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

An indicator of fairness

As measurement improved for both maternal and child mortality, the data found additional uses, especially as an indicator of fairness in access to care. As addressing the social determinants of health and progress towards universal coverage emerged as priorities for global health, systems for detecting where inequalities exist and monitoring changes over time became essential instruments for health system reform and a tool for accountable public policies. Improvements in equitable care for women and children were regarded as powerful indicators of overall equality within societies.

In 2013, WHO issued a handbook on health inequality monitoring to enable countries to better monitor and evaluate their progress and performance with a high degree of accountability and transparency. The handbook was followed in 2015 with a report on the status of inequality in reproductive, maternal, newborn and child health. Using 22 indicators, the report profiled the status of inequality within and across countries, with data disaggregated by four dimensions of inequality: economic status, education, rural or urban residence and sex of the child.

Where possible, the report tracked changes in health outcomes for population subgroups over time. It showed how a dedicated focus on inequality can compel targeted corrective action that gets to the heart of trouble spots concealed by national averages. For example, the proportion of births attended by skilled health personnel differed by up to 80% between the richest and poorest subgroups. The use of modern contraceptives was at least twice as high among women with a secondary education or higher as among women with no education. For childhood mortality, deaths in rural areas exceeded those in urban areas by 16 child deaths per 1000 live births.

"Improvements in equitable care for women and children were regarded as powerful indicators of overall equality within societies."

Dr Chan, WHO Director-General

What explains the success?

While the leading causes of maternal and child mortality have long been known, less data were available to explain why some countries at the same level of economic development have achieved superior results or what strategies were used to accelerate progress. In an effort to extract every possible lesson from the dramatic declines in mortality, WHO, the Partnership for Maternal, Newborn and Child Health, the World Bank, and several academic institutes looked at how ten of the world’s poorest countries achieved outstanding success in reducing maternal and child mortality.

The ten case studies were published in Success factors for women’s and children’s health, a 2014 report which includes statistical and econometric analyses of data from 142 low- and middle-income countries over two decades, and policy reviews in the ten “fast-track” countries.

As demonstrated, the best results were obtained through investments in high-impact interventions such as quality care at birth, immunization, and family planning, combined with investments that target fundamental drivers of preventable mortality in other sectors, including education, nutrition, women’s political and economic participation, and access to clean water, sanitation, and modern energy.