2014年-世界发展银行全球_Bhutan___Maternal_and_Reproductive_Health_at_a_Glance_4页_1mb

Bhutan: Maternal and Reproductive Health at a Glance Summary

Core Content

Bhutan, a small landlocked country in the Himalayas, has made significant progress in improving maternal and reproductive health outcomes over the past two decades. Despite its geographical isolation and limited economic resources, the nation has achieved notable success in reducing poverty and enhancing human development indicators. The country is on track to meet the Millennium Development Goal (MDG) 5, which aims to reduce maternal mortality by three-quarters between 1990 and 2015.

Key Achievements

• Maternal Mortality Ratio (MMR): Bhutan has reduced MMR from 900 deaths per 100,000 live births in 1990 to 120 in 2013, achieving MDG 5 and showing an average annual decline of 8.4 percent.
• Fertility Decline: The total fertility rate (TFR) dropped from 5.6 in 1990 to 2.3 in 2012.
• Contraceptive Prevalence Rate (CPR): CPR increased from 18.8 percent in 1994 to 65.6 percent in 2010, with modern methods being the primary choice.
• Antenatal Care (ANC): 97.3 percent of women had at least one ANC visit from a skilled provider in 2010, with 77.3 percent receiving the recommended four or more visits.
• Skilled Birth Attendance (SBA): SBA increased from 14.9 percent in 1994 to 64.5 percent in 2010, with 63.1 percent of births occurring in health facilities.

Equity and Access Issues

• Geographic Disparities: There are significant differences in access to skilled birth attendance, with 89.5 percent of urban women receiving SBA compared to 54.3 percent of rural women.
• Wealth Disparities: The poorest wealth quintile has a higher CPR (69 percent) than the richest (62.3 percent). SBA is also more accessible to women in the richest quintile, with only 34.3 percent in the poorest quintile receiving it compared to 95.1 percent in the richest.
• Early Childbearing: 6.7 percent of women were married before age 15, and 30.8 percent before 18, contributing to higher risks of poor maternal health outcomes.

Nutrition Challenges

• Anemia: 55 percent of Bhutanese women are anemic, indicating a serious nutritional issue for pregnant mothers.
• Nutrition Transition: Bhutan has shifted from traditional diets to more processed foods, leading to increased sugar, salt, and fat intake.
• Undernutrition Factors: Diarrheal diseases, parasitic infections, and food insecurity in remote areas contribute to undernutrition. Sedentary lifestyles in urban areas also play a role.

Strategies for Improvement

To further enhance maternal and reproductive health outcomes, Bhutan needs to focus on the following strategies:

• Quality of Care: Implement evidence-based revisions of national standards and guidelines, retain healthcare provider skills, and monitor and supervise care during the critical first 1,000 days of life.
• Access and Equity: Develop targeted interventions to reach underserved populations, such as the poor, adolescents, and malnourished, with a special focus on stunting and neonatal health.
• Health Financing: Ensure the sustainability of health financing by exploring alternative measures like social marketing for contraceptives, cost-sharing mechanisms, and public-private partnerships. Strengthen collaboration among stakeholders, including the Ministry of Health, education, agriculture, and civil society organizations.

Conclusion

Bhutan has made substantial progress in maternal and reproductive health, but challenges remain in ensuring equitable access and quality of care. Continued efforts in improving nutrition, expanding access to skilled health services, and sustaining health financing are essential for achieving long-term improvements in maternal health outcomes.