International efforts to address maternal and child health challenges
appear to be working, yet few countries will meet Millennium Development
Goals for maternal mortality and child mortality.
With four years left for countries to
achieve international targets for saving the lives of mothers and children,
more than half the countries around the world are lowering maternal mortality
and child mortality at an accelerated rate, according to a new analysis by
the Institute for Health Metrics and Evaluation (IHME) at the University of
Washington.
In 125
countries, maternal mortality has declined faster since 2000, the year that
countries signed the Millennium Declaration, promising to make improvements
in child and maternal health, and the progress has been particularly strong
in the past five years. Over the same period, in 106 countries, child
mortality rates have declined faster between 2000 and 2011 than in the
previous decade.
The
number of deaths related to pregnancy and childbirth decreased from 409,100
in 1990 to an estimated 273,500 deaths in 2011, and the number of deaths in
children under the age of 5 fell from 11.6 million deaths to an estimated 7.2
million over the same period.
The
trends indicate that efforts to educate more women, to prevent infectious
diseases, and to implement other targeted health programs in developing
countries are having an impact. They also show, though, that few countries
are going to achieve international targets for improving maternal and child
health.
An
estimated 31 developing countries will achieve Millennium Development Goal 4
(MDG 4), which calls for a two-thirds reduction in the child mortality rate
between 1990 and 2015, and 13 developing countries will achieve Millennium
Development Goal 5, which calls for a three-fourths reduction in maternal
mortality ratio over the same period. Of those countries, nine will achieve
both goals: China, Egypt, Iran, Libya, Maldives, Mongolia, Peru, Syria, and
Tunisia. The study, “Progress toward Millennium Development Goals 4 and 5 on
maternal and child mortality: an updated systematic analysis,” is published
in The Lancet.
“If the
world is going to achieve these goals, we need to see immediate, concerted
action on the part of governments, donors, and bilateral agencies to move
these trends in the right direction,” said Dr. Rafael Lozano, Professor of
Global Health at IHME and the paper’s lead author. “We know that accelerated
progress is possible because we are seeing it already.”
Over
the past decade, a significant number of countries saw declines of more than
8% annually over the past decade – twice the global rate – including Kenya,
Morocco, Zambia, and Zimbabwe. Afghanistan, which has
– more –
one of
the worst maternal death rates in the world, has seen a 4.9% annual decline
in maternal mortality since 2000, after increasing 2.2% annually over the
previous decade. In Cambodia, Ecuador, Rwanda, Malaysia, and Vietnam, child
mortality fell by 5% annually or higher, while globally the child mortality
rate fell by 2.6% annually.
Part of
the decline in maternal mortality in much of sub-Saharan Africa is due to
improved prevention and treatment efforts for HIV/AIDS, the researchers note.
In looking for other key drivers for the mortality declines,
the researchers point to global health programs, such as the scale-up of
insecticide-treated bed nets in countries with a high malaria burden, and to
country-level programs, such as the government of India’s ongoing investment
in rural health clinics. In 2010, IHME published a paper showing that
educational attainment among women of reproductive age accounted for 51% of
the decline in child mortality.
“We
must not let the focus on MDGs detract from what has been real and impressive
progress with maternal and child maternal survival, particularly in
sub-Saharan Africa,” said Alan Lopez, Head of the University of Queensland
School of Population Health and one of the report’s co-authors. “It is
critical that this progress be maintained and that lessons learned from this
success be rapidly transferred to other countries where progress has been
less impressive.”
One
area that needs attention is neonatal deaths. Even as the mortality rate in children under 5
fell by 2.2% annually, the mortality rate for infants during the first week
of life declined by only 1.7% annually.
“The
difference between neonatal mortality and overall mortality in children under
5 might seem small to someone outside of global health, but it’s worrisome
because it can be a sign of other problems in the health system,” said Dr.
Haidong Wang, Assistant Professor of Global Health at IHME and one of the
paper’s co-authors. “If countries can’t make sure that children survive
during that first week, they may not be effectively providing prenatal care
to mothers, good obstetrical care during the birth, or important follow-up
care.”
For
these new estimates of child and maternal mortality, researchers used the
most recent data and advancements in statistical tools to provide policymakers
with more precise information as the world intensifies efforts to achieve
international targets for maternal and child health. The authors acknowledge
that the new estimates may lead to some confusion among policymakers, who
have seen a series of analyses on maternal and child deaths in recent years,
including two previous sets of estimates from IHME. For example, maternal
death numbers for 2005 were estimated to be 546,000 by the United Nations in
a 2007 study and are now estimated to have been 347,000 in this study, a
difference of 35%. Reports on child deaths over the years track more closely,
mostly because of the larger amount of data available over a long period of
time.
“People
have argued that we should not be updating these numbers every year, but we
think that as new data are available and as methods are being improved it is
crucial to show governments, funders, and the public at large how much
progress is being made,” said Dr. Christopher Murray, Director of IHME and
one of the paper’s co-authors. “Decisions are being made today that could
mean the difference between thousands of lives being saved or more women and
children dying. That is why improvements in data gathering and measurement
are important for guiding policymakers as well as holding them accountable.”
