Despite severe malnutrition among children, which erstwhile Indian PM Dr Manmohan Singh called a "national shame", India has still not prioritised breastfeeding. Credit: Neeta Lal/IPS

By Neeta Lal
NEW DELHI, Jun 1 2016 (IPS)

The recent launch of Amaara, New Delhi’s first human milk bank, has been greeted with much cheering. The initiative endorses the long-term goal of reducing infant mortality and addresses the critical issue of lack of mothers’ milk for physically fragile newborns in India’s capital city.

The service couldn’t have come a day too soon. India, a nation of 1.25 billion people, has the world’s highest number of low birth weight babies, with a critically high Neo-natal Mortality Rate (NMR) rate described as deaths in the period of 0-28 days per thousand live births. India witnessed 28 deaths per 1,000 live births in 2013 and an Infant Mortality Rate (IMR) of 40 in the age 0-1 year per thousand live births according to the Annual Report of India’s Ministry of Health and Family Welfare.

Of the 26 million babies born in India every year, one million babies are blighted before they reach the age of one month. Despite reducing child mortality – from 2.3 million deaths of children under the age of five in 2001 to 1.4 million in 2012 – India still accounts for 20 percent of infant mortality globally.

Many of these needless tragedies can be avoided, say doctors, if the little ones are nourished with mother’s milk. “Feeding these babies with donor breast milk through milk banks can have the single largest impact on reducing child mortality,” says Bhavdeep Singh, CEO, Fortis Healthcare, a pan-India hospital chain which launched Amaara in collaboration with the Breast Milk Foundation.

Breast milk, described as ‘superfood’ for newborns, contains “bioactive components” which protect them against life-threatening illnesses, serious infections and other complications related to pre-term birth which commercially available formula milk can’t, say doctors. The World Health Organisation (WHO) recommends that the best option for a baby who cannot be breastfed is milk expressed from its own or from another healthy mother. Children who are fed mother’s milk are also less vulnerable to certain non-communicable diseases and grow up to be better workers, says WHO.

“Keeping in mind the complications associated with formula feeding and some mothers’ inability to breastfeed, there’s a strong need to establish human milk banks. It’s a boon for high-risk newborns who are unable to receive the nurturing care a mother provides, ” adds Singh.

Donor banks collect, screen, process, store and prescribe donated human milk to babies who need such milk donated by lactating mothers not biologically related to them. The milk is either extracted manually or with breast pumps and collected by trained staff in labelled and sterile containers. It is transported to the banks under cold storage conditions, and immediately frozen at 20 degrees centigrade, after which a sample is taken for its culture. If the bacterial culture is negative, then the milk is pasteurized for future use.

Who can donate milk? Healthy lactating moms of term or preterm babies who are not on any medications, and have had no significant illnesses in the past or present, can do so. However, it is only the excess milk (milk obtained after fully feeding the donor’s own child) that can be donated.

According to the WHO and UNICEF, globally only 20 per cent of working women are able to breast feed their children – a must for at least for one to one-and-a-half years after birth. A study has indicated that babies not breastfed fall ill more often and have extra days of hospitalisation as well as extra prescriptions in the first year of their lives.

In developing countries like India, Sri Lanka, Bangladesh and several others in the Southeast Asian region — where health resources are poor — the situation is especially dire.

Although globally human milk banking is a common practice, in India, only 14 such banks currently exist, as per the Indian Academy of Paediatrics. This compares poorly to other developing nations like Brazil. Brazil hosts 210 such banks which have helped reduce its malnutrition level by 73 per cent.

India’s poor record in this field is surprising because Mumbai was where the first mother’s milk bank in Asia was established in 1989. Experts attribute the paucity of this service to a lack of public awareness and promotion of formula milk by the industry.

