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MDG 5: Improve Maternal Health

Target 5a: Reduce by three quarters the maternal mortality ratio

Target 5b: Achieve, by 2015, universal access to reproductive health

Disclaimer: Some of the MDG data presented in this website have been adjusted by the responsible specialized agencies to ensure international comparability, in compliance with their shared mandate to assess progress towards the MDGs at the regional and global levels.[1] 

 

Indicators (United Nations)

 

5.1 Maternal mortality ratio (MMR):

a.    2000: 56[2]

b.    2005: 45[3]

c.    2007:

A maternal death is “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration or site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental causes.”[4] According to the 2005 WHO/UNICEF/UNFPA maternal mortality estimates, most of the countries in the Asian region have not reduced the maternal mortality by three quarters as stated in the MDG Goal.[5] 

According to the maternal mortality estimates developed by WHO/UNICEF/UNFPA and World Bank, China has reduced the MMR from 56 in 2000 to 45 in 2005[6]. Official Chinese government data shows that China has reduced the MMR from a baseline of 94.7 maternal deaths per 100,000 live births in 1990 to 36.6 per 100,000 in 2007, a reduction of 61.4%, and placing China on track to achieve this MDG target[7].

However, again regional differences indicate that the MMR in rural areas is far higher than that of urban areas, and higher in poor than in developed regions in China, and higher in the western province . Great disparities exist in China with regards to maternal and child mortality between urban and rural areas, between and within different regions, with rural type IV and rural type III areas experiencing 2 to 5 times higher levels than urban areas. Rural type II and III areas account for over 70% of all maternal and child deaths in China.[8] Disparities in access to and the quality of health services for rural, poor, migrant and ethnic minority women continue, leaving many of these groups with a disproportionate burden of mortality[9] 

 

Critical indicators to comprehensively monitor maternal mortality

5.1.1 Lifetime Risk of Maternal Death

 The concept of adult lifetime risk of maternal death measured as the probability of dying from a maternal cause during a woman’s reproductive lifespan[10], is more holistic in comparison to maternal mortality ratio (MM Ratio) and maternal mortality rate (MM Rate). Whereas the MMRatio and the MMRate are measures of the frequency of maternal death in relation to the number of live births or to the female population of reproductive age, the lifetime risk of maternal mortality describes the cumulative loss of human life due to maternal death over the female life course. Because it is expressed in terms of the female life course, the lifetime risk is often preferred to the MMRatio or MMRate as a summary measure of the impact of maternal mortality[11].

 

The lifetime risk of maternal death is 1 in 1 300 in China, however it is not sure if this number takes into account all women rural, poor, migrant and ethnic minority women in the country.

 

5.1.2 Maternal deaths due to unsafe abortion

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5.3 Adolescent birth rate (per 1000 women):

a.    1998: 6.0[21]

b.    2005: 6.3[22]

c.    2007: 4.6[23]

The adolescent birth rate measures the annual number of births to women 15 to 19 years of age per 1,000 women in that age group. It represents the risk of childbearing among adolescent women 15 to 19 years of age. It is also referred to as the age-specific fertility ra

 

The potential MDG gap in China shows Adolescent births needs to be addressed, particularly in providing services to unmarried people and migrants[24].

 

Teenage fertility and pregnancies are a major health concern because teenage mothers and their children are at high risk of reproductive morbidity and mortality. Early childbearing also impedes the overall development of teenage girls and their access to education and labour force participation.

 

Critical indicators to comprehensively monitor adolescent birth rate would look at the median age at marriage , the legal age at marriage and access to sex and sexuality education

5.3.1 Median age at marriage

Note: The team was not able to access data on this indicator for China

5.3.2 Legal age of marriage 

 

The legal age for marriage for women in China is 20 for women and 22 for men.  

