FAQ: Achieving maternal and child health goals

Each year, it is estimated that 500,000 women lose their lives during pregnancy or childbirth, and nine million children die before their fifth birthday, according to UNICEF.

The figures "should shock and grieve us," Prime MinisterStephen Harper toldthe World Economic Forum in Davos, Switzerland, in January.

"As president of the G8 in 2010, Canada will champion a major initiative to improve the health of women and children in the world's poorest regions,"Harper said in settingCanada's prioritiesfor the G8/G20 summit from June 25 to 27 in Huntsville, Ont., and Toronto.

At the G8 summit,Canada pledged $1.1 billionto a global initiative on maternal and child health for developing countries, which Harper calleda "disproportionate contribution" compared with that of other G8 countries.

More broadly, since all UN member statesadopted the United Nations Millennium Development Goals in 2000, there has been some progress in preventing pregnancy from becoming a death sentence for women and their children, but progress in meeting some of the goals is slow, experts in the field say.

The Millennium Development Goals are eight international development goals, including two devoted to maternal and child health.Goal 4 is to reduce mortality among children under five by two-thirds between 1990 and 2015.

Goal 5aims to cut maternal deaths by 75 per cent from 1990 to 2015 and achieve universal access to reproductive health by 2015.

TheCountdown to 2015Decade Report, published by the medical journal The Lancet, reviews progress on meeting millennium development goals for reducing preventable deaths among children under the age of five and improving maternal health. It alsohighlights areas where the authors sayG8 funding commitments could make a difference.

The G8 strategy strives for care before and after birth, family planning including contraception, reproductive health, treatment and prevention of diseases, prevention of mother-to-child transmission of disease, immunization and nutrition, the G8 Research Group'spolicy briefon the topic says.

During July'sInternational AIDS Conference inVienna , Health Minister Leona Aglukkaqannounced $30 millionin funding topreventmother-to-child transmission of HIVin developing countries.

What are the problems?

According to the Society of Obstetricians and Gynaecologists of Canada, the main causes of maternal mortality during childbirth are:

• Postpartum hemorrhage.
• Eclampsia, serious seizures in pregnancy that are not related to a pre-existing brain condition.
• Dystocia, abnormal or difficult childbirth or labour.
• Sepsis, a serious body-wide response to infection. (Lay people may use the term blood poisoning to refer to the condition.)

Another global problem is the lack of skilled attendants at births, which leads to two million preventable maternal deaths, stillbirths and newborn deaths each year, the countdown report said. Its estimated 700,000 new midwives and other trained providers are needed to offer skilled childbirth care to all women who need it, the report's authors noted.

What are some solutions?

The countdown report lists key services including:

• Giving oxytocin to prevent postpartum hemorrhage, the leading cause of maternal deaths.
• Services to prevent and treat birth complications if they develop.
• Tetanus immunization for mothers.
• Early start for breastfeeding.
• Postnatal visits including family planning informationand to screen for maternal complications.
• Immunization for babies.
• Bed nets to protect against malaria.
• Antibiotics for pneumonia.

During the critical period of birth and the first few days of life, more than half of maternal and childbirth deaths can be prevented through these simple interventions administered by trained community health workers, said Dr. Joy Lawn of Save the Children.

Solutions such as better nutrition and immunization are inexpensive in themselves, Harper saidin calling on G8 governments, non-governmental organizations and private foundations to mobilize on improving maternal and child health.

The Lancetcountdown report provided examples of progress, including how India and Malawi have started managing pneumonia and other childhood illnesses in the community, and removal of user fees in Uganda for essential health services.

The under-five child mortality rate has declined by 28 per cent, from an estimated 90 deaths per 1,000 live births in 1990 to 65 deaths per 1,000 in 2008, according to the report.

What areas need more progress?

But the countdown report also showed that while total under-5 child deaths have declined, the proportion of neonatal deaths in babies in the first 28 days of life has increased from 37 per cent of under-five deaths in 2000 to41 per cent in 2003.

The child findings reflect progress against measles and other vaccine-preventable diseases, better availability of insecticide-treated bed nets and scaling up prevention of maternal to child transmission of HIV, UNICEF said.

How could more funding help?

To save the lives of women, newborns and children, health services need to reach all women and children, but bottlenecks in accessing health services have meant coverage rates remain low,said Nigel Fisher, president and CEO of UNICEF Canada.

In commenting on the countdown report,Peter Berman, lead economist of the World Bank, said average per capita health expenditure in 2007 in the 68 developing countries was $80 compared to thousands in advanced countries.

Development aid for maternal and child health has increased in the past five years, but only 31 per cent of development aid for health was directed to programs for women, newborns and children, the report said. According to the Global Consensus on Maternal, Newborn and Children's Health, another $30 billion US is needed to speed up progress on Millennium Development Goals 4 and 5.

By committing enough funds to strengthen health systems, and supporting innovation and training for community-level workers, the G8 could address the bottlenecks and help galvanize movements on these goals, Fisher said.