Customs and changing social dynamics too play a catalytic role. “In the villages, it’s considered ominous to feed the child with the milk extracted from another woman,” says Anjali Yadav, a volunteer with Save the Child Foundation. “In the cities, we’re finding that women have become increasingly career-oriented. In their rush to rejoin work post-childbirth, their breastfeeding plans get aborted.”

Doctors caution that there are serious health ramifications for women who avoid breastfeeding. These women are apparently at a potential risk of developing cancer at a later stage in life. Studies have proved that mothers who suffer from breast cancer during the pre-menopausal period may have contracted this due to skipping breastfeeding. Women who usually breast feed in their early thirties are more protected as compared to those who do so later in life.

Pratibha Jain, 32, a new mother, has been making life-saving withdrawals for her daughter Kareena, who was born prematurely, from Divya Mother Milk Bank at the Panna Dhai Hospital in Udaipur in the desert state of Rajasthan.

“I’ve enough breast milk during daytime. But night feeds have been a challenge so I’ve to rely on donated bank milk,” she told IPS. “The donated milk has helped me save my only child’s life.”

Interestingly, though the concept of human milk banks is a relatively new one, donation of breast milk from one woman to an unrelated infant goes back centuries. Earlier, weak infants with mothers were breastfed by a “wet nurse”. Rules governing wet nursing came about in 1800 BC. However, by the 15th century, wet nursing became infamous due to the spread of syphilis.

Human milk banking has faced similar challenges largely due to the aggressive promotion of infant formula milk by the industry. In addition, since the 1970s, a fear of transmission of viruses, including HIV in body fluids, also created public anxiety about breast milk.

Despite severe malnutrition among children, which erstwhile Indian PM Dr Manmohan Singh called a “national shame”, India has still not prioritised breastfeeding. Lack of legislation has only made matters worse. Currently the only law that regulates breastfeeding in India is the Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) formulated in 1992 which prohibits advertisement of infant milk substitutes.

However, the lack of rigorous implementation of even this solo law has resulted in its violation by the industry players.

“Also, there’s been no proactive promotion of breast milk or milk banks by the government through mass sensitization campaigns,” Dr. Kirti Saxena, Senior Paediatrician, Max Hospitals, told IPS. “Initiatives such as milk banks are commendable, but unless they’re incorporated in national policy and rigorously enforced by all stakeholders, their impact will be limited. The future of our children is at stake.”

A doctor attends a 10-month-old baby in a public health centre in Bolivia, in one of the regular check-ups that are a requisite for women to receive the mother-child subsidy, one of the mechanisms created to reduce maternal and infant mortality in the country. Credit: Franz Chávez/IPS

By Marianela Jarroud
SANTIAGO, Jun 9 2015 (IPS)

The progress that Latin America has made in reducing child mortality is cited by international institutions as an example to be followed, and the region has met the fourth Millennium Development Goal, which is to cut the under-five mortality rate by two thirds.

But this overall picture conceals huge differences between and within countries in the region.

“There have been major strides in reducing child mortality in Latin America and the Caribbean,” said Luisa Brumana, regional health adviser with the United Nations children’s fund, UNICEF.

“However, that improvement has not benefited everyone equally,” she told IPS from the UNICEF Regional Office for Latin America and the Caribbean, in Panama City.“We tend to think that children in rural areas face the worst conditions. But recently, with the migrations to the large cities and the bad conditions in poor outlying suburbs, things are just as complicated in those areas.” -- Luisa Brumana

In Brumana’s view, “this inequality has given rise to large variations in health indicators, both between and within countries, with results generally based on wealth, education, geographic location, and/or ethnic origin.”

National averages, which in some cases are good, hide enormous inequalities in what continues to be the world’s most unequal region.

Mónica, from Chile, has been fighting for the past three years to keep her fourth child alive. He was born deformed and with brain damage. She asked to remain anonymous, because it is a touchy issue at a family and personal level.

“It has been a constant struggle, but today my son is a survivor,” she told IPS. “We have spent a lot of money, we have gone to the best doctors. I am 100 percent dedicated to his recovery. And he’s doing better every day: he communicates, we go out for walks, we play together,” she said with enthusiasm.

