Chapter 2. Progress towards the EFA goals - Unesco

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CHAPTER 2
2
Education for All Global Monitoring Report
More than one
in three births
in developing
countries take
place without
a skilled birth
attendant
Unsafe pregnancy and childbirth exact an immense
human toll. An estimated half a million women lose
their lives each year from pregnancy and birthrelated
causes – and for every death another thirty
women suffer severe long-term injuries. Almost all
these deaths and injuries could be averted through
access to antenatal care, skilled attendance during
pregnancy and emergency obstetric care. Poor
maternal health, inadequate nutrition and limited
access to care are also implicated in the deaths of
the 4 million newborns who do not survive their first
month (Lawn et al., 2006). Two conditions – birth
asphyxia and sepsis with pneumonia – cause nearly
60% of these deaths. The real cause, however, is
limited access to skilled health professionals at birth
and a failure to prioritize maternal and child health
in national policy (Thea and Qazi, 2008).
This ‘needless human tragedy’ (UNICEF, 2008b)
goes beyond maternal and child mortality and
immediate health risks. Undernutrition in utero, low
birth weight and heightened vulnerability to sickness
after birth can cause direct structural damage to the
brain that impairs cognitive development and locks
children into a future of underachievement. Wider
health risks during pregnancy and childbirth also
have consequences for education:
Maternal iodine deficiency in pregnancy causes
an estimated 38 million children to be born
each year facing risks of mental impairment
and congenital abnormalities (UNICEF, 2007b).
Anaemia, which affects around half of all
pregnant women, heightens the risks associated
with pregnancy and reduces prospects for child
survival (UNICEF, 2008b).
Around half of the stunting observed in infants
occurs in the uterus and the remainder during
the first two years of life (Victoria et al., 2008).
of sexual and reproductive health, early marriage
and poor access to information all contribute.
Providing quality health care
Inadequate maternal and child health care is
holding back advances in education. Progress
towards the Millennium Development Goal target
of a three-quarters reduction in maternal deaths
by 2015 has been close to zero. Meanwhile, limited
improvements in survival in the first month of life
are preventing progress towards the target on
child mortality.
One of the most urgent priorities is providing
quality health services. Intrauterine growth
restrictions and maternal micronutrient deficiencies
can be readily detected through antenatal care and
treated at little cost. Access to facilities providing
skilled attendance at birth, emergency obstetric
care and post-natal care could prevent over 80%
of maternal and neonatal deaths, and set children
on course for a healthy future (UNICEF, 2008b).
Yet more than one in three births in developing
countries take place without a skilled birth
attendant. Skilled attendance rates are lowest
in South Asia (41%) and sub-Saharan Africa (45%)
(UNICEF, 2008b). Not coincidentally, these are the
regions with the highest maternal mortality rates.
Poverty undermines maternal health in several
ways. It heightens exposure to threats such as
malnutrition and infectious disease. It can also
reduce access to vital health care, either because
care is lacking or because it is unaffordable to
the very poor. The poverty risk factor is graphically
captured in a UNICEF review of evidence from
fifty household surveys that found that neonatal
mortality rates among the poorest 20% were
typically 20% to 50% higher than for the wealthiest
quintile (UNICEF, 2008b). These health inequalities
fuel education disparities later in life.
The absence of skilled health personnel during
delivery costs lives and leaves children facing
lifetime disadvantages. Asphyxia contributes
to around one-quarter of newborn deaths
and results in about 1 million children suffering
learning difficulties and disabilities such as
cerebral palsy (WHO, 2005).
Access to health provision is not the only barrier to
improved child and maternal care. Many underlying
problems associated with pregnancy and childbirth
reflect a failure to protect women’s rights. Low
status, heavy workloads, a lack of voice in matters
The poorest mothers and children are often
underserved along the whole continuum of care.
In South Asia, being poor reduces by a factor of
five the probability of having a skilled health person
in attendance during delivery. Even controlling for
poverty, indigenous people and ethnic minorities are
often severely disadvantaged. In Guatemala, nonindigenous
women are more than twice as likely as
their indigenous counterparts to give birth in a
public health facility with trained personnel. The
factors excluding poor and vulnerable households
from basic maternal and child health services vary
by country but include cost, distance and the poor
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