Advice to the G8: Reducing Maternal and Child Mortality

Officials from G8 countries will be gathering in Toronto next month, and scientific bodies from the eight countries (e.g., the Royal Society of Canada and US National Academy of Science) have developed a joint statement about what the G8 should do improve the health of women in children. They begin by citing the Millennium Development Goals of reducing under-five child mortality by two-thirds and maternal mortality by three-quarters by 2015; they note that we've seen "some progress in global child health" but the maternal-mortality reduction goal "remains a distant target." The statement highlights several specific health issues that greatly affect progress toward these goals:

• Maternal mortality and morbidity - A woman in the poorest parts of the world has a one in seven risk of dying as a result of pregnancy or childbirth during her lifetime.
• Perinatal and neonatal death - Each year, 4 million babies die in the first month of life.
• Family planning - "Provision of effective contraception for approximately 200 million women who have none would prevent 23 million unplanned births, 22 million induced abortions and 14,000 pregnancy-related deaths each year."
• Child illness - For children between the ages of one month and five years, the main causes of death are pneumonia, diarrhea, malaria, measles and HIV.
• Maternal and child undernutrition - More than 10% of the global disease burden is attributed to maternal and child undernutrition.
• HIV and AIDS - More than half of the HIV-infected children who don't get treatment die before age two.
• Gender issues and women's rights - "Regions with high maternal death rates are characterized by disenfranchisement and marginalization of women."
• Deficiencies in knowledge translation - A lack of sufficient research funding and personnel in developing countries limits the extent to which health programs are evidence-based and benefit from other areas' implementation experiences.

The scientific institutions then call on the G8 countries to increase funding for maternal and child health, with an emphasis on strengthening health facilities so they can provide increased access to prenatal, midwifery, essential obstetric, and newborn care. They urge access to family planning services integrated with HIV/AIDS prevention services, and policies "which protect women and children from all forms of abuse, injury, exploitation and violence." They also promote better coordination of initiatives on women and children's health and strengthening of research in this area, especially in knowledge translation.

If support for these facilities and services does increase, developing countries will need more health workers to administer the programs - but clinicians trained in developing countries often move to developed countries. The statement also addresses this issue:

Health workforce strategies need to include plans to build a cadre of skilled birth attendants and community health workers to care for pregnant women and children. Developing countries should establish incentive programs to retain clinical staff trained internally and repatriate former staff. Developed countries should be discouraged from actively recruiting trained individuals in healthcare from developing countries and encouraged to form health education partnerships.

We tend to think of funding decisions being the main way that G8 countries' decisions affect countries with high rates of maternal and child mortality, but we also have to consider other ways our actions shape health around the world.