Acting on the Call: Ending Preventable Maternal and Child Deaths

USAID Administrator Raj Shah and Girls' Globe blogger Elisabeth Epstein. Photo c/o the amazing Nicole Schiegg, Consultant for the United Nation's Every Woman Every Child campaign
USAID Administrator Raj Shah and Girls’ Globe blogger Elisabeth Epstein. Photo c/o the amazing Nicole Schiegg, Consultant for the United Nation’s Every Woman Every Child campaign.

On Wednesday, I had the exciting opportunity to attend the Acting on the Call event at which governments, organizations and advocates alike joined forces to emphasize the urgency of including a global focus, strategy and goals for ending preventable maternal and child deaths in the post-2015 agenda.

At the event, the United States Agency of International Development (USAID) launched its Acting on the Call Action Plan and its 2014-2020 Maternal Health Vision for Action.

The Action Plan outlines five strategic focus areas and actions:

  1. Increase efforts in countries that account for the largest share of under-five deaths;
  2. Reach the most underserved populations;
  3. Target priority causes of mortality with innovation efforts and interventions poised to go at scale;
  4. Invest beyond health programs to include empowering women and supporting an enabling environment; and
  5. Create transparency and mutual accountability at all levels, with strengthened commitment to common metrics for tracking purposes.

The Vision highlights the importance of enabling and mobilizing individuals and communities; advancing quality and respectful care; and strengthening health systems and continuous learning. Included in the policy is the goal to end preventable maternal mortality (EPMM) with a target maternal mortality ratio (MMR) of less than 50 maternal deaths per 100,000 live births by 2035. To put that in perspective, the 2010 global MMR was over 200 deaths per 100,000 live births.

In order to achieve the targets stated in the Vision, USAID is committed to supporting ten strategic drivers:

  1. Improve individual, household, and community behaviors and norms;
  2. Improve equity of access to and use of services by the most vulnerable;
  3. Strengthen integration of maternal health services with family planning;
  4. Scale up quality maternal and fetal health care;
  5. Prevent, diagnose, and treat the indirect causes of maternal mortality and poor birth outcomes;
  6. Increase focus on averting and addressing maternal morbidity and disability;
  7. Advance choice and respectful maternity care and improve working conditions for providers;
  8. Strengthen and support health systems;
  9. Promote data for decision-making and accountability; and
  10. Promote innovation and research for policy and programs.

Even though the world has made considerable progress in the past two and a half decades, we must remember that 289,000 women worldwide still die each year as a result of pregnancy and childbirth – the majority of whom live in developing nations.

When a mother dies as a result of pregnancy or childbirth, it threatens her newborn’s chance of survival, lowers her other children’s chances for survival and education, and hurts her family and her country’s prosperity.” – Raj Shah, USAID Administrator

However, the conversation must not stop with maternal deaths. An estimated 190 million women become pregnant each year. Of those 190 million pregnancies, only 122 million result in a live birth and of those 122 million live births, 10 percent suffer from complications and disabilities. Stillbirths, miscarriages and abortions have thus far gone relatively uncounted and unnoticed in global and regional development programs.

The good news is that the issue of newborn health is gaining momentum. In addition to the wonderful and engaging event with hundreds of changemakers in Washington, DC, TIME Magazine brought attention to newborn health by predominantly featuring a photograph of a premature infant on its June cover along with the headline and related article, ‘Saving Preemies.’ The Lancet, an esteemed medical journal, also recently published its Every Newborn Series, a series of reports that now serve as the foundation for the Every Newborn Action Plan (ENAP) – a plan that calls for a renewed global commitment to dramatically improve the health and survival of newborn babies and women and end preventable stillbirths within our generation.

Key findings from the series include:

  • Increasing the amount, availability and accessibility of skilled birth attendants can save 3 million lives by 2025.
  • Newborn deaths account for 44 percent of under-5 deaths.
  • Almost 50 percent of stillbirths occur during labor.
  • 1 million babies die on the day they are born, mostly from preventable causes.
  • More than 75 percent of newborn deaths are in South Asia and sub-Saharan Africa.
  • It would take only USD $1.15 per person to save 3 million women, newborns and stillbirths by 2025.
  • Every year, 2.9 million newborn babies die and 2.6 million are stillborn.

Rather than reading organizations’ commitments to end preventable maternal and newborn deaths, I wanted to hear them from the source. I interviewed several high-ranking officials from development entities and asked them how their organization plans to commit to deliver for women’s and children’s health.

Raj Shah, USAID Administrator

Lisa Schectman, Director of Policy and Advocacy at WaterAid America

Purnima Mane, President and CEO of Pathfinder International

An Instagram interview is a wonderful tool to share organizational commitments in a lightning fast manner. However, I wanted to know more. In order to garner a deeper understanding, I recorded podcast interviews with several more attendees:

Stephanie Lynn Bowen, Senior Communications Manager for Mobile Alliance for Maternal Action (MAMA)

Q: What are some of the broader economic, health and social benefits that arise when you invest in women’s and children’s health?

Lisa Schechtman, Director of Policy and Advocacy at WaterAid America

Q: The global community has made significant progress in saving the lives of women and children. What do you think stands out as a key accomplishment?

Kate Dodson, Vice President for Global Health at the United Nations Foundation

Q: Remaining gaps can be solved through partnership. Where is political will and commitment for women’s and children’s health needed most?