But Mónica admitted that not everyone has access to the best care, and that there are large contrasts despite the technological advances seen in recent years.

In Chile, where GDP stands at over 277 billion dollars, the income of a child who lives in a wealthy household is 8,000 times higher than that of a child born into poverty, according to the Fundación Sol – an example of the challenge of inequality that continues to face the region.

That is reflected in essential areas like education and health.

In 2002, for example, five premature infants from poor families died of septic shock in a public hospital in Viña del Mar, 140 km northeast of Santiago, after the preterm formula they were given through feeding tubes was contaminated by wastewater that dripped from the floor above.

“Inequalities persist and I know that if we didn’t have the means, our son’s health would be much worse. It’s horrible, but it’s true,” Mónica said.

A family in a village on the banks of the Atrato river in the northwestern Colombian department of Chocó, where child mortality is three times higher than in the capital. Credit: Jesús Abad Colorado/IPS

According to UNICEF, between 1990 and 2013 under-five mortality per 1,000 live births was reduced 67 percent in Latin America. This is the region that has made the greatest progress in that regard, along with East Asia and the Pacific, which saw a similar reduction.

According to the MDGs progress chart, the region has met the goal of cutting child mortality by two-thirds, from 54 to 19 deaths of children under five per 1,000 live births between 1990 and 2013.

These advances are linked, among other factors, to economic growth in the region, where some 70 million people left poverty behind in the past decade, according to figures published in late May by the United Nations Food and Agriculture Organisation (FAO).

Worldwide, preventable and treatable causes are the leading culprits in infant mortality. And in this region, child mortality is mainly marked by the persistence of inequalities caused by different factors, such as income level, the population group to which the family belongs, where they live, or the educational level of the parents.

“For example, for a rural family that lives far from a health centre, access to healthcare is much more difficult and that can affect children’s health, such as in terms of keeping to the vaccination schedule,” Brumana explained.

“Other factors in a country that doesn’t have a good social safety net are high medical costs, which are a problem for low-income families, or the quality of health services, which is essential for guaranteeing proper care for children,” she added.

“No less important is for services to take into account cultural differences between regions and to be able to offer services adapted to different customs,” the expert said.

According to UNICEF’s “Committing to Child Survival: A Promise Renewed – Progress Report 2014”, the five countries that stand out the most in the region are Cuba, Chile, Antigua and Barbuda, Costa Rica and St. Kitts and Nevis, which have infant mortality rates below 10 per 1,000 live births.

And the five countries that despite the progress made still face the biggest challenges are Haiti, Bolivia, Guyana, Guatemala and the Dominican Republic, in that order. In the case of Haiti, the poorest country in the hemisphere, 73 children died per 1,000 live births in 2013.

“There are major inequalities within countries,” said Brumana, who added that although certain factors have more of an influence than others, “we can’t generalise about which ones have the strongest influence.

“We tend to think that children in rural areas face the worst conditions. But recently, in the migrations to the large cities and with the bad conditions in poor outlying suburbs, things are just as complicated in those areas,” she said.

One example is Colombia, where the national averages are good, but in the hinterland enormous inequalities are seen from province to province.

For example, she noted, the northwestern department or province of Chocó has an under-five child mortality rate three times higher than the rate in Bogotá: 30.5 per 1,000 live births compared to 13.77, respectively, according to 2011 figures.

“The priority now is to give better access to the most marginalised population groups, which are generally the ones living in remote rural areas, or indigenous or black people,” Brumana said.

She pointed out that there are regional initiatives working towards progress along those lines.

One example is A Promised Renewed for the Americas, whose aim is to reduce inequities in reproductive, maternal, neonatal, child, and adolescent health by means of stepped-up political and technical support for developing countries to detect inequities and raise awareness, bringing together key actors and promoting the sharing of best practices.

