Positive Strategies in Achieving Health for All Children: An Equity Framework and Its Effect on Research Design and Education

The United Nations Millennium Development Goals (MDGs) adopted by world leaders in 2000 aimed to address some of the most pressing global issues of our times: extreme poverty, unequal health, and inequities in development. The MDGs, a set of interrelated targets to be met by 2015, catalyzed political commitment toward improving child survival and maternal health. Millennium Development Goals 4 and 5 called for a two-thirds reduction in the younger-than-5 child mortality rate and a three-quarters reduction in the maternal mortality ratio, respectively, from 1990 base figures.1 Although concerted global efforts have led to substantial reductions in maternal and child mortality over the past 25 years, MDG 4 and 5 targets have not been fully realized. Only 62 of the 195 countries with available estimates achieved the MDG 4 target, of which 24 were low-income and lower-middle–income countries.2 Only 2 regions, East Asia and the Pacific (69% reduction) and Latin America and the Caribbean (67% reduction), met the target at a regional level.2 For MDG 5, of the 95 countries that had a maternal mortality ratio of more than 100 in 1990, only 9 achieved the target for reduction in maternal mortality: Bhutan, Cambodia, Cape Verde, Iran, Laos, Maldives, Mongolia, Rwanda, and Timor-Leste.3 As we celebrate the fact that the global younger-than-5 mortality rate and maternal mortality ratio have fallen by 53% and 43.9%, respectively, since 1990, we also face the sobering reality that high numbers of women and children are still dying every year, largely due to conditions that could have been prevented or treated if existing cost-effective interventions were universally available.2–4 The burden of mortality also remains unevenly distributed, with the largest numbers and highest rates of maternal and younger-than-5 deaths concentrated in countries of sub-Saharan Africa and South Asia, especially in lower-income countries and among fragile states, especially those with ongoing conflict.2,3,5 2015 marked the end of the MDG era and the beginning of a new global framework, the Sustainable Development Goals (SDGs). This new framework presents an opportunity to leverage the momentum built over recent decades to tackle global inequities in maternal and child health. Of these SDGs, goal 3 also calls for an end to preventable deaths of newborns and children younger than 5 years, as well as a reduction in maternal mortality to less than 70 per 100,000 live births, by 2030.6 Achieving this target would require overcoming barriers and inequities in access to quality health services and, thus, implementing strategies to reach all mothers and children, including those who are most vulnerable, remote, and at risk. In this chapter, we discuss the current burden of younger-than-5 and maternal mortality, barriers contributing to health inequities, and, finally, evidence-based strategies to bridge these gaps.