Situation in 2012
Maternal and child health is one of the main public health concerns in the Region. Some countries are among those with the highest maternal and child mortality rates in the world, although several countries are among those with the lowest. In 2012, 80 mothers and 2400 children were estimated to be dying every day due to preventable causes. Of the Region’s maternal and child deaths, 95% occurred in nine high-burden countries, and 45% of under-5 deaths were among newborns. Between 1990 and 2012, maternal mortality decreased by 42% and under-5 mortality by 45%. However, these levels of reduction were not on track for meeting the targets of the Millennium Development Goals (MDGs) for 2015.
High maternal and child mortality in the Region was identified as being largely related to health system gaps and challenges, in particular inadequate health workforce, lack of access to essential medicines, non-functioning referral systems and low quality of care, as well as poor nutrition. Political will and commitment to maternal and child health remain insufficient, while financing mechanisms have been inadequate to ensure universal coverage for maternal and child health services. The situation is more critical in countries where instability, conflict and protracted crises are prevalent. Coordination and alignment of partners, stakeholders and other sectors were also identified as needed strengthening in those countries with high rates of mortality.
Recognizing the need to strengthen the efforts of governments, partners and donors in responding to maternal and child health needs, WHO, UNICEF and UNFPA, in collaboration with Member States and other stakeholders, jointly embarked on a regional initiative on saving the lives of mothers and children. The aim was also to accelerate progress towards achieving MDGs 4 and 5 on reduction of child and maternal mortality. The basic strategic approaches adopted in this initiative were to give priority to countries with high maternal and child mortality, to focus on proven high-impact interventions implemented in primary health care, and to strengthen partnerships.
Progress 2012-2016
Member States joined WHO, UNFPA, UNICEF and other stakeholders at a high-level meeting in January 2013 to launch the initiative. The meeting culminated in the Dubai Declaration “Saving the lives of mothers and children: rising to the challenge” which provided much needed impetus and a way forward for countries and partners.
The Dubai Declaration was endorsed by the Regional Committee in October 2013, demonstrating the commitment by Member States to support maternal and child health as a priority on the national health agenda. The nine countries with a high burden of maternal and child deaths conducted situation analyses of maternal and child health, identifying gaps and determining cost-effective interventions to address maternal and child deaths. Acceleration plans were developed in these countries to ramp up evidence-based, high impact reproductive, maternal, neonatal and child health interventions. Seven out of the nine countries launched their plans with senior political leaders, using start-up funds allocated from domestic and donor sources, along with funds from the Region and the WHO country collaboration programme. Regional surveys were launched to assess the initiative and capacity-building was instituted for reproductive, maternal, neonatal and child health programme managers. Tools were developed to improve infection assessment and control and to assess quality standards for maternal and child health services. An assessment of maternal and child health workforce was conducted for all high-burden countries, with key recommendations to address existing gaps in availability, distribution and quality of training.
Strengthening of health information systems continues to be a critical factor in improving maternal and child health. Maternal death surveillance is at very different levels of implementation among countries in the Region. Initiatives have been launched to strengthen this surveillance, and surveillance tools for perinatal death are being tested at country level. To accelerate maternal and child health plans, intercountry meetings and country missions have been jointly held with UNFPA and UNICEF to identify priority interventions targeting the main causes of preventable deaths.
Continuing with the partnership in improving maternal and child health outcomes in the Region, and in line with the importance of the continuum of care throughout the life span, preconception care is being promoted within maternal and child health programmes. Member States are committed in reinforcing the implementation of a preconception care package, by adopting and implementing evidence-based, cost-effective and culturally-sensitive interventions that have a high impact on maternal and child health the so-called “best buys”.
By the end of 2015, much progress had been made towards achieving MDGs 4 and 5 in the Region. Between 1990 and 2015 maternal mortality ratio decreased by 54% and under-5 mortality by 48%. Eight countries achieved MDG 4 and three achieved MDG 5. Of the nine countries with a high burden of maternal and child deaths, two achieved MDG 4.
Way forward
Maternal, newborn and child health must remain a priority in all countries, regardless of income and development. Progress must be maintained in the programmes already launched, while timelines for future implementations must also be maintained. WHO will continue to support high-burden countries and countries in emergencies. Because of their impact on morbidity and mortality, newborn health, early childhood development, adolescent health and preconception care are emerging as priorities in the Region. Initiatives to achieve universal health care and to improve the quality of care are also critical to maternal and child health.
All countries must be committed to developing or updating their reproductive, maternal, newborn and adolescent strategic plans for 2016-2020, as adopted by the Regional Committee in October 2015 and in accordance with the United Nations global strategy on women’s, children’s and adolescents’ health. Addressing health inequities through tackling the social determinants of health must begin in the planning stages of all maternal and child health initiatives.