5.3.3 Sex and sexuality education

Sex education is defined as the basic education about reproductive processes, puberty and sexual behaviour. Sex education may include other information, for example about contraception, protection from sexually transmitted infections and parenthood.[25] Sexuality education is defined as education about all matters relating to sexuality and its expression. Sexuality education covers the same topics as sex education but also includes issues such as relationships, attitudes towards sexuality, sexual roles, gender relations and the social pressures to be sexually active, and it provides information about SRH services. It may also include training in communication and decision-making skills.[26] 

5.3.4 Access to reproductive health services for adolescents within the public health system

In China the barriers to access to reproductive health services are discrimination rather than the law. The Chinese government has taken steps to improve availability and accessibility of reproductive health care for adolescents. In 2002, a government hospital in Beijing opened the country’s first clinic for adolescent psychological and sexual health-care services. The clinic provides adolescents with free or low-cost gynaecology, maternity, urology, pediatrics, and psychological counselling services. Similar facilities have since opened in several cities. These government-funded adolescent health-care facilities offer free abortion services for pregnant girls under 18 years of age, and some permit anonymous abortions without parental notification.[27]

Voices from the ground:

Videos:

a.    This is a video on arranged marriages in China and how parents arrange marriages for their children, sometimes even without their consent. Watch the video

b.    This video talks about the lack of comprehensive sex education, the high numbers of abortions (in registered clinics only, abortions are estimated to be about 13million annually), lack of knowledge on how to protect themselves from STDs and pregnancies and the fact that up to 10million abortion inducing pills are sold annually. It also mentions that couples are only allowed to have one child per couple yet there is no education on how not to get pregnant.  Watch the video

 

News/MagazineArticles:

a.      Article based on trafficking of women from Myanmar and sold to men in villages and poor communities in china. Most of these men don’t see it as trafficking but as dowry payment for the women. Read it here

b.    “In China, one woman kills herself every four minutes. According to World Health Organisation statistics, China is the only country in the world where more women commit suicide than men.” Read more

c.    This article explores the reason millions of Chinese citizens don’t know how to have sex without getting pregnant, despite the one-child policy in China. Read it here 

d.    “Most Chinese parents are likely to divert sex education subject to other areas or even scold children for asking such questions. And it is not just parents that find it hard to face sex questions. Even teachers shy away from students eager to learn about the subject.” Read more

e.    This article focuses on how the topic of sex education in China is generally avoided by teachers which has lead to a rise of unwanted pregnancies. The Ministry of Education issued new guidelines that said primary schools across China should teach pupils about the human body, including secondary sexual characteristics, which is a start. Read more 

 

 

5.4 Contraceptive prevalence rate (Current contraceptive use among married women 15-49 yrs old any method%:

a.    2001: 86.9[28]

b.    2005:

c.    2007:

China’s CPR in 2000 according to UN data was 86.9; and went to 90.2 according to World Contraceptive Use 2007.

China has one of the highest CPRs in the world.

 

 Critical indicators to comprehensively monitor contraceptive prevalence rate would include looking at range of methods available including access to modern methods and provision of informed choice.

5.4.1 Range of contraceptive methods available.

Beyond the numbers for CPR it is essential to look at access to a range of contraceptive services.

Permanent methods of contraception are highly used with IUD users forming almost half of all contraceptive users (49.7%); and female sterilization - 34.5% of all methods. In comparison, male sterilization only forms 7.42% of all methods.

In countries that strongly implement population control policies such as China, permanent methods and long-term methods such as sterilisation and IUDs are favoured. Targets for permanent methods are mainly women.

 

5.4.2 Provision of informed choice service provision.

Informed choice of family planning methods is an important rights indicator. However it has not been commonly regarded as an important aspect of the service provided with the contraception method. Informed choice includes: information on the full range of methods including traditional and male methods; information on side-effects of all methods and the appropriate course of action; and information on the efficacy of each of the methods.[29] However, data is not readily available for China for this indicator.

 

 

5.5 Unmet Need for contraception:

 

a.    1997: 2.7[30]

b.    2001: 2.3[31]

c.    2007:

China has a low unmet need, which was reduced from 2.7 to 2.3.

