Mothers and Children:
Make Them Count

What is a child's life worth? According to recent research, 3 million newborn babies could be saved for less than $1 per child. Simple interventions such as tetanus immunization during pregnancy, clean deliveries, exclusive breastfeeding, and antibiotics to treat illness are all that's needed.

How important is a mother's life? According to the World Health Organization (WHO), more than 1,400 women die each day from pregnancy-related causes that are mostly preventable or treatable. They leave behind motherless children, and their families and communities suffer from their lost contributions. Every year, an estimated 1 million children die as a result of their mother's death.

For these and many other reasons, World Health Day 2005 is dedicated to "Healthy Mothers and Children—Every Mother and Child Counts." Its organizers are calling on governments and societies around the world to invest in the health of mothers and children not only as a basic human right but also as an essential contribution to the well-being of families, communities and societies.

In the United States, the Pan American Health Organization (PAHO) will host a World Health Day kick-off event on April 7 in Washington, D.C., followed by a series of related events through April 14 as part of "Health in the Americas Week." PAHO member countries in Latin America and the Caribbean are planning their own events. The global launch will be held in New Delhi and will feature the release of the World Health Report 2005, on maternal and child health.

New Lancet series

In the first major U.S. event leading up to World Health Day, a panel of leading international public health experts presented a series of research papers published by the British medical journal The Lancet on newborn survival. Presented at the National Press Club in Washington, D.C., on Mar. 3, the series analyzes the status of newborn health around the world and calls for immediate and sustained action to save newborn lives.

The experts noted that almost 40 percent of all child deaths worldwide occur in the first month of life. Although 99 percent of newborn deaths are in poor countries, the vast majority of funding and research worldwide focuses on high-technology solutions for the 1 percent of deaths in rich countries.

In Latin America and the Caribbean, 60 percent of mothers have access to skilled help during childbirth, a much higher percent than in other developing regions. WHO and PAHO recommend that all pregnant women have such access. Photo by Armando Waak/PAHO

"Eight million children are either stillborn or die each year within the first month of life. This figure never makes news," said Richard Horton, Lancet editor-in-chief, in his series editorial. "The aim of the present Lancet series is to erase the excuse of ignorance for public and political inaction once and for all."

"At less than a dollar per capita per year in additional spending to provide these life saving interventions to 90 percent of mothers and babies, the cost is affordable," said Gary Darmstadt, director of the Center for International Neonatal Health at Johns Hopkins University.

Carissa Etienne, PAHO assistant director, said, "We can use simple techniques to instruct householders on danger signals and simple interventions for conditions they can manage at home. Community health workers and other individuals can be trained so they can provide a second level of care, with clear guidelines, to help improve the care of newborns and avoid these deaths."

All four articles and a number of related papers are available online at www.thelancet.com.

PAHO fact sheets for World Health Day point out that a woman born in Latin America or the Caribbean is 27 times more likely to die as a result of pregnancy complications than a woman born in the United States. Similarly, a child born in Haiti is 17 times more likely to die before reaching the age of 5 than a child born in Canada.

Even within Latin America and the Caribbean, there are huge differences in rates of maternal and child mortality. Bolivia has a maternal mortality rate of 230 per 100,000 live births, 10 times greater than Chile's rate of 23 per 100,000. Within Bolivia, maternal mortality ranges from 124 deaths per 100,000 live births in valley areas to 352 deaths per 100,000 live births in rural areas with predominantly indigenous populations. Similar disparities are found in other countries as well.

Among children, the risk of dying is greatest for newborns, and the chief causes of newborn deaths in the Americas (as in other regions of the world) include asphyxia (the inability of the baby to breathe properly), sepsis (infection), and low birth weight.

The leading cause of maternal deaths in the Americas is postpartum hemorrhage followed by sepsis and eclampsia (convulsions leading to coma).

The most effective way to prevent these deaths is to have skilled medical personnel present during childbirth. PAHO and WHO recommend that all pregnant women have access to skilled attendance at birth. In Latin America and the Caribbean, some 60 percent of mothers have access to skilled help during childbirth, much better than in other developing regions. Yet it means that four out of 10 deliveries in the PAHO region occur in homes and without skilled attendance.

Other important interventions include essential prenatal care, the Integrated Management of Childhood Illness (IMCI) strategy, and education about simple health, hygiene and nutrition practices for mothers and families.

PAHO planned a series of panels and special sessions to highlight these and related issues, including maternal and child health in PAHO priority countries, HIV/AIDs in mothers and children, neonatal health, and the relationship between domestic violence and maternal and perinatal health.

PAHO's partners for the U.S. observance this year are the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention, the U.S. Agency for International Development, the United Nations Children's Fund (UNICEF), Save the Children, the National Alliance for Hispanic Health, Family Care International, the U.N. Population Fund, the World Bank, the Student Campaign for Child Survival, the Child Survival Collaborations and Resources Group (CORE), the U.S. Child Survival Coalition and the National Healthy Mothers, Healthy Babies Coalition.

World Health Day is held each year on the anniversary of the founding of the World Health Organization. For more information visit the World Health Day 2005 web page.