When health systems improve, individual and family lives improve. Lao PDR has made tremendous progress in delivery of sexual and reproductive health services; it was one of the 3 countries to reach the Millenium Development Goal 5 on reducing maternal deaths. To attain the 18 Sustainable Development Goals (SDGs) which aim to “leave no one behind” with 11 years to go, above all, acceleration is needed for countries to meet the ambitious targets. Let us look at progress made to date in Laos and what could be critical catalysts for rapid change.
Children born per woman: In 1995, the average woman in Lao would give birth to 5.8 children. Now, 25 years and a growing family planning programme later, the average woman has 2.7 children. However the poor, the less educated, those in harder to reach areas and the unmarried still do not have easy access to family planning.
Unmet need for family planning services is at 11% for married women of reproductive age but it is at 75% for unmarried women 15-19!
To meet the SDGs targets for family planning in Laos PDR : Acceleration of ongoing efforts through higher investment in procuring contraceptives and making contraceptives more easily accessible for young unmarried women and those in harder to reach areas, along with engaging men to take more responsibility in use of contraception.
Availability of Primary health care: In 1995, a population of 4.6 Million people was served by 533 health centers, in 2019 for the 6.7 million people there is coverage of approximately 1400 health facilities for the 8,500 villages, with each center covering 3-5 villages, depending on distance and terrain.
To meet the SDGs: Health system strengthening in quality of care is a priority for universal health coverage. A key aspect of quality is to ensure consistency between pre-service training, updated job descriptions of all cadres and on-the-job upgrading of skills, including skills of supervisors to enable them to support the technical staff especially midwives at the primary health care level.
Quality of Maternal Health care: In 1995 Maternal Mortality Ratio (MMR) was at 650 maternal deaths per 100,000 live births, dropping to 206 women dying per 100,000 live births in 2015. Laos PDR was one of the three countries that achieved its Millennium Development Goal on reducing maternal deaths. In 2019 MCH care is free in principle, maternal mortality is declining and MOH has adopted a 5 goods and one satisfaction approach as indicators for quality assurance.
To meet the SDG targets: i) Basic emergency obstetric care needs to be delivered through the expanded midwifery work force. Policy allows it, global evidence shows that midwives save lives. Medical professionals need to have comfort level in distribution of roles between emergency and basic obstetric care, giving space to midwives for delivering basic emergency obstetric care.
ii) Investing in client satisfaction and feedback mechanisms would be a tremendous value to maintaining a responsive, high quality health system. This would allow rights holders to be aware of their rights and express their requirements, while duty bearers would engage in delivery of quality services that are technically sound and also responsive to needs of clients
iii) Institutionalised Skills building: regularly updating curricula and consistently ensuring that pre service training include Family planning and Youth friendly sexual reproductive health services as essential learning for relevant health cadres.
Midwives As recently as 2009, the Skilled Birth Attendance (SBA) report showed that over 8 of every 10 births were delivered without a skilled health worker, and in rural areas without roads over 9 of every 10 births were without a health worker. Deliveries were mainly conducted by a relative or friend. Women delivered at home, most of them still believing it is not necessary to seek medical care.
In 2019 Laos can boast of having more than 1800 midwives nationwide, deployed in health facilities including Health Centres. This is translated to around 6 out of 10 deliveries now done by skilled attendants at birth.
To meet the SDGs: Effective deployment of the skilled midwives, to have one midwife per health center and ensuring that those trained come from the variety of ethnic groups in the country so they can communicate in local languages. With almost 1800 midwives and 1400 health facilities, in principle this can now be arranged through solid planning.
What can we do at an individual level?
To meet the SDGs If you have teenagers at home, boys and girls -have a conversation with them about how babies are made. The facts of reproduction, safe, responsible sexual behaviours and the responsibility of young men and women. Boys and girls both need to be informed and aware of basic facts about their bodies and understand physical desires as they mature physically.
The ICPD PoA (International conference on population and development and its Programme of Action) happened in Cairo 1994 and 179 governments endorsed it. They recognised the right of women to decide if, when and how many children to have and with whom ...ICPD touches the most intimate decisions in the lives of women and couples and links their right to autonomy over their bodies with broader development in the community and country...Don’t you think it should be known by more people? We at UNFPA and our partners do! This year we celebrate its 25th anniversary. Join the conversation! #what’s changed #ICPD@25 UNFPA@50
UNFPA works to help every young person realise their full potential. We do this by reducing maternal deaths, ensuring every pregnancy is by choice not by chance, addressing gender-based violence and harmful practices. #Noi2030 #ICPD@25, #what’schanged
Mariam Khan
UNFPA Representative in Lao
