Keep the promise for mothers and children: an agenda to improve maternal and child health.

• Author: Songane, Francisco

Despite the concerted efforts of many players, global progress in child survival has slowed compared to the advances of previous decades. Maternal mortality--deaths of women in pregnancy and childbirth--remains at almost the same level as 20 years ago. Halfway to 2015, the target set in 2000 by world leaders to reach the Millennium Development Goals (MDGs) 4 and 5 on child and maternal health are furthest off track. (1)

Figures paint a stark picture. As of 2005, only 7 out of 60 countries with high child mortality rates were making sufficient progress to reach MDG 4. (2) Almost 10 million children under five years old still die every year, with 40 per cent of them newborns--infants in their first 28 days of life. Until recently, newborn health was often overlooked by health decision makers, who have devoted too little attention or funding to this grave problem. The MDG 4 target is to reduce under-five mortality by two thirds, while MDG 5 is to reduce the maternal mortality ratios by 75 per cent, between 1990 and 2015.

In 2007, leading institutions on maternal health concluded that progress for the achievement of MDG 5 was too slow. There was a minimal change in the global number of women dying in pregnancy and childbirth between 1990 (576,000) and 2005 (536,000). As a result, the world has yielded a decline of less than 1 per cent in maternal mortality ratios, when the required rate to achieve this goal was 5.5 per cent. (3,4) The gravest concern is in sub-Saharan Africa, where the number of maternal deaths has even increased since 1990.

Why does the world seem to stand by idly and accept a 200-fold gap in the lifetime risk that a pregnant woman in a developing country faces compared with a woman in a developed country? And why does the world seem not to notice that almost 10 million children die every year from largely preventable causes? The answer is both obvious and complex. For decades, the health of mothers, newborns and children has ranked low on the global health and development agenda; they have also not been a high priority for political leaders. This has created a vicious cycle of low investment in health services, both in the workforce and in infrastructure, resulting in poor coverage for essential, life-saving care, such as skilled attendance at childbirth for women, protection for newborns and treatment for diarrhoeal diseases and pneumonia for under-fives.

The lack of investment in health services for women and children is...