Hon Chairperson, the question has to do with the maternal and infant and child mortality. We have taken steps in making sure that there is reduction in both maternal and child mortality. According to the latest report from South African Medical Research Council released in January 2020, the maternal mortality ratio declined from a high of 198 per 100 000 deliveries in 2012 to 134 per 100 000 beds in 2018.
There are five major causes which lead to maternal mortality which we have been dealing with. This in simple terms we refer to them as the five "Hs" which we need to intervene to reduce maternal mortality. First one is hypertension, high blood pressure in other words. All pregnant women are given calcium supplements in order to prevent complications caused by high blood pressure which is called pre-eclampsia and eclampsia. Introduction of four additional visits to antenatal care also helped.
The second H is called orthocentric haemorrhage. Introduction of innovations in management of women with orthocentric haemorrhage has also helped to reduce this complication. Also in ensuring availability of blood in every district hospital and a lot of number of other technical interventions which has also assisted.
The next H is that of HIV, Aids and TB. We have developed the last mile plan to accelerate the reduction of mother-to-child transmission and the early detection of HIV, TB and syphilis treatment. Pregnant women are initiated on life long antiretroviral treatment.
Health care worker knowledge is the next H. in this case we are providing a lot of training, skills development, such as helping mothers to breath, management of small and sick neonates and essential steps of management of obstetrics emergency. We are also conducting maternal and prenatal death reviews to establish possible modifiable factors which can help us to empower our health workers.
The last H is the health system strengthening in terms of quality improvement strategies in maternal and neonatal services and the implementation, amongst others, maternity waiting homes. These are some of the interventions which have resulted in the reduction of maternal mortality. On neonatal and infant mortality as well, this has declined even though we are still not happy with the extent of the decline from 208 per 1000 light beds in 2012 to 25 per 100 beds in 2018.
In this case, the causative factors are largely asphyxia, which is lack of oxygen. We have revised the intrapartum care guidelines to improve the monitoring of women in labour so that we reduce the gap where the baby does not get enough oxygen and, strengthening the availability of Continuous Positive Airway Pressure, CPAP, in order to make sure that we help babies to breathe.
Prematurity is also a factor. In this regard, we have implemented the introduction of antenatal steroids during pregnancy in order to mature the lungs where there is a threat of premature delivery. We also recognised that most of our neonatal wards are overcrowded and also staff is overworked. It is a matter which we need to attend to.
Lastly, in terms of neonate, are infections. We have strengthened the implementation of guidelines to prevent mother-to-child HIV transmissions. In terms of child mortality as well which has declined ...