Making Every Mother and Child Count

This blog was originally published in Save the Children International

Whilst the momentum created by the Millennium Development Goals (MDGs) has been a huge catalyst – helping us drive the number of global child deaths down from 12 million in 1990 to 6.9 million in 2011 – the target for MDG 4 only calls upon the international community to reduce child deaths by two-thirds by 2015. So even if we reached this target (which we are currently off-track to do), there would still be an unacceptably large number of children who are dying from preventable causes.

Furthermore, the progress that is being made is often only measured at the national level, hiding big differences in health access and outcomes between different populations within the same country.

From our work in many countries, we know that certain mothers and children are less likely to benefit from the increased investment that has been ploughed into global health over the past decades. For example, our recent analysis shows that a child’s immunisation status is strongly associated with their household wealth, mother’s education and whether they live in an urban or a rural location.

With this in mind, Save the Children joined with Health Poverty Action to organise an event on reducing inequities in maternal and newborn health during the 2013 Women Deliver conference in Kuala Lumpur. Our aim was to contribute to discussions on how we can learn lessons from the MDGs and ensure any new framework to replace them in 2015 has equity at its heart.

Save the Children’s Professor Joy Lawn moderated the event and shared her own experiences of helping to draw more attention to equity issues through her involvement in the Countdown to 2015 initiative’s equity working group. She also highlighted the equity gap analysis for newborn mortality that has been included in our latest State of the World’s Mothers report.

Dr Aluisio Barros from the Federal University of Pelotas in Brazil began by giving a global overview of equity gaps in maternal and newborn care and showed that all countries face equity challenges. Of the different reproductive, maternal, newborn and child health interventions tracked by Countdown, skilled birth attendance is the most inequitable: across 54 countries there is a gap of around 30% coverage for the poorest fifth compared with around 85% coverage for the richest fifth of the population.  

Aluisio then shared the story of Brazil which has seen dramatic reductions in inequality whilst also increasing coverage of key maternal and child health services over the last two decades. For example, the use of contraceptives is now at around 80% for both the richest and poorest.

What drove these changes? A combination of strong political will, the recognition of health as a human right, and sustained investment in health, including health workers were all key elements. More specifically, Brazil also made important policy choices, introducing a free, universal health service and rolling it out in the places that had no healthcare first rather than starting with the easiest places.

After such a positive example, the question on everyone’s mind was whether Brazil’s model could be replicated by all countries?

Hkawn Yi, from Health Poverty Action, gave a presentation based on her experiences as a community midwife serving minority communities in Kachin, northern Myanmar. Unlike Brazil, Myanmar has an ethnically diverse population and ongoing conflict in some regions. Health facilities and health workers in Kachin State are disconnected from the main national health system meaning that ethnic minority groups are denied essential services.

Hkawn argued for more research to address the lack of statistical information around the health outcomes of women and children from ethnic minorities and said that a post-MDG development framework should include disaggregated data to ensure that no sections of society are overlooked. Joy Lawn said that they are looking to disaggregate more data by ethnicity in the future but members of the audience raised doubts about the willingness of some countries to track this kind of information because of its political sensitivity.

Sharing her experiences from another diverse country lacking sufficient data on equity, Norma Sagom from WaterAid drew parallels between Myanmar and her country of Papua New Guinea. Though the population is just 6.5 million, healthcare providers have over 800 languages and challenging terrain to contend with.

The population of Papua New Guinea is mostly rural but there are huge gaps in access to water and sanitation between those in urban and rural settings. An integrated approach that includes access to safe water, improved sanitation and hygiene behaviour change for mothers, girls and newborns is therefore essential for improving health outcomes.

Dr Robin Nandy from UNICEF responded to the presentations with a call to action. Equity is now widely recognised as important, he said, and we know what we need to do. We all have to take responsibility to ensure that marginalised groups count – by collecting data, building capacity, and building evidence for influencing policy. Panellists agreed that more efforts are needed to engage communities and decision makers at subnational level.

Whilst the lessons from Brazil may not be directly applicable to all countries, surely strong political will, along with targeted and sustained investments in maternal and child health are requirements for achieving universal coverage of maternal and newborn health services in all countries?

Our challenge is how to build the political will at the global, national and sub-national level to ensure that every mother and child receives the quality care she is entitled to.

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