of antenatal care 42 unwanted sex 49-50 asphyxia 80, 81, 86 asset quintiles 30 adolescents, lack of access to contraceptives 49 Australia, midwifery training 72 African Region hild mortality 8-9 B immunization coverage 46 G abies see children: newborns Baby-Friendly Hospitals initiative 104-10 ow uptake of contraception 49
221 index A abortion access to services xv, 51, 52 aftercare xv, xxi, 44, 51, 52 complications 51–52 legal aspects xxi, 52 numbers 48, 49 sex-selective 48, 85 unsafe xiv, xx, xxi, 10, 13, 44, 50–51, 63 access to care abortion services xv, 51, 52 adolescents 49 barriers 26, 48, 86 district approach 32 entitlement 4, 5, 7, 35, 129 financial barriers xviii, xxiii, 86, 137, 139 Latin America 130 limited 53 maternal, neonatal and child health 132, 137–140, 141, 143 effect on neonatal mortality 88 refugees 51 reproductive health xiv, 6, 49, 125 third-party authorization 53 universal xiv, xvi–xix, xxii–xxiii, 6, 32, 68, 88–98, 125, 137–141, 143 see also exclusion acute lower respiratory infections, as cause of death 106 adolescent girls unsafe abortion 51 unwanted sex 49–50 vulnerability 48 adolescents, lack of access to contraceptives 49 African Region child mortality 8–9 exclusion from health benefits 26 immunization coverage 26 low uptake of contraception 49 African Region (continued) low uptake of professional birth care 86 maternal deaths 62 neonatal deaths 9, 82 reversal or stagnation of mortality 13, 82 unsafe abortions 50, 51 see also sub-Saharan Africa alcohol see lifestyles, unhealthy Americas (Region of the) child mortality 8–9 immunization coverage 26 neonatal mortality 82 anaemia 45, 63 Angola, expenditure on child health 117 antenatal care barriers to access 48 coverage xx, 48 increased uptake 11, 12, 42–43 ineffective interventions 47–48 as opportunity xiv–xv, xx, 42–48, 86 see also pregnancy antenatal screening 47, 69 antibiotics 108, 113 antimalarials 44, 108, 113 APGAR test 84 Asia neonatal deaths 9 unsafe abortions 50, 51 uptake of antenatal care 42 asphyxia 80, 81, 86 asset quintiles 30 Australia, midwifery training 72 B babies see children; newborns Baby-Friendly Hospitals initiative 104–105
222 The World Health Report 2005 back-up care xv, xxi, XXi, 69, 71-73, 87, 111 Call to Action for safe Motherhood 3-4 estimating requirement 90-91 Cambodia see also hospitals district policies 32 Bangladesh exemptions from user fees 139 community development programmes 110 post-conflict area 127, 133 are 93 salary increases 13 Health and Population Sector Strategy(HPSS)142 unsafe abortions 50-5 massive deprivation 3 Cameroon, public health expenditure 32 basic indicators for wHo Member states 174 Canada Benin abuse during pregnancy childbirth costs 93 midwifery training 72 exclusion from health benefits 27 complementarity 108-109 health centres 32 seeking89,109,111 human resources gap 95 see also child care; continuity of care; health care resuscitation skills 87 neonatal care Bhutan, emergency care 93 caregivers, receptivity 108 Bill Melinda Gates Foundation 126 Caribbean unsafe abortion 51 complications xxi, 32, 62, 63, 65, 69, 86 take of antenatal care 42 costs 93. 139 ase management 109 home2,43,67,73,87,88 causes of death iniuries 81 children under five 106. 190 morbidity/mortality xv, xx, 10 neonates 80-81. 190 number increasing 13 planning Xx, 46-47, 86 risks 62 rituals surrounding 69 expenditure on child health 117 skilled attendance xv. xxi. 10-12 65-74. 86-88.. 91-92 massive deprivation 31 birthing centres/facilities xxi, 72, 91 child care, integrated 108-115 birthing culture 69 child health births and deaths, registration 11, 12, 53 economic aspects 115-119 ood transfusion 63 primary health care programmes 3 maternal mortality decreased 11 see also maternal neonatal and child health National Maternal and child Health Insurance Programme child mortality xiv, xv, xix, 8-9, 14, 80, 182, 186 effect of poor care-seeking 109 uptake of professional birth care 86 effect of socioeconomic development 84-85 womens groups 88 Millennium Development Goals xv child mortality 23 Child survival revolution 104 catastrophic health care costs childbirth see birth communication skills of health workers 110 children Brazzaville(Congo), maternal mortality 92-93 developmental problems 45 eastfeeding87-88,104-105,110,11 exclusion from care 25-32 Burkina Fas failure to thrive 108 mortality see child mortality health system problems 33, 95, 128 nutritional status see malnutrition home management of malaria 110 rights and entitlements 4, 5, 7 C cesarean section 12. 64.71 93.5
222 The World Health Report 2005 back-up care xv, xxi, xxii, 69, 71–73, 87, 111 estimating requirement 90–91 see also hospitals Bangladesh community development programmes 110 emergency care 93 Health and Population Sector Strategy (HPSS) 142 massive deprivation 31 basic indicators for WHO Member States 174 Benin childbirth costs 93 emergency care 93 exclusion from health benefits 27 health centres 32 human resources gap 95 resuscitation skills 87 Bhutan, emergency care 93 Bill & Melinda Gates Foundation 126 birth complications xxi, 32, 62, 63, 65, 69, 86 costs 93, 139 home 2, 43, 67, 73, 87, 88 injuries 81 morbidity/mortality xv, xx, 10 number increasing 13 planning xx, 46–47, 86 risks 62 rituals surrounding 69 skilled attendance xv, xxi, 10–12, 65–74, 86–88, 90, 91–92 birthing centres/facilities xxi, 72, 91 birthing culture 69 births and deaths, registration 11, 12, 53 bleeding see haemorrhage blood transfusion 63 Bolivia maternal mortality decreased 11 National Maternal