Maldives SRMNCAH factsheet: December 2020

Maldives | 1 Country profile Value Year of data GNI (PPP) per capita63 17 880 2019 Percentage of population below international poverty line24 0 2016 Percentage of population using safely managed sanitation services including a handwashing facility with soap and water12 98 2016–2017 Improved sanitation12 98 2016–2017 Handwashing facility with soap and water12 98 2016–2017 Percentage of population using safely managed drinking water services12 99 2016–2017 Source: 63World Bank, World Development Indicators 2019 | 24Global Health Observatory - World Health Organization 2016 | 12Demographic and Health Survey 2016–2017 Demographic Value Year of data Total population65 541 000 2020 Total under-5 population65 36 000 2020 Total adolescent population (10–19 years)65 59 000 2020 Women in reproductive age group (15–49 years)65 114 000 2020 Annual number of births61 7000 2019 Total fertility rate (births per woman)12 2.1 2016–2017 Adolescent birth rate (per 1000 women aged 15–19 years)12 10 2016–2017 Births registered (%)12 99 2016–2017 Source: 65World Population Prospects 2020 | 61United Nations Population Division 2019 | 12Demographic and Health Survey 2016–2017 • Under-5 population 7% • Total adolescent population 11% • Women in reproductive age group 21% • Total fertility rate 2.1 • Adolescent birth rate 10 per 1000 population • Births registered 99% Basic profile Source: 48Trends in maternal mortality 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division 54Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division 3.5% 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 • 58% reduction in MMR between 2000 and 2017 Impact indicators Maternal mortality ratio (per 100 000 live births) 800 600 400 200 0 677 22 125 75 67 54 53 1990 1995 2000 2005 2010 2015 2020 2025 2030 340 MALDIVES SRMNCAH Factsheet December 2020 2 | Maldives • Stillbirth rate (per 1000 births) is 660 • Adolescent mortality rate (deaths per 100 000 adolescents) is 360 Source: 60UN IGME database 2019 • 87% 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) 8.0% 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 Achieved SDG target 1990 1995 2000 2005 2010 2015 2020 2025 2030 100 80 60 40 20 0 39 32 22 12 8 6 5 2 Nutrition indicators • Prevalence of LBWa increased from 11% to 13% between 2009 and 2016–2017 • 19% reduction in stunting among under-5 children between 2009 and 2016–2017 Source: 5Demographic and Health Survey 2009 | 12Demographic and Health Survey 2016–2017 | 47The State of the World’s Children Reports 2019 For definition of the superscript please refer to page number 85 of the country fact sheet Wasting in under-5 childrenb Stunting in under-5 childrenc 100 80 60 40 20 0 9%11% 15%19% 2016–201712 Prevalence of anaemia among pregnant women 62% Prevalence of anaemia in women aged 15–49 63%f 201647 Underweight in adolescents 14%d Overweight in adolescents 16%e 20095 2016–201712 • 91% 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) 8.4% 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) SDG target U5MR:25 Achieved SDG target 1990 1995 2000 2005 2010 2015 2020 2025 2030 100 80 60 40 20 0 86 62 39 21 14 8 3 10 Maldives | 3 Source: 16Global Burden of Disease study 2019 Causes of maternal deaths • Proportion of direct maternal deaths decreased from 74% to 73% between 2015 and 2019 Source: 25Global Health Observatory - World Health Organization 2017 Nearly 60 under-5 children died, mainly due to: • infections • newborn causes • pneumonia and diarrhoea Causes of under-5 deaths Source: 25Global Health Observatory - World Health Organization 2017 Nearly 34 newborns died in the first month of life mainly due to: • prematurity • infections • birth asphyxia Causes of newborn deaths 2.7% 0.5% 0.003%2.3% 0.7% 0% 1.1% 0.5% 0.2% 0% 0%0.2% 0% 3.3% 3.7% 1.4% 0.8% 0.3% 0% 0% 0% Prematurity Congenital anomalies Birth asphyxia and birth trauma Other communicable, perinatal and nutritional conditions Sepsis and other infectious conditions of the newborn Acute lower respiratory infections Injuries Tetanus Other noncommunicable diseases Meningitis/encephalitis Diarrhoeal diseases HIV/AIDS Malaria Measles Other direct maternal disorders Maternal haemorrhage Indirect maternal deaths Maternal hypertensive disorders Late maternal deaths Maternal obstructed labour and uterine rupture Maternal abortion and miscarriage Maternal sepsis and other maternal infections Ectopic pregnancy Maternal deaths aggravated by HIV/AIDS Congenital anomalies Prematurity Other noncommunicable diseases Birth asphyxia and birth trauma Other communicable, perinatal and nutritional conditions Acute lower respiratory infections Injuries Sepsis and other infectious conditions of the newborn Diarrhoeal