Towards elimination of maternal and child deaths

Roselyne Sachiti Features Editor
IN 2010, South Africa became the first African country to host the World Cup Final. The tournament, a runaway success, was the pride and joy of the continent, and the world, too.

Four years down the line, the same tournament is taking place in South America, Brazil being the proud hosts.

The attention of all countries across the globe is focused on Brazil, which hopes to win the World Cup for a record sixth time.

But, back here in South Africa, another “world cup”, the Partnership for Maternal, Newborn and Child Health Partners’ Forum (PMNCH) is also playing out.

This is one that will shape the future of generations to come and “crying” out for world attention.

Brazil, too, has been on the map for the good reasons — they are also winning the battle to save children’s lives.

Since 1990 when the World Cup final was hosted by Italy, Brazil has reduced child mortality by 77 percent. Child mortality refers to the number of deaths among children under the age five. While some countries that took part in the tournament also fared well, others did not. Other countries have not progressed equally and deliberations on how these should up their game and start scoring have stolen the Brazil World Cup spotlight in Johannesburg, South Africa.

Over 800 leaders and public health experts from around the world attending the PMNCH currently underway here have responded by calling for accelerated action to reduce child mortality.

PMNCH chairperson Graca Machel is worried. So are South Africa’s deputy president Cyril Ramaphosa, UN Secretary General Ban Ki Moon, musician and Unicef goodwill ambassador for malaria Yvonne Chaka Chaka, among many others.

While most developing countries have taken substantive action to save women’s and children’s lives, huge areas of “unfinished business” still remain.

According to a new report, Countdown to 2015, released at the conference, substantial inequities persist, even in countries that have made solid gains in maternal and child health.

Zimbabwe, China, Mexico, Morocco, Egypt, Malawi, Cambodia, Brazil, Peru, Bangladesh, Liberia, Senegal, Uganda, Ethiopia, South Africa, Zambia, and Mozambique are some of the 75 countdown countries.

Most countries are still reaching only half or less of women and children who need vital health interventions, and the poorest are being left behind.

The 75 countries covered in Countdown’s 2014 report, Fulfilling the Health Agenda for Women and Children, account for more than 95 percent of all maternal and child deaths each year.

In virtually every countdown country, the wealthy receive far higher coverage of key interventions than the poor.

“Now is the time to make a final push on the health Millennium Development Goals 4 and 5, and to set the stage for elimination of preventable maternal and child deaths in the years beyond 2015,” said Dr Zulfiqar Bhutta of Aga Khan University in Pakistan and the Hospital for Sick Children in Toronto, co-chair of Countdown to 2015.

“To achieve these goals, we need to do a much better job of reaching the poor, young people, indigenous groups, and other vulnerable people with essential health services.”

At the same time as the report’s release, The Lancet published a summary article on the report, together with Maternal Mortality in Bangladesh: a Countdown to 2015 country case study, one of a series of case studies that Countdown is conducting to explore in-depth how countries have achieved or failed to achieve progress in women’s and children’s health.

The Countdown Report shows that in several countries more than half of the mothers and children in the poorest 20 percent of the population receive two or fewer of eight interventions deemed essential for preventing or treating common causes of maternal and child deaths, including vaccinations, skilled birth attendance, pneumonia and diarrhoea treatment, and access to family planning.

In nearly one-third of Countdown countries, more than 20 percent of the poorest women and children receive two or fewer of the eight essential interventions.

In nearly every Countdown country, by contrast, a large majority of the richest women and children receive most or all of these eight key interventions.

“The good news is that some Countdown countries are targeting the poor with programmes to expand coverage of key interventions, and making real strides in reducing inequities,” said Dr Cesar Victora of the Federal University of Pelotas (Brazil), co-chair of Countdown’s Equity Technical Working Group.

“Countries like Bolivia, Cambodia and Niger can serve as models for others in reducing inequality in coverage between rich and poor.”

Stunting, a measure of length/height for age that reflects long-term hunger, illness, or poor child care, is on average 2,5 times higher among poor children than among children from wealthier families.

The report notes that in many Countdown countries more than 30 percent of children are stunted, and that nearly half of all deaths among children under age 5 — or about 3 million deaths a year — are attributable to under-nutrition. Poor nutrition also harms a woman’s health and increases her risk of stillbirth or delivering a low-birth weight baby.

“The high levels of stunting that we continue to see in developing countries, especially among the poor, is a sign of a continuing crisis that the world has yet to effectively address,” said Dr Mickey Chopra, UNICEF’s head of health and co-chair of the Countdown.

“The health and well-being of our next generation, and the right of millions of children to live happy, productive lives, is at stake.”

Consistent with findings from recent reports about the state of newborns and the global health workforce, the new Countdown analysis finds that improving newborn survival and addressing the human resource crisis require urgent action.

The analysis shows that a median of 39 percent deaths of children under age five occur during the first month of life in the Countdown countries, underscoring a need for improved access to quality skilled delivery care for mother and baby around the time of birth, when most stillbirths and maternal and newborn deaths occur.

It also finds that only 7 Countdown countries have enough skilled health professionals to achieve high coverage of essential interventions.

Countdown examined countries’ progress in adopting policies that enable improvements in women’s and children’s health. “Many countries are making important and constructive policy changes, but most Countdown countries are lagging behind in endorsing recommended policies,” said Bernadette Daelmans of the World Health Organisation, co-chair of Countdown’s Health Systems and Policies Technical Working Group. “Experience shows that relatively simple policy changes can bring big results, so more action is needed.”

According to the Countdown analysis, when the Millennium Development Goals (MDG) deadline arrives 18 months from now, the goals related to maternal and child health would not have been achieved. Fewer than half of the 75 Countdown countries are likely to have succeeded in reducing child mortality by two-thirds from 1990 levels (MDG target 4.A), only a small fraction would have cut maternal death by three-quarters (MDG target 5.A), and access to reproductive health (MDG target 5.B) would not be nearly universal. The next 18 months are, therefore, critical for accelerating progress towards the MDG targets and for ensuring that work to achieve the next set of global goals and targets begins right now. This will require intensified support to countries lagging behind and sustained effort in countries where progress is happening. Action to end preventable maternal and child deaths, by improving nutrition and coverage of effective interventions for all population groups, must not be delayed, according to the report.

“Thousands of women and children are suffering and dying every day from causes that are easily preventable and treatable,” said Dr Jennifer Bryce of Johns Hopkins University, a lead author of the report.

“We cannot and must not wait for the post-2015 agenda to be finalised to address these issues and take concerted, emphatic action to save women, newborns and children. We can still make real progress, right now, toward achievement of the health MDGs and we must set a clear path toward a world free of preventable maternal and child deaths in the years beyond 2015.”

As the Brazil World Cup reaches critical stages, discussions on maternal health are also heating, with MDG goals 4 and 5, which have been lagging behind, hopefully finally hitting the 2015 deadline net.

Feedback to: [email protected] or [email protected] or [email protected]

Pin It