“ACHIEVING MATERNAL AND CHILD HEALTH GOALS”-AFRICAN YOUTH CALL FOR ACTION INTRODUCTION The health of mothers and children is central to global concerns; improvements in maternal and child survival are two important Millennium Development Goals. The MDGs specifically deal with maternal and child health, Goal Four aims to reduce child mortality by two-thirds between 1990-2015, while Goal Five is to reduce maternal mortality ratio (the number of maternal deaths per 1000) by three-fourths during the same period. Apart from the obvious linkages between health programmes, mother and child health is intimately bound up with economic development, education, gender issues and rights. MATERNAL, INFANT AND CHILD HEALTH SITUATION IN: Africa Key points to note in MNCH situation in Africa are: • Sub-Saharan countries are lagging behind other regions in progress towards MDG 1, 4 and 5 targets. • Worldwide, 536 000 women lose their life during pregnancy and childbirth every year. The world map below indicates the magnitude of the maternal mortality ratio. Maternal mortality ratio is by far the highest in Sub-Saharan Africa, where 1 in 23 women faces life time risk of dying, when compared to 1 in 2300 in Europe" • Children living in Africa have a much higher chance of dying before the age of five, and among those, are the children of the poorest families who will suffer most. Of these 1 in 4 deaths occur during the neonatal period • There is no sub-Saharan country among the 63 on track for attainment of MDG 1, with 54% of childhood mortality being associated with under nutrition.
Kenya With only six years left to the Millennium Development Goal (MDG) date, there has been a reduction in infant and under five mortality. However, maternal and newborn health indicators in Kenya have generally stagnated or show very marginal improvement. The recently released KDHS revealed the following: • Reduction in Infant Mortality from 77 to 52/1000 • Reduction in Under Five Mortality from 115 to 74/1000 • Newborn mortality rate has reduced from 33 to 31/1000 • Delivery by a health care professional has increased from 42 to 44% • Delivery in a health facility increased from 40 to 43% but with some regions reporting only 17% delivery in a health facility • FP contraceptive prevalence rate has increased from 39 to 46% • Maternal mortality ratio has decreased from 414 to 410/ 100 000 • Breastfeeding coverage In the recently concluded survey, Kenya Demographic and Health Survey (KDHS) 2008 indicate that: • All maternal health indicators remain poor. Kenya is 14th in the list of the worst 20 countries that contribute the highest numbers of maternal deaths • Child Survival has improved but is being pulled back by the high newborn deaths. (In 2008 DHS, neonatal mortality has increase to 60% of the IMR, up from 45% in 2003). • Nutritional indicators have also largely remained unchanged over the last decade.
These changes are still way below the National as well as the MDG targets. Kenya therefore like other sub Saharan Africa countries has to put in place strategies to accelerate the reduction in maternal, newborn and child morbidity and mortality. With NMR contributing over 60% of IMR, we know that if this is addressed, we will be able to attain MDG 4. However issues of the newborn cannot be addressed separately as they are intrinsically entwined with pregnancy, labour, delivery and postpartum care. Hence addressing maternity care automatically translates to improved newborn health. Many stakeholders are expressing greater interest in investing in Maternal and Newborn health. Key policy documents have been developed including the National MNH Road Map which is almost finalized, the Child Survival and Development Strategy and the Infant and Young Child Feeding Strategy and the National MNH Road Map. These key policy documents clearly outline the broad strategies and priority actions necessary to accelerate the reduction in maternal and newborn morbidity and mortality. The priority interventions therefore need to be adapted by the districts and included in the Annual Operational Plans. YOUTH AND MCH Adolescent health: Child bearing begins early in Kenya putting many children at risk of maternal morbidity and mortality. Almost a quarter of young Kenyan women aged 15-19 years have begun child bearing, which means that they are either pregnant with their first18 child or are already mothers (KDHS 2003). Teenage pregnancy leads to disruption of young people’s education and reduces future potential of a good life. Currently DHS data show higher rates of fertility among adolescents. The proportion of adolescents aged 15-19 that are pregnant remained static since 2003 at around 21 percent. With this in mind, there is therefore need to provide reproductive health information and services to the youth aged 10 to 24 years who are sexually active to assist them to prevent and thus reduce the incidence of reproductive health related problems, which will in turn boost MCH among the youth.
RECOMMENDATIONS To improve MCH, by reducing the MMR and IMR according to the MDGs depends largely on every mother and child having the right to access health care from pregnancy throughout the lifecycle. The following are the recommendations: • Organize Maternal and Child Health Weeks at grassroot level: sensitize the youth/ community on diarrheal management, pneumonia management, maternal and pediatric nutrition and the importance of hand washing. • Introduce and facilitate adoption of ‘maternal survival tool kit’-this explores ways of influencing behaviors’ and encouraging use of health services and health professionals during child birth and postpartum period. The toolkit stresses on locally appropriate behaviour based interventions integrating what happens in homes, communities and health facilities. Topics covered are: seeking skilled care, seeking skilled care early postpartum, birth preparedness and providing skilled care to organizations and individuals • Training of youth CHWs and CORPs on MCH to take a leading role in the community sensitization on the its importance • Lobbying and advocacy for reconciling maternal, newborn and child health with the health system development, currently its place is within the wider context of health system development. It is no longer discussed in purely technical terms but as part of a broader agenda of universal access. • Lastly, sensitize the youth on the role of MNCH and family planning in STI/HIV control and management since it’s currently a national pandemic as declared in October 1999 by former President of the Republic of Kenya, Daniel Toroitich Arap Moi