and Child Health Insurance Programme 140 uptake of professional birth care 86 women’s groups 88 Botswana child mortality 23 midwifery training 72 Brazil catastrophic health care costs 140 communication skills of health workers 110 marginal exclusion from health benefits 31 salary increases 137 Brazzaville (Congo), maternal mortality 92–93 breastfeeding 87–88, 104–105, 110, 115 Burkina Faso district hospitals 33 exclusion from health benefits 27 health system problems 33, 95, 128 home management of malaria 110 C caesarean section 12, 64, 71, 93, 94 Call to Action for Safe Motherhood 3–4 Cambodia district policies 32 exemptions from user fees 139 post-conflict area 127, 133 salary increases 137 unsafe abortions 50–51 Cameroon, public health expenditure 32 Canada abuse during pregnancy 47 midwifery training 72 care complementarity 108–109 seeking 89, 109, 111 see also child care; continuity of care; health care; neonatal care caregivers, receptivity 108 Caribbean unsafe abortion 51 uptake of antenatal care 42 case management 109 causes of death children under five 106, 190 neonates 80–81, 190 reporting 11, 12 Chad emergency care 93 expenditure on child health 117 massive deprivation 31 child care, integrated 108–115 child health economic aspects 115–119 integrated approach 111 primary health care programmes 3 uneven gains 8–9 see also maternal, neonatal and child health child mortality xiv, xv, xix, 8–9, 14, 80, 182, 186 effect of poor care-seeking 109 effect of socioeconomic development 84–85 Millennium Development Goals xv stagnated or reversed 16 variations 83 Child Survival Partnership 127 Child Survival Revolution 104 childbirth see birth children causes of death 106, 190 core interventions for survival 115 developmental problems 45 exclusion from care 25–32 failure to thrive 108 home care 2, 108, 110 mortality see child mortality nutritional status see malnutrition rights and entitlements 4, 5, 7 seen as national resource 2 stunting and underweight 9
index 223 Ecuador child mortality 9 exclusion from health care 28 sex ratio at birth 85 resuscitation skills 87 civil society organizations 141-143 Egypt Colombia abuse during pregnancy 47 catastrophic health care costs 140 reduced maternal mortality 11, 44, 67 marginal exclusion from health benefits 31 uptake of professional birth care 86 neonatal deaths 85 emergencies see humanitarian crises mmunity health workers 110, 111, 112, 115, 133 non-professional 89, 90 congenital defects/anomalies 80 see also Expanded Programme on Immunization congenital rubella syndrome 81, 86 episiotomy 94 Congo(Democratic Republic) Ethiopia child mortality 9 abuse during pregnancy 47 xpenditure on child health 117 hild mortality 9 health care system 25, 35 ommunity health workers 112 consumer protection 142 expenditure on child health 117 continuity of care Xv, xxi, 48, 73, 86, 88, 89, 111, 113, 129, 131 home management of malaria 110 contraception Xv, xxi, 46, 49, 50 massive deprivation 31 also reproductive health European Region costs see economic aspects; health care costs; health child mortality 8-9 expenditure; user fees immunization coverage 26 Cote d' lvoire, health expenditure 117 maternal deaths 62 improvements in health care 130 neonatal mortality 82 exclusion D caused by user fees 138-139 Darfur 133 feature of inequityⅫi decentralization 32. 90 of mothers and children xx. 2. 25-32 see also district approach patterns and sources Xx, xxi, 29-30, 139 depression, maternal 45, 47, 65, 108 see also access to care see also mental ill-health xpanded Programme on Immunization Xxi, 104 developmental problems of childhood 45 F faeces as cause of death 80-81. 89. 106. 107 ailure to thrive 108 anagement 111, 115 family, see households family planning xx,6,34,46,48,49,86,126,142 discrimination xv. xxi. 29. 41. 85 family practices, key 109, 110 district approach xiv, Xx, 21, 25, 31-35, 73, 114-115, 129 female genital mutilation 53 district hospitals Xx, 21, 33, 34, 67, 73, 109, 119 fertility, global drop 49 doctors fetal alcohol syndrome 45 fetal growth, restricted 79, 81 financial barriers to access xviii. xxii. 86. 137. 139 ricians: health care workers Dominican Republic, exclusion from health care 31 financial protectio donor funding see fundin inst costs of seeking care 137-140 donor interventions in the labour market 136 merging schemes 140-141 drugs see lifestyles, unhealthy tem building 140-143 first-level care xv. xxii. 69.71. 72.73. 90 91 E Eastern Mediterranean Region hild mortality 8-9 channelling resources 140-143 donor126,129,130,142 immunization coverage 26 G lampsia and pre-eclampsia xx, 45, 63, 64 Gambia. health information 128
index 223 China child mortality 9 sex ratio at birth 85 civil society organizations 141–143 Colombia catastrophic health care costs 140 marginal exclusion from health benefits 31 neonatal deaths 85 community health workers 110, 111, 112, 115, 133 non-professional 89, 90 congenital defects/anomalies 80 congenital rubella syndrome 81, 86 Congo (Democratic Republic) child mortality 9 expenditure on child health 117 health care system 25, 35 consumer protection 142 continuity of care xv, xxii, 48, 73, 86, 88, 89, 111, 113, 129, 131 contraception xv, xxi, 46, 49, 50 see also reproductive health costs see economic aspects; health care costs; health expenditure; user fees Côte d’Ivoire, health expenditure 117 Cuba, improvements in health care 130 D Darfur 133 decentralization 32, 90 see also district approach depression, maternal 45, 47, 65, 108 see also mental ill-health development