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UNFPA-Supported Maternal Health Interventions in Three Asian Countries: China, Philippines, Vietnam

This report highlights UNFPA-supported maternal health interventions in China, Philippines, and Vietnam, focusing on addressing cultural barriers, improving access to services, and reducing maternal mortality rates. The interventions include training healthcare providers, developing culturally sensitive materials, involving local religious/spiritual leaders, and advocating for minority-specific programming.

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UNFPA-Supported Maternal Health Interventions in Three Asian Countries: China, Philippines, Vietnam

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  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

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