With four years left for countries to achieve international targets for saving the lives of mothers and children, more than half the countries around the world are lowering maternal mortality and child mortality at an accelerated rate, according to a new analysis by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.
In 125 countries, maternal mortality has declined faster since 2000, the year that countries signed the Millennium Declaration, promising to make improvements in child and maternal health, and the progress has been particularly strong in the past five years. Over the same period, in 106 countries, child mortality rates have declined faster between 2000 and 2011 than in the previous decade.
The number of deaths related to pregnancy and childbirth decreased from 409,100 in 1990 to an estimated 273,500 deaths in 2011, and the number of deaths in children under the age of 5 fell from 11.6 million deaths to an estimated 7.2 million over the same period.
The trends indicate that efforts to educate more women, to prevent infectious diseases, and to implement other targeted health programs in developing countries are having an impact. They also show, though, that few countries are going to achieve international targets for improving maternal and child health.
An estimated 31 developing countries will achieve Millennium Development Goal 4 (MDG 4), which calls for a two-thirds reduction in the child mortality rate between 1990 and 2015, and 13 developing countries will achieve Millennium Development Goal 5, which calls for a three-fourths reduction in maternal mortality ratio over the same period. Of those countries, nine will achieve both goals: China, Egypt, Iran, Libya, Maldives, Mongolia, Peru, Syria, and Tunisia. The study, "Progress toward Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis," is published in The Lancet.
"If the world is going to achieve these goals, we need to see immediate, concerted action on the part of governments, donors, and bilateral agencies to move these trends in the right direction," said Dr. Rafael Lozano, Professor of Global Health at IHME and the paper's lead author. "We know that accelerated progress is possible because we are seeing it already."
Over the past decade, a significant number of countries saw declines of more than 8% annually over the past decade -- twice the global rate -- including Kenya, Morocco, Zambia, and Zimbabwe. Afghanistan, which has one of the worst maternal death rates in the world, has seen a 4.9% annual decline in maternal mortality since 2000, after increasing 2.2% annually over the previous decade. In Cambodia, Ecuador, Rwanda, Malaysia, and Vietnam, child mortality fell by 5% annually or higher, while globally the child mortality rate fell by 2.6% annually.
Part of the decline in maternal mortality in much of sub-Saharan Africa is due to improved prevention and treatment efforts for HIV/AIDS, the researchers note. In looking for other key drivers for the mortality declines, the researchers point to global health programs, such as the scale-up of insecticide-treated bed nets in countries with a high malaria burden, and to country-level programs, such as the government of India's ongoing investment in rural health clinics. In 2010, IHME published a paper showing that educational attainment among women of reproductive age accounted for 51% of the decline in child mortality.
"We must not let the focus on MDGs detract from what has been real and impressive progress with maternal and child maternal survival, particularly in sub-Saharan Africa," said Alan Lopez, Head of the University of Queensland School of Population Health and one of the report's co-authors. "It is critical that this progress be maintained and that lessons learned from this success be rapidly transferred to other countries where progress has been less impressive."
One area that needs attention is neonatal deaths. Even as the mortality rate in children under 5 fell by 2.2% annually, the mortality rate for infants during the first week of life declined by only 1.7% annually.
"The difference between neonatal mortality and overall mortality in children under 5 might seem small to someone outside of global health, but it's worrisome because it can be a sign of other problems in the health system," said Dr. Haidong Wang, Assistant Professor of Global Health at IHME and one of the paper's co-authors. "If countries can't make sure that children survive during that first week, they may not be effectively providing prenatal care to mothers, good obstetrical care during the birth, or important follow-up care."
For these new estimates of child and maternal mortality, researchers used the most recent data and advancements in statistical tools to provide policymakers with more precise information as the world intensifies efforts to achieve international targets for maternal and child health. The authors acknowledge that the new estimates may lead to some confusion among policymakers, who have seen a series of analyses on maternal and child deaths in recent years, including two previous sets of estimates from IHME. For example, maternal death numbers for 2005 were estimated to be 546,000 by the United Nations in a 2007 study and are now estimated to have been 347,000 in this study, a difference of 35%. Reports on child deaths over the years track more closely, mostly because of the larger amount of data available over a long period of time.
"People have argued that we should not be updating these numbers every year, but we think that as new data are available and as methods are being improved it is crucial to show governments, funders, and the public at large how much progress is being made," said Dr. Christopher Murray, Director of IHME and one of the paper's co-authors. "Decisions are being made today that could mean the difference between thousands of lives being saved or more women and children dying. That is why improvements in data gathering and measurement are important for guiding policymakers as well as holding them accountable."
The Institute for Health Metrics and Evaluation (IHME) is an independent global health research center at the University of Washington that provides rigorous and comparable measurement of the world's most important health problems and evaluates the strategies used to address them. IHME makes this information freely available so that policymakers have the evidence they need to make informed decisions about how to allocate resources to best improve population health. For the report and for more information about IHME, please visit http://www.healthmetricsandevaluation.org
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