Another challenge is reducing neonatal mortality rates among children in their first month of life – one of the most critical stages of development.

Globally, 2.8 million babies die during this stage of their lives. One million of them don’t even live to see their second day of life.

According to the regional initiative, the important thing now is to maintain public policies focused on improving access to healthcare, and to decentralise health policies. And, as always, to guarantee education, a factor that leads to a reduction in infant mortality.

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes

Children on their way to school in Kibera, the largest slum in Nairobi. Credit: Save the Children

By Valentina Ieri
UNITED NATIONS, May 5 2015 (IPS)

It’s called the urban survival gap – fuelled by the growing inequality between rich and poor in both developing and developed countries – and it literally determines whether millions of infants will live or die before their fifth birthday.

Save the Children’s annual report on the State of the World’s Mothers 2015 ranks 179 countries and concludes that that “for babies born in the big city, it’s the survival of the richest.”

Speaking from the launch at U.N. Headquarters, Carolyn Miles, president and CEO of Save the Children, said that for the first time in history, more families are moving into cities to give their children a better life. But this shift from a rural to an urban society has increased disparities within cities.

“Our report reveals a devastating child survival divide between the haves and have-nots, telling a tale of two cities among urban communities around the world, including the United States,” Miles added.

The document estimates that 54 percent of the world’s population lives in urban areas, and by 2050 the concentration of people in cities will increase to 66 percent, especially in Asia and Africa.

The World Health Organisation (WHO) says that nearly a billion people live in urban slums, shantytowns, on sidewalks, under bridges and along railroad tracks.

Rizelle, 17, and her three-week-old baby. Rizelle lives in a squatted home under a bridge in San Dionisio, Indonesia. Photo credit: Save the Children

While women living in cities may have easier access to primary health care, including hospitals, many governments have been unable to keep up with this rapid urban growth. One-third of all urban residents – over 860 million people – live in slums where they face lack of clean water and sanitation, alongside rampant malnutrition.

Miles said that despite the progress made on reducing urban under-five mortality around the world, the survival divide between rich and poor children in cities is growing even faster than that of poor children in rural areas.

In most of the developing nations surveyed, children living at the bottom 20 percent of the socioeconomic ladder are twice as likely to die as children in the richest 20 percent, and in some cities, the disparity is much higher.

Robert Clay, vice president of the health and nutrition at Save the Children, explained that urban poor are more transient, as they tend to have unsteady jobs and living situations. In rural areas, many people at least have land and food, and a stronger support system within the community.

“In urban areas this doesn’t exist. Urban cities are overcrowded by many ethnic groups living side by side so it’s a bit harder to bond, communicate and build trust. It’s the hidden population that is more problematic to reach,” Clay told IPS.

He said lack of data makes it harder for charities like Save the Children, or national and municipal governments, to access these marginalised communities.

The 10 developing countries with the largest child survival divide are Bangladesh, Cambodia, Ghana, Kenya, India, Madagascar, Nigeria, Peru, Rwanda and Vietnam.

Among the 10 worst wealthy capital cities for child survival, out of the 25 studied, Washington D.C. (U.S.) was number one, followed by Vienna (Austria), Bern (Switzerland), Warsaw (Poland), and Athens (Greece).

The river that runs through the Kroo Bay slum community in Sierra Leone. Credit: Save the Children

By looking at the mother’s index rankings of 2015, based on five criteria – maternal health, children’s well-being, educational status, economic status and women political status, Save the Children says that conditions for mothers and their children in the 10 bottom-ranked countries – all but two of them in West and Central Africa – are dramatic, as nations struggle to provide the basic infrastructure for the health and wellness of their citizens.

“On average, in these countries one woman out of 30 dies from pregnancy-related causes, and one child out of eight dies before his or her fifth birthday,” Miles said.

