Millennium Development

Goals In Reproductive Health

Dr Rashmi Khandelwal
 The Millennium Development Goals
(MDGs) and targets come from the
Millennium Declaration signed by 189
countries, in September 2000
 The goals & targets
- inter-related
- represent a partnership between
developed countries and developing
countries
 MDGs
 8 Goals
 18 Targets
 48 Indicators

To be achieved by 2015
Millennium Development Goals (MDG)
 Goal 1: Eradicate Extreme Poverty and Hunger
 Goal 2: Achieve Universal Primary Education
 Goal 3: Promote Gender Equality and Empower Women
 Goal 4: Reduce Child Mortality
 Goal 5: Improve Maternal Health
 Goal 6: Combat HIV/AIDS, Malaria and Other Diseases
 Goal 7: Ensure Environmental Sustainability
 Goal 8: Develop a Global Partnership for Development
Why MDGs ?
 Goals are simple, emotive, measurable
 Accepted and endorsed by all
 Challenge to the notion of development as economic
growth
 Conceptual lens to evaluate government policies
 Means to hold governments and donor countries
accountable for results
MDG 5: Improve Maternal health
Target 5: Reduce by three quarters the
maternal mortality ratio

 5.1 Maternal mortality ratio (MMR)

 5.2 Proportion of births attended by skilled health

personnel
Revised MDG 5 (2005)
 Target 5.A:
Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
5.1 Maternal mortality ratio
5.2 Proportion of births attended by skilled health personnel

 Target 5.B:
Achieve universal access to reproductive health by
2015
5.3 Contraceptive prevalence rate
5.4 Adolescent birth rate
5.5 Antenatal care coverage (at least one visit and at
least four visits)
5.6 Unmet need for family planning
Maternal mortality ratio( per100,000 live births)

The Maternal Mortality Ratio (MMR) is the number

of women who die from any cause related to or
aggravated by pregnancy or its management (excluding
accidental or incidental causes) during pregnancy and
childbirth or within 42 days of termination of pregnancy,
irrespective of the duration and site of the pregnancy,
per 100,000 live births

The latest estimate of deaths about 530,000 a year (WHO,

UNICEF, and UNFPA ).
MMR (state wise)

States 1997-98 1999-01 2001-03 2004-06

India Total 398 327 301 254

Karnataka 245 266 228 213

Tamil 131 167 134 111

Nadu
Kerala 150 149 110 95
Uttar 606 539 517 440
Pradesh
Assam 568 398 490 480
 MMR ( per 100,000 live births)

700
600
500
India
400
Karnataka
300 Tamil Nadu
200 U.P
100 Kerala
0
1996- 1999- 2001- 2004-
98 01 03 06
Millennium Development Goals – India Country Report 2009
Target MMR of 109 by 2015
 National MMR
398 (1997-98)

(36% decline)

254 (2004-06)
India tends to fall short by about 26 points as it tends to reach MMR of
about 135 per 100,000 live births in 2015
 Proportion of birth attended by skilled health
personnel

33%(1992-93)

47%(2005-06) INDIA

52%(2007-08)

62%(2015) Target is 100%

Andhra Pradesh, Goa, Karnataka, Kerala, Punjab, Sikkim and

Tamil Nadu are likely to reach universal coverage by 2015
 Proportion of birth attended by skilled health
personnel (2006-08)

100
90
India
80
Arunachal Pradesh
70
Assam
60
Meghalaya
50
Karnataka
40
Tamil Nadu
30
Bihar
20
Target
10
0
Millennium Development Goals – India Country Report 2009
Achieve universal access to reproductive health
by 2015

 Ability to achieve sexual and

reproductive health
 Equitable access
Contraceptive Prevalence Rate

Percentage of women between 15-49 years who are

practicing, or whose sexual partners are practicing,
any form of contraception

- indicator of health, population, development and

women's empowerment

- serves as a proxy measure of access to reproductive

health services
 Contraceptive Prevalence Rate
90%
80%
70% India
60% UK
50% USA
40% Pakistan
30% China
20% Norway
10%
0%
World Health Statistics 2010
Adolescent birth rate

 Annual number of births to women 15 to 19 years of

age per 1,000 women in that age group.

