New momentum to end preventable child and maternal deaths by 2013

A six-year-old girl in a small village in Nicaragua. Photo: David J. Olson

This originally appeared on Global Health TV on July 22, 2014.

In June 2012, the governments of Ethiopia, India and the U.S., in collaboration with UNICEF, hosted the “Child Survival: Call to Action,” designed to focus the disparate priorities of the global health world into a single, achievable goal of ending preventable child deaths by 2035.

Much progress has been made in the last two decades – the total number of child deaths fell from 12.6 million in 1990 to 6.6 million in 2012. And maternal mortality worldwide dropped by 45% between 1990 and 2013, according to the World Health Organization, from 523,000 deaths in 1990 to 289,000 in 2013.

However, there are still unacceptably high levels of maternal and child mortality, as shown in this terrific infographic, and the status quo will not get us where we need to be — the elimination of preventable child and maternal deaths by 2035.

We are not making particularly good progress towards Millennium Development Goals 4 and 5 on child and maternal health, which expire in 2015. Out of the 24 high-priority countries on which the U.S. Agency for International Development focuses, only six countries have achieved MDG 4 (Bangladesh, Malawi, Nepal, Liberia, Tanzania and Ethiopia) and only two have achieved MDG 5 (Rwanda and Nepal).

So I was encouraged to participate in another high level event, “Acting on the Call: Ending preventable child and maternal deaths,” organized by USAID, the Bill & Melinda Gates Foundation, UNICEF and the governments of Ethiopia and India at USAID headquarters in Washington, D.C. on June 25.

USAID Administrator opened the day-long event by announcing that USAID is realigning $2.9 billion of agency resources to save up to a half a million children from preventable deaths by the end of 2015 by refocusing resources on high-impact programs. USAID has already ended global health funding in 26 countries and is now focusing all its attention on 24 countries — primarily in sub-Saharan Africa and South Asia — that account for 70% of maternal and child deaths and half of the unmet need for family planning.

“We are here today because for the first time in our history, we stand within reach of a world that was simply unimaginable for so long: a world without child and maternal death,” said Shah in his remarks. “We know how to reach every woman and every child with simple, low-cost medicines and interventions that will help all of them survive and thrive.”

“Right now, we are partnering with engines of innovation — corporations, foundations, NGOs, faith-based communities, entrepreneurs and local leaders—to solve one of the greatest development challenges: ending extreme poverty and build thriving, resilient societies. We know that, by working with the global community, we can end preventable child and maternal deaths, which is critical to our own national security, economic prosperity and moral leadership.”

World Bank President Jim Kim, who also appeared, said there will be more than enough resources to end preventable maternal and child deaths. “A lack of resources should not be an excuse,” he said. He also urged more focus on domestic resources within developing countries, which is already happening in HIV/AIDS.

But what will it take to achieve further success in maternal and child health? The Partnership for Maternal, Newborn & Child Health looked at more than 250 health and development indicators for 144 low- and middle-income countries and found ten countries “punching well above their spending weight”: Bangladesh, Cambodia, China, Egypt, Ethiopia, Laos, Nepal, Peru, Rwanda and Vietnam. These countries are expected to achieve MDGs 4 and 5 ahead of comparable countries.

On The Lancet Global Health Blog, Carole Presern, director of PMNCH, wrote that they found no standard formula for success but they did find that these 10 countries all acted in three main areas to reduce maternal and child mortality:

•  They invested across various sectors, not just health.
• They adopted strategies to make the best use of available resources.
• They used up-to-date evidence to support decision-making and accountability for results.

 I was pleased to see a Republican make the case for family planning as a tool for reducing maternal and child mortality. A video was screened showing former Senate Majority Leader Bill Frist promoting family planning.

“There are over 222 million women today who want to delay pregnancy but are not using family planning,” he says. “This is not a partisan issue. It’s a humanitarian issue. It comes down to being the right thing to do, scientifically demonstrated, and that is non-partisan. By enabling women to engage in family planning, we know that we can reduce overall maternal deaths by as much as 30% and neonatal and child deaths by as much as 25%.”

It is critical to keep maternal and child health a bipartisan issue, as with HIV/AIDS. A reception on Capitol Hill that evening provided some evidence that that might actually be possible. A highly bipartisan group of members of Congress spoke to the crowd, ranging from conservative stalwarts like Sens. Lindsey Graham and Rep. Chris Smith to liberals like Sen. Chris Coons and Rep. Betty McCollum. The fact that such strange bedfellow can line up behind this issue — perhaps the only issue they can all agree on — gives me hope that perhaps we can achieve such a monumental goal by 2035.