Globally, under-five mortality rates have declined, from 90 to 46 deaths per 1,000 live births. However, these numbers, says the organisation, mask the fact that child survival is strictly linked to family wealth, and miss addressing the conditions of poverty and unhealthy life of slums.  

Positively, the report has also uncovered some successful solutions found by governments to reduce maternal and infant mortality, and close the inequality gap between rich and poor children in their own countries. The most successful countries are Ethiopia (Addis Ababa), Egypt (Cairo), Guatemala (Guatemala City), Uganda (Kampala), Philippines (Manila) and Cambodia (Phnom Penh).

“Ethiopia, which recently had accelerated economic growth, managed to develop effective targeting policies, and provided accessible preventive and curative health care for poor mothers and children,” Clay said.

“[Ethiopia] should be a blueprint for other countries, which should bring access to communities in slums so that local people are not left behind,” he underlined, adding that hiring urban outreach workers who can go into the communities, speak the language of the people living there and understand their conditions and needs is vital.

Save the Children is calling on national governments worldwide to find new policies and plans to invest in a universal maternal and infant health care, develop cross-sectoral urban plans, and reduce urban disadvantages, and to increase the focus on the Sustainable Development Goals in the post-2015 development agenda, concluded Miles.

Edited by Kitty Stapp

The world's population reached 7 billion on Oct. 31, 2011. Pictured near an entrance to UN Headquarters is a banner for a global campaign by the UN Population Fund (UNFPA) to build awareness of the opportunities and challenges posed by this milestone. Credit: UN Photo/Rick Bajornas

By Joseph Chamie
UNITED NATIONS, Feb 25 2015 (IPS)

As the international community marks the 70th anniversary of the founding of the United Nations, one question worthy of some reflection is: Is world population better or worse off demographically since the establishment of the U.N.?

Some contend that the demography of today’s world population is markedly better than it was seven decades ago. Others argue that humanity is definitely worse off demographically and still others – often sceptics and cynics – feel it is neither better nor worse, but just different.This extraordinary demographic growth continues to pose serious challenges for humanity, including food production, pollution, global warming, water shortages, environmental degradation, crowding, reduced biodiversity and socio-economic development.

To consider the merits of those various perspectives and distinguish between personal opinions and measurable facts, it is useful and appropriate to dispassionately examine some fundamental demographic changes that have occurred to world population since the middle of the 20th century.

Perhaps the most visible demographic change is the increased size of world population, which now at 7.3 billion is five billion larger than at the time of the U.N.’s founding.

While world population has more than tripled in size, considerable variation has taken place across regions. Some populations, such as those in sub-Saharan Africa and Western Asia, have increased 500 percent or more over the past seven decades.

In contrast, other populations, such as those in Europe, increased by 40 percent or less over that time span.

The growth of world population, around 1.8 percent per year at mid 20th century, peaked at 2.1 percent in the late 1960s. The current annual rate of global population growth is 1.1 percent, the lowest since the U.N.’s founding.

In terms of absolute numbers, world population was adding approximately 47 million per year in 1950. The annual increase nearly doubled to a peak of 91 million in the late 1980s and then began declining to its current level of 81 million.

An important consequence of the differential rates of demographic growth globally has been the shift in the geographic distribution of world population. Whereas 70 years ago about one-third of world population resided in more developed regions, today that proportion is about half that level or 17 percent.

Also noteworthy are the regional demographic shifts that have occurred. For example, while Europe and Africa at mid 20th century accounted for 22 percent and 8 percent of world population, respectively, their current proportions are 10 percent for Europe and 16 percent for Africa.

Perhaps the most welcomed demographic change in world population that has taken place is the decline in mortality levels, including infant, child and maternal death rates.

During the past 70 years, the global infant mortality rate fell from approximately 140 to 40 infant deaths per 1,000 live births. The improvements in mortality across all age groups have resulted in an average life expectancy at birth for the world of 70 years, a gain of some 25 years since 1950.

Another remarkable transformation in world population over the past seven decades is the decline in fertility.

