Bhutan SRMNCAH factsheet: December 2020

Bhutan | 1 Country profile Value Year of data GNI (PPP) per capita63 10 570 2018 Percentage of population below international poverty line25 1.5 2017 Percentage of population using safely managed sanitation services including a handwashing facility with soap and water NA NA Improved sanitation31 99 2019 Handwashing facility with soap and water31 73 2019 Percentage of population using safely managed drinking water services31 100 2019 Source: 63World Bank, World Development Indicators 2019 | 25Global Health Observatory - World Health Organization 2017 | 31Joint Monitoring Programme for Water Supply, Sanitation and Hygiene 2020 Demographic Value Year of data Total population65 772 000 2020 Total under-5 population65 64 000 2020 Total adolescent population (10–19 years)65 136 000 2020 Women in reproductive age group (15–49 years)65 208 000 2020 Annual number of births61 13 000 2019 Total fertility rate (births per woman)3 2.0 2019 Adolescent birth rate (per 1000 women aged 15–19 years)3 28 2012 Births registered (%)3 100 2010 Source: 65World Population Prospects 2020 | 61United Nations Population Division 2019| 3Countdown 2030 • Under-5 population 8% • Total adolescent population 18% • Women in reproductive age group 27% • Total fertility rate 2.0 • Adolescent birth rate 28 per 1000 population • Births registered 100% Basic profile BHUTAN SRMNCAH Factsheet December 2020 Source: 48Trends in maternal mortality 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division 50Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division 4.3% annual rate of reduction between 2010 and 2017, and the assumption that all things will remain as in 2017 considered for calculating the 2030 projection for maternal mortality ratio • 57% reduction in MMR between 2000 and 2017 Impact indicators Maternal mortality ratio (per 100 000 live births) 945 636 423 310 247 203 183 81 1000 800 600 400 200 0 1990 1995 2000 2005 2010 2015 2020 2025 2030 2 | Bhutan • Stillbirth rate (per 1000 births) is 1060 • Adolescent mortality rate (deaths per 100 000 adolescents) is 1060 Source: 60UN IGME database 2019 • 60% reduction in neonatal mortality rate between 1990 and 2019 Source: UN Inter-Agency estimates: Levels and Trends in Child Mortality: Report 2020 (UN IGME 2020) 2.3% annual rate of reduction between 1990 and 2019, considered for calculating the 2030 projection for neonatal mortality rate Neonatal mortality rate (per 1000 live births) SDG target NMR: 12 1990 1995 2000 2005 2010 2015 2020 2025 2030 100 80 60 40 20 0 13 42 37 32 27 22 19 17 • 78% reduction in under-5 mortality rate between 1990 and 2019 Source: UN Inter-Agency estimates: Levels and Trends in Child Mortality: Report 2020 (UN IGME 2020) 5.2% annual rate of reduction between 1990 and 2019, considered for calculating the 2030 projection for under-5 mortality rate Under-5 mortality rate (per 1000 live births) 127 101 77 57 42 33 28 16 SDG target U5MR: 25 1990 1995 2000 2005 2010 2015 2020 2025 2030 200 150 100 50 0 Nutrition indicators • Prevalence of LBWa increased from 10% to 12% between 2010 and 2015 • 76% reduction in stunting among under-5 children between 2010 and 2015 Source: 36Multiple Indicator Cluster Survey 2010 | 47The State of the World’s Children Reports 2019 For definition of the superscript please refer to page number 45 of the country fact sheet 201647 Underweight in adolescents 15%e Overweight in adolescents 9%d Wasting in under-5 childrenb Stunting in under-5 childrenc 201036 201547 100 80 60 40 20 0 6% 6% 34% 8% Prevalence of anaemia in women aged 15–49, disaggregated by age and pregnancy statusf NA Bhutan | 3 Source: 16Global Burden of Disease study 2019 Causes of maternal deaths • Proportion of direct maternal deaths decreased from 60% to 59% between 2015 and 2019 Maternal haemorrhage Indirect maternal deaths Late maternal deaths Other direct maternal disorders Maternal hypertensive disorders Maternal abortion and