Photo credit: Charlie Forgham-Bailey / Save the Children, Oct 2018

Getting to 2030 Vision to End Preventable Child and Maternal Deaths: Building on the global progress for women and children

Written by Smita Baruah, Senior Director, Global Health and Development Policy, Save the Children

Children today have a better chance than any time in history to grow healthy, be educated and be protected, as noted in Save the Children’s latest report, Changing Lives in our Lifetime: Global Childhood Report. Today there are 49 million fewer children stunted, a form of malnutrition that impacts a child’s ability to survive and thrive than two decades ago. There are 4.4 million fewer child deaths than they were in the year 2000.

These successes are not by accident.  Strong and increased political leadership at both global and national level have greatly contributed to changing the lives of women and children around the world in addition to scaling up of proven interventions and innovation.

The United States is one donor government who deserves much credit for accelerating progress on women and children’s health, beginning with its leadership at the first child survival resolution in 1982 through hosting the Child Survival Call to Action meeting in 2012 that set the stage for the vision to end preventable child and maternal deaths by 2030.

Critical Role of US Leadership in Reducing Maternal and Child Deaths
Last month, USAID launched its 5th annual progress report, Acting on the Call: A Focus on the Journey to Self-Reliance for Preventing Child and Maternal Deaths.  The report notes that in 2018 alone, USAID helped reach 81 million women and children access essential — and often life-saving — health services. USAID’s contributions have led to significant reductions in child mortality in many countries such as in Bangladesh where child deaths were reduced by 63% since 2000 and in Uganda, which experienced a 66% in reduction of child deaths during the same time period.

The report demonstrates the ways in which USAID has also helped increase national political will. Since the Child Survival Call to Action forum in 2012, governments in more than half of USAID’s priority countries for maternal and child survival have increased their domestic budgets for health.  In Uganda, for example, USAID worked with the Ministry of Health to increase the percentage of the allocated budget for health from 79% to 97%. 

Bangladesh, a USAID maternal and child health priority country, is an example of how donor assistance coupled with national political will, creates change for women and children. According to the Global Childhood Report, Bangladesh has had a sustained commitment to improving child health despite changing leadership. With donor and their own investments, Bangladesh has focused to strengthen health systems and scale up proven solutions for mothers, children and newborns with a focus on equity. However, focusing on health interventions alone did not contribute to Bangladesh’s success.  Women and girls’ education and empowerment are also key factors driving progress as well as the engagement of civil society, including children and young people.

Getting to 2030
In 2015, the United States and other world leaders and stakeholders committed to a set of global goals which includes the ambitious goal of ending preventable and child and maternal deaths by 2030. There is indeed much to celebrate.  To continue on the path to achieve the global goal of ending preventable child and maternal deaths, U.S. and other stakeholders must continue to focus on continuing to invest in maternal and child survival programs and designing and implementing highest-impact evidence based interventions. 

This also includes investing more resources in areas that are becoming the greatest contributions to child deaths: newborn health, pneumonia and addressing malnutrition.  Without increased focus on malnutrition, Save the Children’s report notes that in 2030, 119 million children will still find their physical and cognitive development stunted by malnutrition, with the poorest children at highest risk. Addressing pneumonia must also be prioritized. According to the Global Childhood Report, childhood pneumonia is the leading infectious cause of deaths in children under age 5 and it kills more children than diarrhea, malaria and HIV combined.

While much progress has been made in increasing national governments’ political will to reduce child and maternal deaths, resources must follow this commitment. The U.S. should work with national and local governments to continue to increase its own domestic investments in health, particularly for maternal and child survival interventions. This also includes working with national and local governments in ensuring that these resources are reaching the hardest to reach populations. Women and children who are furthest behind must be identified and prioritized in terms of investments, service provision and decision making. US should also work with governments to ensure that all women and children, especially excluded women and children, are counted to measure progress towards reducing child and maternal deaths. 

Going beyond just working with the Ministries of Health is critical.  U.S. and other stakeholders must continue to engage local civil society in the efforts to change the lives of women and children. In Ethiopia, for example, Kes Melakeselam Hailemnase, a 64 year old Orthodox Priest and head of Embaalaje Woreda Orthodox Churches Forum, reached more than 8.000 individuals with maternal, child, newborn health messages during regular sermons and other religious festivities after receiving training on Community Based Newborn Care, organized for faith-based leaders.  Kes’ efforts helped Abeba Mesele, a 21 year old mother of two, learn the importance of going to a health facility for antenatal check up and early post natal check ups.  

Change often happens at the local, community level. As USAID works with countries in their journey to self-reliance, development plans must be made in consultation with recipient country governments and civil society.  To ensure sustainability and self-reliance, development must be owned by the people of the countries receiving foreign assistance.

As the 2019 report shows, USAID has greatly contributed to building in country capacity by training health professionals including community health workers. This may not be enough. With increased natural disasters and the resurgence of pandemic threats such as Ebola, U.S. should work with governments and other stakeholders in helping to build resilient health systems. 

Finally, continued U.S. partnership and assistance is critical to a country’s success in improving the lives of women and children around the world. USAID should maintain evidence-based, highest-impact interventions and a comprehensive approach to addressing maternal and child survival and continue to provide robust resources.