DR ALLISYN MORAN: In 2015, countries adopted the 2030 agenda for sustainable development and its 17 Sustainable Development Goals (SDGs) and 169 targets. The Sustainable Development Goals build on the success of the Millennium Development Goals, aim to go further, and end all forms of poverty, build economic growth, and address a range of social issues, including health and environmental protection. Health is one of the 17 Sustainable Development
Goals, Goal 3: to ensure healthy lives and promote well-being for all at all ages. Other Sustainable Development Goals also influence good health and well-being, including Goal 1, ending poverty; Goal 2, zero hunger; Goal 4, better education; Goal 5, gender equality; and Goal 6, clean water and sanitation. So what are the targets in the SDG targets for maternal health? Well Sustainable Development Goal 3.1, the first Sustainable Development Goal for health, outlines global targets for maternal mortality reduction based on maternal mortality ratios. A maternal mortality ratio is a number of maternal deaths per 100,000 live births.
And by 2030, all countries should reduce maternal mortality by two thirds to achieve a global average maternal mortality ratio of 70 per 100,000 live birth, with no country having a maternal mortality ratio of more than 140, which is two times the global average. These targets will be further explained in a future lecture. And they can also be found with more information in the see also section. We know for maternal mortality reduction that context is crucial. There’s no silver bullet for maternal mortality reduction, and each country much tailor its approach based on its baseline maternal mortality ratio, its health system structure, its population structure and distribution, and political priorities.
The stages of the obstetric transition are a good model for how to assess what types of interventions might be most effective. So in this slide, you will see stages one and two represented in countries where maternal mortality ratio is greater than 420. As you can see, there is a crucial need for multi-sectoral action. In this slide we see stages three, four and five of the obstetric transition. In stage three, where the maternal mortality ratio is between 70 and 420, we look at different types of interventions such as the management of normal and complicated births, as well as improving service quality and demand for those interventions.
In stages four and five, where the maternal mortality ratio is greater than 70, we look again at similar types of interventions, but also the importance of addressing delays between and within facilities. There are a variety of related global initiatives to support achieving Sustainable Development Goal 3.1. For example, in 2015 the Strategy Toward Ending Preventive Maternal Mortality was launched, which outlined global targets as well as 11 key themes for maternal mortality reduction. Underscoring the multi-sectoral nature of maternal survival and well-being, including four guiding principles, three crosscutting objectives, and five strategic objectives which look at multi-sectoral action, empowering women and girls and families, and including measurement for maternal mortality.
In addition, there are other related initiatives, such as a Global Strategy for Women’s, Children’s and Adolescents’ Health, including
three objectives: survive, thrive, and transform; the Global Financing Facility; and the Countdown to 2030, which tracks progress for maternal health; as well as several other initiatives in the RMNCNH (reproductive, maternal, newborn, child and adolescent health) continuum.
In addition, reducing maternal mortality– SDG 3.1– has synergy with other health targets, such as interventions for helping mothers with babies, Goal 3.2; hypertension and obesity in pregnancy, Goal 3.3; postpartum depression, 3.4; and a variety of others as demonstrated in this slide. In addition, the multi-sectoral nature of maternal mortality reduction requires synergy with non-health Sustainable Development Goals. So just to give a few illustrative examples, SDG Goal 1 around no poverty is very related to maternal ill health and well-being. It’s related to looking at catastrophic health expenditures, putting more at risk of maternal mortality, which results in more underlying ill health, which leads to poor access to health services and more disrespect and abuse.
In addition, Goal 2, no hunger, good nutrition; relates to obesity and anaemia, which both increase the risk of adverse birth outcomes. So finally what are the challenges and opportunities? Well first, in terms of challenges, with the multi-sectoral nature of the Sustainable Development Goals and the focus moving away from just health, but to all of sustainable development, there is the challenge of potentially losing in attention and focus to health related goals. However, this also provides an opportunity to really promote sustainable development and linking maternal health and maternal mortality reduction to other sectors that are not within the health area. Another challenge is to really think about how to work multisectorally and across different silos.
This also presents an opportunity in terms of the potential to leverage resources from maternal health from other sectors. Finally, in conclusion, the achievement of Sustainable Development Goal 3.1 will require multi-sectoral collaboration and national leadership, and linking with other Sustainable Development Goals.