The accepted definition of “[u]nmet need for contraception is the percentage of fertile, married women of reproductive age who do not want to become pregnant and are not using contraception.”[32] The concept of unmet need is an important one because it assesses the ‘need’ for contraception based on whether and when a woman wants a child or another one rather than focusing on government limits on family size. The limitation, currently, is that the DHS calculates unmet need based on a sample of married, heterosexual women and not single, unmarried women and this does not accurately capture the extent of unmet need in a country. Another limitation is that it assumes all users as having their need ‘met’ including women with infertility and secondary infertility. But many women may be using a contraceptive method not of their choice due to provider bias or government policy as earlier discussed and this constitutes an ‘unmet need’ too. It is also important to keep in mind that contraception is primarily focused on pregnancy prevention. There is also an urgent unmet need for disease/infection prevention which is not being considered.[33]

Critical indicators to comprehensively monitor unmet need would take into account differences between total and wanted fertility rates and reasons for non-use of contraception.

5.5.1      Total and Wanted Fertility Rates

     Wanted fertility rates compared to Total Fertility Rates

 

a.    Total Fertility Rate (2005): 1.7[34]

b.    Wanted Fertility Rate (2005): 

c.    % difference:

 

It is important to look at Wanted Fertility Rates and Total Fertility Rates to also establish unmet need.

However, data is not available on Wanted Fertility Rates in China.[35]

5.5.2 Reasons for non-use of contraception

Data is not available on reasons for non-use in China.

 

 

5.6 Antenatal care coverage

a.    At least one visit (%):

Ø  2000: 89.4[36]

Ø  2005: 89.9[37]

Ø  After 2005: 90.9[38]

b.    At least four visits(%):

Ø  2000:

Ø  2005:

Ø  2007:

 

 

 

 

 

[1] Department of Economic and Social Affairs, United Nations Statistics Division, United Nations. Retrieved July 30, 2010, from Millennium Development Goals Indicators official site for United Nations’ MDG Indicators Web site: http://mdgs.un.org/unsd/mdg/Data.aspx

[2] Department of Economic and Social Affairs, United Nations Statistics Division, United Nations. Retrieved July 30, 2010, from Millennium Development Goals Indicators official site for United Nations’ MDG Indicators Web site: http://mdgs.un.org/unsd/mdg/Data.aspx

[3] Department of Economic and Social Affairs, United Nations Statistics Division, United Nations. Retrieved July 30, 2010, from Millennium Development Goals Indicators official site for United Nations’ MDG Indicators Web site: http://mdgs.un.org/unsd/mdg/Data.aspx

[4] The International Classification of Diseases, Injuries and Causes of Death – 9th revision (ICD9) defines a maternal death as “the death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” These are subdivided into Direct, Indirect, and Fortuitous, but only Direct and Indirect deaths are counted for statistical purposes. The latest revision, ICD10, recognises that some women die as a consequence of Direct or Indirect obstetric causes after this period, and has introduced a category for Late maternal deaths defined as “those deaths occurring between 42 days and one year after abortion, miscarriage or delivery that are due to Direct or Indirect maternal causes.” The ICD 10 further defines direct maternal deaths as those resulting from obstetric complications of the pregnant state (pregnancy, labour, and puerperium), from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above. Indirect deaths are those resulting from previous existing disease, or disease that developed during pregnancy and which was not due to direct obstetric causes, but which was aggravated by the physiological effects of pregnancy.  Late deaths are those occurring between 42 days and one year after abortion, miscarriage, or delivery that are due to Direct or Indirect maternal causes. Please refer to ICD-10, WHO. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Geneva, World Health Organization (WHO).

[5] World Health Organization (WHO); United Nations Chidlren’s Fund (UNICEF); United Nations Population Fund (UNFPA); The World Bank. (2007). Maternal Mortality in 2005. Estimates developed by WHO,UNICEF and UNFPA. Geneva, Switzerland: WHO.

[6] World Health Organization (WHO); United Nations Chidlren’s Fund (UNICEF); United Nations Population Fund (UNFPA); The World Bank. (2007). Maternal Mortality in 2005. Estimates developed by WHO,UNICEF and UNFPA. Geneva, Switzerland: WHO

[7] United Nations; Ministry of Foreign Affairs of the People’s Republic of China. (2008).China's Progress Towards the Millennium Development Goals 2008 Report. China: United Nations; Ministry of Foreign Affairs of the People’s Republic of China

[8] Ministry of Health China; World Health Organisation (WHO); United Nations Population Fund (UNFPA); United Nations Children’s Fund (UNICEF). (2006). Joint Review of Maternal and Child Survival Strategies in China December 2006 (p. 59). Beijing, China: WHO, UNFPA, UNICEF, Ministry of Health China.