diseases Meningitis/encephalitis Tetanus HIV/AIDS Malaria Measles 27.6% 39.4% 11.2% 9.9% 6.6% 30.3% 24.8%10.1% 8.6% 7.7% 7.5% 4.9% 29.5% 27.9% 21.3% 9.3% 5.7% 4 | Maldives 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 care45   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 Source: 24Global Health Observatory - World Health Organization 2016 2 Drowning 3 DengueCollective violence and legal intervention 1 5 Congenital anomalies 4 Interpersonal violence Maldives | 5 Source: 5Demographic and Health Survey 2009 | 12Demographic and Health Survey 2016–2017 | 66Global Health Observatory - World Health Organization 2019 Coverage indicators Sexual, reproductive and maternal health • 82% received 4+ ANC visits during last pregnancy • 94% institutional deliveries • 100% deliveries attended by skilled health personnel • Postpartum contact with a health provider within two days of delivery has increased from 67% to 80% between 2009 and 2016–2017 • 23% increase in C-section between 2009 and 2016–2017 • 10%–50% women aged 30–49 were screened for cervical cancer66 Source: 12Demographic and Health Survey 2016–2017 Equity in coverage 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 20095 2016–201712 43 % 30 % 85 % 82 % 82 % 70 % 95 % 10 0% 95 % 94 % 80 % 67 % 40 % 32 % 28 % 31 % By geography Rural Urban ** A figure based on fewer than 25 unweighted cases that has been suppressed By maternal education No education (Pre-primary or none) Secondary education By wealth 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 (%) Poorest Richest 38 28 97 NA NA 33 25 79 100 89 80 86 99 71 Contact with a health provider within two days of delivery (%) FP satisfied with modern methods (%) FP unmet need (%) ANC 4+ visits (%) Two doses of tetanus (%) SBA (%) Institutional delivery (%) 32 30 33 92 81 80 96 71 100 99 69 80 84 28 Contact with a health provider within two days of delivery (%) FP satisfied with modern methods (%) FP unmet need (%) ANC 4+ visits (%) Two doses of tetanus (%) SBA (%) Institutional delivery (%) 38 37 64 7099 95 ** 78 96 100 24 NA NA 22 6 | Maldives 20095 2016–201712 Child health and development • 33% increase in exclusive breastfeeding between 2009 and 2016–2017 • 55% increase in use of vitamin A supplements between 2009 and 2016–2017 • 75% children with diarrhoea received ORS and 42% received both ORS and zinc • Less than 1% of children under age 5 were reported to have had symptoms of ARI, in the two weeks preceding the survey Source: 5Demographic and Health Survey 2009 | 12Demographic and Health Survey 2016–2017 100 80 60 40 20 0 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 93 % 76 % 89 %95 % 48 % 64 % 48 % 75 % 90 % 97 % 48 % 42 % N A 12 % N A 75 % N A N A N A N A N A N A 20095 2016–201712 Newborn health • 3% increase in breastfeeding within the first hour of birth between 2009 and 2016–2017 • 22% increase in postnatal contact with a health provider within two days of delivery between 2009 and 2016–2017 Source: 5Demographic and Health Survey 2009 | 12Demographic and Health Survey 2016–2017 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 100 80 60 40 20 0 64% 67% 67% 82% NA NANA NANA NA Adolescent health and development Source: 28Global School-based Student Health Survey 2014 | 12Demographic and Health Survey 2016–2017 For definition of the superscript please refer to page number 85 of the country fact sheet 100806020 400 NA 12% 13% 29% 2% 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 201428 2016–1712 Maldives | 7 RMNCH service coverage index UHC service coverage index 100 80 60 40 20 0 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 Total expenditure on health, per capita (USD) 201517 201818 • Out-of-pocket health expenditure is increasing 20% 21%19% 21% Source: 17Global Health Expenditure database 2015 | 18Global Health Expenditure database 2018 Health system indicators Health financing Health workforce Source: 23Global Health Observatory - World Health Organization 2015 | 64World Health Statistics 2020 • 118 per 10 000 population availability of doctors, nurses, midwives versus 44.5 per 10 000 recommended in Global Strategy23 • 64 per 10 000 population availability of midwives & nurses versus 18 per 10 000 population in the South-East Asia Region64 Service delivery Source: 44Provisional calculation (2021) based on available data in DHS/MICS 2012–2019; Step surveys & Nationally reported data 67% 62% 1500 1200 900 600 300 0 1177 1443 202144 8 | Maldives 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 75% 99% 90% 29% 47% 100% 63% 100% 63% 47% Tuberculosis (effective) treatment coverage HIV antiretroviral therapy coverage Access to basic sanitation 99% 51% 19% 67% 71% 46% 67% 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