organizations, recruitment policies 136 developmental problems of childhood 45 diarrhoea as cause of death 80–81, 89, 106, 107 management 111, 115 disability 10, 79 discrimination xv, xxi, 29, 41, 85 district approach xiv, xx, 21, 25, 31–35, 73, 114–115, 129 district hospitals xx, 21, 33, 34, 67, 73, 109, 119 doctors numbers required 91 role in childbirth 70 see also gynaecologists-obstetricians; health care workers Dominican Republic, exclusion from health care 31 donor funding see funding donor interventions in the labour market 136 drugs see lifestyles, unhealthy E Eastern Mediterranean Region child mortality 8–9 immunization coverage 26 maternal deaths 62 neonatal mortality 82 eclampsia and pre-eclampsia xxi, 45, 63, 64 economic decline xiv, 83 ectopic pregnancy 45 Ecuador exclusion from health care 28 resuscitation skills 87 Egypt abuse during pregnancy 47 reduced maternal mortality 11, 44, 67 uptake of professional birth care 86 emergencies see humanitarian crises emergency referral 71 EPI-plus 108 see also Expanded Programme on Immunization episiotomy 94 Ethiopia abuse during pregnancy 47 child mortality 9 community health workers 112 expenditure on child health 117 home management of malaria 110 massive deprivation 31 European Region child mortality 8–9 immunization coverage 26 maternal deaths 62 neonatal mortality 82 exclusion caused by user fees 138–139 key feature of inequity xiii of mothers and children xx, 2, 25–32 patterns and sources xx, xxi, 29–30, 139 see also access to care Expanded Programme on Immunization xxii, 104 F faeces, safe disposal 110 failure to thrive 108 family, see households family planning xx, 6, 34, 46, 48, 49, 86, 126, 142 family practices, key 109, 110 female genital mutilation 53 fertility, global drop 49 fetal alcohol syndrome 45 fetal growth, restricted 79, 81 financial barriers to access xviii, xxiii, 86, 137, 139 financial exploitation 93, 94 financial protection against costs of seeking care 137–140 merging schemes 140–141 system building 140–143 first-level care xv, xxii, 69, 71, 72, 73, 90, 91 fistulae 64 funding channelling resources 140–143 donor 126, 129, 130, 142 G Gambia, health information 128
224 The World Health Report 2005 gender health outcomes, inequalities 30 as source of exclusion 26 health professionals see health care workers see also violence, gender-related; women health sector commercialization 93 infrastructure gap 93 childbirth costs 9 reforms127-128,129 health centres 32 state underfunding 12 human resources crisis 33 health services/systems Global Campaign for the Elimination of Fistula 64 building 65-68 Global Strategy for Infant and Young Child Feeding 104 disruption 83 GOBI (growth monitoring, oral rehydration therapy for diarrhoea insufficient investment xiv breastfeeding, and immunization) 104 public expenditure xvil government, role 141, 142 scaling up xvi.-xⅶi Guatemala, indoor air pollution 110 strengthening Xvi-Xvii sustainable xili district structure 33-35 health workers /workforce see health care workers failings of health system 29 Healthy Newborn Partnership 12 Guinea-Bissau, salaries and incentives 33 HIV/AIDS gynaecologists-obstetricians 70, 71, 91, 95 as cause of death 106 effect on health care system xiv, 21-24, 33 H effect on maternal, neonatal and child health xx haemorrhage xxi, 45 effect on neonatal mortality 83 Haiti, exclusion from health benefits 27 mortality during pregnancy 4 orphans 23 health care prevention and care 115 iccess see access to care in sub-Saharan Africa 23 st- evel xv,xxi,69,71,72,73,90,91 home birth see birth. home public sector xvii, xix, 134-136, 138, 141 home visits by health staff 89 see also health care workers, and households/ communities health care costs Honduras failings of health system 28 cause poverty xiv reduced maternal mortality 67 prepayment and pooling 137 health care workers district xx,21,33,34,67,73,109,119 referral32,86,111-112 communication skills 110 and households/communities 89. 108. 109-111. 112. 119 human resources shortage xiv, xvi, XXi, 33, 93, 95 see also back-up care 132-13 household surveys 82 households ICMI guidelines, tools and training 109 care of children 112 propriate behaviour 134-135 lack of effectiveness 133-134 and health workers 109-111 qualifications and competence 93 human resources crisis 33.93. 95. 132 ecruitment difficult 24 rehabilitation 132-137 see also health care workers emuneration and incentives xvii-xvili xxiii 33. 134 human rights 3, 5, 53 136-137 humanitarian crises xiv, xx, 21, 22, 24-25 72,87,113,13 hypertensive disorders see eclampsia and pre-eclampsia vulnerable to HIVIAIDs 33 working environment xvill health centres, I are 32 ogen health districts see district approach immunization/vaccination health expenditur increase xxii. xxiii indicators in WHO Member States 204 national health accounts indicators 192 200 key intervention 115 xvi. 104 also scaling up
