Fulfilling the Health Agenda for Women and Children: The 2014 Report

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Countdown Headlines for 2014

In June 2014, Countdown released its 2014 Report, which highlights country progress—and obstacles to progress— towards achieving Millennium Development Goals 4 and 5 to reduce child mortality and improve maternal health. It focuses, like previous Countdown reports, on evidence-based solutions—health interventions proven to save lives—and on contextual factors that affect the equitable delivery of these interventions to women and children. Country profiles for 75 Countdown countries were published together with the report. The 2014 Report's headline messages include:

 

  

 

 

Real progress has been achieved.

  • The median annual rate of reduction in under-5 mortality in the Countdown countries doubled over 2000–2012 compared with 1990–2000, and child deaths have been almost halved since 1990. (View Table 1)
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  • Three-quarters of Countdown countries reduced maternal mortality faster in 2000–2013 than in the 1990s. (View Table 2)

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  • Median national coverage is 75% or higher for several key interventions (at least one antenatal care visit with skilled health personnel, vitamin A supplementation, immunizations and improved source for drinking water). (View Figure 4)

 

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  • Rapid advances in coverage for malaria interventions show the impact of advocacy, investment and sustained effort and provide a model (and a challenge) for lagging interventions. (View Box 3 Figure)
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  • High coverage has been reached among the wealthy populations in many Countdown countries. Similar levels can be achieved across the whole population. Countries that have closed the equity gap provide a model of success. (View Figure 6)
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  • Countdown countries continue to expand adoption of key policies that support improved coverage and quality of reproductive, maternal, newborn and child health interventions.
 
  • Total per capita health expenditure in the Countdown countries grew more than 10% between 2010 and 2012.
 
  • More than 75% of Countdown countries conducted a nationally representative household survey between 2008 and 2012. Before 2000 few countries had survey data available. (View Map 1)
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But substantial business remains unfinished.

  • Fewer than half of Countdown countries will achieve Millennium Development Goal (MDG) 4, and very few will achieve MDG 5.
 
  • Half of Countdown countries still have a high maternal mortality ratio (300–499 deaths per 100,000 live births), and 16 countries—all of them in Africa—have a very high maternal mortality ratio (500 or more deaths per 100,000 live births). (View Table 2)
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  • Progress in reducing preventable newborn deaths is much slower than progress in reducing deaths among children under age 5 in many Countdown countries. Most newborn deaths occur on the day of birth from intrapartum events, infections or preterm birth complications.
 
  • Preventable and treatable infectious diseases such as pneumonia and diarrhea remain the leading causes of child deaths, and coverage of treatment interventions remains low in most Countdown countries. (View Figure 4)
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  • Nearly half of child deaths are attributable to undernutrition. In 42 of the 62 Countdown countries with available data, more than 30% of children are stunted. Poor nutrition also harms women's health and increases women's risk of experiencing a stillbirth or delivering a low birth weight baby. (View Figure 1)
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  • Severe health workforce shortages limit countries' ability to provide high-quality care to women and children. Only seven Countdown countries report having enough skilled health professionals to achieve high coverage of essential interventions.

 

  • Not one Countdown country has adopted all 10 "tracer" policies that support delivery of proven interventions across the reproductive, maternal, newborn and child health continuum of care. (View Figure 8Figure 9Figure 10Figure 11)
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  • Official development assistance for maternal, newborn and child health in the Countdown countries decreased slightly between 2010 and 2011, driven by a 3% reduction in child health aid. Official development assistance for family planning grew substantially in 2011 but remains low. The amount of aid varies widely across countries and is not always proportional to need. (View Box 10 Figure 1Box 10 Figure 2Box 10 Figure 6Box 10 Figure 7)
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  • Only eight Countdown countries reported recent data on all coverage indicators recommended by the Commission on Information and Accountability for Women's and Children's Health. Half of Countdown countries reported new data from 2011–2012 on only one recommended indicator. (View Figure 12)
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Inequities — between and within countries — mean that too many women and children are being left behind.

  • Even for interventions with high coverage in most Countdown countries, such as immunizations, some countries reach less than half of their population of women and children. (View Figure 7)
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  • Across Countdown countries coverage for key interventions along the continuum of care is much higher for the wealthy than for the poor. Stunting is, on average, 2.5 times higher among poor children than among children from wealthier families. (View Figure 2Figure 5)
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Concerted, emphatic action is needed now to save lives and accelerate progress.

  •  The next 18 months are critical for accelerating progress towards the MDG targets and for ensuring that work to achieve the next set of goals begins right now.
 
  •  Countries that achieve high coverage of key interventions tend to have lower child mortality. (View Figure 3)
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  •  Sustainable development requires intensified support to countries that do not achieve the health MDGs and continued effort by and with countries that have.
 
  • Action on improving nutrition and coverage of effective interventions for all population groups in order to end preventable maternal and child deaths must not wait for the post-2015 targets to be finalized. These goals are crucial to any global agenda, and delays in pursuing them are unacceptable and unconscionable.
 
  • Increasing access to high-quality, skilled care around the time of birth will reduce maternal deaths, stillbirths and newborn deaths. Investment in water and sanitation programs and strategies to increase coverage of treatment interventions for pneumonia and diarrhea will help end the huge toll of deaths from these two leading killers of children.
 
  • Greater efforts are needed to help countries facing rapid population growth develop innovative approaches, including plans to increase health workforce production, deployment and retention, in order to reach all women and children with essential services. (View Box 4 Figure)
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  • We must all act to protect families, women and children from the destructive health impact of war and civil conflict and to help countries rebuild once conflict subsides. (View Box 5 Figure 2)
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  • Countries and their partners must invest in collecting and reporting health data that are fit for purpose, reliable, representative, timely and able to be disaggregated for subnational equity analyses.
 

 The end of 2015 will inaugurate a new era in global health. We will enter that new era with unfinished business that can and must be addressed. As we move forward, setting new goals and establishing new accountability structures, we must renew and redouble our efforts in key areas where progress has been slowest:

  • Meeting the vast unmet need for contraception, so that women and families can better control their fertility and their lives.
  • Ensuring that there are enough adequately trained health care workers equipped with the supplies needed to provide high-quality care before, during and after pregnancy to make pregnancy and childbirth safer for both mother and baby.
  • Improving maternal and newborn survival, including reducing preterm births and stillbirths, by investing in care on the day of birth when the risk of mortality is highest.
  • Addressing the infectious diseases, especially pneumonia and diarrhea, that needlessly kill millions of children because they do not have access to effective treatments, appropriate nutrition, safe water and adequate sanitation facilities.
  • Confronting the huge burden of undernutrition that retards both the growth and the life opportunities of far too many children and adolescents in the majority of Countdown countries, where more than 30% of children are stunted.

Together, we face a unique challenge, a compelling opportunity, and a pressing obligation: to end the heavy toll of millions of preventable women's and children's deaths. We can achieve this, but it will not happen on its own. We, as Countdown, challenge ourselves and the global reproductive, maternal, newborn and child health community to make the remaining days in the MDG era and the years beyond 2015 count for women and children. There must be continued, even increased, accelerations in coverage for lifesaving interventions and in improving nutrition and making family planning universally available. Coverage must be more equitable. And there must be greater commitment to data evolution that results in more and better data and data use for improving programs.