As a result of men and women gaining unprecedented control over the number, spacing and timing of their children, global fertility has decreased significantly from an average of about 5 births per woman at mid-20th century to 2.5 births per woman today.

Due to the declines in fertility as well as mortality, the age structure of world population has aged markedly. Over the past seven decades, the median age of world population has increased by six years, i.e., from 24 to 30 years.

In addition, the elderly proportion aged 80 years or older has tripled during this time period, increasing from about 0.5 to 1.6 percent.

The sex composition of world population has been relatively balanced and stable over the recent past, with a global sex ratio of around 100 -102 males for every 100 females.

Although slightly more boys are born than girls, many countries, especially the more developed, have more females than males due to lower female mortality rates.

Notable exceptions to that general pattern are China and India, whose population sex ratios are approximately 107 males per 100 females due in part to sex-selective abortion of female fetuses.

Whereas the sex ratio at birth of most countries is around 105 males per 100 females, it is 117 in China and 111 in India, markedly higher than their ratios in the past.

Increased urbanisation is another significant demographic transformation in world population. A literal revolution in urban living has occurred across the planet during the past seven decades.

Whereas a minority of world population, 30 percent, lived in urban areas in 1950, today the majority of the world, 54 percent, consists of urban dwellers. The migration to urban places took place across all regions, with many historically rural, less developed countries, such as China, Indonesia, Iran and Turkey, rapidly transformed to predominantly urban societies.

Another striking demographic change in world population is the emergence of mega-cities — agglomerations of 10 million or more inhabitants. In 1950, there was a single city in this category: New York, with 12.3 million inhabitants.

Today there are 28 mega-cities, with Tokyo being the largest at 38 million inhabitants, followed by Delhi with 25 million, Shanghai with 23 million and Mexico City, Mumbai and San Paulo each with approximately 21 million.

In addition to internal movements within nations, international migration across countries and regions has also increased markedly over the past decades. A half-century ago 77 million or nearly 3 percent of world population were immigrants, meaning they live in a place different from their place of birth. That figure has tripled to 232 million, representing slightly more than 3 percent of world population.

While most of the international migration is lawful, increasing numbers of men, women and children are choosing due to circumstance and desire to immigrate outside legal channels.

And while precise figures of migrants unlawfully resident are difficult to establish, the total number worldwide is estimated at least 50 million.

The numbers of refugees have also increased substantially during the recent past. At mid-20th century, an estimated one million people remained uprooted following the world war.

In the early 1990s the number of refugees peaked at around 18 million. Latest estimates put the global number of refugees at 16.7 million and growing.

Also, the total number of people forced to flee their homes due to conflict, which includes refugees, asylum seekers and internal displaced persons, has reached 51.2 million, the first time it has exceeded 50 million since the World War II.

From the above discussion, most would probably agree that while some aspects of world population are clearly better today than 70 years ago, others are not necessarily better and still others are decidedly worse.

Lower mortality rates and people living longer lives are certainly welcomed improvements. Men and women having the ability to decide more easily and freely the number, spacing and timing of births has also been an advance.

The logical consequence of lower mortality and fertility is population aging, a remarkable achievement that will, however, require major societal adjustments.

The scale of refugees and internally displaced person is plainly worse than a half century ago. The growing numbers and difficult circumstances of those fleeing their homes are unlikely to improve in the near future given the increasing political upheaval, ongoing civil conflicts and deteriorating economic conditions in many parts of the world.

Finally, the unprecedented growth of world population – the most rapid in human history –added about 5 billion more people since the mid 20th century.

This extraordinary demographic growth continues to pose serious challenges for humanity, including food production, pollution, global warming, water shortages, environmental degradation, crowding, reduced biodiversity and socio-economic development.

The recent declines in world population growth provide some indication of future demographic stabilisation or peaking, perhaps as early as the close of the 21st century.