miscarriage Ectopic pregnancy Maternal obstructed labour and uterine rupture Maternal sepsis and other maternal infections Maternal deaths aggravated by HIV/AIDS Source: 25Global Health Observatory - World Health Organization 2017 444 under-5 children died, mainly due to: • newborn causes • pneumonia and diarrhoea • injuries Causes of under-5 deaths Prematurity Birth asphyxia and birth trauma Acute lower respiratory infections Other communicable, perinatal and nutritional conditions Sepsis and other infectious conditions of the newborn Congenital anomalies Injuries Diarrhoeal diseases Other noncommunicable diseases Measles Meningitis/encephalitis Tetanus HIV/AIDS Malaria Source: 25Global Health Observatory - World Health Organization 2017 244 newborns died in the first month of life mainly due to: • prematurity • birth asphyxia • infections Causes of newborn deaths Prematurity Birth asphyxia and birth trauma Sepsis and other infectious conditions of the newborn Congenital anomalies Other communicable, perinatal and nutritional conditions Acute lower respiratory infections Injuries Diarrhoeal diseases Tetanus Meningitis/encephalitis Other noncommunicable diseases HIV/AIDS Malaria Measles 2.5% 0.6% 0.4% 0.1% 1.1% 1.8% 1.1% 0.5% 0.2% 0% 32.9% 23.2% 17.4% 11.5% 10.4% 0%1.1% 2.4% 0.3% 0.3% 0% 0.1% 0% 21.9% 16.5% 14.2% 5.2% 4% 33.9% 20.2% 14.6% 13.1% 11% 9.4% 9.1% 7.6% 6% 5.4% 4 | Bhutan SRMNCAH policy survey Presence of key national policy/guidelines on SRMNCAH at the national level (Y/N) On family planning/contraception45  On sexually transmitted infections diagnosis, treatment and counselling45  On comprehensive national cervical cancer prevention and control45  On antenatal care45  On childbirth45  On postnatal care for mothers and newborns45  On management of low birth weight and preterm newborns45  On child health and development of children45  On early childhood development45  On integrated management of childhood illness45  On management of childhood pneumonia45  On management of childhood diarrhoea45  On management of malaria with appropriate recommendations for children45  On management of acute malnutrition in children45  On adolescent (10–19 years) health issues45  Multisectoral plan of action for violence against women45  On CAC/post-abortion care15   Yes  No Source: 45Reproductive, Maternal, Newborn, Child and Adolescent Health Policy Survey, 2019 | 15Global Abortion Policies Database, 2017 Causes of adolescent deaths Top 5 causes of adolescent deaths 3 Self-harm 4 Drowning 5 Congenital anomalies 2 Lower respiratory infections Road injury 1 Source: 24Global Health Observatory - World Health Organization 2016 Bhutan | 5 Source: 36Multiple Indicator Cluster Survey 2010 | 32Ministry of Health, National Health Survey 2012 | 47The State of the World’s Children Reports 2019 | 66Global Health Observatory - World Health Organization 2019 Coverage indicators Sexual, reproductive and maternal health Equity in coverage By wealth • 82% got 4+ ANC visits during last pregnancy • 90% received two doses of tetanus • 15% increase in deliveries attended by skilled health personnel from 2010 to 2012 • Institutional deliveries have increased from 63% to 74% between 2010 and 2012 • More than 50% but less than 70% women aged 30–49 were screened for cervical cancer66 By geography By maternal education 100 80 60 40 20 0 Pe rc en ta ge o f w om en o f re pr od uc tiv e ag e (1 5– 49 ) w ho h av e th ei r n ee d fo r fa m ily p la nn in g s a tis fie d w ith m od er n m et ho d s U nm et n ee d fo r f am ily pl an ni ng (t ot al ) Pr op or tio n of w om en ag ed 1 5– 49 w ho re ce iv ed fo ur o r m or e an te na ta l c ar e vi sit s Pr op or tio n of w om en ag ed 1 5– 49 w ho re ce iv ed tw o d os es o f t et an us In st itu tio na l d el iv er y Pr op or tio n of b irt hs at te nd ed b y sk ille d he al th p er so nn el C -s ec tio n Pr op or tio n of w om en w ho ha ve p os tp ar tu m c on ta ct w ith a h ea lth p ro vi d er w