A review of the state of the World’s Children Report 2009
In today’s edition of Children’s Corner, we will examine Maternal and Newborn Health under the 2009 State of the Children’s Report. The report which was launched in the Gambia recently by UNICEF and the government of the Gambia focuses mainly on maternal and Newborn Health.

According to the report, each year more than half a million die from cases related to pregnancy and childbirth and nearly 4 million newborns die within 28 days of birth. Millions more suffer from disability, diseases, infection and injury.
Cost effective solutions are available that could bring rapid improvements, but urgency and commitment are required to implement them and to meet the Millennium Development Goals (MDGs) related to Maternal and Child Health.
The report went on to state that millions of women who survive childbirth suffer from pregnancy related injuries, infections, disease and disabilities often with life long consequences.
According to a research conducted, approximately 80 per cent of maternal deaths could be averted if women had access to essential maternity and basic health care services.
However, the 2009 Children’s Report said that death of newborns in developing countries have also received far too little attention. Almost 40 per cent of fewer than five deaths or 3.7 million in 2004 according to the latest World Health Organisation estimates occur in the first 28 days of life. Three quarters of neonatal deaths take place in the first seven days of the early neonatal period.
The 2 report stated that the divide in neonatal deaths between the industrialized countries and developing regions is also wide. Based on the 2004 data, a child born in a least developed country is almost 14 times more likely to die during the first 28 days of life than one born in an industrialized country.
The health of mothers and newborns is intricately related, so preventing deaths requires in many cases implementing the same interventions. Such interventions may include, antenatal care, skilled attendance at birth, access to emergency obstetric care when necessary, adequate nutrition education to improve health amongst others.
The 2009 State of the world’s Children’s Report, examines maternal and new born health across the world and in the developing world in particular complementing last year’s report on child survival. While the emphasis of the report remains firmly on health and nutrition, mortality rates are employed as benchmark indicators. Sub-Saharan Africa and South Asia are the regions which record the highest figures and rates of maternal and newborn mortality and these are principal focuses.

THE CURRENT SITUATION OF MATERNAL AND NEONATAL HEALTH
According to the report since 1990, the estimate of the global annual number of maternal deaths has exceeded 500,000. Although the numbers of death world wide has fallen consistently from around 13 million in 1990 to 9.2 million in 2007, maternal deaths however have remained intractable.
The report also mentioned that limited gains have been made worldwide towards the first target of MDGs five which aims to reduce the 1990 maternal mortality ration by three quarters by 2015. Progress on diminishing maternal mortality ratios has been virtually non existent in sub-Saharan Africa.
Maternal mortality ratios strongly reflect the overall effectiveness of health systems, which in many low income developing countries suffer from weak administrative, technical and logistical capacity, inadequate financial investment and a lack of skilled health personnel, the report said. The report added that antenatal HIV testing; increasing the number of births attended by skilled health personnel, providing access to emergency obstetric care and post natal care for mothers and babies could reduce both maternal neonatal deaths.
Maternal health the report added goes beyond the survival of pregnant women and mothers.
Improving women’s health is pivotal to fulfilling the rights of girls and women under CEDAW and the Convention on the Rights of the Child and achieving the MDGs .
In addition to meeting MDG5, enhancing reproductive and maternal health and services will also directly contribute to attaining MDG4, which seeks to reduce the under -five mortality rate by two thirds between 1990 and 2015.
Enhancing maternal nutrition will also bring benefits for the achievement of millennium development goal 1, which seeks to eradicate extreme poverty and hunger by 2015. A stunted girl is likely to become a stunted adolescent and later a stunted woman. Besides posing threats to their own health and productivity, poor nutrition that contributes to stunting and underweight increases a woman’s likelihood of adverse pregnancy and birth outcomes. Under nourished mothers also have a far higher risk of delivery babies with low birth weight, a condition that gravely heightens the baby’s risk of death? the report noted.
Lowering a mother’s risk of mortality and morbidity directly improves a child’s prospects for survival. Researchers have shown that in developing countries, babies whose mothers die during the first six weeks of their lives are far more likely to die in the first two years of life than babies whose mothers survive. In a study conducted in Afghanistan, 74 per cent of infants born alive to mothers that died of maternal cases also subsequently died. Maternal complications in labour heighten the risk of neonatal deaths, which are rapidly becoming a key focus as overall rates of under-five mortality decline in most developing countries.

