The 2012 Report: Headlines

2012-cover-fullIn June 2012, Countdown released Building a Future for Women and Children: The 2012 Report, which highlighted 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 2012 Report’s headline messages included:

Maternal mortality has declined dramatically, but faster progress is needed.

  • Maternal deaths have dropped from 543,000 a year in 1990 to 287,000 in 2010.
  • Only 9 of 75 Countdown countries are on track to achieve Millennium Development Goal 5; 25 have made insufficient or no progress.
  • Maternal mortality is concentrated in Sub-Saharan African and South Asian countries: an African woman’s lifetime risk of dying from pregnancy-related causes is 100 times higher than that of a woman in a developed country.

Child mortality is down sharply, but more needs to be done.

  • Deaths among children under age 5 worldwide have declined from 12 million a year in 1990 to 7.6 million in 2010.
  • Only 22 of 75 Countdown countries are on track to achieve Millennium Development Goal 4; 3 have made little or no progress.
  • Despite recent improvements, pneumonia and diarrhoea still cause more than two million deaths a year that could be avoided by available preventive measures and prompt treatment.
  • Newborn survival is improving too slowly, and stillbirths, especially intrapartum stillbirths, and preterm births need urgent attention.
  • 40% of child deaths occur during the first month of life.
  • More than 10% of babies are born preterm, a figure that is rising, and complications due to preterm birth are the leading cause of newborn deaths and the second leading cause of child deaths.
  • Countdown countries that have successfully reduced neonatal mortality—such as Bangladesh, Nepal and Rwanda—offer models for improving newborn survival.

Most Countdown countries face a severe nutrition crisis.

  • Undernutrition contributes to more than a third of child deaths and to at least a fifth of maternal deaths.
  • In the majority of Countdown countries, more than a third of children are stunted; stunting is most common among poor children.

Coverage: gains, gaps, inequities, challenges

  • Bangladesh, Cambodia, Ethiopia and Rwanda, countries that have rapidly increased coverage for multiple interventions across the continuum of care, offer lessons for countries with slower or more uneven progress.
  • High coverage levels for vaccines (over 80% on average across all Countdown countries) and  rapid progress in distribution of insecticide-treated nets show what is possible with high levels of political commitment and financial resources.
  • Progress is much slower, and inequities in coverage much wider, for skilled attendant at birth and other interventions that require a strong health system. New approaches are needed that improve the quality of services, bring services closer to home and expand access to essential care.
  • There are wide ranges in coverage across the Countdown countries for many interventions. Coverage of demand for family planning satisfied, for example, ranges from 17% in fragile states such as Sierra Leone to 93% in Vietnam and Brazil and 97% in China. Countries with high coverage of specific interventions show what can be achieved with the right policies, adequate investments, appropriate implementation strategies and strong demand.
  • To increase coverage, the volume of services provided must grow at a faster pace than the population. Nigeria, for example, has seen the number of births grow from 4.3 million in 1990 to 6.1 million in 2008, with 7 million projected in 2015. Although the country has doubled the number of births attended by a skilled health care provider since 1990, coverage has increased only 8%.
  • The Millennium Development Goal 7 target for access to an improved drinking water source  as been achieved globally and in 23 Countdown countries; progress in access to an improved sanitation facility is lagging. For both interventions the need is most pronounced in rural areas.
  • Poor people have less access to health services than richer people, and geographic and  urban-rural inequities also exist in many countries, highlighting the importance of digging deeper into subnational data to support effective planning and resource allocation according to need.

Context matters: supportive policies, adequate financing, sufficient human resources and peace

  • Countries such as Ghana, Malawi, Lao People’s Democratic Republic and Tanzania have achieved results through innovative human resources policies such as task shifting. Other countries need to follow this lead.
  • Official development assistance for maternal, newborn and child health in Countdown countries has increased steadily over the past decade, accounting for around 40% of official development assistance for health that Countdown countries received in 2009, but the rate of increase appears to be slowing.
  • Though domestic health funding is essential, 40 Countdown countries devote less than 10% of government spending to health.
  • In most countries a severe disease episode or a major pregnancy or childbirth complication can push families into financial catastrophe: in all but 5 Countdown countries out-of-pocket payments for health services account for 15% or more of health expenditure.
  • 53 Countdown countries continue to experience a severe shortage of health workers.
  • Countries with high-intensity conflicts have lower coverage and higher inequity and mortality.
  • Providing broader access to education, expanding opportunities for girls and women, reducing poverty and improving living conditions, and respecting human rights, including eliminating violence against women, can improve health and reduce mortality.

Millennium Development Goals 4 and 5 can still be achieved in many countries by 2015, and faster progress and more equitable coverage is needed virtually everywhere. Only a dramatic acceleration of political commitment and financial investment can make it happen. Action is needed now.