MDG4 Progress: Saving Our Little Saviors

A nation’s future is built upon its children. Early childhood development is considered to be the most important phase which determines the overall wellbeing across the individual’s lifespan. Investing in children translates into saving our world from the countless ills that plague society today.

15 years ago, the world made a promise in the form of Millennium Development Goal 4 to reduce the global under-five mortality rate by two-thirds between 1990 and 2015 as our leaders agreed on the eight Millennium Development Goals (MDGs). We have now reached the end of the era of the MDGs, and the world has come together to make a new promise in the form of a new set of goals for the coming 15 years. In that respect, it is important to take a closer look at how well we did in our strive to uphold our promise; and approach the Sustainable Development Goals (SDGs) with a renewed sense of commitment.

We should acknowledge that we have come a long way. According to the 2015 Levels and Trends in Child Mortality report by UNICEF, WHO, World Bank Group and the United Nations, substantial global progress has been made over the years. The number of under-five deaths worldwide has declined from 12.4 million in 1990 to 5.9 million in 2015, leaving us with 19,000 fewer deaths every day. We have also accelerated global progress as a whole. The world’s annual under-five mortality rate reduction has increased from a rate of 1.8% between 1990 and 2000, to 3.9% in 2000-2015. This momentum of recent years was certainly boosted by the Global Strategy for Women’s and Children’s Health launched by the United Nations Secretary- General Ban Ki-moon, and the Every Woman Every Child movement for improving newborn and child survival, including maternal health.

Sub-Saharan Africa, the region with the highest under-five mortality rate in the world has also registered a considerable acceleration with an annual rate of reduction which increased from 1.6% in the 1990s to 4.1% between 2000 and 2015. My own country has contributed its share of achievements for the registered improvement in the region. Among 11 other low income nations, Ethiopia has been able to meet its target of this goal, a success highly attributed to progressive health strategies by the Federal Ministry of Health, stronger partnerships and remarkable outreach work conducted by community health extension workers. Over all, the world has avoided the death of 48 million children under the age of five since 2000- a figure which would not have been possible had the mortality rate at the new millennium remained the same.

A staggering achievement, but not enough! Our progress is shadowed by the realization that despite all the strides, our efforts were still insufficient for us to meet this goal globally. Presently, 16,000 under-five children still die every day. This realization is even more painful with the knowledge that most of these deaths are caused by diseases that are readily preventable or treatable. Our achievements in the MDGs are also varied in-between targets. We now understand that neonatal complications are responsible for the vast majority of under-five deaths; with factors related to the educational attainment of mothers, their level of access to health systems, income, nutrition and the prevalence of HIV. It is particularly worrisome that the 53% global decline we have seen in the under-five mortality rate is far from the two-thirds reduction we need. If current trends are to continue, we would only be able to achieve this goal by 2026! This task is a tremendous unfinished business for the commitment our leaders made in 2012; A Promise Renewed an even more ambitious undertaking with proposed SDG target for child mortality to end preventable deaths of newborns and children under-five, by 2030.

There is a huge fight awaiting us. The SDGs come at a time where emerging global issues that should have been foreseen and prevented well ahead are enormously changing the contexts we work in. The current refugee crisis and the harsh challenges presented by working in conflict settings is a huge wake up call to push for more innovative strategies. We have to explore an integrated approach that complements our success in the different goals and targets. Our movement needs to be people-centered, owned and led by the community. Key actors including powerful players in the private sector have to be equally engaged in the fight.

As a youth advocate, I also want to remind us of the big opportunity we have in our hands. We need to adopt an uncompromising stance for applying the great passion and untapped potential us young people have to offer, in providing more innovative solutions to the multitudes of issues we have yet to confront.

Featured image: Mary Thullah, 20-year old mom comforts her daughter Fatmata Turay after she received vaccinations at the Princess Christian Maternity Hospital on March 10, 2015 in Freetown Sierra Leone. Photo © Dominic Chavez/World Bank

Innovation for Maternal and Child Health

Originally posted on International Innovation 

Ros black and whiteCEO Ros Davies talks to International Innovation about the many dangers and injustices faced by mothers and infants in low-resource settings, and how communities can work together to create effective interventions and reduce pregnancy related mortality and morbidity. 

Women and Children First work in some of the world’s poorest communities to prevent maternal and infant mortality. Can you outline some of the organisation’s priority areas for action?

In general, our priority areas are marginalised communities in countries that still suffer from high rates of maternal and newborn mortality. Our main body of work focuses on populations in rural settings, who often have great difficulties in accessing health services because of distance, poor transport links or unaffordable costs.

