Countdown to 2015 highlights ‘unfinished business’
Bringing health care to world’s poorest women and children remains elusive in many countries
Many developing countries have taken substantive action to save women’s and children’s lives, but vast areas of “unfinished business” still need to be addressed.
This is according to a new report released at the Partnership for Maternal, Newborn and Child Health Partners’ Forum and summarised in The Lancet today. Countdown to 2015 studied progress in 75 countries, finding that substantial inequities persist, even in countries that have made solid gains in maternal and child health. Many countries are still only reaching half or less of women and children with 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 per cent 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 the Hospital for Sick Children in Toronto and Aga Khan University in Pakistan, co-chair of Countdown to 2015.
Bhutta noted: “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.”
The Countdown report shows that in several countries, more than half of the mothers and children in the poorest 20 per cent 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 as well as access to family planning.
In nearly one-third of Countdown countries, more than 20 per cent of the poorest women and children receive two or fewer of the eight essential interventions. In nearly every Countdown country, in 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.
Victora noted: “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 per cent of children are stunted, and that nearly half of all deaths among children under age 5 — or about three million deaths a year — are attributable to undernutrition. 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 Countdown’s other co-chair. Chopra explained: “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 per cent of 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 seven 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. Daelmans added: “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 Goal (MDG) deadline arrives 18 months from now, the goals related to maternal and child health will not be 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 will have cut maternal death by three-quarters (MDG target 5.A), and access to reproductive health (MDG target 5.B) will 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.
According to the report, action to end preventable maternal and child deaths by improving nutrition and coverage of effective interventions for all population groups must not be delayed.
“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 finalized to address these issues and take concerted, emphatic action to save women, newborns and children,” said Bryce. She added: “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 death in the years beyond 2015.”
Countdown to 2015 is a global movement to track, stimulate and support country progress towards the health-related Millennium Development Goals, particularly goals 4 (reduce child mortality) and 5 (improve maternal health).
Established in 2003, Countdown is supra-institutional and includes academics, governments, international agencies, professional associations, donors, non-governmental organisations and other members of civil society, with The Lancet as a key partner. The Countdown Secretariat is hosted by the Partnership for Maternal, Newborn and Child Health.
Countdown focuses specifically on tracking coverage of a set of evidence-based interventions proven to reduce maternal, newborn and child mortality in the 75 countries where more than 95 per cent of maternal and child deaths occur.
Countdown produces periodic publications, reports and other materials on key aspects of reproductive, maternal, newborn and child health, using data to hold stakeholders to account for global and national action. At the core of Countdown reporting are country profiles that present current evidence to assess country progress in improving reproductive, maternal, newborn and child health..