New England Journal of Medicine
December 5, 2013  Vol. 369 No. 23
http://www.nejm.org/toc/nejm/medical-journal

Review Article
Global Health
Global Maternal, Newborn, and Child Health — So Near and Yet So Far
Zulfiqar A. Bhutta, M.B., B.S., Ph.D., and Robert E. Black, M.D.
N Engl J Med 2013; 369:2226-2235December 5, 2013DOI: 10.1056/NEJMra1111853

Excerpt [Free full text] http://www.nejm.org/doi/full/10.1056/NEJMra1111853
…Recent assessment of global statistics suggests that despite major gains, among the 75 so-called Countdown countries that have 98% of all maternal deaths and deaths among children younger than 5 years of age, only 17 are on track to reach the MDG 4 target for child mortality and only 9 are on track to reach the MDG 5 target for maternal mortality.2 However, estimates from the Institute for Health Metrics and Evaluation suggest that 31 countries will achieve MDG 4, 13 countries will achieve MDG 5, and only 9 countries will achieve both targets.3 As we celebrate the fact that the annual number of deaths among children younger than 5 years of age has fallen to 6.6 million (uncertainty range, 6.3 to 7.0 million), which is a 48% reduction from the 12.6 million deaths (uncertainty range, 12.4 to 12.9 million) in 1990, despite an increased number of births in many high-burden countries during the same time period,4 the sobering realization is that even in countries that will reach their MDG 4 and 5 targets, many will still have high numbers of deaths, with much scope for improvement….

…Clearly, countries need to tackle multiple priorities, and many countries struggle with the growing demands for addressing the increasing burden of noncommunicable diseases as well as the challenges of maternal, newborn, and child health and infectious disease. Thus, there are enormous challenges regarding integration into generally fragmented health systems. The integration of new maternal and child health interventions with existing programs for maternal, newborn, and child health has been limited and has occurred only relatively recently at a global policy level. The situation is much worse with regard to integration across other, disease-specific programs and the management of various diseases. This lack of integration is most notable in large-scale vertical programs such as those addressing initiatives in HIV infection, AIDS, tuberculosis, and malaria, which have largely failed to link up with essential interventions for maternal, newborn, and child health and nutrition.

…Although the focus during the past decade has been on the saving of lives, it is also important to look beyond survival to issues of reducing morbidity and disability and improving long-term outcomes of relevance to human development. The close links among poverty, inequity, undernutrition, and human deprivation are well known, and all these factors have been shown to reduce the potential for human development considerably.43 There are promising interventions that can benefit survival as well as human development,44,45 and there is a huge public health need to integrate the two issues. Linking the agenda for maternal and child health and nutrition with the emerging issues of long-term development, human capital, and economic growth may well be the most appropriate strategy to ensure that we stay the course in solving one of the most important moral dilemmas of our times. Although the MDG target dates are in 2015, the need to keep a sustained focus on maternal and child health will remain.