With recent reports of difficult pregnancies and births from celebrities like Beyonce, Serena Williams, and Alyson Felix, and the death of Olympian Tori Bowie during childbirth, the long-overlooked dangers of maternal and child mortality have become increasingly prominent.
In a new report published by the Bill & Melinda Gates Foundation, the global health philanthropic group highlights lagging progress in achieving United Nations (UN) goals for lowering mother and child deaths, along with innovative ways of addressing the problems with relatively inexpensive and easy to implement solutions that the group projects could cut such deaths by as much as half, saving 2 million lives
“Every death matters,” says Bill Gates, of the group’s decision to draw attention to maternal and child mortality. Under current circumstances, the world will not reach the UN Sustainable Development Goals (SDG) to reduce maternal mortality to less than 70 per 100,000 live births and neonatal mortality to lower than 12 per 1,000 live births by 2030. Currently, maternal mortality has plateaued at 150 to 160 per 100,000 live births since 2015, and child mortality ranged from 16 to 18 per 1,000 live births in the same period. “Global health does not get the attention it deserves, and we want to remind people that the UN did pick these goals, and we are off track,” says Gates.
Each day, 800 mothers around the world die giving birth, and the chance that their babies survive past their first year is less than 37%.
That sobering reality is more concerning when considering previous success in lowering maternal and child mortality rates. Thanks to the UN’s Millennium Development Goals (MDG), which set ambitious targets for lowering deaths by improving access to basic health care including childhood vaccines, contraceptives, and bed nets to ward off malaria-carrying mosquitoes, mortality among mothers giving birth dropped 3% annually from 2000 to 2015, and child mortality declined 2% yearly in the same period. “We’ve never seen a reduction like that and 2000 to 2015 was a magical period,” says Gates. “We achieved something miraculous.”
Those encouraging trends, however, have stalled. The MDGs were replaced with SDGs, a set of 17 global sustainability goals that extended the MDG targets, including eliminating poverty and hunger, improving access to quality education, achieving gender equality, and moving to affordable and clean energy. They also include health goals of reducing maternal and child mortality, addressing HIV, expanding prevention and treatment programs for substance abuse, and implementing stricter tobacco control regulations. Continued political and civil unrest, as well as unstable economies, not to mention the emergence of climate priorities, have created a more competitive space for achieving health targets, says Gates.
Goalkeepers, a Gates Foundation initiative begun in 2017 to support and accelerate achieving the SDGs, tracks progress toward the targets, and this year, documents that at current rates, targets for lowering maternal and child mortality won’t be met by 2030.
One reason for the slowdown may be an artifact of the remarkable success of the MDGs. “There comes a point when you start to see plateaus [in your outcomes],” Laura Lamberti, deputy director of maternal, newborn, and child health discovery and tools at the Gates Foundation said during a briefing. “Even if you are delivering high quality interventions and have high coverage of them, those interventions are addressing some of the leading causes of mortality, and you reach a point where the existing package of care is not addressing what is causing the residual deaths that continue to occur.”
That’s why the current report highlights solutions that focus more on expectant mothers, and their health before delivery, as well as on the delivery itself. One major cause of maternal mortality in childbirth is the excessive loss of blood, but in many busy birthing centers, it’s hard for doctors, nurses, or midwives to gauge how much blood a woman is losing, and how much is too much. A simple cup device hung on the bed allows nurses and doctors at a glance to see which women are bleeding excessively and prioritize treating them.
There are five ways to stop postpartum bleeding—uterine massage, examining the genital tract, administering IV fluids, and two drugs—which health professionals traditionally tried one at a time. But a study involving 200,000 women in Africa showed that using all five at once could lower risk of postpartum bleeding by 60%, and the Foundation is working with local health facilities to train people to optimize their use simultaneously.
Even simpler ways to address such bleeding, which is more common among women who have low iron levels or are anemic, is to provide them with iron supplements. While pills are common, women need to take them for about six months to build up adequate levels in their blood, and the pills can cause side effects. The Goalkeepers report includes the example of a Nigerian obstetrician who found that giving women a single 15-minute intravenous infusion of iron during a prenatal visit, could treat anemia and significantly lower the chance of bleeding after giving birth.
Infections are another common cause of complicated delivery and mortality, but a trial conducted in sub-Saharan Africa found that treatment with a common antibiotic, azithromycin, can cut risk of sepsis infections, a danger during childbirth, by a third. Broader use of azithromycin could also help in the U.S., where 23% of maternal deaths are due to sepsis.
Gates says the Foundation is continuing to research ways to drive down mortality rates by supporting several large trials around the world that focus on understanding, for example, the major drivers behind diarrhea and pneumonia among children, two of the major causes of death in the first few years of life.“ Getting the information about deaths, particularly very young deaths, guides our work in a pretty profound way,” says Gates of the continued effort to broaden the database. For example, that knowledge is underscoring the importance of basic needs such as good nutrition for babies and young children, which is critical for good development.
But even inexpensive and simple solutions won’t be effective if they aren’t in the hands of midwives, doctors, and nurses at delivery centers. Gates is optimistic this can happen, though. “We can start accumulating lives saved very quickly. We show that 2 million lives can be saved by the end of the decade, if we implement some of these measures, which is a mind-blowing number,” he says. “That could be well over 6 million by the end of the next decade. And that’s taking into account difficulties in delivering some of these solutions. If we have perfect delivery of them, the lives saved would be more than double that.”
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