Maternal, neonatal, and child health in southeast Asia: towards greater regional collaboration

Abstract

Although maternal and child mortality are on the decline in southeast Asia, there are still major disparities, and greater equity is key to achieve the Millennium Development Goals. We used comparable cross-national data sources to document mortality trends from 1990 to 2008 and to assess major causes of maternal and child deaths. We present inequalities in intervention coverage by two common measures of wealth quintiles and rural or urban status. Case studies of reduction in mortality in Thailand and Indonesia indicate the varying extents of success and point to some factors that accelerate progress. We developed a Lives Saved Tool analysis for the region and for country subgroups to estimate deaths averted by cause and intervention. We identified three major patterns of maternal and child mortality reduction: early, rapid downward trends (Brunei, Singapore, Malaysia, and Thailand); initially high declines (sustained by Vietnam but faltering in the Philippines and Indonesia); and high initial rates with a downward trend (Laos, Cambodia, and Myanmar). Economic development seems to provide an important context that should be coupled with broader health-system interventions. Increasing coverage and consideration of the health-system context is needed, and regional support from the Association of Southeast Asian Nations can provide increased policy support to achieve maternal, neonatal, and child health goals.

Figure 1

Trends in maternal (A), infant (B), and under-5 (C) mortality in southeast Asia (1990–2008) Data from WHO (A) and UNICEF (B, C).

Figure 2

Causes of maternal (A) and child (B) deaths in southeast Asia Data for maternal deaths are from UN MDG southeast Asia, 2010, including from ten ASEAN countries and Timor Leste (data not broken down to country level). Data for child deaths are from Black et al. ASEAN=Association of Southeast Asian Nations.

Figure 3

Maternal (A), neonatal (B), and child (C) deaths averted at 60, 90, and 99% coverage of interventions for the ASEAN region and regional subgroups as defined by mortality reduction patterns Subgroup 1=Brunei, Singapore, Malaysia, and Thailand; subgroup 2=the Philippines, Indonesia, and Vietnam; and subgroup 3=Laos, Cambodia, and Myanmar. ASEAN=Association of Southeast Asian Nations.