 Risk of childbearing among adolescent women

 Pregnancy will most times be an end to a young

mothers education, furthering the cycle of a poor
education and poverty
Adolescent birth rate (per 1000 girls aged 15-19
years)

55(1996-97)

51 (2000-01) India

45 (2006-07)
Adolescent birth rate (per 1000 girls aged 15-19
years)

120

100

80 China
Canada
60 India
UK
40 Nepal
20

0
World Health Statistics 2010
Antenatal care coverage
 The percentage of women aged 15-49 with a live
birth in a given time period that received antenatal
care four or more times.
 Women should receive care from a trained health-care
practitioner at least four times during the course of their
pregnancies,
(WHO and UNICEF Recommendations).

 Less than half of pregnant women in developing regions

and only a third of rural women receive the recommended four
visits
(The Millennium Development Goals Report,2010 : United Nations)
 Antenatal care coverage
100%
90%
80%
70% India
60%
Pakistan
50%
Nepal
40%
USA
30%
20% UK
10%
0%
1 visit 4 visit

World Health Statistics 2010

Unmet Need For Family Planning

Lead to unintended pregnancies

Less developed countries – ¼ pregnancies are unintended

Unwanted pregnancies result in

-unsafe abortion maternal death and injury

-unwanted births risk for health & well being

of child

rapid population growth

increasing the burden on

family
 Unmet Need For Family Planning

25.00%

20.00%
USA
15.00%
UK
10.00% India
Nepal
5.00%

0.00%

World Health Statistics 2010

 MDG 3
Gender Equality & Women
Empowerment

MDG 5

MDG 2 Maternal Health MDG 6 Combat HIV /

Increasing Primary
AIDS & Malaria
Education

Other MDGs Related to Maternal Health

How can MDG 5 be achieved?
 Maternal mortality strategies should focus on building a
functioning primary health care system from first referral
facilities to the community level

 Emergency obstetric care must be accessible for all women who

experience complications in pregnancy and childbirth.

 Skilled birth attendants, whether based in facilities or

communities, should be the backbone of the system.

 Skilled attendants for all deliveries must be integrated with a

functioning district health system that supplies, supports and
supervises them adequately
Achieving Millennium development Goal of
improving maternal health

Universal access to
Basic Reproductive Health Care Services
-contraceptive services and supplies (family planning);
-abortion and treatment of post abortion complications;
-voluntary sterilization services; basic infertility services;
-management of STDs (including HIV and cancers of
the reproductive system)
- maternity care, including prenatal, delivery and
postnatal care.
Emergency Obstetric Care (EmOC)

 Depending on the functions

Comprehensive Emergency Obstetric care
Basic Emergency Obstetric Care

UN recommends : per 500,000 population

1 Comprehensive EmOC
4 Basic EmOC
Functions of Basic and Comprehensive
Emergency Obstetric Services

Basic Comprehensive
-Administer parenteral All services included in
antibiotics,oxytocic & basic emergency
anticonvulsant obstetric care plus
-Perform manual removal of -Perform surgery
retained products (cesarean section)
-Perform assisted vaginal
delivery
-Blood transfusion
facilities
References
 World Health Statistics 2010
 Millennium Development Goals – India Country Report 2009; Central
Statistical Organization, Ministry of Statistics and Programme
Implementation, Government of India
 WHO. The World health report 2005: make every mother and child
count. Geneva: World Health Organization, 2005.
 Government of India Ministry of Family Health and Welfare. The
national rural health mission framework for implementation, 2005–
2012.New Delhi: Government of India, 2005.
 Allan Rosen field, Deborah Maine, Lynn Freedman: Meeting MDG-5: an
impossible dream? The Lancet,2006:368:1129-31
 The Millennium Development Goals Report,2010 : United Nations
Thank You