A G8 plan that works: Reducing maternal, newborn and child

mortality

Dr. André Lalonde, FRCSCSOGC Executive Vice PresidentFIGO Executive Board MemberPMNCH Executive Board Member

Dr. Heather MacDonnell, FRCPC, FAAP, DTMH(UK)

Co-Head International Adoption ClinicDivision of Pediatric Medicine, CHEO

Assistant Professor of Pediatrics, U Ottawa

Dr. Mark Walker, FRCSCAssociate Professor University of OttawaSenior Scientist OHRI

Scientific Director BORN Ontario

Canada to host the 2010 G8 Summit

This year, Canada is presented with an important opportunity to reaffirm itself as a global

humanitarian leader, as we welcome world leaders to the 2010 G8 and G20 Summits.

G8 to focus on Maternal and Child Health

Prime Minister Harper’s announcement is a step in the right direction.

But what exactly is included in the mother and child initiative?

And will promises be met?

Millennium Development Goals

Millennium Development Goals4. Reduce Child Mortality

• Target:– Reduce by 2/3, between 1990

and 2015, the mortality rate of children under 5

• Indicators:– Under-five mortality rate– Infant mortality rate– Proportion of one-year-old

children immunized against measles

• Target 5.A:– Reduce by 3/4, between

1990 and 2015, the maternal mortality ratio

• Indicators:– Maternal mortality ratio– Proportion of birth

attended by skilled health personnel

Millennium Development Goals5. Improve Maternal Health

• Target 5.B: Achieve, by 2015, universal

access to reproductive health

• Indicators: Contraceptive prevalence

rate Adolescent birth rate Antenatal care coverage Unmet need for family

planning

Global Situation Global Situation

• 180-210 million pregnancies every year• 80 million unwanted pregnancies• 50 million induced abortions• 20 million unsafe abortions • 68,000 deaths from unsafe abortion• 20 million women suffer from maternal morbidity• Estimated 536,000 maternal deaths• 3 million babies are born dead • Almost 10 million children under 5 die • Of which 3 million newborns die within the first week of life• 500,000 infants are infected with HIV

Progress toward MDG 4:

Source: Progress for children. A world fit for children. Statistical tables on MDG4. Available at http://www.unicef.org/progressforchildren/2007n6/index_41854.htm

No progress

InsufficientOn track Countries with

increasing U5MR

15 countries 'on track'25 countries 'no progress'

Progress toward MDG 5

• 12 of 13 countries with highest Maternal Mortality Ratios are in sub-Saharan Africa

• Pattern of contextual factors differs from that of MDG4.

High HIV prevalence (>5%, 1/13)

Conflict (8/13)

Coverage failures across the continuum of care

Coverage estimates for interventions across the continuum of care in the 68 priority countries (2000-2006). Vertical bars indicate the range in coverage across countries.

For some interventions:

• Family planning

• Exclusive breastfeeding

• Clinical care for newborn and child illnesses

In some countries:

• Wide gaps in coverage across countries

Key strategies to reduce maternal mortality

Skilled attendance at birth saves mothers and babies

Skilled attendance at childbirth is the most effective interventionWorld Health Organization

April 05

1. Political leadership and community engagement and mobilization

2. Delivering high quality services

3. Removing financial, social, and cultural barriers to access

4. Ensuring skilled and motivated health workers

5. Accountability at all levels for credible results

The Global Consensus for Maternal, Newborn and Child Health:

Lives that can be saved and investment required:

Global Child Mortality: Key Messages

Globally, 1 in 7 children die before the age of 5

= 9.2 million children in 2007

= 15 filled school buses crashing per hour

Most under-5 deaths are preventable

• pneumonia, newborn causes, diarrhea, malaria, measles

Simple strategies prevent deaths and are not necessarily expensive!

Sub-Saharan Africa

South Asia

Latin America

East Asia

Under-Five

MortalityRate

(per 1000 live births)

244

188

171

62

206

129

92

42.6

122

5431

17.8

123

58

36

19.1

1970 1990 2004 2015

MDG-4Goals

Under 5 (Child) Mortality Reduction Rates

UNICEF State of the World’s Children

Child Mortality Rate/1000 live births 6 130

Infant Mortality Rate/1000 live births 5 84

Stillbirth Rate

/1000 total births 3 32UNICEF State of the World’s Children

Preventable Conditions Cause Most Child Deaths

Infection 36%

Prematurity 27%

Asphyxia 23%}

Malnutrition

55%

WHO data

What can be done to save the children?

Postpartum

• Clean cord care• Skin to skin with mother (kangaroo care)• Antibiotics for suspected sepsis • Early breastfeeding, exclusive x 6 months

.

.

Early Infancy and Beyond

• Routine immunizations• Regular growth measurements• Health education to mothers

– Hygiene, clean water, sanitation• Antibiotics for pneumonia• Iron, Zinc, Vitamin A supplementation• Insecticide treated bed nets

What can be done to save the children?

Save a child’s life for a pittance

Estimated cost of interventions:

Insecticide-treated bed net $6Full WHO EPI immunizations (Africa) $14Oral rehydration solution (ORS) < $1

Total cost $887 per life saved

Save 800,000 African newborns at $1.39 per person per year

Recommendations• Focus on essential interventions that will prevent or

reduce maternal, newborn and child mortality and morbidity

• Increase capacity with training of skilled birth attendants and health care providers at all levels

• Improve and strengthen physical infrastructure of health care facilities and supply of commodities

• Embed surveillance into programs to drive process with measureable outcomes and send feedback on progress made back to the community

3 + 3 + 3

Maternal Health

-Post partum hemorrhage

-Eclampsia

-Dystocia

Maternal Health

-Post partum hemorrhage

-Eclampsia

-Dystocia

Newborn Health

-Infection

-Prematurity

-Asphyxia

Newborn Health

-Infection

-Prematurity

-Asphyxia

Child Health

-Acute respiratory illness

-Diarrhea

-Malaria

Child Health

-Acute respiratory illness

-Diarrhea

-Malaria

By focusing efforts on the 3 main causes of death, we can make real progress to improve the health of women, newborns and children

The way forward for Canada to lead in the area of Maternal and

Child Health • Increased funding for maternal and child health programs• Focus on the main causes of mortality and morbidity• Capitalize on Canada’s expertise in the field of maternal and child

health to strengthen programs and improve health outcomes• Use a rights-based approach• Ensure family planning• Upgrade the skills of health professionals, especially in the area of

Emergency Obstetric Care• Ensure programs are directed at all levels of service delivery

(local, regional, national)• Use the three delays model to influence program design and fund

allocation• Allocate funding in a way that addresses gaps along the

continuum of care

ConclusionConclusion• Maternal survival and health is essential for the

economic development of nations

• Survival and health of the world’s newborns and children depends on their mothers

• Parliamentarians need to play their part for Canada to assume a leadership role

There is no better time to raise your voice for women and children worldwide