Small steps and big goals: Two countries' experiences in achieving MDGs 4 & 5

Source: World Health Organization (Press Release)

MANILA, 21 December 2010—Complex problems can sometimes be solved with simple solutions. For maternal and child health, significant progress has been achieved in Viet Nam by providing weekly supplements of iron and folic acid, and in the Philippines by encouraging breastfeeding. In the process, both countries have taken a step closer to achieving Millennium Development Goal (MDG) 4, which calls for a two thirds reduction in under-5 mortality between 1990 and 2015, and MDG 5, which calls for a three quarters reduction in the maternal mortality ratio.

Viet Nam: preventing anaemia in women of reproductive age

In a developing country such as Viet Nam, children and young women often suffer from iron and folate deficiency, resulting in anaemia and increased risk of death. In addition, the negative consequences of iron deficiency anaemia on the cognitive and physical development of children and on the work productivity of adults are of major concern for the Government.
A simple solution is to provide a regular supplement of iron and folic acid for women during child-bearing years. Evidence suggests that this is a desirable intervention in those parts of the world where women do not yet have access to fortified foods or to diets that are high in bioavailable iron.
In 1998, the World Health Organization's Western Pacific Regional Office initiated a weekly iron and folic acid supplementation (WIFS) project. The project was piloted in four Member States: Cambodia, the Lao People's Democratic Republic, the Philippines and Viet Nam.
Viet Nam became the first country in the Region to implement this anaemia prevention programme in women of reproductive age, using WIFS, combined with twice-yearly deworming. This was piloted in Than Mienh province in the late 1990s. The same initiative was introduced in 2006 in the Yen Binh and Tran Yen districts of Yen Bai province, covering 50 000 women ranging from 15 to 45 years of age. In 2008, the project was expanded to cover the whole province for a total of 250 000 women. Options to further scale up the programme from the provincial to national level are under discussion.
Thanks to the programme, anaemia prevalence in Yen Bai was reduced from 37.5% to 18%, and hookworm infestation decreased from 78.2% to 12%, according to a November 2010 evaluation of the nearly 5-year-old project. The birth weight of infants increased by about 130 grams. WHO is now working to support Yen Bai to secure a sustainable supply of iron and folic acid and to find viable ways to expand the programme.

The Philippines: a push for breastfeeding

A National Demographic Health Survey conducted in 2003 highlighted the dangerously low breastfeeding rates in the Philippines. The results came just after UNICEF and WHO launched the Global Strategy on Infant and Young Child Feeding (IYCF). In response to the survey and the strategy, the Philippines launched a national policy on IYCF and a five-year national action plan to provide strategic direction for improving breastfeeding practices in the country.
Among the follow-up initiatives is the Essential Newborn Care (ENC) protocol under the slogan "The First Embrace", which encourages early skin-to-skin contact and non-separation of the newborn child from the mother in order to promote breastfeeding. The exclusive breastfeeding rate at 28 days of life in the pilot hospital was double the national average for all hospitals.
Supportive supervision for IYCF was stepped up in health centres, with regular visits by national and regional coordinators. Key IYCF indicators were included in the Integrated Child Survival Monitoring Tool.
Progress has been encouraging, but much work remains to be done. Other areas that need attention include:

• the implementation of the Essential Newborn Care protocol in hospitals to increase breastfeeding initiation rates within the first hour of life;
• reaching 1 million pregnant women through an integrated marketing communication effort;
• full implementation of the Expanded Rooming-In Act, which includes provisions for breastfeeding breaks and support for working women;
• the integration of IYCF in the curricula of all health workers; and
• the strengthening of implementation, monitoring and reporting of violations of the Milk Code, which regulates the marketing of breastmilk substitutes.

The latest national data (2008) show that the exclusive breastfeeding rate for the first six months remains unchanged at 34% and the rate of initiation of breastfeeding within the first hour remains at 54%. The figures may not be very dramatic, but they suggest the decline in breastfeeding in the Philippines is reversible.