Women, newborns, children, and adolescents: life-saving momentum after a slow start

After decades of stagnation, political will to cut the number of needless deaths of mothers and children emerged in 2010 with the United Nation’s US$ 40 billion Every Woman Every Child initiative. Dramatic progress came from better data collection, more births in health facilities, better nutrition and vaccines against diarrhoea and pneumonia, the biggest child killers. A revised global strategy views the focus on maternal, newborn, child and adolescent health as an entry point for increasing universal health coverage.

Mother with a child at a clinic in Afghanistan
WHO/Rada Akbar

Maternal health

In 1985, The Lancet published a pivotal, thought-proving commentary that riveted attention on a neglected tragedy: maternal mortality. “Where is the M in MCH?” the authors asked. The article opened with the WHO estimate that complications of pregnancy, unsafe abortions and childbirth were killing at least half a million women in developing countries every year. Left out of that calculation were many more poor adolescents and women who suffered life-long complications from unsafe abortions and deliveries.

In part, the article attracted so much attention because it challenged the widespread assumption that most maternal deaths could be prevented by detecting at-risk women during antenatal care and screening. As pointed out, a sizeable proportion of serious complications occur among women with no recognizable risk. When those complications occur, the authors stressed, most life-saving interventions require emergency obstetric care in hospital facilities staffed with highly trained doctors, midwives and nurses. A reliance on traditional birth attendants would not save those lives.

"Lack of political will to face the problem was the biggest reason why a tragedy on this scale continued."

Dr Chan, WHO Director-General

In other words, an agenda that aimed to get the death rate down needed to be an agenda that improved access to essential health services, including emergency obstetric care and facility-based birth with skilled attendants. Citing the excellent maternal health care provided in Cuba and China, the authors concluded that lack of political will to face the problem was the biggest reason why a tragedy on this scale continued .

In the published debate that followed, some authors questioned whether MCH really needed an M at all. The better focus was on women, and this needed to be a focus on the health of girls and women throughout the life course. Though women’s reproductive functions made them vulnerable to health problems, an exclusive focus on these functions reduced the status of women to vessels for procreation. Both the health needs of women and their contributions to society were much, much broader.

All of these concerns were eventually reflected in formal WHO policies and strategies.