Going forward, the world must remember and, more importantly, act upon these and other commitments to end preventable maternal and child deaths. We can and must do more for women and newborns. If global leaders, organizations and advocates continue this shared fight for justice, I am sure that one day in the not too distant future I will be able to proudly say that the issue of ending preventable maternal and child deaths is a thing of the past – and that I was lucky enough to help.

2014-06-25Read more about ending preventable maternal and child deaths:

Special thanks goes out to Matt Matassa and Anne McNulty of FHI360 for letting me borrow their camera and recording equipment!

Girls’ Globe will be at the Third Partners Forum in Johannesburg for the Partnership for Maternal, Newborn and Child Health, taking place on 30 June – 1 July 2014. Follow the discussion on Twitter via #PMNCHLive and @PMNCH and sign up for the Daily Delivery for up-to-date news from Johannesburg! 


State of the World's Mothers Report: Synopsis

“The first hours and days of a baby’s life are especially critical. About three-quarters of all newborn deaths (over 2 million) take place within one week of birth. 36 percent of newborn deaths (over 1 million) occur on the day a child is born.”

~ State of the World’s Mothers Report, Save the Children

In 1990, global leaders, institutions and national governments agreed upon concrete goals to reduce poverty by 2015. Now known as the Millennium Development Goals (MDGs), MDG 4 aims to reduce the under-5 mortality rate by two-thirds and MDG 5 strives to reduce the maternal mortality ratio by 75 percent. Since implementing the MDGs in 1990, maternal deaths from pregnancy and/or childbirth have decreased nearly 50 percent worldwide (543,000 to 287,000). Unfortunately, the global newborn mortality rate has only declined by 32 percent. With 3 million babies still dying within the first year of life (43 percent of the global under-5 mortality rate), clearly much progress can still be made.

Image Courtesy of Save the Children

Yesterday, Save the Children published its State of the World’s Mothers Report, a report that analyzed and summarized the successes, failures, and lessons learned regarding global progress with MDG 4 and MDG 5. Here are the report’s major findings:

  • Helping babies survive the first few days of life poses the greatest challenge to reducing child mortality;
  • Three major causes of death include complications during birth, prematurity, and perinatal infections; and
  • By using proven interventions, creating stronger health systems, and training more skilled health care workers, there is the potential to reduce newborn deaths by up to 75 percent.

Image Courtesy of Save the Children

Globally, there are over 1 million estimated child deaths on the first day of life – equating to 15 percent of all under-5 deaths. Of those first day deaths, 80 percent occur in Sub-Saharan Africa and South Asia.

Sub-Saharan Africa

Sub-Saharan Africa (SSA), a region accountable for 12 percent of the global population, suffers from 38 percent of the world’s first day deaths (397,000 per year; 34 deaths per 1000 live births). Unfortunately, pregnancy and childbirth also pose incredible risks to mothers. For example, mothers in Somalia face a 1 in 16 risk of dying during pregnancy and/or childbirth (18 maternal deaths per 1000 births). Across the entire region, ten SSA countries ranked as the worst for mothers to give birth and seven countries scored the highest number of first day child deaths.

Image Courtesy of Save the Children

South Asia

In South Asia, approximately 83,000 women die each year during pregnancy and/or childbirth and 423,000 babies die each year on their first day of life (more than any other region in the world). With 24 percent of the global population, the region experiences 41 percent of the world’s first day deaths (420,000 per year; 11 deaths per 1000 live births).

Although most of South Asia has become synonymous with a growing economy, great disparities and inequalities still exist, particularly in India. Enduring the most maternal deaths in the world (56,000 per year) and 29 percent of the world’s first day deaths (309,000 per year), it is safe to say that India’s economic growth benefits are not shared equally.

Although 98 percent of newborn deaths occur in the developing world, 1 percent of first day deaths take place in industrialized nations. Ranked as the developed country with the highest amount of first day deaths, the United States sustains 50 percent more first day deaths than all other industrialized countries combined (11,300 deaths per year).

Highlighting the three most effective proven interventions, the Report advocates for further investments in female education, nutrition, and family planning in order to curb maternal and newborn deaths.

Image Courtesy of Save the Children

Although newborn death is most commonly caused by complications from preterm births, other prenatal and postnatal dangers exist. Therefore, investing in prenatal and postnatal care has also proven incredibly valuable.

For HIV-infected women, mother-to-child transmission rates can be reduced to less than 5 percent with the proper antiretroviral regimen. Similarly, by treating malaria in pregnant women, incidence of newborn low birthweight can decline by 40 percent.

Tetanus, a disease that kills 58,000 mothers and newborns every year, is entirely preventable with a $0.40 vaccination. Often caused by mothers cutting the umbilical cord with unsanitary tools, tetanus also can be avoided by applying chlorhexidine, a $0.25 antiseptic, to the newborn’s umbilical cord.

Other forms of important postnatal care include educating mothers on the importance of breastfeeding, a practice that provides the newborn with essential nutrients, warmth and a strong immunity; “kangaroo mother care,” a simple and effective approach that increases child survival rate in preterm and low birthweight babies by warming newborns through continuous skin-to-skin contact on the mother’s chest; and access to low-cost antibiotics to treat sepsis.

Does your country rank in the top or bottom 10 for maternal health?

Image Courtesy of Save the ChildrenAlthough much progress has been made since 1990, we must continue to push for improved maternal and child health care around the world – particularly in the Post 2015 Agenda.


All images courtesy of Save the Children.