A G8 plan that works:
Reducing maternal, newborn and child mortality
Dr. André Lalonde, FRCSC
SOGC Executive Vice President
FIGO Executive Board Member
PMNCH Executive Board Member
Dr. Mark Walker, FRCSC
Associate Professor
University of Ottawa
Senior Scientist OHRI
Scientific Director BORN Ontario
Dr. Heather MacDonnell,
FRCPC, FAAP, DTMH(UK)
Co-Head International Adoption Clinic
Division of Pediatric Medicine, CHEO
Assistant Professor of Pediatrics, U Ottawa
Canada to host the 2010 G8 Summit
This year, Canada is presented with an important
opportunity to reaffirm itself as a global
humanitarian leader, as we welcome world leaders
to the 2010 G8 and G20 Summits.
G8 to focus on
Maternal and
Child Health
Prime Minister Harper’s
announcement is a step
in the right direction.
But what exactly is
included in the mother
and child initiative?
And will promises be
met?
Millennium Development Goals
Millennium Development Goals
4. Reduce Child Mortality
• Target:
– Reduce by 2/3, between 1990
and 2015, the mortality rate
of children under 5
• Indicators:
– Under-five mortality rate
– Infant mortality rate
– Proportion of one-year-old
children immunized against
measles
Millennium Development Goals
5. Improve Maternal Health
• Target 5.A:
– Reduce by 3/4, between
1990 and 2015, the
maternal mortality ratio
• Indicators:
– Maternal mortality ratio
– Proportion of birth
attended by skilled health
personnel
• Target 5.B:
 Achieve, by 2015, universal
access to reproductive health
• Indicators:




Contraceptive prevalence rate
Adolescent birth rate
Antenatal care coverage
Unmet need for family
planning
Global Situation
•
•
•
•
•
•
•
•
•
•
•
180-210 million pregnancies every year
80 million unwanted pregnancies
50 million induced abortions
20 million unsafe abortions
68,000 deaths from unsafe abortion
20 million women suffer from maternal morbidity
Estimated 536,000 maternal deaths
3 million babies are born dead
Almost 10 million children under 5 die
Of which 3 million newborns die within the first week of life
500,000 infants are infected with HIV
Progress toward MDG 4:
15 countries 'on track'
25 countries 'no progress'
No progress
Insufficien
t
On track
Source: Progress for children. A world fit for children.
Statistical tables on MDG4. Available at
http://www.unicef.org/progressforchildren/2007n6/index_41854.htm
Countries with
increasing U5MR
Progress toward MDG 5
• 12 of 13 countries with highest
Maternal Mortality Ratios are
in sub-Saharan Africa
• Pattern of contextual factors
differs from that of MDG4.

High HIV prevalence (>5%, 1/13)

Conflict (8/13)
Coverage failures across the continuum of care
For some
interventions:
• Family planning
• Exclusive
breastfeeding
• Clinical care for
newborn and child
illnesses
In some countries:
• Wide gaps in
coverage across
countries
Coverage estimates for interventions across the continuum of care in the 68
priority countries (2000-2006). Vertical bars indicate the range in coverage
across countries.
Key strategies to reduce maternal mortality
Access to
contraceptives, to
avoid unintended
pregnancies
Access to skilled
care at the time of
birth
Timely access to
emergency obstetric
care in the event of
complications
Skilled attendance at birth
saves mothers and babies
Skilled attendance at childbirth is the most effective intervention
World Health Organization
April 05
The Global Consensus for
Maternal, Newborn and Child Health:
1. Political leadership and community engagement and mobilization
2. Delivering high quality services
3. Removing financial, social, and cultural barriers to access
4. Ensuring skilled and motivated health workers
5. Accountability at all levels for credible results
Lives that can be saved and investment required:
Global Child Mortality: Key Messages
Globally, 1 in 7 children die before the age of 5
= 9.2 million children in 2007
= 15 filled school buses crashing per hour
Most under-5 deaths are preventable
• pneumonia, newborn causes, diarrhea,
malaria, measles
Simple strategies prevent deaths
and are not necessarily expensive!
Under 5 (Child) Mortality
Reduction Rates
244
UnderFive
Mortality
Rate
206
188
Sub-Saharan Africa
171
123
129
(per 1000 live births)
South Asia
122
92
58
54
East Asia
36
31
Latin America
1970
2004
UNICEF State of the World’s Children
1990
2015
62
42.6
19.1
17.8
MDG-4
Goals
Child Mortality Rate
/1000 live births
Infant Mortality Rate
/1000 live births
Stillbirth Rate
/1000 total births
UNICEF State of the World’s Children
6
130
5
84
3
32
Preventable Conditions
Cause Most Child Deaths
Infection
36%
Acute
Respiratory
Illnesses, 17%
Prematurity 27%
Asphyxia
23%
}
Neonatal
deaths, 37%
Malnutrition
55%
Malaria, 7%
WHO data
Other, 23%
Diarrhea, 16%
What can be done
to save the children?
Postpartum
•
•
•
•
.
Clean cord care
Skin to skin with mother (kangaroo care)
Antibiotics for suspected sepsis
Early breastfeeding, exclusive x 6 months
What can be done
to save the children?
Early Infancy and Beyond
• Routine immunizations
• Regular growth measurements
• Health education to mothers
– Hygiene, clean water, sanitation
• Antibiotics for pneumonia
• Iron, Zinc, Vitamin A supplementation
.
• Insecticide treated bed nets
Save a child’s life for a pittance
Estimated cost of interventions:
Insecticide-treated bed net
Full WHO EPI immunizations (Africa)
Oral rehydration solution (ORS)
Total cost $887 per life saved
Save 800,000 African newborns
at $1.39 per person per year
$6
$14
< $1
Recommendations
• Focus on essential interventions that will prevent or
reduce maternal, newborn and child mortality and
morbidity
• Increase capacity with training of skilled birth
attendants and health care providers at all levels
• Improve and strengthen physical infrastructure of
health care facilities and supply of commodities
• Embed surveillance into programs to drive process with
measureable outcomes and send feedback on progress
made back to the community
3+3+3
By focusing efforts on the 3 main causes of death, we can make real
progress to improve the health of women, newborns and children
Maternal
Health
-Post partum
hemorrhage
-Eclampsia
-Dystocia
Newborn
Health
-Infection
-Prematurity
-Asphyxia
Child
Health
-Acute respiratory
illness
-Diarrhea
-Malaria
The way forward for Canada to lead in
the area of Maternal and Child Health
• Increased funding for maternal and child health programs
• Focus on the main causes of mortality and morbidity
• Capitalize on Canada’s expertise in the field of maternal and child
health to strengthen programs and improve health outcomes
• Use a rights-based approach
• Ensure family planning
• Upgrade the skills of health professionals, especially in the area of
Emergency Obstetric Care
• Ensure programs are directed at all levels of service delivery (local,
regional, national)
• Use the three delays model to influence program design and fund
allocation
• Allocate funding in a way that addresses gaps along the
continuum of care
Conclusion
• Maternal survival and health is essential for the
economic development of nations
• Survival and health of the world’s newborns and
children depends on their mothers
• Parliamentarians need to play their part for Canada to
assume a leadership role
There is no better time
to raise your voice for women
and children worldwide