224 The World Health Report 2005 gender as source of exclusion 26 see also violence, gender-related; women Georgia, salary increases 137 Ghana childbirth costs 93 health centres 32 human resources crisis 33 Global Campaign for the Elimination of Fistula 64 Global Strategy for Infant and Young Child Feeding 104 GOBI (growth monitoring, oral rehydration therapy for diarrhoea, breastfeeding, and immunization) 104 government, role 141, 142 Guatemala, indoor air pollution 110 Guinea district structure 33–35 failings of health system 29 Guinea-Bissau, salaries and incentives 33 gynaecologists-obstetricians 70, 71, 91, 95 H haemorrhage xxi, 45, 63 Haiti, exclusion from health benefits 27 health care access see access to care discriminatory 28 first-level xv, xxii, 69, 71, 72, 73, 90, 91 public sector xviii, xix, 134–136, 138, 141 health care costs catastrophic 140 cause poverty xiv prepayment and pooling 137 unaffordable 28 health care workers absenteeism 33 communication skills 110 and households/communities 89, 108, 109–111, 112, 119 human resources shortage xiv, xvii, xxiii, 33, 93, 95, 132–133 ICMI guidelines, tools and training 109 inappropriate behaviour 134–135 lack of effectiveness 133–134 multipurpose 74, 86, 133 qualifications and competence 93 recruitment difficult 24 rehabilitation 132–137 remuneration and incentives xvii–xviii, xxiii, 33, 134, 136–137 training 72, 87, 113, 133 vulnerable to HIV/AIDS 33 working environment xviii health centres, primary care 32 health districts see district approach health expenditure increase xxii, xxiii national health accounts indicators 192, 200 per capita 200 see also scaling up health outcomes, inequalities 30 health professionals see health care workers health sector commercialization 93 infrastructure gap 93 reforms 127–128, 129 state underfunding 127 health services/systems building 65–68 disruption 83 insufficient investment xiv public expenditure xvii scaling up xvi–xvii strengthening xvi–xvii sustainable xiii health workers/workforce see health care workers Healthy Newborn Partnership 127 HIV/AIDS as cause of death 106 effect on health care system xiv, 21–24, 33 effect on maternal, neonatal and child health xx effect on neonatal mortality 83 mortality during pregnancy 45 orphans 23 prevention and care 115 in sub-Saharan Africa 23 home birth see birth, home home visits by health staff 89 see also health care workers, and households/communities Honduras failings of health system 28 reduced maternal mortality 67 hospitals back-up care 71, 87, 111 district xx, 21, 33, 34, 67, 73, 109, 119 referral 32, 86, 111–112 transport to 112 see also back-up care household surveys 82 households care of children 112 empowerment 112 and health workers 109–111 key practices 110 human resources crisis 33, 93, 95, 132 see also health care workers human rights 3, 5, 53 humanitarian crises xiv, xx, 21, 22, 24–25 hypertensive disorders see eclampsia and pre-eclampsia I iatrogenesis 87, 93 immunization/vaccination coverage 104 indicators in WHO Member States 204 key intervention 115 programmes xvi, 104 trends 26 used as opportunity 108
index 225 Liberia, post-crisis situation 133 abortion 52 lifestyles abuse during pregnancy 47 outselling 46, 48, 86 child mortality 9 unhealthy 44, 45 counselling 111 failings of health system 28, 29 health problems after birth 64 inappropriate oxytocin use 94 malaria number of births increasing 13 sex ratio at birth 85 Indonesia midwifery 72, 91 management 110, 112, uptake of professional care 42, 86 morbidity and mortality 44, 45 indoor air pollution 110 industrialized countries, first-level midwifery care 73 child mortality 23 see also breastfeeding increasing number of midwifes infection xxi laternal mortality 11 as cause of death 63. 64. 80-81 triage in hospital 112 reducing risk 86 Malaysia insecticide-treated bednets 25. 44. 46. 108. 110. 115 73 insurance schemes xviii. xxii. 137-140 voluntary/limited 139-140 Integrated Management of Childhood Illness(IMCI)xvi, Xxii, exclusion from health benefits 107-108.109,111 penditure on child health 117 national and sub-national guidelines 112 lealth centres and services 33 scaling up 112-119 human resources problems 33, 95 ntermittent Preventive Treatment in Infants Consortium 44 nternational Code of Marketing of Breast-milk Substitutes 104 9,4581 international community, sustained political commitment xix International Conference on Population and Development, Cairo marriage, minimum age 53 4-6,51,125,128 massive deprivation xx, 29-30 International Labour Organization, Maternity Protection maternal and child health( MCH), now maternal, neonatal and child health(MNCH) 125 maternal deaths maternal and neonatal mortality 68 definition 62 Jamaica, resuscitation skills 87 npredicta maternal health xvii. 10-12. 22. 81 Kazakhstan, exclusion from health care 26 maternal mortality urrent figures 15, 61 Kenya decreased 10-11 health centres 32 fficulty of obtaining information 11, 12 effect of skilled attendance 10. 88 ser fees 138-139 nowledge-skills gap 72 main causes xX and professionalization of midwifery 65-68 Lao People's Democratic Republic, antenatal care 43 atin America ri Lanka 66 exclusion from health benefits 26 variations 83 mproved access to care 130 maternal, neonatal and child health(MNCH) unsafe abortion 51 arriers to uptake uptake of antenatal care 42 efinition xiii economic aspects 6, 137
