Between 1990 and 2015, maternal mortality worldwide dropped by about 44%. Yet in many of the world’s poorest countries, ensuring that mothers stay alive, are healthy and that their children can survive and thrive still represents a significant challenge. 303,000 mothers died in 2015 from pregnancy-related causes and millions more suffered from complications related to pregnancy or childbirth, including hemorrhage, infection, hypertensive disorders and obstructed labour. A woman’s lifetime risk of maternal death is 1 in 180 in developing countries (compared to 1 in 4900 in developed countries). In countries designated as fragile states, the risk is 1 in 54.
Because children who lose their mothers are ten times more likely to die in infancy than those who do not, maternal health is deeply intertwined with child health, which also remains a significant global challenge. By 2015, 5.9 million children died before their fifth birthday, and only 62 countries had reached the Millennium Development Goals (MDG) 4 target of a two thirds reduction in under-five mortality since 1990. If levels of under-five mortality for each country remain at today’s levels, 94 million children under the age of 5 will die between 2016 and 2030.
More than any other region, sub-Saharan Africa is home to the highest number of child deaths – roughly 3 million in 2015. Despite some countries making improvements – and in some cases, dramatic gains – in child health in recent years, sub-Saharan Africa’s average child mortality rate is still almost 12 times the average of high-income countries. Many of these deaths are from entirely preventable and treatable causes, such as pneumonia, diarrhoea, malnutrition and malaria.
With proper care and treatment, nearly all of these deaths could be avoided. However, many health systems in low- and middle-income countries have a shortage of health-care workers, a lack of basic equipment, inadequate access to basic life-saving prevention and treatment tools, and poor infrastructure. Improving health systems is essential to saving the lives of mothers and children in the developing world.
Fortunately, simple, cost-effective solutions to improve maternal and child health already exist. Enabling women to plan and space births, treating infectious diseases and improving nutrition can help women stay healthy during pregnancy. Additionally, efforts to educate women – both in general and specifically during and immediately following their pregnancy – help ensure that mothers know how and when to seek health care services for themselves and their children.
Skilled care by a birth attendant during pregnancy and labour, emergency obstetric care, and immediate postnatal care all help reduce maternal mortality. These kinds of basic maternal health services before and after delivery could prevent up to 80% of maternal deaths, and have already helped cut the annual number of maternal deaths by 44% since 1990.
It is also possible to save many more children’s lives with low-cost interventions. Vaccinations against diseases like hepatitis B, Haemophilus influenzae type b (Hib), pertussis, measles, and yellow fever can save millions of lives each year. Since 2000, Gavi, the vaccine alliance, has supported the immunisation of close to 580 million children and has helped save 8 million young lives. Measles vaccination also resulted in a 79% drop in measles deaths worldwide and an 86% decline in sub-Saharan Africa between 2000 and 2014. Simpler interventions like Vitamin A supplements, which cost as low as $1 per child per year, could save over a quarter of a million young lives annually by reducing the risk and severity of diarrhoea and infections, which could also be reduced by Oral Rehydration Salts (ORS) and zinc supplements.
Treatment to prevent mother-to-child transmission of HIV, anti-malarial bed nets and the promotion of breastfeeding and proper nutrition can also guard against infectious diseases and ensure good health in the early stages of childhood.
The rapid drop in global child deaths in the last 20 years is one of the world’s most spectacular, and most hopeful, success stories. It shows what is possible with the right resources, programs and political will in place. But the story isn’t over yet – we have a long way to go before achieving the Sustainable Development Goals (SDG) targets to reduce the global maternal mortality ratio to less than 70 per 100 000 live births, the neonatal mortality ratio to at least 12 per 1,000 live births and under-5 mortality ratio to at least 25 per 1,000 live births. With millions of women and children still at risk of dying of preventable causes, maternal, newborn and child survival must remain at the heart of the post-2015 global development agenda.