At that time, would population is expected to be about 10 billion, 2.5 billion more than today or four times as many people as were living on the planet when the United Nations was founded.

Edited by Kitty Stapp

Excerpt:

Bosena, 25, sits on the side of a busy road in Addis Ababa, Ethiopia’s capital, with a baby in her arms. Ethiopia is among the countries listed as having made significant progress in reducing child and maternal mortality rates. Credit: Jacey Fortin/IPS

By Nqabomzi Bikitsha
JOHANNESBURG, Jun 30 2014 (IPS)

Every year, three million newborn babies and almost 6.6 million children under five die globally, but if the rest of the world looked towards the examples of two of Africa’s least-developed countries (LDCs), Rwanda and Ethiopia, they would perhaps be able to save these children.

At the 2014 Partners’ Forum being held in Johannesburg, South Africa from Jun. 30 to Jul. 2 – hosted by the Partnership for Maternal, Newborn and Child Health (PMNCH), the South African government and other partners – significant commitments in finance, service delivery and policy were announced that could put an end to these deaths. In total, there were 40 commitments from stakeholders, governments and the private sector who are committed to ending child and maternal mortality were revealed at the forum today.

It was noted that while remarkable progress has been made in reducing maternal and child mortality rates globally, over the last two decades the reduction in the rates of newborn deaths has lagged behind considerably.

However, Rwanda and Ethiopia were among 10 countries across the globe listed as having made significant  progress in reducing child and maternal mortality rates, according to a new global action plan launched at the forum.

The Every Newborn Action Plan (ENAP) provides evidence on the effective interventions needed to end preventable stillbirths and newborn deaths. It also outlines a strategy to prevent 2,9 million newborn deaths and 2,6 million stillbirths annually.

These countries invested in high-impact health interventions, including immunisation, family planning, education and good governance.

Tedros Adhanom Ghebreyesus, Ethiopian Minister of Foreign Affairs, told IPS that multi-sectoral investments, and not just direct investments in the health sector, would help reduce maternal and child mortality.

“If we don’t invest in agriculture, water and sanitation as well as the health sector then any gains we make in reducing child and maternal mortality will be futile.

“Community-based health care workers helped reduced Ethiopia’s mortality rates for mothers and children.”

According to the ENAP, newborn deaths account for 44 percent of all under five deaths worldwide, and investments in quality care at birth could save the lives of three million women and children each year.

“Now is the time to focus on action and implementation, to ensure more lives are saved,” said Graça Machel, co-chair of the PMNCH.

“Other countries have made progress and others have not, we need to learn from them, so we keep momentum.”

Accompanying the launch of the ENAP, was the launch of Countdown to 2015 report titled “Fulfilling the Health Agenda for Women and Children”, which serves as a scorecard of gains made in maternal and child health.

According to the report, which studied the progress of 75 countries in child and maternal mortality efforts, substantial inequities still persist.

“The theme of the Countdown report is ‘unfinished business,’” said Machel. “Too many women and children are dying when simple  treatment exists.”

Over 71 percent of newborn deaths could be avoided without intensive care, and are usually a result of three preventable conditions; prematurity, birth complications and severe infections.

Dr. Mariame Sylla, United Nations Children’s Fund (UNICEF) regional health specialist, told IPS that countries needed to learn from one another.

“Community-based approaches, where governments bring health services to the people and people to the services, have shown to be effective,” she told IPS.

“Monitoring of results is also very important to ensure accountability in the health sector.”

Dr. Aaron Motsoaledi, South Africa’s Minister of Health, said “having professional midwives would also help new mothers understand motherhood better and help reduce mortality rates among women and children.”

However,  Ethiopia’s Minister of Foreign Affairs pointed out that “these  efforts are are simple but often hard to deliver.”

“Least-developed countries like Ethiopia were able to make strides in curbing child and maternal mortality through their political will,” Dr. Janet Kayita, health specialist for maternal, newborn and child health for UNICEF, told IPS.

