Health :: Continuum of care – approach for mother and child

Hundreds of millions of women and children have no access to potentially life-saving care with often fatal results, the World Health Organization (WHO) says in a report published. The report says the resulting death toll could be sharply reduced through wider use of key interventions and a “continuum of care” approach for mother and child that begins before pregnancy and extends through childbirth and into the baby’s childhood.

About 530 000 women a year die in pregnancy or childbirth, more than three million babies are stillborn, more than four million newborns die within the first days or weeks of life, and altogether 10.6 million children a year die before their fifth birthday, according to WHO’s latest figures.

In The World Health Report 2005 – Make every mother and child count, WHO estimates that out of a total of 136 million births a year worldwide, less than two thirds of women in less developed countries and only one third in the least developed countries have their babies delivered by a skilled attendant. The report says this can make the difference between life and death for mother and child if complications arise.

Make every mother and child count is being launched on World Health Day, which shares the report’s main theme. The event is being marked in many countries, with a major launch in New Delhi, India.

According to the report, almost 90% of all deaths among children under five years of age are attributable to just six conditions. These are: acute neonatal conditions, mainly preterm birth, birth asphyxia and infections, which account for 37% of the total; lower respiratory infections, mostly pneumonia (19%); diarrhoea (18%); malaria (8%); measles (4%); and HIV/AIDS (3%). Most of these deaths are avoidable through existing interventions that are simple, affordable and effective. They include oral rehydration therapy, antibiotics, antimalarial drugs and insecticide-treated bednets, vitamin A and other micronutrients, promotion of breastfeeding, immunization, and skilled care during pregnancy and childbirth. To reduce the death toll, the report calls for much greater use of these interventions, and advocates a “continuum of care” approach for mother and child that begins before pregnancy and extends through childbirth and into the baby’s childhood. This in turn requires a massive investment in health systems, particularly the deployment of many more health professionals, including doctors, midwives and nurses. “For optimum safety, every woman, without exception, needs professional skilled care when giving birth,” the report says, adding that continuity of care for the newborn in the following weeks is vital.

“This approach has the potential to transform the lives of millions of people,” says Dr LEE Jong-wook, WHO Director-General. “Giving mothers, babies and children the care they need is an absolute imperative.”

The report focuses on those developing countries where progress in maternal and child health is slow, stagnating or has even gone into reverse in recent years. Within such countries, less than half of mothers and newborns receive care, but by no means the full range of what they need. Make every mother and child count is a wide-ranging study of the obstacles to health facing women before and during pregnancy, in childbirth, and in the weeks, months and years that follow for them and their children. It pays particular attention to the plight of newborns, whose specific needs have “fallen between the cracks” separating maternal and child care programmes.

It is being published in the “report card year” of the United Nations’ Millennium Development Goals (MDGs), two of which are to improve maternal and child health drastically by the year 2015. The latest available data show that total public health expenditure for the 75 countries with the biggest problems amounts to US$ 97 billion per year. The report calculates that this amount needs to be increased by an average of US$ 9 billion a year for each of the next ten years in order to increase access to care in those countries to a level that would permit them to move towards and even beyond the MDGs.

Exclusion from maternal, newborn and child health care is a key feature of inequity as well as a crucial obstacle to progress towards the MDGs, the report says. The health of mothers and children “is at the core of the struggle against poverty and inequality, as a matter of human rights”.

Lack of access to skilled care and to major obstetric interventions is the prime reason why large numbers of mothers in rural areas are excluded from life-saving care at childbirth. For example, in a study of 2.7 million deliveries in seven developing countries, only 32% of women who needed a major life-saving intervention received it.

More than 18 million induced abortions each year are performed by people lacking the necessary skills or in an environment lacking the minimal medical standards, or both, and are therefore unsafe. As a consequence, 68 000 women a year die.

In many countries, “numerous women and children are excluded from even the most basic health benefits: those that are important for mere survival”. Some countries, often the poorest, show a pattern of massive deprivation, with only a small minority, usually the urban rich, enjoying reasonable access to health care, while an overwhelming majority is excluded.

Among those left out, women and their children suffer most. “Being poor or being a woman is often a reason for being discriminated against, and may result in abuse, neglect and poor treatment, poorly explained reasons for procedures, compounded by views sometimes held by health workers that women are ignorant. The care that women are offered may be untimely, ineffective, unresponsive or discriminatory,” the report says

The report adds that putting in place the health workforce needed for scaling up maternal, newborn and child health services towards universal access is the first and most pressing task. The extra US$ 9 billion a year that is required to scale up maternal, newborn and child health includes US$ 3.5 billion in additional costs for human resources. Making up for the huge shortages and imbalances in the distribution of health workers in many countries will remain a major challenge for years to come. WHO is currently assessing the need for a massive scale-up in the numbers of health workers of all categories, not just maternal and child care, in the coming decade. The human resources crisis relates not just to shortages of people but also to issues such as pay and working conditions. WHO is developing a series of policy actions for each of the areas covered in the report and is encouraging governments and other stakeholders to introduce recommended interventions and scale up maternal, newborn and child health programmes. WHO will monitor and evaluate progress in these programmes.

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