[9] United Nations; Ministry of Foreign Affairs of the People’s Republic of China. (2008).China's Progress Towards the Millennium Development Goals 2008 Report. China: United Nations; Ministry of Foreign Affairs of the People’s Republic of China

[10] World Health Organization (WHO); United Nations Chidlren’s Fund (UNICEF); United Nations Population Fund (UNFPA); The World Bank. (2007). Maternal Mortality in 2005. Estimates developed by WHO,UNICEF and UNFPA. Geneva, Switzerland: WHO.

[11]John Wilmoth. (2009). The lifetime risk of maternal mortality: concept and measurement. Published online: 13 February 2009 . Retrieved 12 August 2010, from World Health Organization  (WHO) Web site: http://www.who.int/bulletin/volumes/87/4/07-048280/en/

[12] World Health Organization (WHO), Department of Reproductive Health and Research. (2007). Unsafe abortion: global and regional estimates of incidence of unsafe abortion and associated mortality in 2003. Geneva. Switzerland: WHO

[13] Department of Economic and Social Affairs, United Nations Statistics Division, United Nations. Retrieved July 30, 2010, from Millennium Development Goals Indicators official site for United Nations’ MDG Indicators Web site: http://mdgs.un.org/unsd/mdg/Data.aspx

[14] Department of Economic and Social Affairs, United Nations Statistics Division, United Nations. Retrieved July 30, 2010, from Millennium Development Goals Indicators official site for United Nations’ MDG Indicators Web site: http://mdgs.un.org/unsd/mdg/Data.aspx

[15] Department of Economic and Social Affairs, United Nations Statistics Division, United Nations. Retrieved July 30, 2010, from Millennium Development Goals Indicators official site for United Nations’ MDG Indicators Web site: http://mdgs.un.org/unsd/mdg/Data.aspx

[16] Department of Reproductive Health and Research, World Health Organization (WHO). (2008). Proportion of Births Attended by a Skilled Health Worker 2008 Updates Factsheet. Geneva, Switzerland: WHO

[17] Monitoring the Situation of Children and Women. (2009). Retrieved August 12, 2010, from Childinfo.org: Statistics by Area Web site: http://www.childinfo.org/delivery_care.html

[18] United Nations; Ministry of Foreign Affairs of the People’s Republic of China. (2008).China's Progress Towards the Millennium Development Goals 2008 Report. China: United Nations; Ministry of Foreign Affairs of the People’s Republic of China

[19] Geller E; Adams,  M.G; Kelly,  P.J; Kodkany, B.S;, Derman R.J. (2006). Postpartum hemorrhage in resource-poor settings. In International Journal of Gynecology and Obstetrics Vol. 92 Issue 3 (pp. 202-211). Maryland, USA:  Elsevier Inc. 

[20] United Nations; Ministry of Foreign Affairs of the People’s Republic of China. (2008).China's Progress Towards the Millennium Development Goals 2008 Report. China: United Nations; Ministry of Foreign Affairs of the People’s Republic of China

[21] Department of Economic and Social Affairs, United Nations Statistics Division, United Nations. Retrieved July 30, 2010, from Millennium Development Goals Indicators official site for United Nations’ MDG Indicators Web site: http://mdgs.un.org/unsd/mdg/Data.aspx

[22] Department of Economic and Social Affairs, United Nations Statistics Division, United Nations. Retrieved July 30, 2010, from Millennium Development Goals Indicators official site for United Nations’ MDG Indicators Web site: http://mdgs.un.org/unsd/mdg/Data.aspx

[23] Department of Economic and Social Affairs, United Nations Statistics Division, United Nations. Retrieved July 30, 2010, from Millennium Development Goals Indicators official site for United Nations’ MDG Indicators Web site: http://mdgs.un.org/unsd/mdg/Data.aspx

