Fewer mothers, children dying, but progress could be better


Deaths of mothers giving birth in developing countries have dropped by nearly half since 1990, while deaths of children under 5 have fallen from 12 million to 7.6 million, according to a new report released Wednesday by the United Nations Children’s Fund(UNICEF). A few countries have made “spectacular progress” toward lowering death rates, but some others have made virtually no progress at all, according to the report, Building a Future for Women and Children, which was published under the auspices of the Countdown to 2015 Initiative. That initiative, which is targeted at the 75 countries with the highest rates of maternal and young child deaths, aims to reduce maternal deaths by three-quarters by 2015 (compared with 1990) and deaths of young children by two-thirds. “We are optimistic, but realistic,” said Dr. Mickey Chopra, chief health officer of UNICEF and co-chair of the initiative. “Our main message is that it can be done.”

In the United States, the number of deaths among children under age 5 is about six or seven per 1,000 live births. In Somalia and Mali, in contrast, the rates are 180 and 178 per 1,000 births, respectively. Extreme poverty and violent conflicts are primarily responsible for the high rates, Chopra noted. But in many countries, such as Botswana, Egypt, Malawi and Liberia, the rate of child deaths has been dropping by 5% or more per year. These countries can get to the same low rates as the United States “if they continue the same rates of progress with a little acceleration,” Chopra said. “We are on the cusp of achieving quite amazing things in terms of saving lives.”

One area where progress has been made is vaccination, including new vaccines for pneumonia and diarrhea. Vaccine coverage has increased to 80% in the countdown countries. Great progress has also been made in distributing bed nets to limit spread of malaria.

But progress is lagging in other areas. About 10% of births in the countdown countries are premature, which is a major cause of death. Antenatal steroid injections can help immature baby lungs develop at a cost of only about $1 and could save nearly 400,000 lives per year, but they are provided to only about 10% of preterm babies. Kangaroo care, in which the infant is held skin-to-skin on the mother’s chest, could save 450,000 lives per year, but is not widely encouraged. Diarrhea and pneumonia cause more than 2 million deaths per year that could be avoided through prevention or prompt treatment, such as rehydration with salt and zinc. Such a treatment costs only about 50 cents.

Similar, but lesser, progress has also been made in reducing maternal deaths. Equatorial Guinea, Nepal and Vietnam, for example, have reduced maternal deaths by 75% and their programs could be models for the rest of the world. Overall, maternal deaths are down 47% over the last two decades, but more than a third of the 75 countdown countries have made little if any progress. In Chad, for example, there are 1,100 maternal deaths per 100,000 live births, and 1,000 in Somalia.

Worldwide, a mother dies during childbirth or from complications of pregnancy every two minutes. For every one who dies, an additional 20 to 30 suffer significant and sometimes lifelong problems as a result of the pregnancy. During the same two minutes, nearly 30 young children die of disease and illness that could have been prevented or effectively treated.

The release of the report precedes a meeting in Washington early June convened by the governments of the United States, India and Ethiopia, in collaboration with UNICEF. The Child Survival Call to Action will examine ways to further reduce death rates.

The successes so far, Chopra concluded, have followed common themes. First, the political leadership has highlighted the problems. “Giving them visibility within a country seems to be an important factor for better progress,” Chopra said. With that attention, he added, community members, health services and others can then remember to do “fairly basic things that can save mothers and children.”

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