SKILLED CARE DURING CHILDBIRTH - Family Care International

Skilled Care During Childbirth: Country Profiles Botswana
TUNISIA
SRI LANKA
MALAYSIA
Botswana
Introduction
Population size (millions) (1) 1.6
Population distribution (%) (1)
Rural 50
Urban 50
Adult illiteracy rate (%) (1)
Male 25
Female 20
GDP (US$ millions) (1) 5,285
% GDP spent on health* 2.5
Total fertility rate (1) 4.0
Contraceptive prevalence (%) (2) 33
National maternal mortality ratio ✝ 480
Skilled care during childbirth
requires the presence of a
doctor or midwife, or a nurse
with midwifery skills, who is
trained to manage normal
labour and delivery, recognise
complications, and offer
either emergency treatment
or immediate referral to health
centres for more advanced
care. Skilled care also
requires functioning referral
and transport systems and
necessary drugs, equipment,
and supplies.
Botswana is a landlocked country in the centre of Southern Africa, bordered by Namibia, South Africa,
Zambia, and Zimbabwe. Its population is small but rapidly growing, with a trend toward urbanisation.
Botswana is also youthful: in 2000, approximately 42% of its citizens were under the age of 15. (1)
At independence in 1966, Botswana was one of the poorest countries in Africa with Gross National
Product (GNP) per capita of about US$12. However, the discovery of diamonds, coupled with prudent
economic management and political stability, dramatically increased the GNP per capita to US$3,300
by the year 2000.
Trends in health and development: Government spending on the public sector exceeds 30% of Gross
Domestic Product (GDP), of which 8% is spent on health. (3) This investment in infrastructure and
services has led to tremendous improvements in a number of health and social indicators, including
the under-five mortality rate, access to clean drinking water, and life expectancy at birth. Botswana’s
total fertility rate experienced a steady decline, from 6.1 children per woman in 1980 to 4.0 children
in 2000. (1) In education, Botswana has achieved significant improvements in female primary
education enrolment and adult literacy levels.
Despite these achievements in health and development, Botswana is now struggling with one of the
highest HIV infection rates in the world. An estimated 35% of the adult population is HIV infected, ✦
and in 1998 approximately 35% of pregnant women were HIV positive. +
Maternal health: In 1973, the Ministry of Health (MOH) formally established a national Maternal and
Child Health/Family Planning (MCH/FP) programme, coordinated by the MCH/FP Unit in the MOH. As
part of the national programme, the Government developed a network of health care infrastructure
throughout the country for provision of integrated MCH/FP services (see section on Developing Health
Services Infrastructure).
Although antenatal, delivery, and postnatal services were made available to women in the 1970s,
Botswana’s maternal health situation did not improve. In 1984, one-third of women gave birth without
a skilled attendant present during childbirth and just over half sought postpartum care. In 1993, a
study of maternal deaths found that haemorrhage, sepsis, and obstructed labour accounted for almost
* This reflects public health expenditures, as percentage of GDP, and consist of recurrent and capital spending from government
budgets and social health insurance funds.
✝ The maternal mortality ratio or MMR is the number of women who die during pregnancy or childbirth per 100,000 live births.
This estimate is from the publication, Maternal Mortality in 1995: Estimates developed by WHO, UNICEF, UNFPA, and is assumed
to be high given the relatively high coverage and good quality services of Botswana’s health system. The government conducted
a pilot study to test data collection tools for an upcoming study that will produce a revised estimate of maternal mortality and
provide data on the leading causes of maternal mortality and circumstances surrounding maternal deaths.
✦ 1999.
+ 1998, sentinel surveillance.
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