World Vision’s
Little Book of
Maternal
and Child
Health
in the Asia Pacic
Statistics and strategies to help bring Millennium
Development Goals Four and Five within reach
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© World Vision Asia-Pacic 2009
Stories researched and contributed by
World Vision communicators, 2008/2009
Editing and design: Katie Chalk

4
An introduction by Watt Santatiwat,
Vice President, World Vision Asia Pacic region
Maternal and child health and nutrition interventions
are complex issues for the Asia Pacic region.
As statistical indicators they measure the health of a
nation and the level of its development. But behind
those statistics are the shadows of many other urgent
development issues - gender inequality, massive wealth
discrepancies, inadequate education or public health
spending, and the tragedy of avoidable deaths through
under-prioritisation of women, children and the poor.
The Asia Pacic region has made some progress in
changing the health of mothers and children for the
better. But we still seriously lag behind in our efforts.
The region still makes up 43% of the world’s total
maternal deaths, and well over 40% of our children are
malnourished.
In our region, 18 of the 29 developing countries are
currently off-track to achieve Goal 4 – to reduce child
deaths by two-thirds, and 23 are off-track to achieve
Goal 5 – to reduce maternal deaths by three-quarters.
In 2010, World Vision will commence advocacy efforts
across the region to encourage solutions at national
Why health, why now?
level on maternal and child health. Each country faces
a different set of challenges, and no country can rest
just yet.
My home country of Thailand, for instance, has shown
what can be possible with appropriate investment of

and resources to improve the health of mothers
and children in the Asia Pacic’s most vulnerable
communities.
I urge governments and donors in the Asia Pacic to
recognise the way forward on sustainable, equitable
health solutions to protect mothers and their children.
It is at once a humanitarian duty and an investment in
the future resilience of every nation in the region.
Watt Santatiwat
August 2009
This book is for anyone with an interest in maternal
and child health, but in particular for people who can
play a role in strengthening it.
The Asia Pacic has some of the biggest health
challenges of any region. Here, health is a complex
issue, at the heart of community development and
wellbeing and yet held back by resources, attitudes and
traditions. These aspects come together as barriers
to deny fair access to health for more than half the
people living in the Asia Pacic.
As an international NGO with a strong grassroots
approach, World Vision is ideally placed both to deliver
health strategies in under-resourced communities, and
to recognise gaps that cannot be lled without the
support and mobilisation of others.
This book explores some of these gaps, as well as
potential solutions to ll them, by sharing stories
from World Vision’s eld experiences. A single story
may not constitute “evidence” but it can bring unique
insight into challenges, and how current health

Reduce child deaths
(under ve) by two
thirds by 2015
MDG Five:
Reduce maternal
deaths by three
quarters by 2015
Statistics and case studies in this book include only countries where World Vision is working in the Asia Pacic.
The summary above is based on World Vision’s 2009 report “Strategies that Work”:
http://wvasiapacic.org/downloads/publications/StrategiesThatWork.pdf
8
Under ve mortality rate
The probability (expressed as a rate per 1,000 live
births) of a child dying before reaching the age of
ve.
Infant mortality rate
The probability (expressed as a rate per 1,000 live
births) of a child dying before reaching the age of
one year.
Maternal mortality ratio
The probability (expressed as a rate per 100,000
pregnancies) of a woman dying during pregnancy,
childbirth or the rst 42 days after delivery.
Low birth weight
A birth weight of under 2,500 grams. Babies born
with a low birth rate are twenty times more likely to
die than babies born above the minimum weight of
2,500 grams.
Stunting
Measures height against age: usually caused by

Maternal and child health terms and denitions
9
Across Asia and the Pacic, World Vision’s child-
focused programmes are partnering at house-
hold, community and national level to:
• Improve standards and increase action around
maternal and child health
• Empower girls and women with the knowledge
to take good care of themselves and their
children, including nutrition, vaccinations, rst aid
and family health responses, and birth spacing
• Encourage governments and international
donors to nd ways to provide affordable, equal
access for all to healthcare, in particular services
for mothers and children under ve
World Vision is working
in nearly 90 countries
worldwide with health
interventions to support the
achievement of Millennium
Goals Four and Five.
Bangladesh
Cambodia
China
DPRK (North Korea)
India
Indonesia
Lao PDR
Mongolia
Myanmar

Statistics
All statistics in this section are taken from UNICEF’s
State of the World’s Children 2009 unless otherwise
noted.
11
Cambodia
% children underweight: 28%
Under 5 mortality (per 1000): 91
Living with improved water: 65%
Living with improved sanitation: 28%
Maternal mortality (per 100,000): 470
Despite many years of international aid and
involvement, Cambodia still has the second highest
level of child mortality in the region. Out of every
1,000 children, 91 die before their fth birthday.
Cambodia’s family and community poverty, especially
outside Phnom Penh, prevents many children from
getting both macro- and micro-nutrients they need
to develop normally, while an under-resourced
healthcare system struggles to face up to water-borne
disease, malaria and dengue in children.
Maternal mortality is one of the leading causes
of death for women aged 15-49, with around 470
maternal deaths per 100,000 live births. Eight in
every ten women give birth at home. Only around
40% have skilled help at hand during delivery
2
.
Roughly three quarters of maternal deaths occur in
the immediate post partum period.

