Annual UN Inter- Agency Support Group on Indigenous Peoples Issues 22 November 2011

1. Unfpa-supported Maternal Health interventions in three asian countries: china, Philippines, Vietnam Annual UN Inter- Agency Support Group on Indigenous Peoples Issues 22 November 2011

2. CHINA - background • 55 ethnic minorities - 105 million people (8.1% total pop) • Southwest China: Yunnan 14.5 m. ethnic minority pop. Guizhou 13.6 m. ethnic minority pop. • Constraints: less developed, poorer, geographical challenges Higher MMR and IMR among minorities: home deliveries unattended by skilled providers, poor uptake of ANC & PNC, high anemia in pregnant women Cultural barriers – traditional beliefs & practices

3. Spanish MDG Fund: Improving MCH in Minority Areas 2009 –2011 • UNFPA supported base & end-line qualitative studies in 6 counties, among 6 ethnic groups: Miao, Dong, Jingpo, Dai, Hui and Tibetans • Ethnic minority researchers used wherever possible • Data collected on: • traditional & spiritual practices relating to maternal and child health and health-seeking behaviour • harmful practices (delivery-related, dietary restrictions, feeding practice for infants and young children etc.) • perceived barriers of minorities to uptake of MCH services • community suggestions for increasing uptake of services

4. UNFPA inputs to improving service delivery • Manual developed on culturally sensitive service provision; each training includes inputs from minority people in person • IEC materials in local languages developed; MCH messages transmitted through ethnic cultural media • Local religious/spiritual leaders consulted & involved Advocacy at local and national levels: resulted in the National Centre for Women and Children’s Health recognizing value of ‘culturally sensitive’ programming & adopting the tool for minority areas

5. Achievements: Improved access to and uptake of MCH services in project counties Annual percentage increase in Hospital Delivery Rate and Antenatal Care coverage (%) % Data source: Baseline survey & endline survey; & China Health Statistical Abstract, 2011

6. PHILIPPINES: background • 10-15% total population (between 6.5 and 12 million people) are IPs comprising 110 ethno-linguistic groups • National MMR is 162 per 100,000 live births MMR among IPs (data is available in 3 IP Provinces: Bukidnon (2009 FHSIS): 18 deaths/ 1,000 pop.; North Cotabato 14 deaths/1,000 pop. ; Misamis Oriental 8 deaths/ 1000 population • Challenges: securing availability of FP supplies & other life saving RH commodities, geographical isolation, difficult terrain, security

7. Community Empowerment to advance RH and rights among IPS in Mt. Province and Ifugao • Participatory Community Needs Assessment • Strengthening of IP organizations for RH service delivery and referrals for FP and EmONCcases • RH and gender education informed by needs assessment findings, designed to use IP community health systems • Federation building of IP organizations as a sustainability mechanism

8. Achievements • Network of community RH advocates established • Mechanisms in place for dialogue between health providers & community leaders to ensure inclusive community health planning • Revitalization of the “Ayod” system (indigenous term for hammock, also system for transporting sick people to traditional healer or health clinic) • Emergency health fund from livelihood incomes established for women with pregnancy-related complications • IEC developed in local languages, used for awareness raising • Increased male involvement (adoption of non scalpel vasectomy)

9. VIETNAM: Background • 13.7% population ethnic minorities, located mainly in remote mountainous and coastal regions • Socio-economic and health status of EMs low compared to national average, especially in mountainous areas • National MMR is 69 per 100,000 live births (MOH, 2010) • MMR is over 200/100,000 live births in mountainous and remote regions • Diff. terrain & cultural barriers affect access to services • Health services in general, and RH services in particular, are under-utilized in ethnic minority regions

10. Addressing high maternal mortality • A 2009 national maternal mortality assessment identified major causes of high maternal deaths: • shortage of skilled birth attendants • poor capacity of service providers in EM regions • cultural barriers limited access to RH services (even when basic EmOC services were available, they were under-utilized). • National Safe Motherhood Master Plan 2003-2010 was developed by MoH supported by UNFPA (in collaboration with UNICEF and WHO). • Focusing on reduction of maternal mortality, the following approach was adopted: • Improve skills and competencies of RH providers to deliver BEmOC and CEmOC in mountainous and difficult-to-reach regions: network of ethnic minority midwives established; their work is monitored by the MOH • Conduct culturally sensitive community-based activities using behavior change approach to create demand for RH services • Develop and implement appropriate local human resource policies to ensure availability of trained birth attendants in mountainous and difficult-to-reach villages

11. Ethnic minority midwifery training Why special training programmes? • Home deliveries are common, and unsafe for women • Poor socio-economic status results in high drop out rates amongst ethnic minority girls • Few people from local communities complete high school (minimum condition for formal midwifery training courses) • Two training programmes developed for ethnic minority with low education levels; participants selected by communities

12. Focus of the two ethnic minority courses • 6 month training programme : • Focuses on normal deliveries, early detection of complications and referral of complicated cases to higher levels. • So far, the programme has trained 783 ethnic minority midwives, most of whom have returned home to serve their local communities • 18 month training programme: • Initiated in 2007, this 18-month programme has been piloted in three mountainous and coastal provinces. • Building on the 6-month programme, it focuses more on skills required for management of complicated deliveries. • By the end of 2011, the first 78 ethnic minority womengraduatedand returned to work at their community

13. Challenges and the way foward • Challenges: • Retention and recognition from authorities • Supportive supervision and quality assurance of services • Way forward: • Document cost effective evidence of the interventions • Support development and implementation of evidenced-based policies on human resource policies including ethnic minority midwives • Support the government to scale up best practices of the interventions in ethnic minority regions