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Global Women and Children's Health in the 21st Century: the Case for a Comprehensive Approach

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"The world hasn't come together to do what's necessary to save women's and children's lives," declared Melinda Gates at last week's Women Deliver conference in Washington. "But now, we have the world's attention. Now, the world is changing." Announcing a new $1.5B commitment from the Gates Foundation over the next five years to support maternal and child health, family planning, and nutrition programs in developing countries, Gates focused her keynote address on the need to integrate health services, develop more comprehensive approaches to healthcare, and forgo compartmentalized health programs operating in silos -- moving towards treating woman and children as full human beings. "The woman worried about giving birth is also worried about her starving two-year-old," she explained.

With initial grants totaling $94 million in India and $60 million in Ethiopia, investments will primarily fund NGOs and research institutions--closely coordinated with government programs -- and focus on a variety of issues: training front-line health workers to provide multiple services; developing and introducing simplified antibiotics for newborn infections; conducting social and behavioral research on promoting lifesaving practices such as immediate, exclusive breastfeeding and skin-to-skin contact to keep newborns warm; among other initiatives. A convergence of health services is an approach far more comprehensive than simply merging maternal and newborn health. A truly holistic approach must address nutrition, immunization, contraception, safe abortions, sexual violence, HIV/AIDS, education and more, while also considering the indirect challenges of access to care often posed by culture and tradition, including inherently oppressive social structures and policies.

"We should not truncate a woman's experience as one of maternal health. It is one phase of a woman's life, and therefore we must address the before, during, and after. It is a life cycle, and healthcare must be delivered on a continuum of care," asserted Thoraya Ahmed Obaid, Executive Director of the United Nations Population Fund. "There are so many examples we can point to that work, but the problem is they are just that -- examples -- and not systematic change. We need to think of comprehensive service delivery as a range of care and collaboration," emphasized Anne M. Mulcahy, Chair of Save the Children's Board of Trustees.

Reflecting a more integrated framework, United Nations Secretary General Ban Ki-Moon announced Investing in Our Common Future: Joint Action Plan for Women's and Children's Health. Inviting the Women Deliver audience to criticize and better the draft action plan by September, Mary Robinson, President of Realizing Rights and former United Nations High Commissioner for Human Rights, underscored a critical absence: a comprehensive human rights approach. Robinson maintained that we must address child marriage, family planning, cultural hurdles, and economic empowerment, among other issues, based on the foundation of core human rights principles. "At the moment of birth, women have rights, and children have rights, and at that moment they are powerfully intertwined," commented UNICEF Executive Director Anthony Lake.

The integration of services built upon a solid human rights framework is also very much tied to the direct correlation of progress between many of the United Nations Millennium Development Goals (MDGs). For example, MDG4 (reducing child mortality), MDG5 (improving maternal health), and MDG6 (combating HIV/AIDS, malaria and other diseases) are inextricably linked. Improving access to quality obstetric care -- including technologies and techniques to prevent mother-to-child HIV transmission, which affect 400,000 babies born each year in Africa -- improves maternal health and reduces child mortality. With 60 million worldwide touched by HIV/AIDS, the impact on one issue can have profound effects on another. "The number one cause of death in Africa is HIV/AIDS, not maternal mortality," explained World Health Organization Director-General Margaret Chan. Therefore, a concerted effort to tackle multiple crises at once is not simply a novel idea, but rather it is the only way to achieve lasting and sustainable impact on a global scale.

While this is true, there are inherent challenges to partnerships. A real barrier to convergence amongst actors and action plans stems from the complexities of human nature. "We need to keep focused on the issue and not the organization. We need to do more joint appeals as to increase the pie instead of simply focusing on our own slice," discussed Anthony Lake. "I wish there was a technology to change human behavior of selfishness in that regard." Above all, however, the age-old model of specialized research and interventions that are executed in silos will necessarily transform to the reality of people and the way in which we truly engage the world: as one human being in need of varying levels of comprehensive care throughout our lives. With global leaders convening next week in Canada for the G8 and G20 Summits, maternal and child health is now a top international priority. "The whole world will be looking to us for leadership," affirmed Melinda Gates. "We need to be ready with a single plan."

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