Focus on Rotary’s Child and Maternal Health Initiatives

By Eric Ombok

Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period, while child mortality tracks death of children below the age of five years.

Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth. About99% of all maternal deaths occur in developing countries and maternal mortality is higher in women living in rural areas and among poorer communities. Young adolescents face a higher risk of complications and death as a result of pregnancy than other women.

However, skilled care before, during and after childbirth can save the lives of women and newborn babies. Between 1990 and 2015, maternal mortality worldwide dropped by about 44%. Between 2016 and 2030, as part of the Sustainable Development Goals, the target is to reduce the global maternal mortality ratio to less than 70 per 100, 000 live births.

The major causes of maternal morbidity and mortality include hemorrhage, infection, high blood pressure, unsafe abortion, and obstructed labour, according to the World Health Organization.

In sub-Saharan Africa, a number of countries halved their levels of maternal mortality since 1990. In other regions, including Asia and North Africa, even greater headway was made.

Between 1990 and 2015, the global maternal mortality ratio (the number of maternal deaths per 100,000 live births) declined by 2.3% per year between 1990 and 2015. However, increased rates of accelerated decline in maternal mortality were observed from 2000 onwards. In some countries, annual declines in maternal mortality between 2000–2010 were above 5.5%.

In a concerted effort to strengthen maternal and child health services across Africa, the World Health Organization, in collaboration with the United Nations Children’s Fund (UNICEF) and the United States Agency for International Development (USAID), convened a capacity-building workshop targeting healthcare professionals, policymakers, and stakeholders from 10 countries (Ethiopia, Ghana, Kenya, Malawi, Nigeria, South Sudan, Tanzania, Uganda, Zambia, and Zimbabwe).

The four-day workshop was held in Nairobi, Kenya, in February and focused on enhancing countries’ capabilities to effectively implement the Baby-Friendly Hospital Initiative (BFHI) as an integral component of maternal and newborn health quality care strategies.

The Baby-Friendly Hospital Initiative, established by the WHO and UNICEF aims to protect and support breastfeeding and mother-baby bonding by ensuring that maternity facilities adhere to the guidelines for successful breastfeeding.

In the African region, only 2 out of 42 countries have more than 50% of births in Baby-friendly facilities. This coupled with the plunging breastfeeding rates worldwide driven by aggressive marketing of infant formula to mothers. WHO and UNICEF launched the BFHI more than three decades ago to motivate managers and staff working in health facilities to provide maternity and newborn services through the implementation of successful breastfeeding. Over the years, WHO has revised the BFHI guidelines.

Child Mortality
The global under-five mortality rate declined by 60%, from 93 deaths per 1,000 live births in 1990 to 37 in 2022. according to UNICEF.

“However, progress in reducing under-five mortality has slowed in the first half of the SDG era (2015–2022) compared to what was achieved in the MDG era (2000–2015), according to the agency.
Globally, the annual rate of reduction in under-five mortality decreased to 2.1% in 2015–2022 from 3.8% in 2000–2015.

In 2022, 4.9 million children under five years of age died. This translates to 13,400 children under the age of five dying every day in 2022. Globally, infectious diseases, including pneumonia, diarrhoea and malaria, remain a leading cause of under-five deaths, along with preterm birth and intrapartum-related complications.

Sub-Saharan Africa continues to be the region with the highest under-five mortality rate in the world—71 deaths per 1,000 live births. In 2022, 1 in 14 children in Sub-Saharan Africa died before reaching their fifth birthday—15 times higher than the risk for children born in high-income countries and more than 20 years behind the world average, which achieved a 1 in 14 rate by 2001.

“Due to growing child populations and a shift of the population distribution towards high-mortality regions, the share of global under-five deaths that occurred in Sub-Saharan Africa increased from 3% in 1990 to 58% in 2022 and is expected to increase even further in the next few decades,’’ according to UNICEF.

Infectious diseases, which disproportionately affect children in poorer settings, remain highly prevalent, particularly in Sub-Saharan Africa. Ending preventable child deaths worldwide will require targeted interventions to the age-specific causes of death among children.