index 225 India abortion 52 abuse during pregnancy 47 child mortality 9 counselling 111 failings of health system 28, 29 health problems after birth 64 inappropriate oxytocin use 94 number of births increasing 13 sex ratio at birth 85 Indonesia midwifery 72, 91 uptake of professional care 42, 86 indoor air pollution 110 industrialized countries, first-level midwifery care 73 infant feeding 115 see also breastfeeding infection xxi as cause of death 63, 64, 80–81 reducing risk 86 insecticide-treated bednets 25, 44, 46, 108, 110, 115 insurance schemes xviii, xxiii, 137–140 voluntary/limited 139–140 Integrated Management of Childhood Illness (IMCI) xvi, xxii, 107–108, 109, 111 national and sub-national guidelines 112 scaling up 112–119 Intermittent Preventive Treatment in Infants Consortium 44 International Code of Marketing of Breast-milk Substitutes 104 international community, sustained political commitment xix International Conference on Population and Development, Cairo 4–6, 51, 125, 128 International Labour Organization, Maternity Protection Convention 3, 53 Iraq breakdown of health system 68 maternal and neonatal mortality 68 J Jamaica, resuscitation skills 87 K Kazakhstan, exclusion from health care 26 Kenya health centres 32 midwifery training 72 user fees 138–139 knowledge–skills gap 72 L Lao People’s Democratic Republic, antenatal care 43 Latin America exclusion from health benefits 26 improved access to care 130 unsafe abortion 51 uptake of antenatal care 42 Liberia, post-crisis situation 133 lifestyles counselling 46, 48, 86 unhealthy 44, 45 M malaria as cause of death 106 endemic areas 25 intermittent preventive treatment 86, 115 management 110, 112, 115 morbidity and mortality 44, 45 Malawi breakdown of health system 67 child mortality 23 increasing number of midwifes 67 maternal mortality 11 triage in hospital 112 Malaysia midwifery 66, 73 sustained improvements 130 Mali exclusion from health benefits 27 expenditure on child health 117 health centres and services 33 human resources problems 33, 95 inappropriate oxytocin use 94 malnutrition 9, 45, 81, 108 marginalization xx, xxi, 29–30 marriage, minimum age 53 massive deprivation xx, 29–30 maternal and child health (MCH), now maternal, neonatal and child health (MNCH) 125 maternal deaths causes 62 definition 62 devastating effect 1 during pregnancy 44 mortality rates xiv postpartum xxi unpredictable 62 maternal health xvii, 10–12, 22, 81 maternal mortality current figures 15, 61 decreased 10–11 difficulty of obtaining information 11, 12 effect of skilled attendance 10, 88 large variations 62 main causes xxi and professionalization of midwifery 65–68 reduction 65, 95 reversals 11 Sri Lanka 66 variations 83 maternal, neonatal and child health (MNCH) barriers to uptake 86 definition xiii economic aspects 6, 137
226 The World Health Report 2005 maternal, neonatal and child health(MNCH)(continued) effect on child mortality 85 N funding125,126,137 national health accounts indicators global partnerships 127 neonatal care xvi. 87 88-89. 115 historical aspects 2-3 neonatal conditions as cause of death 106 indicators 212 neonatal mortality xiv, xv, Xix, xxii, 9-10, 15, 85, 88 integration 128 variations 9.83 international advocacy 132 key intervention 115 inappropriate oxytocin use 94 lack of progress Xx, 1 Millennium Development Goals xix, 2, 7-8 newborns political aspects xix, XXi, 129-132, 141 causes of death 80-81. 190 and primary health care movement 31 first week of life 79 priorities xii, 128 health problems xi, XV, XXi-XXil, 10 public health aspects xix, 2-3, 6-7, 45, 47, 52 repositioning xil, 125-130 Nicaragua scaling up xvil,xi,xxil,93-98,114-119,133,137 abuse during pregnancy technical focus 127. 128. 129, 132 emergency care 93 universal access/entitlement to care 137-140. 141. 143 neonatal deaths 85 maternity leave 53 measles, as cause of death 106 district policies 32, 33, 34 mental ill-health, in pregnancy 45 Mexico, abuse during pregnancy 47 exclusion from health benefits 27 micronutrients 45. 81. 110. 115 expenditure on child health 117 midwife-led birthing facilities xxi, 72, 91 external funding 126 midwifery skills xxi, 64, 68, 69, 71, 8 midwives insecticide-treated bednets 46 icensed/professional XV, 65-66, 70 numbers required 91 ena training 72, 133 Millennium Development Goals expenditure on child health 117 child mortality Xv northern Africa. increase in skilled attendance at birth 92 health-related xili, xxiii. 8 nurse-midwives 67 68 70 72 87.93 maternal neonatal and child health xvii. xix. 1. 27-8 see also health care workers; midwifery skills; midt nurses see health care workers nutrition breakdown of health syster see also micronutrients conomic crisis 22-23. 127 OCCO 0 emergency care obesity uptake of professional birth care 86 obstetric fistulae 64 mortality rates obstetric interventions, life-saving 27 hildren under five 1 see also birth reversals xiv, xy. xix, 11.13. 16. 82.83 obstetricians see gynaecologists-obstetricians obstructed labour, as cause of maternal death 63 64 Mothers charter 3 oral rehydration therapy xxii, 104, 108 mothers and children orphans, HIV/AIDS 23 access to care 132 out of pocket payments see user fees exclusion from care 25-32 outreach services 112. 115 rights and entitlements 35 overmedicalization 48, 87, 93, 94 see maternal. neonatal and child health oxytocin 63, 94 Mozambique low salaries for nurses 134 ost-crisis situation 133 multipurpose health care workers 74, 86, 133 Pakistan child mortality 9
