4 doable actions for mother & newborn care.

• Author: Mafubelu, Daisy
• Position: Report

With only six years to go before the 2015 deadline to achieve the Millennium Development Goals (MDGs) to reduce child mortality and improve maternal health, some countries have made encouraging progress, while many have stagnated, or worse, slipped backwards since the Millennium Declaration was adopted in 2000.

Although the greater picture of overwhelming challenge remains, there are many glimmers of hope around the world. Communities across Africa and Asia have involved both families and caregivers in formulating solutions to their local challenges. They have succeeded in making essential care available to many, if not all, mothers and newborns. Governments have pledged money and other resources, while international aid organizations have developed programmes with local groups to drive change from the ground up.

MAGNITUDE OF THE PROBLEM

Despite current programmes to improve the health of mothers and newborn babies, most recent figures show that one woman dies every minute due to pregnancy, childbirth or soon after giving childbirth. The figure is so staggering that seven newborns die each minute. The main causes of maternal deaths are severe bleeding, eclampsia, infections and obstructed labour. Just three causes--infection, asphyxia and preterm birth--together account for nearly 80 per cent of newborn deaths.

The "Countdown to 2015", a multi-partner initiative to track progress towards MDGs 4 (to reduce child mortality) and 5 (improve maternal health), estimated in its 2008 report, that 68 countries worldwide account for 97 per cent of maternal and newborn deaths. The report focused on the coverage of essential interventions for maternal, newborn and child health. Annually, maternal deaths are estimated at 536,000 and some 3.7 million babies die within the first 28 days of life, while at least 3.3 million are stillborn. Almost all (98 per cent) of these deaths occur in developing countries, with rates highest in sub-Saharan Africa and in South-East Asia.

In addition to the women who die as a result of pregnancy or childbirth, about 10 million to 20 million world-wide are left each year with physical and mental disabilities. Furthermore, millions of newborns who survive fail to reach their full potential due to complications during birth and the early newborn period.

A joint statement issued in September 2008 by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United Nations Population Fund and the World Bank stated that "maternal mortality has root causes in gender inequality, limited access to education--especially for girls, early marriage, adolescent pregnancy, low access to sexual and reproductive health (including for adolescents) and other social determinants".

Although there has been some improvement in the global maternal mortality ratio since 1990, progress is limited and too slow. An annual decline of 5.5 per cent in maternal mortality is required to reach MDG 5 by 2015; the actual average annual rate of decline is less than 1 per cent. Sub-Saharan Africa remains the most dangerous region in the world in which to give birth, with a negligible annual decrease in maternal and newborn deaths. Newborn deaths and stillbirths are strongly related to the availability and quality of care provided to mothers--and unless maternal health improves, there is little chance of progress in the health of newborn babies.

Adolescent pregnancy poses a particular challenge. About 16 million girls aged 15 to 19 give birth every year. Worldwide, one in ten babies is born to an adolescent mother. These infants and their mothers need special protection since they are at a higher risk of disease and death, as well as social exclusion. Almost 95 per cent of adolescent mothers live in developing countries, with the highest levels of adolescent pregnancy in sub-Saharan Africa, where every second a woman gives birth to a child before her 20th birthday. There are also high rates in Asian countries like Bangladesh and India, in Latin America and the Caribbean and in the United States.

In general, early pregnancies mean an increased risk to the life of the mother and her baby. In many countries the risk of death in pregnancy or childbirth is twice as high for mothers aged 15 to 19...