One measure of international efforts to reduce maternal and child mortality relate to the United Nations (UN) Millennium Development Goals (MDGs). First agreed at the UN Millennium Summit in September 2000, the eight MDGs set worldwide objectives for reducing extreme poverty and hunger, improving health and education, empowering women, and ensuring environmental sustainability by 2015. MDG four and five specifically relate to improving maternal and child health and reducing maternal and child mortality. At the UN MDG Summit in September 2010, world leaders reaffirmed their commitment to the goals and called for intensified collective action and the expansion of successful approaches. For example, a Global Strategy for Women’s and Children’s Health was launched and garnered over $40 billion in commitments. But despite this progress, more work is needed to meet the MDGs by 2015.
“Already the MDGs have helped lift millions of people out of poverty, save countless children’s lives and ensure
that they attend school, said UN Secretary-General Ban Ki-moon said, in a July 7, 2011, press release. “They have reduced maternal deaths, expanded opportunities for women, increased access to clean water, and freed many people from deadly and debilitating disease. At the same time, the report shows that we still have a long way to go in empowering women and girls, promoting sustainable development, and protecting the most vulnerable from the devastating effects of multiple crises, be they conflicts, natural disasters or volatility in prices for food and energy.”
Some key points of progress is that the world as a whole is still on track to reach the poverty-reduction target, and by 2015, the global poverty rate should fall below 15%, well under the 23% target despite setbacks from recent economic, food, and energy crises. Some of the poorest countries have made the greatest strides in education. For example, Burundi, Rwanda, Samoa, Sao Tome and Principe, Togo, and Tanzania have achieved or are nearing the goal of universal primary education. The number of deaths of children under the age of five declined from 12.4 million in 1990 to 8.1 million in 2009, which means nearly 12,000 fewer children die each day. Increased funding and intensive control efforts have cut deaths from malaria by 20% worldwide from nearly 985,000 in 2000 to 781,000 in 2009. New HIV infections have declined steadily. In 2009, some 2.6 million people were newly infected with HIV, a 21% drop since 1997, when new infections peaked. The number of people receiving antiretroviral therapy for HIV or AIDS increased 13-fold from 2004 to 2009, due to increased funding and expanded programs. An estimated 1.1 billion people in urban areas and 723 million people in rural areas gained access to an improved drinking water source during the period 1990–2008.
Despite these successes, more progress is needed. “Progress tends to bypass those who are lowest on the economic ladder or are otherwise disadvantaged because of their sex, age, disability or ethnicity,” said Ban in the UN statement. “And disparities between urban and rural areas remain daunting.”
The report shows that the poorest children have made the slowest progress in terms of improved nutrition and survival. In 2009, nearly a quarter of children in the developing world were underweight, with the poorest children most affected. Children from the poorest households in the developing world have more than twice the risk of dying before their fifth birthday as children in the richest households. Being poor, female, or living in a conflict zone increases the probability that a child will be out of school, the report says. Worldwide, among children of primary school age not enrolled in school, 42%, or 28 million, live in poor countries affected by conflict. While stressing that achieving the MDGs largely depends on ensuring women’s empowerment and equal opportunities for women and men, girls and boys, the report also shows that achieving this goal remains elusive. The report finds that opportunities for full and productive employment remain particularly slim for women. Following significant job losses in 2008–2009, the growth in employment that occurred during the economic recovery in 2010, especially in the developing world, was lower for women than for men.
In May 2011, the Global Strategy for Women and Children’s Health announced new commitments by 16 countries: Burundi, Chad, the Central African Republic, Comoros, Guinea, Kyrgyzstan, the Lao People's Democratic Republic, Madagascar, Mongolia, Myanmar, Papua New Guinea, Sao Tome and Principe, Senegal, Tajikistan, Togo, and Vietnam. Nine of these 16 countries represent the African continent. These commitments come in addition to the 18 made in September 2010 by African states, bringing the total of African countries having committed to the health of women and children to 27. These commitments to the Global Strategy follow a declaration by heads of states at the 2010 July Summit of the African Union to strengthen efforts to improve maternal, newborn, and child health and a March 2011 Resolution by African ministers of finance and budget to improve health investment and strengthen their dialogue with health counterparts.
