Preventing maternal and child mortality: upcoming WHO Resolution must galvanise action to tackle the unacceptable weight of preventable deaths
Authors: Ali Hajji Adam, Mekdes Daba
Journal: The Lancet Global Health (2024)

Global progress on improving maternal, newborn, and child survival has stalled. Many regions of the world continue to experience persistently high rates of maternal and child mortality, and despite improvements between 2000 and 2015, progress is now stagnating.1WHOTrends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. World Health Organization, Geneva2023Google Scholar The combination of ongoing and new conflicts, climate change, and the impact of the COVID-19 pandemic create a perfect storm to drive back any gains that might have been made during the Sustainable Development Goal (SDG) era. The global community is off track from targets for reducing maternal mortality (SDG 3.1)2UNTransforming our world: the 2030 Agenda for Sustainable Development. SDG 3.1 target. United Nations, New York City, NY2015Google Scholar and ending preventable deaths of newborns and children younger than 5 years (SDG 3.2).3UNTransforming our world: the 2030 Agenda for Sustainable Development. SDG 3.2 target. United Nations, New York City, NY2015Google Scholar Globally, 287 000 women died from a maternal cause in 2020, averaging 223 deaths of mothers for each livebirth.1WHOTrends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. World Health Organization, Geneva2023Google Scholar For children younger than 5 years, 4·9 million died globally in 2022, 2·3 million of these in the first month of life.4United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME)Level and trends in child mortality: report 2023. United Nations Children's Fund, New York City, NY2024Google Scholar In addition, almost 1·9 million babies were stillborn in 2021.5United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME)Never forgotten: the situation of stillbirth around the globe. United Nations Children's Fund, New York City, NY2023Google Scholar The stark reality is that 46 countries are projected to have a ratio greater than 140 maternal deaths per 100 000 livebirths by 2030,6WHOAcceleration towards the Sustainable Development Goal targets for maternal health and child mortality.https://apps.who.int/gb/ebwha/pdf_files/EB154/B154_12-en.pdfDate: 2023Date accessed: February 29, 2024Google Scholar 59 countries will miss the SDG target for mortality for those younger than 5 years, and even more— 64 countries—will miss the neonatal mortality target.4United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME)Level and trends in child mortality: report 2023. United Nations Children's Fund, New York City, NY2024Google Scholar The tragedy is that so many of these deaths are preventable. More than 70% of maternal deaths are due to obstetric causes including hypertension, sepsis, abortion, and embolism.7Say L Chou D Gemmill A et al.Global causes of maternal death: a WHO systematic analysis.Lancet Glob Health. 2014; 2: e323-e333Summary Full Text Full Text PDF PubMed Scopus (3614) Google Scholar As for mortality for those younger than 5 years, prematurity is the leading cause, while birth trauma and asphyxia, acute respiratory infections, malaria, diarrhoea, and congenital anomalies are among the top causes.8Villavicencio F Perin J Eilerts-Spinelli H et al.Global, regional, and national causes of death in children and adolescents younger than 20 years: an open data portal with estimates for 2000–21.Lancet Glob Health. 2023; 12: e16-e17Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar It is an indictment of the global health community that we know these facts and have done very little about them. There is a myriad of approaches that could be tailor-made for each challenge, but the political will to do so has been lost. This is why the World Health Assembly Resolution on maternal, newborn, and child health9WHOAccelerate progress towards reducing maternal, newborn, and child mortality in order to achieve Sustainable Development Goal targets 3.1 and 3.2.https://apps.who.int/gb/ebwha/pdf_files/EB154/B154_CONF4-en.pdfDate: 2024Date accessed: February 29, 2024Google Scholar is crucial. Initiated by Somalia, co-sponsored by Botswana, Djibouti, Ethiopia, Egypt, Kenya, Lebanon, Nigeria, Paraguay, Sierra Leone, South Africa, and Tanzania, the Resolution is going through consultation, with growing support from other member states, and we, as Ministers of Health, consider it to be essential to future progress in maternal and child survival. The Resolution aims to tackle the persistent disparities in maternal, newborn, and child health and accelerate progress. It calls for urgent action to address inequities across the life course to create resilient health systems focused on primary health care. The Resolution is a resounding call for prioritising maternal, newborn, and child health in policy, service delivery, and financing. Healthy and empowered women, children, and adolescents are central to the transformational change envisioned by the 2030 Agenda. Investing in their wellbeing leads to healthier communities, vibrant economies, and more prosperous, peaceful, and resilient societies. That is why the entire continuum of care must always be considered, starting with the health and wellbeing of parents before conception, and then following through all stages of a newborn's, child's, and adolescent's life. Otherwise, the global community risks looking back at the SDG era as one that failed vulnerable mothers and children. Fortunately, what works is known. Successful approaches include high-quality essential health and nutrition services; a multipronged approach to maximise resources and address workforce shortages; stronger primary health-care delivery; prioritising the hardest-to-reach communities; and universal access to reproductive and sexual health services.9WHOAccelerate progress towards reducing maternal, newborn, and child mortality in order to achieve Sustainable Development Goal targets 3.1 and 3.2.https://apps.who.int/gb/ebwha/pdf_files/EB154/B154_CONF4-en.pdfDate: 2024Date accessed: February 29, 2024Google Scholar Knowing what works is just the beginning. Successfully implementing these strategies requires political will, unerring commitment, and consistent investments. That is why massively accelerated action is needed and why the Resolution matters. And we call on all stakeholders to support it. We declare no competing interests.