Maternal health in Lao PDR: repositioning the goal posts

Abstract

This paper reviews attempts made in the Lao People's Democratic Republic (PDR) to achieve Millennium Development Goal (MDG) 5: Improve Maternal Health and its two targets: (1) to reduce by three quarters the maternal mortality ratio and (2) to achieve universal access to reproductive health. It will be shown that significant strides have been made in relation to both the targets, especially in the province of Xayaboury where the contraceptive prevalence rate is the highest and maternal mortality is the lowest in the country. That said, it is unlikely that either target will be realised by 2015 for the nation as a whole. Some of the reasons for this are canvassed such as problems with the existing health infrastructure and its personnel, the cost of health care, the demographic profile and cultural expectations of women of childbearing age, geographic barriers, the absence of communication and transport infrastructure and the influence of international donors on how monies are expended. As discussions now begin to set the framework for the post-MDG compact of the international community to address poverty and well-being, it would be valuable to consider the multiplicity of factors which directly impact maternal and infant mortality rates (such as family planning, age at first birth, access to antenatal care and government expenditure on maternal health care) and explain what causes change, over non-contextualised statistics that simply report changes.

Keywords:

• Millennium Development Goals
• Laos
• maternal health
• reproductive health

JEL classifications:

• O19
• O53

Notes

1. Countries with MMR < 100 in 1990 are not categorised (WHO 2010, p. 32).

2. Xaysombourn was a special zone which ceased to exist in January 2006 when its two remaining districts were absorbed into neighbouring Vientiane and Xieng Khoung provinces, respectively, but it continues to be referred to as a separate reporting area within many official publications.

3. Literacy rates also differ significantly between ethnic groups in these provinces.

4. The Global Campaign for Health is an alliance formed by global leaders in 2007 to focus on the three health-related Millennium Development Goals. It is currently led by the Prime Minister of Norway, Jens Stolzenburg.

5. It must be acknowledged that there are multiple factors which influence a woman's decision to have a medically assisted birth. Cultural beliefs, lack of access and expense are all important considerations. For a detailed discussion of these refer to Eckermann (2006, 2010) where she describes the role of the Silk Homes in southern Lao PDR as an innovative solution to encourage women to have ready access to expert help should the need arise.