Analytical summary - Maternal and newborn health
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The Government of Malawi is implementing a comprehensive and integrated sexual and reproductive health programme at all levels. The National Sexual and Reproductive Health and Rights Policy 2009 provides the framework for the implementation of the sexual and reproductive health programmes.
This Policy incorporates emerging issues in the various components of sexual and reproductive health in line with both national and international recommendations, including:
- basic emergency obstetric and neonatal care
- community-based neonatal care
- cervical cancer screening
- youth-friendly health services
- antiretroviral therapy and prevention of mother-to-child transmission therapy.
These emerging issues are in line with other policy guidelines, such as the:
- African Union sexual and reproductive health policy guidelines
- Maputo Plan of Action
- Malawi Growth and Development Strategy
- Health Sector Strategic Plan
- Millennium Development Goals
- Road map for accelerating the reduction of maternal and neonatal mortality and morbidity in Malawi
- Malawi Gender Policy.
Trends in neonatal and postneonatal mortality rates show that although neonatal mortality has declined from 41 deaths per 1000 live births to 31 deaths per 1000 live births and postneonatal mortality has declined from 94 deaths per 1000 live births to 35 deaths per 1000 live births, it is still a problem.
Sentinel surveillance surveys on HIV in pregnant women attending antenatal clinics have been carried out in Malawi since the 1980s to measure HIV in pregnancy. Available data from sentinel sites indicate the HIV prevalence among pregnant women aged 15–24 years increased from 18.5% in 1995 to 23.1% in 1999. A sentinel surveillance survey conducted in 2007 shows a prevalence of 12.3%.
The implementation of a sexual and reproductive health policy requires systems strengthening of provision of adequate financial and human resources to improve intervention coverage. The Ministry of Health is mobilizing financial resources through both pooled and discrete development partners to ensure adequate resources are allocated for sexual and reproductive health programmes.
The Ministry of Health has developed a Human Resources Development Plan and the implementation of the Plan will result in a large pool of human resources for the health sector. This will eventually lead to an increased number of skilled health workers providing integrated sexual and reproductive health services.
Programme intervention coverage implemented for maternal and newborn health in Malawi includes family planning, antenatal care, maternal services and postnatal care. The need for family planning services arises from the risks of maternal, infant and child morbidity and mortality when pregnancies are too early, too many, too late and too frequent and from a high fertility rate of 6.0. The need is compounded by a population density of 189 per square kilometre (2008 census) and limited resources.
In addition, the unmet need for family planning in Malawi is still high at 28%. The Demographic and health survey 2010 results indicate that the contraceptive prevalence rate is 46% among the currently married using any method of contraception, an increase from 33% in the Demographic and health survey 2004. Antenatal care from a skilled attendant is important to monitor the pregnancy and reduce the risk of morbidity for mother and baby during pregnancy and delivery.
In Malawi, the focused antenatal care approach is part of the Essential Health Care Package and includes maternal and neonatal health guidelines as outlined in the National Reproductive Health Strategy, 2006–2010 and the Road map for accelerating the reduction of maternal and neonatal mortality and morbidity in Malawi. The National Reproductive Health Strategy provides guidelines for improving access to skilled attendants at childbirth and for improving the availability of, and access to, quality emergency obstetrical care.
Malaria prevention in pregnancy relies on both the use of insecticide-treated mosquito nets and intermittent preventive treatment. The policy guidelines for intermittent preventive treatment require a pregnant woman to take at least two treatment doses of an effective antimalarial drug to protect her and her baby from malaria during routine antenatal care visits. The Demographic and health survey 2010 shows that among pregnant women aged 15–49 years, 43% reported sleeping under any net the night before the survey while 35% slept under an insecticide-treated net.
Assistance during childbirth is an important variable influencing the birth outcome and the health of the mother and infant. Child delivery is increasingly taking place in health facilities where medical personnel assist in the delivery. Between 2005 and 2009, child delivery in health facilities increased from 59% to 75%. Contributing factors include:
- the implementation of service-level agreements between district health officers and the Christian Health Association of Malawi in the provision of maternal and child services;
- the changing roles of traditional birth attendants from conducting delivery to referring pregnant women to deliver in health facilities;
- the construction of basic emergency obstetric and neonatal care sites throughout the country has contributed to more child deliveries taking place in health facilities.
The Health Sector Strategic Plan has developed strategies to increase skilled attendant deliveries so as to reach the Millennium Development Goal target by 2015. One of the crucial strategies is increasing the availability of trained midwives in all maternity units.
Available data show that nearly half (48%) of women do not receive any postnatal care. Among women who do receive a postnatal check-up within 2 days of delivery (43%), 26% were seen in less than 4 hours, 6% were seen in 4–23 hours and 11% were seen within 2 days. A total of 7% of women received their first postnatal check-up between 3 and 41 days after delivery.
- ↑ 1.0 1.1 1.2 Malawi demographic and health survey 2010 (pdf 3.85Mb). Zomba, National Statistical Office and Calverton, Maryland, ICF Macro, 2011
- ↑ Malawi demographic and health survey 2004 (pdf 3.99 Mb). Zomba, National Statistical Office and Calverton, Maryland, ICF Macro, 2005
- ↑ Road map for accelerating the reduction of maternal and neonatal mortality and morbidity in Malawi (pdf 179.93kb) Lilongwe, Government of Malawi, Ministry of Health, 2005
- ↑ Malawi Health Sector Strategic Plan 2011–2016. Moving towards equity and quality (pdf 3.69Mb). Lilongwe, Government of Malawi, Ministry of Health, 2011