The Millennium Development Goals (MDGs) expired last year to give way for Sustainable Development Goals (SDGs), which have recently been endorsed by the United Nations General Assembly in New York. Since the SDGs are meant to ‘sustain’ and improve on the progress that has already been made towards the MDG targets, it is important to take stock of what has been achieved thus far in maternal and newborn health (MNH) to celebrate where we are, as well as have a clear view of the road ahead.
Out of the eight goals in the MDGs, goals number 4, 5 and 6 are directly related to MNH. According to the United Nations Report on the MDGs 2015, tremendous progress has been made in increasing access to MNH services, and in reducing global maternal and newborn mortality. Since 1990, the global maternal mortality ratio has declined by 45 per cent, while worldwide under-five mortality rate has declined by more than half, dropping from 90 to 43 deaths per 1,000 live births between 1990 and 2015. Likewise, the worldwide neonatal mortality rate has dropped from 33 deaths to 19 deaths per 1,000 live births.
However, despite those achievements, indicators still remain low in some parts of the world, particularly in sub-Saharan Africa. The UN report has indicated much higher maternal and neonatal mortalities in those regions than in other parts of the world. The incidence of, and mortality from, diseases like HIV and tuberculosis are also high.
Another major challenge that would need attention in the years ahead is the disparity between rich and poor. For example, under-five mortality rates for children from poor families is almost double that of their peers in rich households. Similarly, only 56% of pregnant mothers in rural areas receive care from skilled birth attendants, compared to 87% of women living in urban areas.
Recognising those challenges, the global community made history once again by agreeing on a common front to fight against some of the most daunting developmental challenges facing humanity today. Experts in various fields from all over the world are already examining the SDGs, trying to find out whether some of the challenges of the MDGs will be addressed in the newly adopted SDGs.
The SDGs have 17 goals to “stimulate action over the next fifteen years in areas of critical importance for humanity and the planet”. The goals are categorised into 5 areas (5 P’s): people, planet, prosperity, peace and partnership. Of the 17 goals in the SDGs, goals number 1, 2, 4, 5, 6, 8, 11 and 13 are indirectly related to MNH, while only goal number 3 explicitly deals with health problems, including maternal and newborn health issues.
Goal number 3 of the SDGs, to “ensure healthy lives and promote well-being for all at all ages”, aims to reduce, by the year 2030, the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births from the current global rate of 210 per 100,000 live births, according to a recent UNFPA report. The MMR sub-targets also considers progress made by countries. If the inequity challenges are addressed, the new targets may be achieved by 2013. We should also harness the potentials of countdown reports, which unlike MDGs, report disaggregated country specific data. It is hoped that SDG reports will follow a similar trend. This will keep the focus on reducing the equity gap and accelerating progress.
The SDGs also aim to reduce neonatal mortality from 22 per 1,000 live births to as low as 12 per 1,000 live births and under-5 mortality to at least 25 per 1,000 live births. In addition, goal number 3 aims to increase universal access to quality maternal, newborn, sexual and reproductive health-care services, among other targets.
With the launch the global strategy for women’s children’s and adolescent’s health, as well as the strategies toward ending preventable maternal mortality, there is a new hope to achieve highest attainable standard of health for all women, children and adolescents.
It is particularly exciting for stakeholders in MNH that the new SDGs have taken into consideration the acute shortage of human resources for health, especially in developing countries, by focusing on training and retention of healthcare workers. The recognition of the importance of health financing will also draw attention to this critical factor for universal access, and will go a long way in addressing some of the issues related to inequity and inequality in healthcare.
Achieving the SDG health-related targets will require a concerted effort from all stakeholders. The emphasis should not be just on increasing access to care, but also on improving quality of care provided to women and children. We, at the Centre for Maternal and Newborn Health, will continue to work to increase the availability of quality care to mothers and their babies through programmes aimed at increasing number of healthcare workers with skills necessary to deliver quality MNH services in some of the poorest regions in the world. We also work to improve quality of care through innovative research and measurement of effectiveness of care.
About the Author:
Dr. Mamuda Aminu is a Research Associate at the Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine and a Fellow of the Royal Society for Public Health with interests in maternal and newborn health.