The ‘Countdown to 2015: Maternal, Newborn & Child Survival’ has highlighted that there are still 75 countries with unacceptably high maternal and/or newborn death rates. As we’re a small organisation with limited resources and funding to work internationally, we focus on a small number of countries – currently, Bangladesh, Ethiopia, Malawi and Uganda. We’ve also got plans to work in Sierra Leone, Guatemala and Nicaragua. As we are not in the business of building our partners’ organisational capacity, we endeavour to find strong and stable organisations on the ground with a good reputation with which we can share our tried and tested women’s group approach. We’ve chosen these specific countries because, in addition to them having high maternal and newborn mortality rates, we have identified suitable local partners there. Our history of collaborating closely with colleagues at University College London’s Institute for Global Health led us to organisations with which they had established good working relations, and others were identified because Women and Children First’s staff had worked with them previously.

Why did you decide to dedicate your career to advocating for the health and safety of mothers and children?

I haven’t been in this field all my working life; half of it was spent on community development and women and children’s issues in London. It was initially by luck that I became involved with international development issues. I was doing a Master’s degree, and took on a part-time job at Marie Stopes International to look after their office administration. As I was specialising in Latin America, and nobody else on the team could speak Spanish, I started working on some of the programmes. Much of the work was on family planning, and I soon realized how grossly unfair it is that women in Western countries have access to family planning and fertility services, while those in many developing countries face constant barriers, and do not often have knowledge about or access to health services – or even contraception. As time went on and I gained more experience, I began to look further into maternal and child health and the dangerous and exhausting cycle of pregnancy, wherein families have more children than they wish to have or can afford to look after, which can limit educational opportunities and damage women’s health. So my general interest is in international development, but I specifically focus on women’s issues, such as empowering them to be able to control their own fertility and improve their economic circumstances.

What are some of the biggest risk factors affecting mothers and infants during pregnancy, childbirth and in the following weeks and months?

There are a wide range of factors that can affect mothers and babies across these time scales. I’ve talked about family planning, and related to that is the fact that pregnancies become more risky when women can’t control their fertility. It is particularly dangerous for young girls (often as young as 10) and older women to become pregnant. Risks are also involved when pregnancies occur too closely together; the ideal spacing is three years, but without contraception, there are women who fall pregnant year after year. In addition, conditions that may not be life threatening in a non-pregnant woman, such as malaria, can result in severe problems for both mother and baby. Pregnancy-related conditions, including pre-eclampsia, can also be fatal where health services cannot be reached.

Many women don’t have access to antenatal or postnatal care, or skilled attendants to deliver the baby. This can result in an increase in complications, leading to mortality or morbidity. Often, mothers must live with physical disabilities, pain and stigma – as in the case of obstetric fistula (characterised by incontinence), which is difficult to manage and can lead to them being ostracised by their families and the community.

In brief, there are three delays that contribute to increased risk in childbirth: delay in deciding to get skilled care when ready to give birth or during pregnancy (no antenatal care in the first trimester); delay in reaching a health facility when in labour (which can lead to serious complications); and delay in assessing the pregnant woman once she arrives at the clinic (wherein she may not receive the exact care required).

Over 70 per cent of infant deaths occur within the first year of life, many of them in the first 28 days. Could you describe some of the most effective interventions to safeguard newborns?

In areas where there are still very high rates of newborn mortality, small changes can make quite a big difference in reducing deaths. As mentioned, antenatal care is vital so that any problems are flagged up as early as possible, particularly for those with high-risk pregnancies. Postnatal care, often recommended within the first 48 hours of birth, is also essential to detecting any suffering in the newborn. Skilled practitioners will identify danger signs, such as the risk of maternal exhaustion in a prolonged labour or a blockage, which can affect a baby’s airway – but parents should also be given the knowledge to recognize risk factors, such as fever, which can be life threatening in a newborn.

Practices that people might think are a good idea, like washing a newborn, can result in problematic decreases in body temperature, so something as simple as keeping the baby warm is an effective intervention. In terms of traditional customs, some populations put dung on an umbilical cord because they think that will protect it, but it is far more likely to cause an infection. Others may feed infants cow’s milk, which they can’t digest. We would recommend immediate and exclusive breastfeeding for newborns. In Kangaroo mother care, the newborn baby is wrapped skin-to-skin against the mother and can easily breastfeed
and be kept warm. This is particularly effective for premature babies.