The diversity of living standards
across Indonesia’s islands is not
necessarily reected in their national
statistics. In urban areas like Jakarta,
micro-nutrient malnutrition affects
the development of children even
in areas with improved healthcare
facilities. Isolated regions are more
likely to suffer from famine or
untreated illnesses, especially malaria
which affects up to 20% of the
population.
Across the country, UNICEF
estimates up to 70% of women and
children are anemic.
India
% children underweight: 43%
Under 5 mortality (per 1000): 72
Living with improved water: 89%
Living with improved sanitation: 28%
Maternal mortality (per 100,000): 300
Despite its recent economic growth,
India’s child health improvements are
markedly behind the goals set by the
MDGs.
In India, the challenges start before
birth. Food shortages affect nearly
350 million Indians. Nine out of ten
pregnant women are undernourished,
20% of infant deaths can be

population.
DPRK also faces regular food
shortages, but the situation became
dire in 2008 as oods devastated
harvests, China erected barriers to
food exports, and global food prices
skyrocketed. The WFP projected a
doubling of prices for staples such as
rice, soybeans and maize.
One third of pregnant women are
reportedly under-nourished or
anaemic.
3. WFP statistic: />13
Laos PDR
% children underweight: 31%
Under 5 mortality (per 1000): 70
Living with improved water: 60%
Living with improved sanitation: 48%
Maternal mortality (per 100,000): 410
Humanitarian development is a recent initiative
for Laos; while the current under-ve mortality
rate is still unacceptably high, it is worth noting
that around 20 years ago it was a staggering
170 per 1000 live births. In line with general
improvements in poverty indicators, child health
statistics are improving – but not quickly enough
to meet the goals of the MDGs. Laos still sits at
50 on Unicef’s under-ve mortality rate ranking.
Every day three Lao women die due to maternal
health issues. Only 19% of mothers give birth

children. In Myanmar, at least one in ten children
will die before the age of ve – three quarters of
them before the age of one. At the heart of these
statistics is malnutrition. Only around 15% of children
are exclusively breastfed to the age of six months.
Susceptibility to illness and infection as a result of this
is increased – water-borne diseases, left untreated,
claim many lives, and Myanmar’s malarial deaths
account for around half of those in South East Asia.
Signicant percentages of women suffer maternal
deaths – annually 320 women die per 100,000 live
births. A total 43% of women deliver their child
without any skilled professionals attending.
Nepal
% children underweight: 39%
Under 5 mortality (per 1000): 55
Living with improved water: 89%
Living with improved sanitation: 27%
Maternal mortality (per 100,000): 280
Broad issues of poverty and isolation mean that the
health and wellbeing of Nepal’s children is severely
compromised. A low level of education for many
women means that many mothers do not have an
understanding of good nutrition or the skills to
recognise when their children are dangerously ill or
malnourished.
Malnutrition is considered the underlying cause of
more than 60% of child deaths. As well, the majority
of children do not practice good hygiene habits, like
daily bathing or washing hands after going to the

In rural and highland areas, a priority
is to support communities to
take responsibility for their own
healthcare, by equipping them with
basic knowledge on hygiene, nutrition
and treatment of illnesses like malaria
and diarrhoea.
Philippines
% children underweight: 21%
Under 5 mortality (per 1000): 28
Living with improved water: 93%
Living with improved sanitation: 78%
Maternal mortality (per 100,000): 160
The Philippines could be considered
a success story for Asia in prioritizing
children, their health and their
rights. However, communities living
in poverty, both urban and rural,
may not have the capacity to access
the benets that the government
provides.
Nutrition, especially micro-nutrition,
is still of concern, and tuberculosis
exists in epidemic proportions in
many areas. Community access to
clean water, though at a respectable
level of around 90%, has not changed
markedly since 1990.
Solomon
Islands

