Not such a long time ago, it was common, even expected, that many babies, children, and mothers would die. Family histories (mine included) are full of poignant stories of lives lost to a multitude of causes. Today, in our country the death of a mother or child is rare and tragic. Many parts of the world have yet to experience the transformation that modern medicine and better public health can bring, but there is rapid progress and very reasonable hope that we will soon live in a world where all families experience this miraculous change. With so much bad news bombarding us, the astounding improvements in child and maternal health that have come in recent decades are a true beacon of hope.
There's a grand celebration in Washington these days of this miracle of child and maternal survival. A Capitol Hill event today highlights bipartisan fellowship and USAID is hosting an event June 26 where partnerships are the theme song. An impressive and all too rare facet of this effort is that it does not represent one off hoopla, but is part of a continuing series of public events and increasing programatic focus.
The public campaign that the Capitol Hill and USAID events are featuring focuses on something everyone should find it easy to relate to: a fifth birthday celebration. Apart from eliciting adorable pictures of oneself and one's children at five, the message is deeply serious: in much of the world living to five years old is an achievement. Websites for World Vision, Rotary, the Religious Action Center of Reform Judaism, the Salvation Army, and many others have joined the celebration and are campaigning to finish the job.
The campaign (known by various names including A Promise Renewed or APR) combines the array of cute pictures with statistics and graphs that tell the story, and highlight the science and practice that lie behind the transformation in survival. Based on the best estimates we have, between 1990 and 2012, the total number of child deaths fell by 48 percent, from 12.6 million to 6.6 million. The numbers of mothers who died as a result of pregnancy are even less hard, and progress is less clear, but still instead of an estimated 523,000 deaths in 1990 the 2013 estimate is under 290,000.
What explains this progress? Some explanations are unsurprising but well worth emphasizing: vaccination, breastfeeding babies, and better hygiene. Others may be surprising: for example the important role that family planning plays in better mother and child health.
But the most important ingredient seems to be political will. Where there is strong leadership and commitment, and a will to work together across divides, there is progress. That is as true for Ethiopia and Bangladesh as it is for the United States. U.S. leadership in global health is something to be proud of and a willingness to bridge divides in the interest of child welfare is a central feature of the success.
This is the good news. The less good news is that there is still far to go, and what lies ahead is more difficult. There are three special challenges. The first is to reach children and mothers in areas where there is conflict and failures of governance (Syria, the Central African Republic, South Sudan for example). That calls both for extraordinary measures like temporary ceasefires to allow vaccination campaigns to do their work and work to end conflicts and improve governance. The second is to reach marginalized groups, those who are outside the mainstream, many stigmatized. A glaring example right now is the Rohingya people in Myanmar, but also many people who are displaced or difficult to reach.
The third tough challenge is attitudes and behavior. Experts have puzzled as to why maternal mortality has been so difficult to address. The reason is only partly the practical challenge of getting women to clinics that have the necessary health workers and supplies. Slow progress is also due to attitudes that give low priority to women and to their health, and to myths and apathy. Similar attitudes are behind one of the tragic realities that statistics reveal even better than poignant individual stories: girls are more neglected than boys so an age pyramid in parts of the world shows more living boys than girls.
To meet these three tough challenges, a more purposeful, thoughtful, and energetic engagement of faith communities, faith leaders, and faith inspiration is needed. Experience shows that such engagement is feasible and that it works. There are well documented stories from all corners of the world that show the important roles that religious communities play in encouraging changes in behavior and in providing services. There are many more untold stories of quiet heroism in distant places; documenting them better can both break barriers that distort expectations about religious actors and offer new ideas for policies and programs.
Attention recently has tended to zero in on awful news about religious communities and public health: the harsh discrimination against LGBT communities and attacks on vaccinators, for example. But these destructive pockets are a tiny part of the broader picture. Far more significant is the reality that these vast faith resources are not fully engaged and deployed. And their potential to galvanize child survival programs and to bestir apathy and cut into a sense of fatalism is far from exploited.
Child and maternal health achievements are truly a modern miracle. It is a miracle of science but also a miracle of faith. Here's to many billions of happy fifth birthdays!