The Institute for Health
Metrics and Evaluation (IHME) is an independent global health research center
at the University of Washington that provides rigorous and comparable
measurement of the world's most important health problems and evaluates the
strategies used to address them. IHME makes this information freely available
so that policymakers have the evidence they need to make informed decisions
about how to allocate resources to best improve population health.
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Nobel laureate Wangari Maathai, center, in Nairobi in 2004.
Wangari Maathai of Kenya holding her Nobel Peace Prize in Oslo, Norway, on Dec. 10, 2004
The cause was cancer, her organization, the Green Belt Movement, said. Kenyan news organizations said she had been treated for ovarian cancer in the past year and had been in a hospital for at least a week when she died.
Dr. Maathai, one of the most widely respected women on the continent, wore many hats — environmentalist, feminist, politician, professor, rabble-rouser, human rights advocate and head of the Green Belt Movement, which she founded in 1977. Its mission was to plant trees across Kenya to fight erosion and to create firewood for fuel and jobs for women.
Dr. Maathai was as comfortable in the gritty streets of Nairobi’s slums or the muddy hillsides of central Kenya as she was hobnobbing with heads of state. She won the Peace Prize in 2004 for what the Nobel committee called “her contribution to sustainable development, democracy and peace.” It was a moment of immense pride in Kenya and across Africa.
Her Green Belt Movement has planted more than 30 million trees in Africa and has helped nearly 900,000 women, according to the United Nations, while inspiring similar efforts in other African countries.
“Wangari Maathai was a force of nature,” said Achim Steiner, the executive director of the United Nation’s environmental program. He likened her to Africa’s ubiquitous acacia trees, “strong in character and able to survive sometimes the harshest of conditions.”
Dr. Maathai toured the world, speaking out against environmental degradation and poverty, which she said early on were intimately connected. But she never lost focus on her native Kenya. She was a thorn in the side of Kenya’s previous president, Daniel Arap Moi, whose government labeled the Green Belt Movement “subversive” during the 1980s.
Mr. Moi was particularly scornful of her leading the charge against a government plan to build a huge skyscraper in one of central Nairobi’s only parks. The proposal was eventually scrapped, though not long afterward, during another protest, Dr. Maathai was beaten unconscious by the police.
When Mr. Moi finally stepped down after 24 years in power, she served as a member of parliament and as an assistant minister on environmental issues until falling out of favor with Kenya’s new leaders and losing her seat a few years later.
In 2008, after being pushed out of government, she was tear-gassed by the police during a protest against the excesses of Kenya’s well-entrenched political class.
Home life was not easy, either. Her husband, Mwangi, divorced her, saying she was too strong-minded for a woman, by her account. When she lost her divorce case and criticized the judge, she was thrown in jail.
“Wangari Maathai was known to speak truth to power,” said John Githongo, an anticorruption campaigner in Kenya, who was forced into exile for years for his own outspoken views. “She blazed a trail in whatever she did, whether it was in the environment, politics, whatever.”
Wangari Muta Maathai was born on April 1, 1940 in Nyeri, Kenya, in the foothills of Mount Kenya. A star student, she won a scholarship to study biology at Mount St. Scholastica College in Atchison, Kan., receiving a degree in 1964. She earned a master of science degree from the University of Pittsburgh.
She went on to obtain a doctorate in veterinary anatomy at the University of Nairobi, becoming the first woman in East or Central Africa to hold such a degree, according to the Nobel Prize Web site. She also taught at the university as an associate professor and was chairwoman of its veterinary anatomy department in the 1970s.
A day before she was scheduled to receive the Nobel, Dr. Maathai was forced to respond to a report in The East African Standard, a daily newspaper in Nairobi, that she had likened AIDS to a “biological weapon,” telling participants in an AIDS workshop in Nyeri that the disease was “a tool” to control Africans “designed by some evil-minded scientists.”
She said her comments had been taken out of context. “It is therefore critical for me to state that I neither say nor believe that the virus was developed by white people or white powers in order to destroy the African people,” she said in a statement released by the Nobel Committee. “Such views are wicked and destructive.”
In presenting her with the Peace Prize, the Nobel committee hailed her for taking “a holistic approach to sustainable development that embraces democracy, human rights and women’s rights in particular” and serving “as inspiration for many in the fight for democratic rights.”
Dr. Maathai received many honorary degrees, including an honorary doctorate from the University of Pittsburgh in 2006, as well as awards, including the French Legion of Honor and Japan’s Grand Cordon of the Order of the Rising Sun.
She is survived by three children, Waweru, Wanjira and Muta, and a granddaughter, according to the Green Belt Movement.
Former Vice President Al Gore, a fellow Peace Prize recipient for his environmental work, said in a statement, “Wangari overcame incredible obstacles to devote her life to service — service to her children, to her constituents, to the women, and indeed all the people of Kenya — and to the world as a whole.”
In her Nobel Prize acceptance speech, Dr. Maathai said the inspiration for her work came from growing up in rural Kenya. She reminisced about a stream running next to her home – a stream that has since dried up – and drinking fresh, clear water.
“In the course of history, there comes a time when humanity is called to shift to a new level of consciousness,” she said, “to reach a higher moral ground. A time when we have to shed our fear and give hope to each other. That time is now.”
Courtesy of New York Times