226 The World Health Report 2005 maternal, neonatal and child health (MNCH) (continued) effect on child mortality 85 funding 125, 126, 137 global partnerships 127 historical aspects 2–3 indicators 212 integration 128 international advocacy 132 key intervention 115 lack of progress xx, 1 Millennium Development Goals xix, 2, 7–8 political aspects xix, xxiii, 129–132, 141 and primary health care movement 31 priorities xiii, 128 public health aspects xix, 2–3, 6–7, 45, 47, 52 repositioning xiii, 125–130 scaling up xvii, xxii, xxiii, 93–98, 114–119, 133, 137 technical focus 127, 128, 129, 132 universal access/entitlement to care 137–140, 141, 143 maternity leave 53 measles, as cause of death 106 mental ill-health, in pregnancy 45 Mexico, abuse during pregnancy 47 micronutrients 45, 81, 110, 115 midwife-led birthing facilities xxi, 72, 91 midwifery skills xxi, 64, 68, 69, 71, 86 midwives licensed/professional xv, 65–66, 70 numbers required 91 training 72, 133 Millennium Development Goals child mortality xv health-related xiii, xxiii, 8 maternal, neonatal and child health xvii, xix, 1, 2, 7–8 misoprostil 63 molar pregnancy 45 Mongolia breakdown of health system 67 economic crisis 22–23, 127 Morocco emergency care 93 uptake of professional birth care 86 mortality rates children under five 182, 186 inequalities and patchy progress 12–13 reversals xiv, xv, xix, 11, 13, 16, 82, 83 Mothers’ Charter 3 mothers and children access to care 132 exclusion from care 25–32 rights and entitlements 35 see maternal, neonatal and child health Mozambique low salaries for nurses 134 post-crisis situation 133 multipurpose health care workers 74, 86, 133 N national health accounts indicators 192 neonatal care xvi, 87, 88–89, 115 neonatal conditions, as cause of death 106 neonatal mortality xiv, xv, xix, xxii, 9–10, 15, 85, 88 variations 9, 83 Nepal inappropriate oxytocin use 94 women’s groups 88, 110 newborns causes of death 80–81, 190 first week of life 79 health problems xiii, xv, xxi–xxii, 10 resuscitation 87 Nicaragua abuse during pregnancy 47 emergency care 93 neonatal deaths 85 Niger district policies 32, 33, 34 emergency care 93 exclusion from health benefits 27 expenditure on child health 117 external funding 126 human resources gap 95 insecticide-treated bednets 46 salaries and incentives 33 Nigeria child mortality 9, 26 expenditure on child health 117 northern Africa, increase in skilled attendance at birth 92 nurse-midwives 67, 68, 70, 72, 87, 93 see also health care workers; midwifery skills; midwives nurses see health care workers nutrition adequate 110 see also micronutrients O obesity 45 obstetric fistulae 64 obstetric interventions, life-saving 27 see also birth obstetricians see gynaecologists-obstetricians obstructed labour, as cause of maternal death 63, 64 oral rehydration therapy xxii, 104, 108 orphans, HIV/AIDS 23 out of pocket payments see user fees outreach services 112, 115 overmedicalization 48, 87, 93, 94 oxytocin 63, 94 P Pakistan child mortality 9
index 227 Pakistan(continued) primary health care movement 3, 31, 32, 35, 73, 103-105, 112 exclusion from health benefits 2 professional staff see health care workers Lady Health Workers 112 public health aspects, maternal, neonatal and child health xix number of births increasing 13 2-3,6-7,45,4752 efugees 24 public sector health care xvi, xix, 134-136, 138, 141 Pan American Health Organization 26 Papua New Guinea, user fees 138-139 Paraguay, exclusion from health benefits 28 R parenting skills Xx, 47, 86, 88, 108 Reaching Every District initiative 115 Partnership for Safe Motherhood and Newborn Health 127 referral see hospitals, referral Peru efugees abuse during pregnancy 47 ccess to abortion 51 exclusion from health benefits 28 Pakistan 24 placenta, disorders 45 pneumonia104,106,110,115 Rwandan 25 polio 104, 105 registration of births and deaths 11, 12 olitical aspects, of maternal, neonatal and child health xix, xxii 129-132,141 olitical stability 130, 133, 134 universal access to care xiv. 6. 125 post-abortion care see abortion, aftercare see also contraception post-crisis situations 133 reproductive tract infections 86 see also humanitarian crises resource availability lack of information 128 postnatal visits, low take-up 74 suscitation skills 86 87 postpartum period reversals, in mortality rates xiv, xv, xix, 11, 13, 16, 82, 83 care xv, xx. 73-74 deaths 62 rubella vaccination 80. 86 rubella virus infection 79-80 caused by health care costs xiv, xvi, 28, 140 Rwanda 25. 87 effect on health care systems xiv, 21-23 effect on maternal, neonatal and child health reason for exclusion 28-29 sample surveys 12 poverty reduction strategy 127, 128, 141 Poverty Reduction Strategy Papers(PRSPs) 128, 129 economic aspects 97, 98, 155-119 ealth services/systems xvi-xvii pregnancy Integrated Management of Childhood lIness(IMCI) 112-119 maternal, neonatal and child health xvii, xxii, xxi, 93-98 adverse circumstances xy 114-119,133,137 cause of death, disease or disability xx, 10, 64-6 sector-wide approach(SWAp) 128, 129, 137 dangers 42, 44-46 emergency care 9 ectopic 45 hopes and expectations 42-43 appropriate oxytocin use 94 illness during 44, 45 creased uptake of services 91 egal protection 52-53 mental ill-health 45 64.107.111.115 molar 45 mortality rates xiv, 10 Service Availability Mapping 128 sex ratio 85 professional care 86 sex selection 8 spacing 86 sexual assault/ coercion 49-50. 65. 85. 141 unwelcome xv. xxi. 13. 48-51 see also antenatal care xually transmitted infection pregnant women terra Leone. childbirth costs 139 marginalized skilled attendants status 41. 42 see also birth, skilled attendance; midwifery skills prematurity/low birth weight 79, 80, 81, 84 smoking cessation programmes 46 prepayment and pooling schemes xiv, xix, xxi, 137, 138-140 social, political and legal environments xv, xxi
