Since the start of an international effort to reduce maternal and child mortality, millions of lives have been saved globally, a new study by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington shows. The vast majority of countries have seen accelerated reductions in maternal and child deaths—with child deaths declining by 3.5 percent per year since 2000 and maternal deaths by 2.7 percent per year since 2003.

In 2000, world leaders made a consolidated yet ambitious commitment to work towards achieving significant progress in areas such as poverty eradication, environment sustainability and improved health. This included reducing child mortality rates by two-thirds and maternal mortality ratio by three-fourths, between 1990 and 2013. This week The Lancet published two studies covering the progress in these issues.

Child mortality

Globally, child death rates dropped by 48 percent between 1990 and 2013. The reduction in child deaths has been remarkable since 2003 and is expected to accelerate in many developing countries. Nepal, along with Bangladesh, Bhutan and Maldives from the South Asian region, is among the 27 developing countries that are likely to achieve the goal of reducing child mortality by two-thirds within 2015.

The report estimates that as many as 6.3 million children died before their 5th birthday in 2013. A third of these deaths occurred within the first week of child’s life. Globally, under-5 mortality rates varied by a colossal 66 times (0.2 percent in Singapore and 15 percent of live born neonates in Guinea Bissau). In South Asia, Afghanistan currently bears the highest under-5 mortality rates, whereas Pakistan’s progress has been sluggish. Sub-Saharan Africa continues to bear the greatest burden.

Over 22,000 Nepali children under 5 years of age died in 2013—roughly four percent of live births. In comparison to other South Asian nations, Nepal maintained most steady progress in preventing under-5 mortality rates since 1990s. Since 2000, the decrease has been even faster at annual rates of six percent. Generally, these improvements were attributed to a rising income, education and secular shifts. Although the changes are greatly encouraging, Nepal still has a long way to go as one in two of all under-5 mortality occurs in the first week after birth, most of which are preventable by appropriate interventions.

Maternal mortality

The study also shows that on a global scale, every second minute, one mother loses her life in connection to pregnancy or childbirth. One in four of nearly 300,000 estimated maternal deaths in 2013 took place during pregnancy and another quarter during or shortly after delivery. Women younger than 20 years had 50 percent increased risk for dying in relation to pregnancy or delivery than their 20-30 year old counterparts. Age above 45 years poses a 10-fold increase in such risks. HIV was related to only 0.4 percent of maternal deaths globally.

Although death during delivery has reduced substantially, the number of women dying within six weeks of delivery has actually increased. This suggests a need for increased vigilance of post-partum risks. In the last 10 years, maternal mortality has reduced annually by almost three percent with evidence of continued acceleration. However, only 16 countries—most in Central and Eastern Europe—are likely to meet the millennium development target by 2015; none but Maldives from Saarc nations falls in the list. Maternal mortality actually increased, not only in sub-Saharan Africa but also in the US in the last decade.

In South Asia, Bangladesh and Bhutan have made significant progress in reducing maternal mortality during the last decade—closely followed by Nepal and India. Pakistan performed least impressive progress also in maternal health.

In developing countries, abortion and hemorrhage have always remained the main causes of maternal deaths. Last year, around 1,600 Nepali women died due to causes related to pregnancy and childbirth. Between 1990 and 2013, maternal mortality has fallen 53 percent to 272 per 100,000 livebirths. This figure can and should be reduced further. Preventing maternal mortality may prove far more challenging in Nepal and its neighbouring countries, alongside much of Africa. Even though development aid for maternal and child health might has helped achieve current levels, further efforts are needed to increase access, encourage skilled attended delivery and post-partum care.

Dr Neupane co-authored one of the Lancet papers cited in the text