世界银行-释放马达加斯加妇女和少女的潜力-健康方面的挑战和机遇：手册2（英）-2023.10-43页_1mb

Summary: Challenges and Opportunities in Health for Women and Adolescent Girls in Madagascar

Madagascar faces significant challenges in women's and adolescent girls' maternal, sexual, and reproductive health (SRH). Despite some progress, high maternal mortality (MMR = 335 deaths per 100,000 live births) and limited access to professional healthcare services persist. Key barriers include scarcity of health facilities, prohibitive costs, and poor quality of care. Poverty and lack of means are major constraints, exacerbating these issues.

Adolescent fertility is also a concern, with one-third of girls aged 15–19 having begun childbearing. Teenage pregnancy is linked to increased risks for girls' education, health, and economic opportunities. Key drivers include lack of access to information, insufficient youth-oriented family planning services, and harmful social norms.

The report recommends three strategic directions:

1. Address supply-side barriers in access to maternal, sexual, and reproductive health services: Improve availability and accessibility of healthcare institutions, expand access to frontline providers, reduce financial constraints through vouchers and subsidies, acknowledge traditional medicine's role, and improve staff training.

2. Improve girls’ knowledge on SRH, FP, and prevention of pregnancy: Enhance reliable information through school curricula, edutainment, social marketing, and digital platforms.

3. Enhance access to youth-friendly SRH services and empower girls: Train health staff, establish youth-friendly clinics, and implement community and empowerment programs to strengthen girls’ agency.

This analysis is part of a larger study on gender inequalities in Madagascar, with related insights from other thematic notes covering education and economic opportunities.