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 Table of Contents  
EDITORIAL
Year : 2016  |  Volume : 3  |  Issue : 1  |  Page : 1-3

What next for maternal health in the post–2015 UN Global Development Goals?


1 District AIDS Program Officer, Chief Medical Office, Kangra at Dharamshala, Department of Health and Family Welfare, Himachal Pradesh, Cum Epidemiologist- in-charge, Chamba, India
2 Freelance Researcher in Epidemiology and Ayurveda, Kangra, Himachal Pradesh, India

Date of Web Publication22-Dec-2015

Correspondence Address:
Surender N Gupta
District Program Officer, CMO office, Kangra at Dharamshala, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-3334.172409

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How to cite this article:
Gupta SN, Gupta N. What next for maternal health in the post–2015 UN Global Development Goals?. CHRISMED J Health Res 2016;3:1-3

How to cite this URL:
Gupta SN, Gupta N. What next for maternal health in the post–2015 UN Global Development Goals?. CHRISMED J Health Res [serial online] 2016 [cited 2019 Oct 21];3:1-3. Available from: http://www.cjhr.org/text.asp?2016/3/1/1/172409

Millennium Development Goals (MDG)-5 is one of the most important goals that we still need to achieve globally and holistically. Statistically, maternal health includes two targets as reducing maternal mortality ratio by 75% and universal access to reproductive health. While the proportion of births attended by a skilled health worker has increased globally, fewer than 50% of births are attended to in the WHO African Region. Despite a significant reduction in the number of maternal deaths–from an estimated 543,000 in 1990 to 287,000 in 2010–the rate of decline is just over half of what is needed to achieve the MDG-5A target by 2015. In 2008, 63% of women, aged 15–49 years who were married or in a consensual union were using some form of contraception, whereas 11% wanted to stop or postpone childbearing but were not using contraception, women over 4.4 million would, otherwise, have died during pregnancy or childbirth by 2030.[1],[2],[3] The principle causes of death among young women in low-income countries are complications from pregnancy and childbirth such as teenage pregnancies,[4] antepartum hemorrhage, postpartum hemorrhage, severe anemia, and obstructed labor.[5] As per the WHO report, ill health due to sexual and reproductive diseases burdened nearly 32% of the total in women of reproductive ages. Estimates due to maternal ailments show that neonatal disorders resulted in the loss of 201,959,000 disability-adjusted life years (DALYs), whereas a total of 16,104,000 DALYs were lost in 2010 owing to maternal ailments, which is an enormous point to note.[6] In low- and middle-income countries, 98% of all stillbirths and 99% of all deaths occurred as per one of the estimates within the first 28 days of life. Almost seven million children die before their fifth birthday, every single year. For the most part, these deaths are easily preventable. We know that the solutions are simple and affordable, having skilled birth attendants present, keeping babies warm and getting them safe water, nutritious food, proper sanitation, and basic vaccinations. Many children who die before they reach their fifth birthdays are born to mothers living in poverty, or in rural communities, or who are still in adolescence or otherwise vulnerable. By ending preventable child deaths, we are aiming for an upper threshold of 20 deaths/1000 live births in all income quintiles of the population.[7]

Certainly, progress has been made, but the goal is still a long way from being achieved. For the post-2015 UN Global Development Goals, one of the recommendations is that this goal be put on the agenda again, but, in a more comprehensive version: Ensure to improve maternal health. There are other points of concern such as (i) Universal access to primary education: Fewer children means families and governments have more resources to spend on education per child ensuring that more girls will receive primary education (MDG 2), and even more so secondary education have a strong impact on young people (especially girls) in terms of development (economically, due to later marriage, fewer children, earning potential, etc.,) and in lowering under-5 mortality (MDGs 4 and 5). Better health (MDGs 4–6) enables children to learn (MDGs 2–3). Let me add one more important point that every day, poverty condemns 1 out of 7 people on the planet to a struggle to survive. Many of those living in extreme poverty are ignored, excluded from opportunities, sometimes for generations. Today, over one billion people suffer under the hardship of living on less than the equivalent of $1.25 per person per day (MDG i). Today, globally 870 million people do not have enough to eat. Undernourished women give birth to underweight babies, who are less likely to live to their fifth birthday and more likely to develop chronic diseases and other limitations. First, one thousand days of a child's life are crucial to giving a child a fair chance; 165 million children are “stunted” or smaller than they should be for their age; others are “wasted” and anemic. Inadequate nutrition prevents their brains from developing fully and, ultimately, limits their ability to make a living.

