Iraq | Programme areas | Maternal, newborn, child and adolescent health

Maternal, newborn, child and adolescent health

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Improving the health of mothers and children is everybody’s responsibility. Healthy mothers and children contribute to a healthy family and form the backbone of a prosperous and economically productive society.

Although widespread public health and developmental progress has been made in recent decades, women, children and adolescents still face numerous health challenges and risks.

In the past 25 years, the population of Iraq has increased by more than 50% to about 40 million in 2018 according to most recent civil society organization data, with about 30% of the population living in rural settings1.

The population is young, with 13.9% children less than 5-years of age and 22.3% adolescents aged 10–19 years old. Women of reproductive age (15-49) represent 24.7% of the total population1.

Iraq is among 10 countries in the Eastern Mediterranean Region in terms of total fertility rate 3.6 and adolescent fertility rate 70/1000 15-19 girls.2

Decades of conflict, sanctions and political instability have slowed Iraq's progress in reducing child and maternal mortality but improving maternal and child health is a priority in the Ministry of Health’s strategic plans. Reproductive health services are improving after decline following the 2003 conflict but access to reliable data remains somewhat limited.

The UN Inter-Agency Group Estimate for Maternal Mortality Ratio shows a decline in Maternal Mortality Ratio (MMR) from 107 to 50 per 100,000 live births during the period between 1990 and 2015, while according to IPMM survey conducted in Iraq, MMR was 35.7 per 100,000 live births in 2013.

maternal_mortality_ratio

Fig. 1. Trend of maternal mortality ratio between 1990 and 2015

Direct causes of maternal mortality according to Ministry of Health statistics for 2017 were:

  • haemorrhage 32.4%
  • pre-eclampsia/eclampsia 14.5%
  • thromboembolism 14.4%
  • rupture uterus 4.7%
  • sepsis 4.4%.

Early age of marriage and adolescent pregnancy negatively impact on the socioeconomic status of those women and their families; putting an under-served population in a more vulnerable context.

United Nations estimates for under-5 child and neonatal mortality show a decline between 1990 and 2017 from 54 to 30 deaths per 1000 live births and from 27 to 17, respectively.

under_5_mortality_fig_2

Fig 2.  Trend in under-5 mortality and neonatal mortality 1990–2017

Neonatal mortality constituting 54% of U-5 mortality in Iraq and most of these losses are preventable with high-quality, evidence-based interventions delivered before and during pregnancy, during labour and childbirth, and in the crucial hours and days after birth.

However, inequity between urban and rural, educated and no or less educated mothers, geographical area and wealth quintile remains a contrast across all categories.

Policies and strategies

Ministry of Health has adopted several policies and strategies in favour of maternal and child health with a vision that Health of women and children is the key to progress towards all development goals; investing more in their health will help building peaceful and productive societies and reduces poverty.

Following are some of the major policies and strategies introduced and currently being implemented:

  • National Health Policy (2014-2023)
  • Reproductive, Maternal, Newborn, Child & Adolescent Health Strategy (2016-2020)
  • Iraq Every Newborn Action Plan (2016-2020).
  • Iraq Nursing and Midwifery Strategy and Action Plan (2017-2027)
  • National Nutrition Strategy (2012-2021)
  • National Code of Marketing Breast Milk Substitutes, 2016.
  • National Strategic Plan of HIV/AIDS (2016-2020)
  • Maternal Death Surveillance and Response, 2012.

On the other hand, adolescent health services for young people (10-24 years) are still neglected in the public sector. The lack of sustainable programme within the Ministry of Health and the overlap of the services among different programmes such as maternal and child health, noncommunicable diseases and school health represent one of the main obstacles. Trials to integrate the program within school health since it is the section which cover most of the adolescent had been tried at 2013 which needed further restructuring and integration work within the Ministry of Health.

adolescent_health_profile

1. Iraq multiple indicator cluster survey 6, 2018.
2. Global Youth Tobacco Survey factsheet, Iraq, 2014.
3. Global status report on noncommunicable diseases, 2014.
4. Global school-based student health survey factsheet, Iraq, 2012.

Fig. 3. Adolescent health profile

Priority areas

  • Maternal and perinatal death surveillance and response.
  • Child health and development.
  • Adolescent/youth health and development.
  • Adoption/Update and implementation of WHO guidelines regarding reproductive, maternal, newborn child and adolescent health.

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1 WHO 2015. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, the World Bank and the United Nations Population Division. Geneva. 2015.
2  CSO, UNFPA Iraq, 2013.Iraq Poverty Map and Maternal Mortality Survey (IPMMS), 2013.
3 Ministry of Health 2017. Annual Statistics Report 2017.
4 WHO EMRO 2018. Framework for health information system and core indicators for monitoring health situation and health system performance, 2018.

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Key health-related statistics

Total population (000s) 37 140
Total health expenditure on health (% of general government expenditure) 6.5
Maternal mortality ratio (per 100 000 live births) 50
Number of primary health care units and centres (per 10 000 population) 0.7
Total life expectancy at birth (years) 69.8

Source: Framework for health information systems and core indicators for monitoring health situation and health system performance, 2018

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