ADB raises the quality of maternal and child health care in Asia and the Pacific through infrastructure development, governance and financing reforms, and targeted support for high-risk groups.

Asia has made significant progress in improving maternal health and reducing child mortality. However, much still needs to be done as several countries are expected not to achieve the Millennium Development Goals (MDGs) of reducing the maternal mortality ratio by three-quarters and the child mortality rate by two-thirds in 2015.

According to ADB's Key Indicators 2012, the maternal mortality ratio in the region has been reduced by more than half the 1990 levels. The United Nations Children's Fund (UNICEF) estimates that developing Asia's child mortality rate has also dropped by nearly 50% in 2011 compared with 1990 levels. However, it was still more than twice the rate in Latin America and the Caribbean, though much lower than Sub-Saharan Africa's.

Lack of infrastructure and access to essential health services are major causes of high maternal and child mortality in physically and socially isolated communities. These communities often lack basic amenities and connectivity to be able to access life-saving mother and child care. Health policy reform is needed to ensure that competent staff is available in rural health facilities and that services and transportation are made affordable for these rural communities.

In the absence of affordable quality public health services, studies show maternal or child health care could account for as much as 100% to 200% of a poor household's monthly income. High out-of-pocket health care spending is the single major cause of households slipping into poverty, and it forces poor families to reduce spending on food, education, and other essentials.

Under a regional technical assistance project, ADB published a series of technical reports and country briefs discussing the impact of out-of-pocket maternal and child health expenditures on poverty and inequity.

Supporting health reforms

ADB supports improvements in the health sector by focusing on its core areas of expertise - infrastructure, good governance and public expenditure management, and support of regional public goods. It also provides targeted support for communities that are lagging behind in achieving the MDGs.

In Mongolia, ADB plays a key role in assisting the government in formulating and implementing health sector reforms. It is the largest external financier of the health sector in the country. In the Songinohairkhan district, one of the poorest districts in Ulaanbaatar and a center for new rural migrants, ADB is helping build a hospital that will include modern surgical and maternity services.

Through the Improved Maternal and Child Health through Connectivity project, ADB is managing a grant from the Japan Fund for Poverty Reduction that will provide rural communities in eastern Tajikistan better access to health services.

In Bangladesh, 12 comprehensive reproductive health care centers and 26 primary health care centers will be built near slums and other densely populated areas. The project, funded by ADB and the Governments of Bangladesh and Sweden, is expected to strengthen maternal and child health, nutrition, and family planning.

ADB also helps improve maternal and child health through projects that bring piped clean water and sanitation facilities to poor households, particularly in rural areas.

In two of Uzbekistan's poorest provinces, Novoi and Kashkadarya, women and children traveled long distances to fetch water from contaminated sources or purchased bottled water in the market. An ADB-supported project improved rural water supply and sanitation facilities, including chlorination and wastewater drainage systems. Health and hygiene awareness programs were also implemented as part of the project.

ADB also provided targeted support for lagging communities, many of them ethnic minorities such as in the Lao People's Democratic Republic and Viet Nam, to help countries move closer toward MDG 4 (reduce child mortality) and MDG 5 (improve maternal health). The Lao PDR Health Sector Development Program is supporting access to maternal and child health services, staff development, training of skilled birth attendants, and health equity funds in the eight northern provinces. The proposed Viet Nam Second Health Care in the Central Highlands Project will target poor ethnic minority communes and improve referral services. Also in Papua New Guinea, ADB support helps provide maternal and child health services in remote mountain areas.

In addition, ADB partners with other organizations in pushing forward health initiatives and reforms. It has helped form the Maternal Newborn and Child Health Network for Asia and the Pacific, which involves individuals from across the UN system, the World Bank, major bilateral development partners, and the Bill and Melinda Gates Foundation. Read the investment case developed by the network, which advocates for increased spending on maternal, newborn, and child health interventions.