ith in tw o d ay s o f d el iv er y 201036 201232 2013–201847 85 % 85 % 77 % 82 % 73 % 90 % 65 % 7 5% 63 % 7 4% N A 12 % N A 12 % N A 41 % Poorest Richest FP satisfied with modern methods (%) FP unmet need (%) ANC 4+ visits (%) Two doses of tetanus (%) SBA (%) Institutional delivery (%) Contact with a health provider within two days of delivery (%) Rural Urban FP satisfied with modern methods (%) FP unmet need (%) ANC 4+ visits (%) Two doses of tetanus (%) SBA (%) Institutional delivery (%) Contact with a health provider within two days of delivery (%) No education (Pre-primary or none) Secondary education Source: 36Multiple Indicator Cluster Survey 2010 FP satisfied with modern methods (%) FP unmet need (%) ANC 4+ visits (%) Two doses of tetanus (%)SBA (%) Institutional delivery (%) Contact with a health provider within two days of delivery (%) 86 92 7795 34 96 33 71 11 12 64 84 NA NA 85 84 12 10 72 73 75 87 90 54 90 52 NA NA 79 86 11 15 74 88 8094 54 71 93 52 NA NA 6 | Bhutan Pe rc en ta ge o f i nf an ts <6 m on th s w ho a re fe d ex cl us iv el y w ith b re as t m ilk In tro d uc tio n to se m iso lid o r s of t fo od s 6 –8 m on th s Pe rc en ta ge o f c hi ld re n fu lly im m un ize d M ea sle s/ M R va cc in at io n at 9 m on th s V ita m in A su pp le m en ta tio n 6– 59 m on th s Pe rc en ta ge o f c hi ld re n w ith d ia rrh oe a re ce iv in g or al re hy d ra tio n sa lts (O RS ) Pe rc en ta ge o f c hi ld re n w ith d ia rrh oe a w ho re ce iv ed O RS a nd z in c Pr op or tio n of c hi ld re n w ith su sp ec te d p ne um on ia ta ke n to an a pp ro pr ia te h ea lth p ro vi d er A nt ib io tic tr ea tm en t f or ch ild re n w ith a cu te re sp ira to ry in fe ct io n (A RI ) s ym pt om s C hi ld re n ha ve p la y th in gs a t h om eg C hi ld re n w ith in ad eq ua te su pe rv isi on h 100 80 60 40 20 0 201036 201232 2013–201847 201962 Child health and development • 95% children fully immunized • 30% increase in taking semisolid or soft foods between 2010 and 2013–2018 • 74% pneumonia suspected children taken to appropriate health provider Source: 32Ministry of Health, National Health Survey 2012 | 62WHO vaccine-preventable diseases: monitoring system. 2020 global summary | 36Multiple Indicator Cluster Survey 2010 | 47The State of the World’s Children Reports 2019 52 % 52 % 74 % 74 % 61 % 74 % 87 % 67 % 51 % 49 % 92 %97 % 14 % 14 % N A N A 49 % N A N A N A 95 % N A Source: 30Global School-based Student Health Survey 2016| 47The State of the World’s Children Reports 2019 For definition of the superscript please refer to page number 45 of the country fact sheet Adolescent health and development 100806020 400 14% 29% 11% 40% 26% Physical activity (>1 hour/day) or prevalence of insufficient physical activity among adolescentsi Current tobacco use (any form)j Attempted suicidek Percentage of students who were in a physical fight one or more times during the 12 months before the surveyl Percentage of women aged 20–24 who were married or in a union before age 18 201630 2012–1847 201036 2013–201847 Newborn health • 32% increase in breastfeeding within the first hour of birth between 2010 and 2013–2018 • 30% got postnatal contact with a health provider within two days of delivery Source: 36Multiple Indicator Cluster Survey 2010 | 47The State of the World’s Children Reports 2019 Proportion of infants who were breastfed within the first hour of birth Proportion of newborns who have postnatal contact with a health provider within two days of delivery Skin-to-skin contact in the first hour of life Hospital discharge at least after 24 hours after birth Proportion of newborns who have home visits in the first week of life NA NANA NANA NA 100 80 60 40 20 0 59% 78% 30% NA Bhutan | 7 • Out-of-pocket health expenditure is decreasing Source: 17Global Health Expenditure database 2015 | 18Global Health Expenditure database 2018 Health system indicators Health financing Health workforce Source: 24Global Health Observatory - World Health Organization 2016 | 64World Health Statistics 2020 • 19 per 10 000 population availability of doctors, nurses, midwives versus 44.5 per 10 000 recommended in Global Strategy24 • 19 per 10 000 population availability of midwives and nurses versus 18 per 10 000 population in the South-East Asia Region64 Total expenditure on health, per capita (USD) 500 400 300 200 100 0 312 322 General government expenditure on health as % of total government expenditure Out-of-pocket health expenditure as % of total expenditure on health 100 80 60 40 20 0 10% 8% 20% 13% 201517 201818 RMNCH service coverage index UHC service coverage index 100 80 60 40 20 0 Service delivery Source: 44Provisional calculation (2021) based on available data in DHS/MICS 2012–2019; Step surveys & Nationally reported data 86% 64% 202144 8 | Bhutan Break-up of UHC coverage index of essential health services with RMNCH sub-index RMNCH Care-seeking behaviour of suspected pneumonia Child immunization coverage (DPT3) Pregnancy care Family planning coverage – satisfied needs Infectious disease control Noncommunicable diseases Prevalence of normal blood pressure level in population age standardized Tobacco non-use Prevalence of normal fasting blood sugar level in population Service capacity and access Health worker density (Physician, pyc., surg.) (%) Density of hospital beds, expressed as % of global threshold, 18/10 000 (proxy for basic hospital access) Health security IHR compliance (%) Source: 44Provisional calculation (2021) based on available data in DHS/MICS 2012–2019; Step surveys & Nationally reported data 74% 97% 89% 85% 21% 97% 73% 93% 64% 44% Tuberculosis (effective) treatment coverage HIV antiretroviral therapy coverage Access to basic sanitation 69% 76% 37% 86% 58% 64% 53% aLow birth weight (LBW): Percentage of births with a reported birth weight <2.5 kilograms regardless of gestational age bWasting in under-5 children: Children whose Z-score is below minus two standard deviations (-2 SD) from the median of the reference population are considered thin (wasted), or acutely undernourished cStunting in under-5 children: Children whose height-for-age Z-score is below minus two standard deviations (-2 SD) from the median of the reference population are considered short for their age (stunted), or chronically undernourished dUnderweight in adolescents: Percentage of adolescents aged 10–19 years with BMI <−2 SD of the median according to the WHO growth reference for school-age children and adolescents eOverweight in adolescents: Percentage of adolescents aged 10–19 years with BMI > 1 SD of the median according to the WHO growth reference for school-age children and adolescents fHaemoglobin levels are shown in grams per decilitre (g/dl) (For non-pregnant women <12.0 g/dl and for pregnant women <11.0 g/dl) gChildren have play things at home: Percentage of children under age 5 who play with two or more types of playthings hChildren with inadequate supervision: Percentage of children under age 5 left alone or under the supervision of another child younger than 10 years of age for more than one hour at least once during the past week iPhysical activity (>1 hour/day) or prevalence of insufficient physical activity among adolescents: Percentage of students aged 13–17 years had physical activity (>1 hour/day) or prevalence of insufficient physical activity among adolescents jCurrent tobacco use (any form): Percentage of students aged 13–17 years who currently used any tobacco products (used any tobacco products on at least 1 day during the last 30 days before the survey) kAttempted suicide: Percentage of students aged 13–17 years who seriously considered attempting suicide during the 12 months before the survey lPercentage of students who were in a physical fight one or more times during the 12 months before the survey: Percentage of students aged 13–17 years who were in a physical fight one or more times during the 12 months before the survey