Lao PDR

Millennium Development Goal 5

Improve Maternal Health

It is widely acknowledged that to reduce maternal mortality, women need access to broader reproductive health services, especially family planning, ante-natal care, 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 progressed in reducing maternal mortality, from 650 deaths per 100,000 live births in 1995 to 405 in 2005. Irrespective of estimated progress, the maternal mortality ratio is one of the highest in the region, and it is a great challenge for Lao PDR to reach the MDG5 target given the current low levels of investment for maternal health. Reduction in maternal mortality 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 from complications during pregnancy or childbirth, 20 women survive but suffer from ill health or disability. Serious investments will be required for Lao PDR to achieve this target.

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 personnel increased by less than 5 percentage points between 1994 and 2005. Meanwhile, universal access to reproductive health is measured by indicators on access to and usage of contraception, antenatal care and adolescent fertility; while progress has been significant in access to and use of contraception, the proportion of births to women receiving antenatal care remains low, at 28.5 percent. Early marriage and pregnancy are still the norm in rural areas, where access to life-saving services in case of pregnancy-related complications is limited.

Meeting the targets: 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, however, 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 percent reduction in the age-specific fertility rate, along with 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 further progress on MMR.

In order to increase use of health services and provide the reproductive health care needed to improve maternal and neonatal health, investment in training and capacity strengthening 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.

Update from the 2010 report Beyond the Midpoint: Achieving the Millennium Development Goals:

Although improving, the maternal mortality rate of 405 per 100,000 live births in 2005 is among the highest in the region. Women lack access to skilled health personnel and adequate health infrastructure, and access to reproductive health services and rights to family planning are limited.