Challenges to reproductive, maternal and child health

“Children are our future, and their mothers are its guardians.”

^{-Kofi Annan, UN Secretary General 1997–2006}

We have seen in previous steps how the Millennium Development Goals (MDGs) were created at the turn of the century as targets to improve our world. One of the key areas that these goals focused on was reducing maternal and child mortality. For example:

• MDG 4 aimed to reduce the under-five mortality rate by two thirds between 1990 and 2015.
• MDG 5 aimed to reduce the maternal mortality ratio by three quarters between 1990 and 2015. It also aimed to achieve universal access to reproductive health by 2015.

Fifteen years later much had been achieved. We can clearly see this in some of the key indicators of child and maternal health:

• Between 2000 and 2015, the global maternal mortality ratio, or number of maternal deaths per 100,000 live births, declined by 37% to an estimated ratio of 216 per 100,000 live births in 2015.
• Under-five mortality rates fell rapidly from 2000 to 2015, declining by 44% globally.
• The neonatal mortality rate, that is the likelihood of dying in the first 28 days of life, declined from 31 deaths per 1,000 live births in 2000 to 19 deaths per 1,000 live births in 2015.
• Worldwide, in 2015, approximately 3 in 4 women of reproductive age (15 to 49 years of age) who were married or in union satisfied their need for family planning by using modern contraceptive methods.

A key factor contributing to these successes was that more women received antenatal care (care during their pregnancy) with benefits for both the mother and child. In developing regions antenatal care increased from 65% in 1990 to 83% in 2012. Increased use of modern contraception also improved outcomes.

^{Accessed from World Bank Databank}

You can take a look at this visualisation from the World Bank which shows the decrease in many of these indicators over time.

Although much has been achieved, improvements are needed

Despite these successes, every day in 2015 about 830 women died due to complications of pregnancy and child birth. Since 1990, the global maternal mortality ratio has declined by only 2.3% annually instead of the 5.5% needed to achieve the MDG.

When we look at child mortality, an estimated 5.9 million children under five died in 2015, with a global under-five mortality rate of 43 per 1,000 live births.

Although childbearing in adolescence has steadily declined in almost all regions, wide disparities persist. If we compare the birthrate among adolescent girls in 2015, there were 7 births per 1,000 girls in Eastern Asia to 102 births per 1,000 girls in Sub-Saharan Africa.

So, why are there so many child and maternal deaths in developing countries?

Inequality in maternal mortality

The key obstacle to improving maternal mortality is pregnant women’s lack of access to quality care before, during, and after childbirth.

Only 51% of women in low-income countries benefit from skilled care during childbirth, so millions of births are not assisted by a midwife, doctor, or trained nurse. This situation is made more difficult by a global shortage of qualified healthcare workers.

Preventing unintended pregnancy and reducing adolescent childbearing through universal access to sexual and reproductive healthcare services are critical to further advances in the health of women, children, and adolescents.

What can be done? What next?

As we have now moved on from the MDGs to the SDGs, the new targets are:

• By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births
• By 2030, end preventable deaths of newborns and children under five, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-five mortality to at least as low as 25 per 1,000 live births
• By 2030, ensure universal access to sexual and reproductive healthcare services, including family planning, information and education, and the integration of reproductive health into national strategies and programmes

How can we achieve the SDG targets for child and maternal health?

As we have talked about at the start of the course, both local level participation and government engagement is needed for sustainable development. Many global, national, and local organisations are engaged in the fight to save mothers’ and children’s lives and improve the health of women and children. These play different roles but they all align to the agenda laid out by the SDGs.

In the next step, we will look at some of these organisations, and how they are engaged in the fight to save mothers’ and children’s lives and improve their health services.

This image from the World Health Organization neatly sums up some of the challenges that face improving child and maternal health.

^{World Health Organization, 2015}

• Which of these do you think is the biggest challenge to achieving child and maternal health goals?