Moreover, getting timely treatment for any infections from a skilled medical practitioner is very important. Even though attendance at medical centres has not increased significantly in our programmes, newborn death rates have reduced quite dramatically. Addressing these simple, basic habits and changing behaviour can be extremely effective with very low to no cost, as we have shown with our work.

What are the greatest benefits of running self-help community groups for women?

The groups provide women with an environment in which to learn all about how to look after themselves properly during pregnancy, including getting skilled care for themselves and their newborn babies, as well as going to a health centre for the delivery. More generally, the groups empower women because their awareness is raised. Although the focus is on running women’s groups, we mobilise the communities and bring on board husbands, brothers, fathers and mothers-in-law – those who can help but are often also the gatekeepers, and prevent women from attending the clinic or hospital because of the cost of transport or medicines, or due to local customs. The groups are designed to create positive, sustainable change within the local communities, empowering them to address what they themselves see as the biggest problems faced during pregnancy, childbirth and the newborn period. They work together to devise solutions, such as lobbying for a bicycle ambulance to overcome the obstacles created by distance from a health facility, or setting up a village fund to address lack of financing to travel there. In order to tackle poor nutrition or anaemia, they might set up a communal vegetable garden or keep domestic animals like pigs or chickens. If more knowledge is required, they may organise health education talks and spread the word.

We estimate that for every one woman who is in a women’s group, around two or three more will benefit because they talk to each other, especially intergenerationally. I’ve been at several open days in Malawi where they have brought together the communities and women’s groups in the area and involved the local district officials and Members of Parliament, so the whole community can really work together. Once a women’s group has been set up in a community, it is very low cost to run and it is likely to carry on after project funding comes to an end. In Nepal, for example, many groups have been meeting for seven years without any external financial inputs. Looking from the outside, the main benefit is that this approach has been demonstrated to reduce newborn mortality. Seven randomised control trials have been conducted in Nepal, Bangladesh, India and Malawi and a meta-analysis of the results has been accepted by the World Health Organization (WHO), which recommends women’s groups to improve maternal and newborn health, particularly in rural settings with poor access to services. On average, we have shown that the groups are reducing newborn mortality rates by 33 per cent and maternal mortality rates by 49 per cent.

Cover photo credit: European Commission, Flickr Creative Commons

Race for Survival – Take Action!

race-for-survival

Every five seconds, a child dies needlessly from preventable causes and Save the Children’s Global Day of Action on October 23rd is shining a light on the gross injustice of preventable child deaths and pushing for accelerated progress to save children’s lives. This year over 50,000 children in more than 67 countries – from Iraq, to Nepal to Ethiopia – will participate in a global relay race to call on their leaders to take urgent action in the fight against preventable child deaths.

Save the Children today launched a star-studded film called “Race for Survival”, featuring Hollywood star, Isla Fisher, former Kenyan world record holder, Patrick Makau Musyoki, Bollywood megastar, Kunal Kapoor and US actor, Cameron Boyce.

The short film, aimed at galvanising world action against preventable child death, has each of the stars running a leg of a relay race, in different corners of the world. The race kicks off in Kenya, with athlete Patrick Makau Musyoki, deftly gliding through rural countryside. Cut to Bollywood’s Kunal Kapoor as he charges past ruins on the outskirts of Mumbai, before passing the baton to the US, to Actress Isla Fisher.

The action-packed film also features children, young acrobats, parkourists and free-runners from around the world and was exec-produced by renowned music video producer Nabil Elderkin, best known for his work with Kanye West, John Legend and the Arctic Monkeys.

Kunal Kapoor said: “This breath-taking film is energetic, exciting and fun. It is a celebration of the power, resilience and ingenuity of children and young people around the world. I have seen first-hand the work done by Save the Children and ask people to back their global campaign to save children’s lives.”

Isla Fisher said “I recently visited Save the Children’s work in Brazil and there is nothing more important than making sure every child gets the health and nutrition they need. All children should be able to reach their potential”.

Former world record holder, Patrick Makau said: “Dramatic progress is being made around the world in saving children’s lives from poverty and disease. Change is possible and I encourage people to join Save the Children’s campaign and be part of this movement. Growing up is hard enough. It shouldn’t be a race for survival.”

Jasmine Whitbread, CEO of Save the Children said: “Our global ambassadors have given their support to this critical issue. We want this energetic film to inspire people to take action all around the world. All children must be able to access life-saving care and given the opportunity to thrive, no matter where they are born.”