a maternal death rate around 1/10th
of that of countries like Cambodia or
Papua New Guinea. A total of 98% of
births take place in a medical facility.
However, Sri Lanka’s children suffer
from a high level of malnutrition,
caused in part by a lack of knowledge
on the benets of breastfeeding and
under-two nutrition requirements.
Malnutrition is particularly prevalent
in the children of Sri Lanka’s tea-
planting regions, born into the
families that live and work on the
estates.
The state of children’s health in Sri
Lanka is set to worsen as a result
of massive displacement, which has
disrupted health services in affected
areas, and rapidly rising food costs in
the country’s capital Colombo.
Thailand
% children underweight: 7%
Under 5 mortality (per 1000): 7
Living with improved water: 98%
Living with improved sanitation: 96%
Maternal mortality (per 100,000):12
Overall, Thailand’s food security and
child health needs have been met
with committed determination from
its government. Maternal deaths are

making them very susceptible to childhood illnesses. Food
shortages in East Timor regularly impact more than one
third of the population. In 82% of cases women do not
have skilled professionals attending the delivery of children.
Timor-Leste’s birth rate of over seven children per family
contributes further to the problem; mothers are often
malnourished themselves and family incomes cannot meet
their children’s health needs.
Vanuatu
% children underweight: 20-25%
4

Under 5 mortality (per 1000): 34
Living with improved water: 60%
Living with improved sanitation: 50%
Maternal mortality (per 100,000) 68
Though a small country in population, Vanuatu is made
up of 83 different islands. Around 20% of the population
have no access to healthcare whatsoever. Planning for
support of Vanuatu’s maternal and child health should take
into account the need for basic infrastructure as well as
interventions specic to neonatal care.
Vietnam
Percentage children underweight: 25%
Under 5 mortality (per 1000): 17
Living with improved water: 85%
Living with improved sanitation: 61%
Maternal mortality (per 100,000) 160
Vietnam’s rapidly improving economy has allowed it to
provide better health services to its people, but the gap

• Increase community knowledge and commitment
to maternal health
• Include maternal health care in emergency
responses
• Ensure mothers know benets of exclusive
breastfeeding and an appropriate diet
• Inform and involve children
• Encourage mothers to recognise and share their
child health achievements
20
Parbati cuddles her newest baby girl,
Karuna, aged around three months.
Photo: Pratigya R. Khaling/World Vision Nepal
21
The grief of Deepak’s loss was not healed properly for
Parbati before she bore another child, a boy, Maila, who
resembled Deepak but also passed away at the age of
two.
Parbati says, “Despite everything I tried, I couldn’t save
him. My mother in law tried her hand with all kinds of
traditional healers. They also failed and told us to take
him to a hospital. My husband worked more hours than
ever before then and made some money but I guess it
was too late. Maila also died in front of my eyes.”
Parbati, now 35, has had three more children, a surviving
son and two more daughters. She is terried of ill health,
because until recently she has had no way to understand
it or address it.
Parbati says, “I have such a big family. We have no savings.
If anyone falls sick in the family, we do not have extra

and ante-natal checkups, monitoring of children’s weight
and health and general medical advice.
Patients are checked by Dr. Ragunath from Jaffna who has
been working in the estate sector for the past 20 years.
Ministry of Health midwife, Kamala, says that many of these
women would nd it too difcult to attend a clinic further
away, because they need to work or because they cannot
afford the bus fare to get there.
“Anaemic conditions are very common in these young
mothers and their babies. Almost all who visit this clinic are
estate labourers. They have no knowledge about nutrition.
They get through the day on plain tea and roti. And now
through the clinic we have made them aware of their
conditions and taught them what could be done.”
Local women working as World Vision mobilisers are very
involved in the clinic arrangements every month. They visit
every house in the area and inform them beforehand of
the clinic day. They also come on the day in case language
becomes a barrier to accurate diagnosis or advice.
Strategy: Strengthen communities to
respond to preventable children’s diseases
Kamala is pleased to report that the children are
healthier. “When the clinic was rst started two years
ago, we found a lot of children who had not received
a single vaccination since their birth. So we had to
start right from the beginning.”
“Since then, we have seen a positive increase in the
interest of the mothers in their children’s health.
Every month the clinic is packed with over 50
mothers.”

in Davao City, Philippines, walks home
with daughter Emelyn after helping fellow
Task Force members conduct a class
on tuberculosis in her home village in
Malabog.
Located nearly 25 kilometres away from
town, Malabog can only be reached
after more than one hour of trekking
through the mountains. Judith helps her
neighbours with TB symptoms to get
proper consultation in the nearest health
centre in town.
The TB Task Force is a community-based
volunteer group organised by World Vision’s
Social Mobilisation on TB (SMT) Project
to help TB prevention and control in the
country.
Photo: Maria Soccoro Melic