Analytical summary - Maternal and newborn health
Preventive health care for children is part of the integrated primary health care services under sexual and reproductive health services and starts before the child is conceived, through family planning and antenatal care with prevention of mother-to-child transmission where appropriate.
Childbirth occurs under skilled care. A course of immunization is provided to children aged under 5 years (see Table 1), and the child’s growth and development is monitored. Breastfeeding is encouraged where it is appropriate and supplementary feeding is provided for at-risk children. Insecticide-treated bednets are provided to pregnant women and infants in malaria-prone areas.
Botswana has seen declining fertility and population growth rates during the past few years. Although teenage childbearing is a major problem in the country, teenage fertility has shown a decline from 23.7% in 1988 to 11.8% in 2006. Abortion performed by a qualified medical practitioner is allowed during the first 6 weeks of pregnancy under conditions of rape or incest, fetal impairment, and when pregnancy carries a risk to the woman.
Antenatal care attendance in Botswana is the highest in the WHO African Region at 97%. Attendance by skilled provider for pregnant women and those in childbirth was 98.5% in 2000, 94% in 2006 and 99% in 2009. Infant mortality rate has been declining since 2004 (see Table 2).
However, maternal mortality remains high, especially for young mothers. Ratios for 1991 and 2007 were 326 and 193 per 100 000 live births, respectively. Sepsis, toxaemia and haemorrhage are the three main causes of maternal death.
Botswana has a successful Prevention of Mother-to-Child Transmission Programme that has been integrated into its antenatal care services. The Programme has reduced HIV transmission from the expected 35–40% to about 3% as in 2007. The proportion of antenatal care women testing for HIV was 83% and 81% in 2006 and 2007, respectively; 90% of HIV-positive women have enrolled in the Prevention of Mother-to-Child Transmission Programme.
The success of Botswana's Prevention of Mother-to-Child Transmission Programme may be partly attributable to the high political commitment coupled with a liberal attitude toward new developments in HIV care, effective partnership and collaboration, as well as intensive resource mobilization and advocacy on the part of the Government.