Child and Maternal Mortality
in Islamic Countries
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at the national level to over 90% to 95%. Reaching the poorest population remains a challenge
in many countries. Our results have shown that the poorest women have almost no access to
private facilities. Improving access to high-quality MNCH services, assuring high-quality
services in public facilities, and improving the availability of skilled providers to poor segments
of the population will be critical for substantially reducing maternal and child mortality at the
national level. In countries where physicians are not available, task shifting is another approach
for improving access to qualified health workers. 87 The countries should examine the
distributions of workforce and determine the needs of task shifting for improving access to
MNCH care.
Lack of money was the most cited cause for not delivering at a health facility in all the study
countries. Financial supports and subsidies through voucher programs, health insurance
schemes and social protection strategies may help families to overcome access barriers. Out-of-
pocket expenses are very high in case-study countries and other settings. There are needs to
develop a national strategy and plan for reducing catastrophic financial burdens on families.
Improving the availability of trained health workers and affordable, high quality, easily
accessible services in poor settings and rural areas will be critical too for reducing inequity. The
countries need to strengthen MNCH workforce capacity and develop incentive strategies for
equitable distribution of health providers.
Reduce barriers to accessing care
The WHO now recommends conducting ANC visits 8 times and initiating early in the first
trimester. In many countries, even ANC4+ visits are substantially low; reaching 8 visits will need
more than double resources and the countries must accelerate the current efforts and promote
this new recommendation in national MNH strategies. Because all complications are not
preventable, there is also a need to include planning for EmOC during ANC visits. Postnatal visits
are critical, but currently, the rates of PNC are substantially low. Although some surveys inquire
about the causes of not delivering at a hospital, no such questions are asked for the causes of no
PNC. Improving the knowledge base on the barriers to PNC and addressing these barriers –
physical, economic, and societal/cultural --- effectively in different settings will be needed.
Countries must strive for improving access to MNH care to the universal level.
Improve FP access and contraceptive use
Despite high SBA rates and facility deliveries in sub-Saharan Africa countries, maternal
mortality ratios and child mortality rates in these countries are highest in the world. In many
countries, MMR is over 500 deaths per 100,000 live births; this situation prevailed in developed
countries a century ago. Fertility levels are concurrently high in the SSA countries. Contraceptive
use is very low in these countries. Improving contraceptive use can substantially reduce
maternal and child mortality in high fertility countries. Although FP was identified as one of the
four pillars of safe motherhood since 1987, the integration of family planning with the MNCH
program is weak. Postpartum family planning provides a unique opportunity to improve
women's access to family planning. MNCH country strategies must include FP as an intervention
and PPFP counseling and services as part of ANC, delivery and postpartum care packages.