[24] United Nations; Ministry of Foreign Affairs of the People’s Republic of China. (2008).China's Progress Towards the Millennium Development Goals 2008 Report. China: United Nations; Ministry of Foreign Affairs of the People’s Republic of China

[25] Glossary. (2009). Retrieved September 29, 2009, from International Planned Parenthood (IPPF)/ Western Hemisphere Region Web site: http://www.ippfwhr.org/en/resources/glossary#S#ixzz0RtBLHMT9

[26] Glossary Browser. (2009). Retrieved September 29, 2009, from International Planned Parenthood (IPPF) Web site:  http://glossary.ippf.org/GlossaryBrowser.aspx

[27] Centre for Reproductive Rights (CRR); Asian- Pacific Resource and Research Centre for Women (ARROW). (2005). Women of the World: Laws and Policies Affecting Their Reproductive Lives, East and Southeast Asia. New York,USA: CRR. 

[28] Department of Economic and Social Affairs, United Nations Statistics Division, United Nations. Retrieved July 30, 2010, from Millennium Development Goals Indicators official site for United Nations’ MDG Indicators Web site: http://mdgs.un.org/unsd/mdg/Data.aspx

[29] Thanenthiran, S; Racherla S.J. (2009).  Reclaiming & Redefining Rights – ICPD+15: Status of Sexual and Reproductive Health and Rights in Asia. Kuala Lumpur, Malaysia: The Asian-Pacific Resource & Research Centre for Women (ARROW).

[30] Department of Economic and Social Affairs, United Nations Statistics Division, United Nations. Retrieved July 30, 2010, from Millennium Development Goals Indicators official site for United Nations’ MDG Indicators Web site: http://mdgs.un.org/unsd/mdg/Data.aspx

[31] Department of Economic and Social Affairs, United Nations Statistics Division, United Nations. Retrieved July 30, 2010, from Millennium Development Goals Indicators official site for United Nations’ MDG Indicators Web site: http://mdgs.un.org/unsd/mdg/Data.aspx

[32] % of Married Women Ages 15-49, Unmet Need for Contraception Statistics, Countries Compared. (2005). Retrieved August 6, 2009, from Nationmaster.com Web site: http://www.nationmaster.com/graph/hea_unm_nee_for_con_of_mar_wom_age_1549-married-women-ages-15-49

[33] Thanenthiran, S; Racherla S.J. (2009).  Reclaiming & Redefining Rights – ICPD+15: Status of Sexual and Reproductive Health and Rights in Asia. Kuala Lumpur, Malaysia: The Asian-Pacific Resource & Research Centre for Women (ARROW).

[34] Department of Economic and Social Affairs, United Nations Statistics Division, United Nations. Retrieved July 30, 2010, from Millennium Development Goals Indicators official site for United Nations’ MDG Indicators Web site: http://mdgs.un.org/unsd/mdg/Data.aspx

[35] Thanenthiran, S; Racherla S.J. (2009).  Reclaiming & Redefining Rights – ICPD+15: Status of Sexual and Reproductive Health and Rights in Asia. Kuala Lumpur, Malaysia: The Asian-Pacific Resource & Research Centre for Women (ARROW).

[36] Department of Economic and Social Affairs, United Nations Statistics Division, United Nations. Retrieved July 30, 2010, from Millennium Development Goals Indicators official site for United Nations’ MDG Indicators Web site: http://mdgs.un.org/unsd/mdg/Data.aspx

[37] Department of Economic and Social Affairs, United Nations Statistics Division, United Nations. Retrieved July 30, 2010, from Millennium Development Goals Indicators official site for United Nations’ MDG Indicators Web site: http://mdgs.un.org/unsd/mdg/Data.aspx

[38] Department of Economic and Social Affairs, United Nations Statistics Division, United Nations. Retrieved July 30, 2010, from Millennium Development Goals Indicators official site for United Nations’ MDG Indicators Web site: http://mdgs.un.org/unsd/mdg/Data.aspx

 

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