To view the film, and to find out how to take part in the Race for Survival visit: http://www.savethechildren.net/raceforsurvival/

Join the conversation using #Race4Survival

Scaling up efforts for maternal and newborn health

Somalia Suffers from Severe Drought
Photo Courtesy: United Nations on Flickr

On September 25th, during UNGA week, Johnson & Johnson hosted an event in collaboration with Save the Children, March of Dimes, and The MDG Health Alliance. Richard Horton, Editor-in-Chief at the Lancet, led the conversation to discuss how we can create success in the status of maternal and newborn health.

The dynamic conversation between leaders in the field agreed that we must invest in prevention, as well as care. Christopher Howson, VP at March of Dimes emphasized that prevention has been neglected, a lot because it is invisible, hard to measure, and not dramatic. If we succeed with prevention, including investing in adolscents’ health literacy, we will see unique benefits.

A success in prevention and care in the post-2015 agenda means reaching the most vulnerable, utilizing and replicating successful interventions, creating innovative solutions and collaborating through multi-sectorial partnerships. In order to truly understand if we are being successful with improving maternal and newborn health, we need to capture the data that shows who the most vulnerable populations are and address the challenges for them.

We don’t know what the scale of the problem is! We don’t know how many adolescents get married. – Dr. Carole Presern, Executive Director, The Partnership for Maternal, Newborn & Child Health

In order to reach the most vulnerable, interventions must be community based and led by the people. We must listen to mothers and empower them to hold their governments accountable

Accountability can also be enhanced by making the invisible visible, to see where progress is being made and where it is not. William Keenan also emphasized the importance of persistent advocacy for accountability.

This Johnson & Johnson event also emphasized the importance of partnerships. Not only do we need more partnerships to create new solutions, but we need more partnerships to invest in solutions that we know are working! This is where the private sector has a unique advantage to make the work efficient and invest in targeted interventions that have proven success rates.

The status of maternal and newborn health is unacceptable. Scaling up efforts needs to be urgent, targeted and efficient to support the 3.7 million lives that are at risk in the next 826 days.

Join the conversation on how to step up and accelerate change and progress for mothers and newborns. #EveryNewborn #MDG456Live 

The Partnership for Maternal, Newborn and Child Health 2013 Report

PMNCH Report Pic

To kick off UN General Assembly Week in New York City, Girls’ Globe bloggers attended the launch of the Partnership for Maternal, Newborn and Child Health 2013 Report. Some of the Report’s contributors and reviewers included members of the World Health Organization, Foreign Affairs Canada, India’s Ministry of Health and Family Welfare, SickKids Center for Global Child Health, and the Bloomberg School of Public Health at John Hopkins University. The representatives spoke on the current issues and accomplishments regarding maternal and child health, as well as accountability and moving beyond 2015.

Discussions of the Report show that improvements have been made in several countries regarding maternal, newborn, and child health. Bangladesh was cited as a success story reporting a significant decrease in maternal and child mortality in the past decade. Increased access to modern contraceptives, access to skilled birth attendants and private sector facilities, gains in female education, and better roads and mobile phone use have all contributed to the decrease in maternal and infant mortality rates in Bangladesh.

“Commitments to advance the Global Maternal and Child Health Strategy continue to increase- the number of commitment-makers rose from 111 in 2010 to 293 in 2013, and there is growing evidence that committed funding is being disbursed.”

Although Bangladesh provides the Report with positive statistics, many contributors and reviewers believe although some progress has been made, it is not sufficient to meet goals by 2030. Dr. Richard Horton, co-chair and editor of The Lancet, points out there are still 38 countries that have experienced no reduction in child mortality. Horton believes a need for increased civil society engagement, greater focus on the issue of violence against women, and a more human rights-focused universal approach are necessary factors in the fight to decrease maternal and child mortality rates. Similarly, Dr. Neff Walker, Senior Scientist at John Hopkins University,  recognizes if we continue at this rate of growth, only 9 of the 75 countries will hit the MDG for reducing mortality. A lack of data surrounding adolescent reproductive health was also cited as a hindrance to achieving the goals.

There is an overwhelming sense of urgency to build effective accountability systems for countries, governments and organizations to ensure progress is being achieved. The report recognizes the need for stronger partnerships across a number of sectors in order for fundamental changes to occur. The majority of contributors and reviewers agreed in order to accelerate the goals on maternal and child health development initiatives must go beyond “business as usual.”

If you missed the conversation, check out our recap of the entire session and launch of the Report on Storify.

Blog Post by: Diane Fender and Justine Stacey

Featured Image Courtesy of: DFID