index 227 Pakistan (continued) exclusion from health benefits 27 Lady Health Workers 112 number of births increasing 13 refugees 24 Pan American Health Organization 26 Papua New Guinea, user fees 138–139 Paraguay, exclusion from health benefits 28 parenting skills xx, 47, 86, 88, 108 Partnership for Safe Motherhood and Newborn Health 127 Peru abuse during pregnancy 47 exclusion from health benefits 28 placenta, disorders 45 pneumonia 104, 106, 110, 115 polio 104, 105 political aspects, of maternal, neonatal and child health xix, xxiii, 129–132, 141 political stability 130, 133, 134 post-abortion care see abortion, aftercare post-crisis situations 133 see also humanitarian crises postnatal visits, low take-up 74 postpartum period care xv, xxi, 73–74 deaths 62 poverty caused by health care costs xiv, xviii, 28, 140 effect on health care systems xiv, 21–23 effect on maternal, neonatal and child health xx reason for exclusion 28–29 poverty reduction strategy 127, 128, 141 Poverty Reduction Strategy Papers (PRSPs) 128, 129 pre-eclampsia see eclampsia and pre-eclampsia pregnancy abuse during 47 adverse circumstances xv cause of death, disease or disability xx, 10, 64–65 complications 44, 45, 62 dangers 42, 44–46 ectopic 45 hopes and expectations 42–43 illness during 44, 45 legal protection 52–53 mental ill-health 45 molar 45 mortality rates xiv, 10 outcomes xx–xxi, 49 professional care 86 spacing 86 unwelcome xv, xxi, 13, 48–51 see also antenatal care pregnant women marginalized 52 social, political and legal environments xxi status 41, 42 prematurity/low birth weight 79, 80, 81, 84 prepayment and pooling schemes xiv, xix, xxiii, 137, 138–140 primary health care movement 3, 31, 32, 35, 73, 103–105, 112 professional staff see health care workers public health aspects, maternal, neonatal and child health xix, 2–3, 6–7, 45, 47, 52 public sector health care xviii, xix, 134–136, 138, 141 R Reaching Every District initiative 115 referral see hospitals, referral refugees access to abortion 51 in Pakistan 24 parasuicide 65 Rwandan 25 registration of births and deaths 11, 12 reproductive health indicators 212 universal access to care xiv, 6, 125 see also contraception reproductive tract infections 86 resource availability, lack of information 128 resuscitation skills 86, 87 reversals, in mortality rates xiv, xv, xix, 11, 13, 16, 82, 83 rituals surrounding birth 69 rubella vaccination 80, 86 rubella virus infection 79–80 Rwanda 25, 87 S sample surveys 12 scaling up economic aspects 97, 98, 155–119 health services/systems xvi–xvii Integrated Management of Childhood Illness (IMCI) 112–119 maternal, neonatal and child health xvii, xxii, xxiii, 93–98, 114–119, 133, 137 sector-wide approach (SWAp) 128, 129, 137 Senegal emergency care 93 health centres 32 inappropriate oxytocin use 94 increased uptake of services 91 midwifery training 72 sepsis 23, 63, 64, 107, 111, 115 see also infection Service Availability Mapping 128 sex ratio 85 sex selection 85 sexual assault/coercion 49–50, 65, 85, 141 see also violence sexually transmitted infections 126 Sierra Leone, childbirth costs 139 skilled attendants definition 70 see also birth, skilled attendance; midwifery skills smoking cessation programmes 46 social, political and legal environments xv, xxi
228 The World Health Report 2005 social exclusion Sweden es xxI abuse during pregnancy 47, 72 see also exclusion midwifery training 72 social health insurance 138 Switzerland, abuse during pregnancy 4 socioeconomic development 84-85, 130 socioeconomic inequalities 25, 29-30 solid fuels, indoor air pollution 110 South africa human resources crisis 33 Tajikistan Nn of health system 67-68, 127 ser fees eliminated 139 Tanzania (United Republic of) exclusion 27 28. 139 unsafe abortions 50 health workers 110. 113 see also Americas(Region of the); Latin America South Korea, sex ratio 85 South-East Asia Region tax-based systems xvii, 137, 138, 140 child mortality 8-9 technical knowledge/technology xiv-Xvi, xxii, health districts 90 132 immunization coverage 26 maternal deaths 62 as cause of death xv. 80.81. 106 midwifery training 72 immunization 81. 86. 115 skilled attendance at birth 92 Thailand stillbirths and neonatal deaths 79. 82 child health programmes 4 Sri Lanka financial first-level midwifery care 73 first-level midwifery care 73 incentives for rural health 136 maternal mortality 65-66 neonatal deaths 8 tobacco see lifestyles, unhealthy postnatal visits 74 sustained improvements 130 salaries and incentives 33 statistical modelling, difficulty of interpreting 11, 12 skilled care at birth 86 stillbirths xiv,xxi,9,49,62,64,79-80,88,94 traditional birth attendants 66.70. 89 90 strategic choices xiv-Xvi, 125-129 transport to hospital 112 ub-Saharan Africa tuberculosis xiv, xxi. 23. 45. 46. 127 caesarean section rates 94 Tunisia, child mortality 105 effects of hiviaids xx 23 exclusion from health care 26 health districts 90 human resources crisis 33 trained health workers 113 maternal deaths nal mortality 23 maternal mortality 12 psychiatric morbidity in pregnant women 45 United Kingdom abuse during pregnancy 47 reversals in mortality xv, 82, 83 midwifery training 72 killed attendance at birth 92 suicide as cause of maternal mortality 65 tillbirths and neonatal deaths 9.79 United Nations unted and underweight children 9 uptake of antenatal care 42 Universal Declaration of Human Rights ubstance abuse see mental ill-health see also Millennium Development Goals Sudan, post-crisis situation 133 United Nations Childrens Fund (UNICEF) 11, 44, 91, 104 udden infant death syndrome 45 United Nations International Conference on Population and uicide or self-harm 65 Development xiv, 5 see also mental ill-health United Nations Population Fund 11, 64, 91 urvival gap, between rich and poor 30, 31 niversal access see access to care, universal; exclusion SWAp see sector-wide approach Inmet Obstetric Needs Network 2 waziland, private sector 33 user fees xvii, xxi, 53, 138, 139