But she pointed out that “Ethiopia’s key to success, was not just about the leadership making the decision to reduce child and maternal mortality rates, but also organising at community level.”

“Ethiopia is one of the few LDC’s to institutionalise quality improvement in the health sector, using the mechanism of rewarding good quality health services and holding accountable those not performing.”

There are 135 million live births every year, with only 11 million benefitting from quality care. Credit: Photo stock

By Joan Erakit
UNITED NATIONS, May 8 2013 (IPS)

The story goes like this: a young mother lies quietly in a dimly lit room having just given birth to her baby. For the next seven days she watches over the child with caution, nursing and swaddling it patiently. Fearful that the infant will not survive past a few days, she refuses to give it a name.

Unfortunately, this scenario remains the reality for many women across the globe. There are 135 million live births every year, with only 11 million benefitting from quality care – a divide not only between rich and poor but also between life and death.“We’re not going to solve all these issues without involving and engaging men.” -- CEO of Save the Children Carolyn Miles

On Tuesday, Save the Children launched their annual report State of The World’s Mothers 2013: Surviving the First Day. The report emphasises the need for quality care around pregnancy, delivery and postnatal care.

“The first hours and days of a baby’s life are especially critical,” it says. “About three-quarters of all newborn deaths (over 2 million) take place within one week of births. Thirty-six percent of newborn deaths (1 million) occur on the day a child is born.”

Sometimes it is as simple as not having access to an educated midwife or community nurse. Other times it’s as complicated as having to wait for a husband’s approval in order to go to the hospital to deliver the baby.

Then there are the infections that newborns are prone to when they come into this world, and also the health of the mother during and after pregnancy.

Empowered mothers

“An empowered and educated mother is the best thing for a child,” President and CEO of Save the Children Carolyn Miles said as the report was launched at the United Nations.

The report cites three major causes of newborn mortality: severe infections, pre-term birth and complications during childbirth.

At the heart of the problem is the fact that millions of women lack access to a physician or healthcare facility.

“As we start to do more for newborns, the quality of care is also really critical, because we want babies not just to survive, but to survive without disability,” said Professor Joy Lawn, director of the MARCH Centre at the London School of Hygiene and Tropical Medicine.

This means making maternal and child health a priority for government officials and community leaders. It means having conversations with husbands and fathers about the need to have a birthing plan.

“We’re not going to solve all these issues without involving and engaging men,” Miles told IPS.

“We have got to work in communities to actually engage husbands, make them part of the plan. A woman develops a plan to get to the hospital to be able to deliver; engage her husband in that plan. Make sure he’s expected to be part of the plan and has put away a little money if there’s a transportation need. He’s actually part of that.”

Growing midwifery

Losing a baby during childbirth has become commonplace in the developing world. It is understood that childbirth is a terribly difficult thing with sometimes devastating results, but still a natural order.

“There is this sense of, ‘this is just what happens’. Babies die, babies are born too early, and they’ll die. Mothers don’t name their children for seven days because so many will die,” Miles told IPS. “So it’s changing that idea that every mother and every child deserves to live through birth.”

According to the report, 800 women die during pregnancy or childbirth and 8,000 newborn babies die during their first month of life. It all seems to boil down to two essential factors: education and access.

Those few midwives or birth attendants who are available – especially in rural areas – usually lack adeqate training in prenatal and postnatal care. What little education on the topic they have, they’ve learned along the way from previous childbirths, some not so successful.

Public health advocates say these providers need proper training and tools to carry out basic tasks like cleaning the umbilical cord after childbirth and teaching new mothers about infection.

This leads to access, another issue preventing pregnant women from receiving the best care during such a critical time. Rural areas are hard to reach, community workers are not paid enough to allow travel, and resources are scant.

“Part of the solution is to train more community midwives and health workers,” says Catherin Ojo, a chief nursing officer at Ahmadu Bello University Teaching Hospital in Zaria, Nigeria.