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Maternal, Newborn and Child Survival: Celebrating Progress, Continuing the Fight

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"I think the 21st century is our century," declared Kavita Ramdas, President and CEO of the Global Fund for Women. The Fund is an actor among many propelling the international grassroots-to-government movement towards a better understanding of the value and impact of investing in the health, education, security and rights of women and girls worldwide. Adding to the momentum of the movement, the 2010 Women Deliver Conference begins Monday, June 7th, and will convene 3,000 participants including heads of state, ministers of health and leading maternal health advocates to call on governments, donors, and multi-lateral organizations to increase their financial commitments to women and girls around the world. Make no mistake: a special focus on women and girls is not an aberration on the global agenda, for it is quickly emerging as the secret to unlocking humanity's potential in securing a more stable and sustainable future for all. In short, it is an idea whose time has come.

Indeed, according to a draft text for the G8 Summit to be held at the end of June in Canada, the group of industrialized nations will "champion a new initiative on maternal, newborn and under-five child health," in an effort to meet faltering goals for slashing world poverty by 2015. Moreover, as his signature initiative for the G8 Summit, Canada's Prime Minister Stephen Harper recently announced a willingness to commit $1B towards maternal and child health--so long as other nations follow suit. Canada's commitment is not without evidence of progress, for according to a recent study by the University of Washington's Institute for Health Metrics and Evaluation (IHME), which published their findings in The Lancet, the number of maternal deaths worldwide in 2008 was 343,000, down from 526,000 in 1980--an overall decrease of 35%. Moreover, using a new method to calculate mortality, the Institute conducted another study, funded by the Bill and Melinda Gates Foundation, on deaths among children under 5 and discovered a quicker-than-expected level of progress: a decrease from 16 million deaths in 1970, to 11.9 million in 1990, to 7.7 million in 2010.

Dr. Christopher Murray, IHME DIrector and one of the study's co-authors, credited three reasons for the decline in mortality rates: improved maternal education; efforts to curb mother-to-child HIV/AIDS transmission; and increased childhood disease intervention, such as mosquito nets and drugs. Borrowing from birth control to develop a novel tool for HIV prevention, the non-profit International Partnership for Microbicides just launched a clinical trial in Southern and East Africa testing the safety and acceptability of a vaginal ring containing an antiretroviral drug. The tool could one day empower women by providing long-lasting, discreet protection from HIV infection during sex, ultimately affecting the challenge of mother-to-child HIV/AIDS transmission.

While laying out the groundwork for success, "much of this progress is driven by increased investments in proven, cost effective programs--such as children's immunization initiatives and programs to educate pregnant women about the importance of exclusive breastfeeding," asserted Gary Darmstadt, Director of Family Health at the Bill and Melinda Gates Foundation, in an interview. "Many of these solutions have existed for years, but simply haven't reached enough people. At the same time, it's critical to promote innovation in maternal and child health. For instance, we need additional behavioral research to identify how to educate women in diverse communities and cultures about keeping themselves and their newborns healthy." Signs of progress, however, expose critical areas of related concern, including the negative cascade of health effects on child marriage and the role of HIV/AIDS in maternal mortality.

According to the International Center for Research on Women, nearly half of the girls in India are married before they turn 18, making India home to a third of the world's 60 million child brides. Such marriages increase the chances of maternal death due to an increase in the likelihood of complications during pregnancy, inadequate knowledge of maternal health, lack of control over medical decisions, and ultimately, poor access to timely and proper health services. Furthermore, the United Nations Population Fund estimates that girls who give birth between the ages of 10 and 14 are five times more likely to die in pregnancy or childbirth than women aged 20 to 24. Girls 15 to 19 are twice as likely to die. These startling statistics must be digested into the planning and action of initiatives targeting maternal mortality, as to address the multiple layers of this health atrocity. In addition, the connection between HIV/AIDS and maternal mortality injects yet another concern with regard to the spending of health dollars in the developing world.

AIDS, a top killer among women of reproductive age, is responsible for roughly 61,000 of the 343,000 annual deaths worldwide of women in childbirth or pregnancy. Julio Montaner, president of the International AIDS Society, remarked that "In many African countries, about 30 percent of women of reproductive age have the virus," and that "there will be no success in maternal and child health unless the G8 delivers on HIV/AIDS treatment." Médecins Sans Frontières health policy analyst Mit Philips concurs, and recently asserted that "What's being proposed is to take resources from HIV and give them to maternal health, but you cannot separate the two, because it's the same patient." With the United States taking the lead in global health, a new report issued last week by the Kaiser Family Foundation examines the U.S. role in improving global maternal, newborn, and child health, including the heightened focus placed on these issues by the Obama Administration's Global Health Initiative.

The health challenges confronting women and girls worldwide are a matter of life and death. And while progress over the last three decades in reducing the number of maternal, newborn and child deaths should be celebrated, such improvements must be tempered by the fact that numbers in the hundreds of thousands (with regard to maternal deaths), and millions (with regard to the death of children), are just as unacceptable as they were three decades ago. This is a fight for life that must be tackled with a sustained commitment in order for such progress to be replicated in the decades to come. Now is the time to renew those very commitments.

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