'”The Global Strategy is an unprecedented opportunity to help the women and children who need it most. The commitments made by Members States, donors and other partners are an impressive signal that we collectively take responsibility to achieve the health-related Millennium Development Goals and save more women's and children's lives,'” said World Health Organization Director-General Dr. Margaret Chan, in a May 19, 2011, statement.
Every year, 358,000 women in the developing world aged 15–49 die of pregnancy and childbirth-related complications. Every year, 2.6 million children are stillborn, and a further 8.1 million die before their fifth birthday, including 3.3 million babies in the first month of life. “Focusing on the women and children in greatest need is not only the right thing to do, it moves us faster and most cost-effectively towards meeting the health Millennium Development Goals,” said Anthony Lake, UNICEF executive director, in the May 19th statement. “By choosing to redouble their efforts on maternal and child health, these 16 nations are not only saving lives, they are making an investment in their future.”
The commitments, made with the support of UNAIDS, UNFPA UNICEF, the World Bank and WHO (collectively known as the H4+ agencies), focus on measures proven effective in preventing deaths, such as increased contraceptive use, attended childbirth, improved access to emergency obstetric care, prevention of mother to child transmission of HIV, and childhood immunizations.
Pharmaceutical company efforts
In September 2011, Merck & Co. announced the launch of "Merck for Mothers," a long-term effort with global health partners to prevent women from dying from complications of pregnancy and childbirth. The launch includes a 10-year, half-billion-dollar initiative that applies Merck's scientific and business expertise to make solutions more widely available, develop technologies, and improve public awareness, policy efforts, and private-sector engagement for maternal mortality.
In September 2010, UN Secretary-General Ban launched the Global Strategy for Women's and Children's Health supported by Every Woman Every Child, a global effort to improve the health of women and children. Merck, in concert with the UN and its partners, has committed to help tackle the MDG that aims to reduce the maternal mortality ratio by 75% and create universal access to reproductive health.
Based on input from more than 100 experts in the field, Merck developed a strategic framework identifying where the company will focus its people and resources in the Merck for Mothers initiative. The initiative will focus on the two leading causes of maternal mortality (excessive and uncontrolled bleeding after childbirth, known as post-partum hemorrhage, and life-threatening high blood pressure during pregnancy, known as preeclampsia) as well as family planning, which is known to play an important role in reducing maternal mortality. The initiative will be guided by input from both an internal steering committee and an external advisory board. Merck will hold itself accountable for the initiative's programs and outcomes by ensuring that an independent organization will monitor and evaluate its efforts. There are three main approaches for the long-term initiative.
The first approach is to accelerate access to proven solutions. Merck intends to improve the quality and supply of diagnostic, prevention, and treatment interventions for post-partum hemorrhage and preeclampsia. In addition, the company will strengthen medical education for skilled birth attendants, help develop sustainable models for health deliver, and expand access to family planning.
The company’s second strategy is product Innovation. Merck will collaborate with partners to develop maternal health technologies for widespread use in resource-poor settings. Merck will start with an assessment of more than 30 promising existing technologies in partnership with leading donors, nongovernmental organizations (NGOs), and researchers, with a goal of developing at least three innovations that address post-partum hemorrhage, preeclampsia, and family planning.
The company’s last effort focuses on global awareness and advocacy. Merck will join maternal-health experts to create greater public awareness of the need to reduce maternal deaths in an effort to improve global and national policy. Merck also will work with NGOs and multilateral organizations to advocate for broad private-sector engagement. As part of "Merck for Mothers", Merck is among the first companies to join the UN Global Compact/UN Foundation's Private Sector Task Force for Every Woman Every Child.