In the Journals

Preventable maternal, child deaths could be eliminated in a generation

Avoidable maternal and child deaths could be “largely eliminated” in a generation by a rapid, global push to prioritize and expand essential reproductive and newborn health interventions, and by addressing violence against women, according to a review published in The Lancet.

In their review of “Reproductive, Maternal, Newborn and Child Health,” a volume to be published by the World Bank as part of Disease Control Priorities 3rd Edition, the authors estimated the cost and effect of expanded implementation of such interventions, concluding that if every person spent $5 on essential health services including contraception, medication and nutritional supplements, millions of maternal and child lives could be saved every year.

“The UN Secretary General’s Global Strategy for Women’s and Children’s Health, launched in 2010 and recast as the Global Strategy for Women’s, Children’s and Adolescents’ Health in 2015, is an indication of the continued global commitment to the survival and well-being of women and children,” Robert E. Black, MD, MPH, of the department of international health at Johns Hopkins Bloomberg School of Public Health, in Baltimore, and colleagues wrote. “However, a substantial burden of disease still remains in [low-income and middle income countries (LMICs)] from unwanted pregnancies; high maternal, neonatal and child mortality; prevalent malnutrition; frequent communicable and noncommunicable diseases; and loss of human capacity to contribute to society. Cost-effective interventions that can be implemented widely in LMICs could greatly reduce these problems at an affordable cost, with substantial societal benefits.”

According to the review, scaling up all preventive and therapeutic interventions cited by the World Bank volume, from coverage in 2015 to hypothetically immediately cover 90% of the world’s population, would prevent 149,000 maternal deaths, 849,000 stillbirths, 1,498,000 neonatal deaths and 1,515,000 additional child deaths.

In an alternative calculation, only estimating the effects of reducing the number of pregnancies through contraception, the authors said meeting 90% of the unmet need for contraceptives would reduce global births by 28 million. This, in turn, would prevent deaths that could have occurred at 2015 rates of fertility and mortality, or 67,000 maternal, 444,000 neonatal and 473,000 child deaths, plus 564,000 stillbirths.

Effective interventions include the management of labor and delivery, care of preterm births and treatment of serious infectious diseases and acute malnutrition. According to the review, all of these essential interventions could be provided by health workers in the local community, or by primary health centers.

Regarding incremental cost, the authors estimated that immediately scaling up essential interventions would be $6.2 billion in low-income countries, $12.4 billion in lower-middle-income countries, and $8 billion in upper-middle-income countries.

“The objectives of universal health coverage, including public health interventions as well as preventive and curative services, and ensuring financial security and health equity are key to realizing the health goal of Sustainable Development Goals beyond 2015,” Black and colleagues wrote. “As the world begins efforts to achieve the targets of this health goal, there is a need for articulation of a clear vision and commitment to realize good health and human rights of all women, adolescents and children.” – by Jason Laday

Disclosure: Black reports receiving grants from the Bill and Melinda Gates Foundation. See the full review for additional author disclosures.

Avoidable maternal and child deaths could be “largely eliminated” in a generation by a rapid, global push to prioritize and expand essential reproductive and newborn health interventions, and by addressing violence against women, according to a review published in The Lancet.

In their review of “Reproductive, Maternal, Newborn and Child Health,” a volume to be published by the World Bank as part of Disease Control Priorities 3rd Edition, the authors estimated the cost and effect of expanded implementation of such interventions, concluding that if every person spent $5 on essential health services including contraception, medication and nutritional supplements, millions of maternal and child lives could be saved every year.

“The UN Secretary General’s Global Strategy for Women’s and Children’s Health, launched in 2010 and recast as the Global Strategy for Women’s, Children’s and Adolescents’ Health in 2015, is an indication of the continued global commitment to the survival and well-being of women and children,” Robert E. Black, MD, MPH, of the department of international health at Johns Hopkins Bloomberg School of Public Health, in Baltimore, and colleagues wrote. “However, a substantial burden of disease still remains in [low-income and middle income countries (LMICs)] from unwanted pregnancies; high maternal, neonatal and child mortality; prevalent malnutrition; frequent communicable and noncommunicable diseases; and loss of human capacity to contribute to society. Cost-effective interventions that can be implemented widely in LMICs could greatly reduce these problems at an affordable cost, with substantial societal benefits.”

According to the review, scaling up all preventive and therapeutic interventions cited by the World Bank volume, from coverage in 2015 to hypothetically immediately cover 90% of the world’s population, would prevent 149,000 maternal deaths, 849,000 stillbirths, 1,498,000 neonatal deaths and 1,515,000 additional child deaths.

In an alternative calculation, only estimating the effects of reducing the number of pregnancies through contraception, the authors said meeting 90% of the unmet need for contraceptives would reduce global births by 28 million. This, in turn, would prevent deaths that could have occurred at 2015 rates of fertility and mortality, or 67,000 maternal, 444,000 neonatal and 473,000 child deaths, plus 564,000 stillbirths.

Effective interventions include the management of labor and delivery, care of preterm births and treatment of serious infectious diseases and acute malnutrition. According to the review, all of these essential interventions could be provided by health workers in the local community, or by primary health centers.

Regarding incremental cost, the authors estimated that immediately scaling up essential interventions would be $6.2 billion in low-income countries, $12.4 billion in lower-middle-income countries, and $8 billion in upper-middle-income countries.

“The objectives of universal health coverage, including public health interventions as well as preventive and curative services, and ensuring financial security and health equity are key to realizing the health goal of Sustainable Development Goals beyond 2015,” Black and colleagues wrote. “As the world begins efforts to achieve the targets of this health goal, there is a need for articulation of a clear vision and commitment to realize good health and human rights of all women, adolescents and children.” – by Jason Laday

Disclosure: Black reports receiving grants from the Bill and Melinda Gates Foundation. See the full review for additional author disclosures.