Recent articles in these pages have referred to the Millennium Development Goals (MDGs). These goals were set in 2000 by the General Assembly of the United Nations to be achieved by 2015. While aimed primarily at development and poverty reduction, 3 goals refer to measures of health. Of the 8 goals, the one of interest to this section of IJGO is MDG5, which refers to maternal health:
•Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio. Achieve, by 2015, universal access to reproductive health care.
A related goal is MDG4, which is to:
•Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate.
The other 6 goals, in brief, are: (1) eradicate extreme poverty and hunger; (2) achieve universal primary education; (3) promote gender equity and empower women; (6) combat HIV/AIDS, malaria, and other diseases; (7) ensure environmental sustainability; and (8) develop a global partnership for development.
In April 2008 a Countdown to 2015 conference was held in Cape Town, South Africa, to assess progress made toward MDGs 4 and 5. The focus for the countdown for maternal and child health is on 68 countries, of which 56 have high or very high maternal mortality ratios; these 68 countries together account for 97% of maternal, newborn, and child deaths each year. Half of all maternal deaths occur in sub-Saharan Africa, and 45% occur in South Asia. The lifetime risk of dying from pregnancy or childbirth is as high as 1 woman in 7 (in Niger); this number of course is based on the number of pregnancies per woman as well as the obstetric risk.
More than 400 delegates (including 16 ministers of health and a similar number of deputy ministers) from 61 of the 68 focus countries learned that only 12 countries have so far made “good” progress toward MDG5. These are Azerbaijan, Bolivia, Brazil, China, Egypt, Guatemala, Mexico, Morocco, Peru, the Philippines, Tajikistan, and Turkmenistan—none from sub-Saharan Africa and none from South Asia [1]. It is unfortunate that MDGs 4 and 5 were assessed together; again, mothers took a backseat to children [2].
Using Egypt as an example of a country making good progress and nearby Chad as an example of a country making no progress, Table 1 shows some relevant statistics. Malawi is also included because it is discussed in a paper featured in these pages.
On a positive note, from 2003 to 2006, external resources for maternal and neonatal health increased by 71%, from US $7 to US $12 per live birth [1]. It is also evident that many countries are working hard, in the face of considerable constraints, to achieve MDG5.
Malawi is one country that has used a country-wide assessment of health facilities to develop strategies for ensuring availability of emergency obstetric care to reduce mortality [3]. The first paper in this issue reports on the strategy chosen by Malawi to reduce delay associated with referral (the “second delay”) by locating motorcycles (with sidecars) at health centers to transport women with obstetric emergencies to an emergency obstetric care (EmOC) facility. This requires much less time than contacting the hospital to send a car ambulance which may or may not be available [4].
Another strategy used by Malawi is to contract (through memoranda of understanding or “service level agreements”) with faith-based organizations such as mission hospitals to provide pregnancy care and emergency obstetric care. While some may see this as controversial, it is not an uncommon practice. The second paper in this issue describes the potential role of mission hospitals in achieving MDG5 [5]. While the commitment of faith-based organizations to some aspects of comprehensive reproductive health care could be questioned, involving them is an option we cannot afford to ignore.
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