Make every mother and child count

Tracking progress in child survival

London, United Kingdom
13 December 2005

Countdown to 2015: tracking progress in child survival. In the first of a series of two-yearly reviews of progress in child survival, WHO joined a high-level panel in London, UK to review and debate the central issues affecting child health. Dr Lee's presentation follows the story of several women and their young children, in Ethiopia, Lao People's Democratic Republic, Niger, and Pakistan.

The birth of a child is a time of hope. Its new life is a symbol of potential for growth. Its death is a denial of progress. When I was born in 1945, the child mortality rate in Korea was 152 per 1000 live births. That's roughly the equivalent today of the death rates in Benin, or Mozambique, Swaziland, Cameroon, or Ethiopia.

Tremendous progress is possible. The mortality rate in my country has now dropped to just 5 children per 1000. That's one of the lowest rates in the world; lower than the rates in New Zealand, the United States, or the United Kingdom.

Our goals - part of the Millennium Development Goals - are to cut child deaths by two thirds by 2015 from 1990 rates, and maternal deaths by three quarters.

Every minute 20 children under the age of five die. More than 70% of all child deaths are caused by preventable and treatable conditions, like malaria, measles, HIV or diarrhoea. The greatest risk is in their first four weeks of life when babies die from conditions like low birthweight, birth trauma, asphyxia, and severe infections like pneumonia, meningitis or tetanus.

This is Elizabeth. She lives in Ethiopia. Malaria is endemic, yet only 17% of children under five in this country sleep under mosquito nets. Elizabeth's family can only afford one net, which she and her mother Hiwot sleep under. Many of the local children have died from the disease.

Nine-month-old Lang lives in the Lao Democratic People's Republic. Like 82% of children in her country, she sleeps under a bednet. The family has two nets, but the insecticide treatment wore off a long time ago, and they are full of holes. Many people in their district fall ill from malaria, including Lang's father, who is unable to work at times. Simpler and effective protection measures, like treated bednets, make the difference. But only if every family uses one.

Elizabeth and Lang's mothers try to make their home as protected as possible for their children. It's natural to see home as a safe place. Sadly it's not.

Just last month WHO launched a report on domestic violence. One of the more shocking facts revealed by that report was the extent of violence against women during pregnancy. One quarter to one half of the women who reported this abuse, said that they had been deliberately kicked or punched in the abdomen. Unsurprisingly, women in violent relationships are significantly more likely to suffer miscarriages, or to undergo abortion.

The study also found that, in some settings, a significant proportion of women thought it was acceptable for a man to beat his wife under certain circumstances. Women in these violent households have more health problems than others, yet often feel unable to talk to anyone about their situation or seek help. This violence is also associated with low birth weight, and with higher infant and under-five mortality.

Every minute a woman is dying from complications in pregnancy and childbirth.

Almost all of these deaths - 99% - are taking place in low and middle income countries. Mothers and children from the poorest families in Sub-Saharan Africa and south Asia are the most likely to die. Malnutrition contributes strongly to these deaths, increasing the risk of dying from other causes. Lack of access to food is one reason for malnourishment, but poor feeding practices and infection also contribute.

Some countries have already made tremendous progress in combating the big killers. Some examples: exclusive breastfeeding is protecting young children in Ghana, Madagascar, Tanzania and Zambia. Globally, only four out of 10 children with pneumonia are treated with antibiotics. But in Egypt, Ghana, Iraq, Liberia, Papua New Guinea and South Africa, rates of care-seeking for pneumonia have improved. Rates of malaria are falling through bednet distribution in Togo and Malawi.

Most effective of all are where several interventions can be put together. These are the high-impact packages: where we can provide vaccines, bednets, vitamin A supplements, and increase breastfeeding. Together these save more lives for less money than one intervention at a time. This is the future of our collaborative work.

Through the new funding coming through the Global Alliance for Vaccines and Immunization and International Financing Facility for Immunization, we will be able to bring vaccines to millions more children over the next 10 years. Those vaccines will include protection against two of the major killers: respiratory infections and diarrhoeal diseases.

Crises stop progress, and test the international community's ability to live up to its ideals. In Pakistan at the moment, around 3.3 million people have lost their homes. As the days and nights get colder – reaching sub-zero temperatures – thousands of people in the alpine areas still have no adequate shelter. They need winterized temporary shelters and blankets. Increasingly, survivors are suffering from acute respiratory infections and hypothermia. Most people also have little or no food and no way to make a living. This is not a good place to be a pregnant woman. It is even worse to be a newborn baby.

This is Tasleem Liaqat. When the earthquake struck, Tasleem managed to escape, despite both her legs being broken. Three hours later, with only her mother beside her, she gave birth. It took eight days for her to be evacuated to the main hospital in Muzaffarabad. Many of those who escaped death may have to cope with long-term disability. They will need specialized support.

Tasleem is one of over 13 000 women who are expected to give birth every month in the earthquake zone. Of these, around 2000 women and 1500 newborn babies are expected to develop complications. The healthcare facilities are still minimal, and there are very few female health workers. In societies where women cannot be seen by a male health worker, access to health care may be desperately limited.

This is Nasleema and her baby Samarine, who is ill because of the cold. Nasleema's other children were killed in their school when it collapsed after the earthquake. The rest of the family is living in a small camp. Like all those living without access to clean water, they are vulnerable to the waterborne diseases that kill small children throughout the world, and which have already badly affected the camps. The earthquake stopped up many natural springs. Water and sanitation infrastructure has been severely damaged.

Sadaf and Shazea Qadoos collect water for their family from the nearby river for cleaning and washing. They are able to get water from a tanker, several kilometers away, for drinking and cooking.

Mohamad Kabir sits in front of his makeshift shelter with his only surviving immediate family member, his son, Wajid. They now live in a relief camp established by government authorities on the university grounds in Muzaffarabad. Like so many families, not just in the earthquake zone, but worldwide, they have to cope with the emotional and practical consequences of the loss of a parent.

Those practical consequences can be deadly, especially for young children. Women currently account for nearly half of all adults living with HIV/AIDS. Every year, an estimated one million young children die as a result of the death of their mother. Where mothers do not have access to HIV treatment, they risk passing on the infection to their infants.

This year, the theme of the World Health Report was to "make every mother and child count". There is just a decade left to achieve the Millennium Development Goals. Achieving each goal is dependent on the others. Poverty reduction will not happen without healthy mothers and children. But too many women and children still have little or no access to care.

Even where there is care, it is not always possible to save life. This is Aminatou Iyaye, standing in her chickpea field in Niger. There is no crop. Locusts, and the drought took everything. She had three children to nourish. But there was simply no money to buy food when her farm could not feed them. Advice from the nutritionist was not enough. Aminatou's family needed more.

This frail child did not survive.

Each loss matters. Each death counts.

Our emphasis now is positive, to count the lives saved, and work towards increasing that number. But keep this child's face in your thoughts.

Thank you.