228 The World Health Report 2005 social exclusion sources xxi see also exclusion social health insurance 138 socioeconomic development 84–85, 130 socioeconomic inequalities 25, 29–30 solid fuels, indoor air pollution 110 South Africa human resources crisis 33 user fees eliminated 139 South America unsafe abortions 50 see also Americas (Region of the); Latin America South Korea, sex ratio 85 South-East Asia Region child mortality 8–9 health districts 90 immunization coverage 26 maternal deaths 62 midwifery training 72 skilled attendance at birth 92 stillbirths and neonatal deaths 79, 82 Sri Lanka emergency care 93 first-level midwifery care 73 maternal mortality 65–66 neonatal deaths 85 postnatal visits 74 sustained improvements 130 statistical modelling, difficulty of interpreting 11, 12 stillbirths xiv, xxii, 9, 49, 62, 64, 79–80, 88, 94 strategic choices xiv–xvi, 125–129 sub-Saharan Africa caesarean section rates 94 effects of HIV/AIDS xx, 23 exclusion from health care 26 health districts 90 health expenditure 32 human resources crisis 33 maternal deaths 62 maternal mortality 12 number of births increasing 13 poverty 22 reversals in mortality xv, 82, 83 skilled attendance at birth 92 stillbirths and neonatal deaths 9, 79 stunted and underweight children 9 uptake of antenatal care 42 see also African Region substance abuse see mental ill-health Sudan, post-crisis situation 133 sudden infant death syndrome 45 suicide or self-harm 65 see also mental ill-health survival gap, between rich and poor 30, 31 SWAp see sector-wide approach Swaziland, private sector 33 Sweden abuse during pregnancy 47, 72 midwifery training 72 Switzerland, abuse during pregnancy 47 syphilis 86 T Tajikistan, breakdown of health system 67–68, 127 Tanzania (United Republic of) exclusion 27, 28, 139 health workers 110, 113 ICMI implementation 113 user fees 138–139 tax-based systems xviii, 137, 138, 140 technical knowledge/technology xiv–xvi, xxii, 85, 127, 128, 129, 132 tetanus as cause of death xv, 80, 81, 106 immunization 81, 86, 115 Thailand child health programmes 4 financial coverage 140 first-level midwifery care 73 incentives for rural health 136 maternal mortality 66–67 tobacco see lifestyles, unhealthy Togo salaries and incentives 33 skilled care at birth 86 traditional birth attendants 66, 70, 89, 90 transport to hospital 112 tuberculosis xiv, xxi, 23, 45, 46, 127 Tunisia, child mortality 105 U Uganda District Development Programme 128 IMCI-trained health workers 113 maternal mortality 23 psychiatric morbidity in pregnant women 45 United Kingdom abuse during pregnancy 47 midwifery training 72 suicide as cause of maternal mortality 65 United Nations human rights initiatives 5 position on abortion 51, 52 Universal Declaration of Human Rights 3 see also Millennium Development Goals United Nations Children’s Fund (UNICEF) 11, 44, 91, 104 United Nations International Conference on Population and Development xiv, 53 United Nations Population Fund 11, 64, 91 universal access see access to care, universal; exclusion Unmet Obstetric Needs Network 27 user fees xviii, xxiii, 53, 138, 139
index 229 nization/vaccination vacuum extra 71 ertical prog xx32,35,103-106,114,127,129 Viet Nam neonatal deaths 85 social insurance schemes 139 suicide as cause of maternal mortality 65 against pregnant women xv, 47, 52 associated with unintended pregnancies 50 related xxi,5,45,47,52,85 see also women egistration 11, 12 underreported 9 vitamin a25,34,107,109,115 W hild mortality ix, 8-9 mmunization coverage 26 maternal and neonatal mortality 10, 82 women barriers to health care 26 effect of sex selection 85 perceived as ignorant 28 rights and entitlements 4, 5, 7 status xxi. 49-50. 52. 88 womens groups 3, 88, 110 discrimination xy. xxi azards 45 World Health Assembly 104, 105, 142 World Health Organization(WHO basic indicators for member states 174 encouragement of TBA strategy 70 Expanded Programme on Immunization XXii, 104 guidelines on pregnancy care 45, 48, 91 neonatal mortality estimates 8 promotion of maternal and child health and welfare 3 role in antenatal screening 69 scaling-up scenarios 93 younger women see adolescent girls human resources crisis 33 maternal mortality 23 unsafe abortion 51 Zimbabwe. human resources crisis 33
index 229 V vaccination see immunization/vaccination vacuum extraction 71 vertical programmes xxii, 32, 35, 103–106, 114, 127, 129 Viet Nam neonatal deaths 85 social insurance schemes 139 suicide as cause of maternal mortality 65 violence against pregnant women xv, 47, 52 associated with unintended pregnancies 50 criminalized 53 gender-related xxi, 5, 45, 47, 52, 85 see also women vital statistics registration 11, 12 underreported 9 vitamin A 25, 34, 107, 109, 115 W Western Pacific Region child mortality ix, 8–9 immunization coverage 26 maternal and neonatal mortality 10, 82 women barriers to health care 26 effect of sex selection 85 perceived as ignorant 28 rights and entitlements 4, 5, 7 status xxi, 49–50, 52, 88 women’s groups 3, 88, 110 workplace discrimination xv, xxi hazards 45 World Health Assembly 104, 105, 142 World Health Organization (WHO) basic indicators for Member States 174 encouragement of TBA strategy 70 Expanded Programme on Immunization xxii, 104 guidelines on pregnancy care 45, 48, 91 neonatal mortality estimates 82 promotion of maternal and child health and welfare 3 role in antenatal screening 69 scaling-up scenarios 93 Y younger women see adolescent girls Z Zaire 32 see also Congo (Democratic Republic) Zambia human resources crisis 33 maternal mortality 23 referrals to hospital 44 unsafe abortion 51 Zimbabwe, human resources crisis 33