Women, newborns, children, and adolescents: life-saving momentum after a slow start
19 000 fewer deaths each day
As low-cost generic antiretroviral treatments for HIV became widely available, further progress in reducing maternal and childhood mortality came from the large number of countries that launched initiatives to eliminate mother-to-child transmission of HIV and followed WHO recommendations to “treat all”, including pregnant women. The Medicines Patent Pool brought paediatric formulations of HIV treatment onto the market, extending the benefits of these medicines to more children. Significant drops in childhood deaths from malaria further contributed to the dramatic decline. Although the MDG goals for reducing maternal and childhood mortality were missed at the global level, the final Countdown report in 2015 recorded impressive progress.
The yearly number of maternal deaths dropped to around 289 000, with deaths still caused by conditions that could have been prevented through the provision of quality antenatal, delivery and postnatal care. Between 1990 and 2015, childhood mortality dropped by 53%. Estimates for 2015 indicated 5.9 million childhood deaths that year, compared with 10.8 million in 2000. This reduction means that 19 000 fewer children are dying each and every day.
The causes of childhood deaths showed a striking shift. In 2000, the leading causes of the 10.8 million deaths were neonatal conditions (33%), diarrhoea (22%), pneumonia (21%), malaria (9%) and AIDS (3%). In 2015, the leading causes of the 5.9 million deaths were preterm birth complications and other neonatal causes (45%), pneumonia (16%), diarrhoea (9%), malaria (5%), and AIDS (1%), strongly suggesting that scaled up coverage with interventions had a major impact. The sharp acceleration of declines in child mortality further suggested that even greater progress can be expected in the coming years. As the report noted, the growing concentration of deaths in the newborn period and the improved understanding about the causes of newborn deaths have sparked the scaling up of long-existing interventions and the development of new ones.
"Estimates for 2015 indicated 5.9 million childhood deaths that year, compared with 10.8 million in 2000. This reduction means that 19 000 fewer children are dying each and every day."
Dr Chan, WHO Director-General
In Countdown countries, suboptimal nutrition, including fetal growth restriction, stunting, wasting and deficiencies of vitamin A and zinc along with suboptimum breastfeeding, were cited as an underlying cause of 45% of all childhood deaths, reinforcing the importance of initiatives like Scaling Up Nutrition. The collection of high-quality country data showed real progress.
For example, the number of countries with information about postnatal care visits for babies increased from five during the period 2000–2006 to 35 by 2014. Against these positive trends, Countdown noted extreme inequalities, within and between countries, in coverage with life-saving interventions. Immunization was the notable exception, with coverage rates consistently reaching or exceeding 85% in most Countdown countries.
As an instrument for accountability, Countdown also tracked resource flows. Official development assistance surged after the MDG summit in 2000. Trends from 2003 to 2012 showed a tripling of development assistance to maternal, newborn, and child health, from $2 billion to $6 billion. Resource flows then slowed under the lingering effects of the 2008 financial crisis.