By Ali Hajji Adam and Mekdes Daba
Global progress on improving maternal, newborn, and child survival has stalled. Many regions of the world continue to experience persistently high rates of maternal and child mortality, and despite improvements between 2000 and 2015, progress is now stagnating.1 The combination of ongoing and new conflicts, climate change, and the impact of the COVID-19 pandemic create a perfect storm to drive back any gains that might have been made during the Sustainable Development Goal (SDG) era.
The global community is off track from our targets for reducing maternal mortality (SDG 3.1)2 and ending preventable deaths of newborns and children younger than 5 years (SDG 3.2).3 Globally, 287 000 women died from a maternal cause in 2020, averaging 223 deaths of mothers for each livebirth.1 For children younger than 5 years, 4·9 million died globally in 2022, 2·3 million of these in the first month of life.4 In addition, almost 1·9 million babies were stillborn in 2021.5 The stark reality is that 46 countries are projected to have a ratio greater than 140 maternal deaths per 100 000 livebirths by 2030,6 59 countries will miss the SDG target for mortality for those younger than 5 years, and even more—64 countries—will miss the neonatal mortality target.4
The tragedy is that so many of these deaths are preventable. More than 70% of maternal deaths are due to obstetric causes including hypertension, sepsis, unsafe abortion, and embolism.7 As for mortality for those younger than 5 years, prematurity is the leading cause, while birth trauma and asphyxia, acute respiratory infections, malaria, diarrhoea, and congenital anomalies are among the top causes.8 It is an indictment of the global health community that we know these facts and have done very little about them. There is a myriad of approaches that could be tailor-made for each challenge, but the political will to do so has been lost. This is why the World Health Assembly Resolution on maternal, newborn, and child health9 is crucial. Initiated by Somalia, co-sponsored by Botswana, Djibouti, Ethiopia, Egypt, Kenya, Lebanon, Nigeria, Paraguay, Sierra Leone, South Africa, and Tanzania, the Resolution is going through consultation, with growing support from other member states, and we, as Ministers of Health, consider it to be essential to future progress in maternal and child survival.
The Resolution aims to tackle the persistent disparities in maternal, newborn, and child health and accelerate progress. It calls for urgent action to address inequities across the life course to create resilient health systems focused on primary health care. The Resolution is a resounding call for prioritising maternal, newborn, and child health in policy, service delivery, and financing.
Healthy and empowered women, children, and adolescents are central to the transformational change envisioned by the 2030 Agenda. Investing in their wellbeing leads to healthier communities, vibrant economies, and more prosperous, peaceful, and resilient societies. That is why the entire continuum of care must always be considered, starting with the health and wellbeing of parents before conception, and then following through all stages of a newborn’s, child’s, and adolescent’s life. Otherwise, the global community risks looking back at the SDG era as one that failed vulnerable mothers and children.
Fortunately, what works is known. Successful approaches include high-quality essential health and nutrition services; a multipronged approach to maximise resources and address workforce shortages; stronger primary health-care delivery; prioritising the hardest-to-reach communities; and universal access to reproductive and sexual health services.9
Knowing what works is just the beginning. Successfully implementing these strategies requires political will, unerring commitment, and consistent investments. That is why massively accelerated action is needed and why the Resolution matters. And we call on all stakeholders to support it.
Ali Hajji Adam is the Minister for Health of the Federal Republic of Somalia and Mekdes Daba is the Minister for Health of the Federal Democratic Republic of Ethiopia.
*This article was first published in The Lancet on 20 May 2024 https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(24)00220-1/fulltext
- WHO. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Geneva: World Health Organization, 2023.
- UN. Transforming our world: the 2030 Agenda for Sustainable Development. SDG 3.1 target. New York City, NY: United Nations, 2015.
- UN. Transforming our world: the 2030 Agenda for Sustainable Development. SDG 3.2 target. New York City, NY: United Nations, 2015.
- United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME). Level and trends in child mortality: report 2023. New York City, NY: United Nations Children’s Fund, 2024.
- United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME). Never forgotten: the situation of stillbirth around the globe. New York City, NY: United Nations Children’s Fund, 2023.
- WHO. Acceleration towards the Sustainable Development Goal targets for maternal health and child mortality. 2023. https://apps.who.int/gb/ebwha/pdf_files/EB154/B154_12-en.pdf (accessed Feb 29, 2024).
- Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2: e323–33.
- Villavicencio F, Perin J, Eilerts-Spinelli H, et al. Global, regional, and national causes of death in children and adolescents younger than 20 years: an open data portal with estimates for 2000–21. Lancet Glob Health 2023; 12: e16–17.
- WHO. Accelerate progress towards reducing maternal, newborn, and child mortality in order to achieve Sustainable Development Goal targets 3.1 and 3.2. 2024. https://apps.who.int/gb/ebwha/pdf_files/EB154/B154_CONF4-en.pdf (accessed Feb 29, 2024).
© 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license