Accountability for Women’s and Children’s Health

The iERG 2012 report

Press release

Most of world will fail to meet goals for women’s and children’s health by 2015 amid declining donor funding

The first report of the UN Secretary-General's independent Expert Review Group (iERG)* on Information and Accountability for Women's and Children's Health, to be launched on September 26 at the UN General Assembly, concludes that although headline reductions in maternal and child mortality during the past decade have been impressive in some countries, millions of women and children still die every year from preventable causes. Unless those causes are more urgently addressed globally and in countries, Millennium Development Goals (MDGs) 4 and 5 will not be met by most nations by the target year of 2015. What is more, declining rates of donor funding and a failure to target resources to the countries with the greatest need could have devastating consequences for the survival of millions of women and children worldwide.

The key findings of the iERG's report are:

  • There are worrying signs that donor and country financial commitments to women's and children's health are declining.
  • The distribution of commitments to countries with the highest burdens of women's and children's mortality are disturbingly uneven, revealing deep and troubling inequities in health care.
  • Among children, the major preventable and still neglected causes of death are increasingly concentrated in the newborn period (3.1 million deaths). Substantial numbers of preventable deaths also take place in the post neonatal period—1.1 million deaths from pneumonia, 0.75 million deaths from diarrhoea, and 0.56 million deaths from malaria.
  • Among women, the decline in maternal mortality falls well short of that needed to reach MDG-5. The predicament for adolescent girls is especially acute: 1 in 8 births in low-income settings is in girls aged 15-19 years; in sub-Saharan Africa, girls aged 15-19 years account for a quarter of unsafe abortions.
  • The region enduring the highest rates of mortality among women and children is sub-Saharan Africa. By any standard, Africa must become a greater global policy priority for all partners than it is today.
  • The predicaments facing women and children are evolving fast. For example, non-communicable diseases are a growing threat. All partners responsible for women's and children's health must move more rapidly to keep pace with these changing threats.
  • The Commission on Information and Accountability made 3 important recommendations for countries with the highest burdens of women's and children's mortality—on monitoring, on working with development partners, and on national oversight of progress. None of these recommendations will be fully met by the end of 2012, disappointing evidence that fine words are not being effectively translated into good deeds.
  • Although 220 commitments have been made to the UN Secretary-General's initiative on women's and children's health, Every Woman, Every Child, it has not been possible to document precisely what impacts those commitments have actually had for women and children. This absence of reliable evidence and results from donors, agencies, and the private sector reflects a serious failure of accountability among partners.
  • Although the remaining recommendations of the Commission on Information and Accountability are not due for delivery until later years, the iERG registers its serious concern that progress on these recommendations is insufficient. There is a severe shortfall in available resources to deliver the Commission's recommendations on time.
  • There are several critically important, yet still neglected, obstacles to reducing preventable mortality among women and children. Many of these barriers relate to pervasive weaknesses in country health systems—inadequate high-level political leadership, insufficient financing, weak national governance, lack of skilled health workers, and unacceptable variations in coverage of life-saving interventions.
  • The iERG also identifies additional areas that remain systematically marginalised in strategies to improve women's and children's health: undernutrition, lack of attention to the needs of adolescent girls, gender discrimination, inadequate investment in safe abortion services, and inattention to conflict-affected and displaced populations, among others.

The iERG makes 6 recommendations to improve accountability as a means to accelerate progress for women's and children's health:

  • Strengthen the global governance framework for women's and children's health: There is currently a damaging governance gap between partner countries, multilateral agencies, donors, NGOs, health professionals, researchers, foundations, and the private sector.
  • Devise a global investment framework for women's and children's health: There is currently no strategic approach or effective mechanism to guide investments on behalf of women and children.
  • Set clearer country-specific strategic priorities for implementing the Global Strategy and test innovative mechanisms for delivering these priorities: Priorities across the continuum of care need to be sharpened during the 3 years remaining to the MDG target date of 2015.
  • Accelerate the uptake and evaluation of eHealth and mHealth technologies: The evidence on which to base decisions about implementation of information and communication technology is weak or non-existent.
  • Strengthen human rights tools and frameworks to achieve better health and accountability for women and children: Human rights treaty bodies that interface with health should routinely incorporate the health of women and children into their work.
  • Expand the commitment and capacity to evaluate initiatives for women's and children's health: Evaluation—the relentless pursuit of results—must become a much stronger foundation for independent accountability.

The test of the world's commitments to women's and children's health and wellbeing lies not in promises, but in results. Although strategies to improve women's and children's health have triggered remarkable energy and rhetoric, there are considerable weaknesses in the enabling environment, which mean these promises will not readily be turned into results. Financial donors must be clearer about the extent to which their stated commitments are being met.

As international efforts to plan for the post-2015 era of sustainable development begin to take place, the lives of women and children must be at the centre of that political vision. Predicaments facing women and children are truly global problems requiring global solutions. Women have an indispensable role as agents for sustainable development.

For a copy of the embargoed report, Every Woman, Every Child: from commitments to action, see and the executive summaries, see (English); (French); (Russian); (Arabic); (Spanish); (Chinese)

For interviews with iERG members

  • Richard Horton, Editor-in-Chief of The Lancet - iERG Co-Chair (English)
  • Joy Phumaphi, Executive Secretary of the African Leaders Malaria Alliance (ALMA) - iERG Co-Chair (English)
  • Marleen Temmerman, Professor of Obstetrics-Gynaecology, Ghent University, Belgium (English, French, and Dutch)
  • Carmen Barroso, Regional Director of International Planned Parenthood Federation, Western Hemisphere Region (English, Spanish, and Portuguese)

Please contact: The Lancet Press Office, 32 Jamestown Road, Camden, London, NW1 7BY; Phone: +44(0)207 424 4949; Mobile: +44(0)7920 592 635; Email:

Note to editors:

*About the iERG—The creation of an independent Expert Review Group reporting to the UN Secretary-General was a recommendation made in 2011 by the Commission on Information and Accountability for Women's and Children's Health. This Commission was formed as part of the UN Secretary-General's Every Woman, Every Child initiative. The iERG consists of 7 members and is chaired by Prof Richard Horton and Mrs Joy Phumaphi. The members include Dr Carmen Barroso, Prof Zulfiqar Bhutta, Prof Dean Jamison, Prof Marleen Temmerman, and Prof Miriam Were. The iERG's functions are to assess the delivery of commitments to the Secretary-General's Global Strategy on Women's and Children's Health, as well as to its subsequent Commission; to review progress in implementing the recommendations of the Commission; to identify obstacles to implementing the Global Strategy and Commission's recommendations; and to make recommendations to improve accountability for women's and children's health. The iERG will report to the UN Secretary-General every year up to and including 2015.

There will be an embargoed press event to launch this report at 12 noon EST time on Wednesday, 26 September at North Lawn Building, Conference Room 6, United Nations, New York. Speakers will include:

  • Margaret Chan, Director General, WHO - Vice-Chair of the Accountability Commission
  • Hamadoun I. Touré, Secretary-General, ITU - Vice-Chair of the Accountability Commission
  • Richard Horton, Editor-in-Chief of The Lancet - iERG Co-Chair
  • Joy Phumaphi, Executive Secretary of the African Leaders Malaria Alliance (ALMA) - iERG Co-Chair

The event will be live-streamed at:

For further information on the launch, please contact: Kathryn Donovan, UNICEF, New York, Tel + 1 212 326 7452, Christian Moen, UNICEF, New York, Tel + 212 326 7516, Etienne Franca, UNFPA, New York, Tel + 212 297 5208,