A special edition of The Lancet this week focuses on findings from a Countdown to 2015 For Maternal, Newborn & Child Survival report. (A first report was written in 2005, and further reports will be written every two or three years up to 2015.)
And the news is not so good. Fewer than a quarter of 68 priority countries are on track to reach the Millennium Development Goals (MDGs) on maternal and child mortality (MDG 4 seeks to reduce the morality rates in children under the age of five by two thirds. MDG 5 calls for a reduction of maternal mortality ratios by three quarters 75%). And while some countries, notably China, have made significant progress, many more – mostly in sub-Saharan Africa – have seen no progress or even reversals of progress.
Fifty eight of these 68 priority countries have high maternal mortality rates (MMRs). In Sierra Leone, the MMR is 2,100 per 100,000 live births. In Afghanistan and Niger it is 1,800. (By contrast, the MMR in Canada is 7, and in the UK 8.) In Chad the infant mortality rate is 209 deaths of children under the age of five per 100,000 live births. In Equatorial Guinea it is 206, in Cameroon it is 149. In 54 of the 68 countries there are fewer than 2.5 health care professionals for every 1,000 people. Which is "too few to make a difference," say the report authors.
However, experts who launched the report in London this week refused to be overwhelmed by the scale of improvements needed, and argued that one of the many agendas that need to be addressed is the very provision and dissemination of the data in the report so that policy makers can assess the scale of the problem. They do believe that many countries can achieve progress if there is more political will, more collaboration between donors and recipient countries, and increases in funding. They also point to the success stories of Tanzania and Bangladesh, poor countries where vast improvements in maternal and child health have been achieved over the last 10 years.
Ann Starrs, President of Family Care International, says essential future actions must include the strengthening of national and local health systems, dramatic increases in resources, and aid must be less volatile and better targeted to countries most in need. Or as Jennifer Byrce from Johns Hopkins put it, "We want big projects. Yes we need more money, but compared to spending on, for example, defense, the actual amounts needed are not huge."
And the reproductive health reality check on this agenda? In an editorial in The Lancet, Richard Horton writes, "Reproductive health, too often forgotten as an essential component of maternal, newborn, and child health strategies, requires immediate attention."
The Countdown report will be launched again in Cape Town at a Countdown Conference on April 17. The Countdown Conference takes place at the same time as the 118th Assembly of the Inter-Parliamentary Union, and also before the G8 Summit in Tokyo in July. Flavia Bustreo, who is facilitating the Countdown Conference, says this is a vital opportunity to engage with parliamentarians from around the world. "There is an urgent need to mobilize Members of Parliament in these 68 countries as well as in donor nations. As elected leaders they should represent the voices of women and children and protect their rights. Getting their commitment to do so is the objective of the Countdown Conference. Parliamentarians can lead the change for women and children."
The Countdown report is essential reading for anyone involved in health development. And the agenda to engage with parliamentarians with the report findings – rather than vague demands and complaints, and out of date information – makes perfect sense. What I do worry about is that any discussions with parliamentarians about reproductive and sexual health in this context will be side-lined. And any promises and commitments to maternal and child health will neatly avoid any commitment to provision of reproductive health services, including access to abortion, access to decent sex education, and access to contraceptives for all those people who need them. (Prevention of unintended pregnancies can apparently reduce maternal mortality by a third.) Whether or not politicians are prepared to make that leap of faith in discussions about maternal and child health remains to be seen.
- Rupert Walder, Beyond the Millennium Development Goals