During the 1980s, less than 30% of the country's population had access to primary health care services. Benin had one of the highest death rates for children under the age of five in the world. Its infant mortality rate stood at 203 deaths for every  live births. Only one in three mothers had access to child health care services. The Bamako Initiative changed that dramatically by introducing community-based healthcare reform, resulting in more efficient and equitable provision of services. , Benin had the 26th highest rate of maternal mortality in the world. According to a 2013 UNICEF report, 13% of women had undergone female genital mutilation. A comprehensive approach strategy was extended to all areas of healthcare, with subsequent improvement in the health care indicators and improvement in health care efficiency and cost. Demographic and Health Surveys has completed three surveys in Benin since 1996.