Trends in Maternal and newborn health
Maternal mortality
The most recent UN inter-agency estimates suggest that in 2005, 536,000 women died from causes related to pregnancy and childbirth. This figure may be far from precise, however, as measuring maternal mortality is challenging, and in many developing countries the required data are no routinely recorded. Beyond he estimation of maternal mortality, determined and recording the causes of death is a complex process. This level of detail is sometimes missing in the statistical reporting systems of industrialized countries, and its absence is common in many developing countries, particularly the poorest.
Efforts to improve data collection on maternal mortality have been ongoing for the past two decades, initially involving the World Health Organisation (WHO), UNICEF and the United Nations Population Fund (UNFPA), later joined by the World Bank. This inter-agency collaboration pools resources and reviews methodologies to arrive at more precise and comprehensive global estimates of maternal mortality. The figures for 2005 are the most accurate yet and the first to estimate maternal mortality trends by an inter-agency process.
In recent years, new methodologies to calculate maternal and neonatal health status, service needs and mortality have been developed by the research community. These efforts are ongoing, enriching the process of arriving to a more precise estimates and causes of mortality and morbidity.
In turn, better data and analysis on health status and heath services are helping enhance the strategies and framework, programmes, policies and partnerships-including those that support gender mainstreaming-that are striving to improve maternal and newborn health.
One issue in the estimation of maternal mortality appears beyond contention: The vast majority of maternal deaths-more than 99 per cent, according to the 2005 UN inter-agency estimates-occurred in developing countries. Half of these (265,000) took place in sub-Saharan Africa and another third (187,000) in South Asia. India alone had 22 per cent of the global total.
The trend estimates available for maternal mortality indicates the lack of sufficient progress towards Target A of MDG 5, which seeks a 75 per cent reduction in the maternal mortality ratio between 1990 and 2015. Given that the global maternal mortality ratio stood at 430 per 100,000 live births in 2005, meeting the target will require more than a 70 per cent reduction between 2005 and 2015.
Global trends can obscure the wide variations between regions, many of which have made appreciable progress in reducing maternal mortality and are laying the foundation for further improvement by increasing access to basic maternity services. In the industrialized countries, the maternal mortality ratio remained broadly static between 1990 and 2005, are a low rate of 8 per 100,000 live births. Near universal access to skilled care during delivery and emergency obstetric care when necessary have contributed to these diminished levels of maternal mortality; no industrialized countries with data have skilled attendance at birth of less than 98 per cent, and most have universal coverage.
In all of the developing regions outside sub- Saharan Africa, both the absolute numbers of maternal deaths and maternal mortality ratios declined between 1990 and 2005. In sub-Saharan Africa, maternal mortality ratios remained largely unchanged over the same period. Given the region’s high fertility rates, this has resulted in higher numbers of maternal deaths over the 15-year period. This lack of progress is particularly worrying, since the region has by far the highest ratios and lifetime risk of maternal mortality deaths. In West and Central Africa, the regional maternal mortality ratio stands at a staggering 1,100 per 100, 000 live births, compared to the average for developing countries and territories of 450 includes the country with the highest rate of maternal death in the world; Sierra Leone, with 2,100 maternal deaths per 100,000 live births.
The West and Central Africa regions also have the highest total fertility rate, at 5.5 children in 2007. The total fertility rate measures the number of children who would be born per woman if she lived to the end of her childbearing years and bore children at each age in accordance with prevailing age-specific fertility rates. Highest fertility rates increase the risk that a woman will die from maternal causes. While mortality risks are associated with all pregnancies, these risks rise more times a woman gives birth.
Courtesy of UNICEF