Poverty is the primary cause of hunger and malnutrition. Reducing malnutrition, especially among the youngest children, is one of the most cost-effective of all development interventions. (ii) Empower Girls and Women and Achieve Gender Equality–the promotion of sexual and reproductive health and rights (SRHRs) is a vital step to achieve women's equality. About 340 million people a year are infected by sexually transmitted diseases.[8],[9] Gender equality transforms not only households but also societies. A woman who receives more years of schooling is more likely to make decisions about immunization and nutrition that will improve her child's chances in life; indeed, more schooling for girls and women between 1970 and 2009 saved the lives of 4.2 million children. (iii) Ensure healthy lives–these reduce infant mortality rate, maternal mortality rate, under-five child mortality rate, and improve neonatal care. It is also important that we need to reduce the burden of diseases such as HIV/AIDS, tuberculosis, malaria, neglected tropical diseases, and priority noncommunicable diseases. Healthy lives can be ensured if; we reduce sexually transmitted infections; promote healthy sexuality and reduce harmful practices; eliminate unsafe abortion; and provide universal access to family planning, etc.

On September 25th, 2015, the countries envisioned a world for 2030 where a renewed global partnership, building on the solid foundations of the Millennium Declaration and the Rio+20 principles, convened in Rio de Janeiro. In June 2012, and the outcomes would transform the world through a universal, people-centered, and planet sensitive development agenda achieved with the shared commitment and accountability of all and to end poverty, protect the planet, and ensure prosperity for all as part of a new sustainable development agenda. Each goal has specific targets to be achieved over the next 15 years, i.e., by 2030. The goals are intended to advance sustainable development through greater integration of its three pillars: Economic, social, and environmental. There should be a convergence of the sustainable development goals, and the Millennium Development Goals (MDGs) beyond 2015. We envision the world in 2030, where extreme poverty and hunger have been ended. We envision a world, where no person has been left behind, and where there are schools, clinics, and clean water for all. It is a world where there are jobs for young people, where businesses thrive, and where we have brought patterns of consumption and production into balance. We envision a world, where the principles of equity, sustainability, solidarity, respect for human rights, and shared responsibilities in accordance with respective capabilities have been brought to life by our common action. The role of civil society and political will would be very important for the success of such goals including MDG-5.

Reflections on political realism: Improvement in maternal health needs to be put on the international agenda. Family planning was recognized as a human right in the Convention on the Elimination of all Forms of Discrimination Against Women (1979). However, the beliefs and barriers on this topic cause a great cultural and political opposition. Improvement in maternal health will also be a major challenge when health systems do not compartmentalize and exclude SRHR. Still, we need to focus on equity, poverty reduction, human rights, gender equality, and empowerment of women and girls and also invite global partners, donors, and implementers, and all decision makers to take a people-centered, context-specific, rights-focused approach, grounded in the implementation of effectiveness and accountability to plan for maternal and newborn health and mortality reduction in the post-2015 period.

 
  References Top

1.
Health in the Post-2015. Agenda-Report of the Global Thematic Consultation on Health; April, 2013.  Back to cited text no. 1
    
2.
WHO Factsheet; 2012. Available from: http://www.who.int/mediacentre/factsheets/fs348/en/. [Last accessed on 2015 Aug 26].  Back to cited text no. 2
    
3.
UN. Millenium Development Goals and Beyond 2015. Goal 5: Improve Maternal Health. United Nations. 2013; 18 October, 2013.  Back to cited text no. 3
    
4.
UNFPA. Framework for ACTION on ADOLESCENTS and Youth. Opening Doors with Young People: 4 Keys. New York: UNFPA; 2007.  Back to cited text no. 4
    
5.
Sed T. Sexual and Reproductive Health and rights: In Defence of Life. A Background Document. Copenhagen: ENRECA HEALTH Working Group on Sexual and Reproductive Health; 2012.  Back to cited text no. 5
    
6.
UNFPA. Sexual and Reproductive Health for All. Reducing Poverty, Advancing Development and Protecting Human Rights. New York: UNFPA; 2010.  Back to cited text no. 6
    
7.
Child Survival Call to Action. Available from: http://www.apromiserenewed.org/files/APR_Progress_Report_2012_final_web3.pdf. [Last accessed on 2015 Aug 26].  Back to cited text no. 7
    
8.
Glasier A, Gülmezoglu AM, Schmid GP, Moreno CG, Van Look PF. Sexual and reproductive health: A matter of life and death. Lancet 2006;368:1595-607.  Back to cited text no. 8
    
9.
Singh S, Darroch J. Adding it Up: Costs and Benefits of Contraceptive Services. Estimates for 2012. UNFPA, Guttmacher Institute: 2012. p. 16. Available from: https://www.guttmacher.org/pubs/AIU-2012-estimates.pdf. [Last accessed on 2015 Aug 26].  Back to cited text no. 9
    




 

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