By: Tunde Ajidagba, Women Deliver Young Leader, Nigeria
In the past 15 years, there has been substantial achievement toward reaching Millennium Development Goals (MDGs) 4 and 5, which seek to reduce child mortality and improve maternal health. Since 1990, the baseline year for the MDGs, child and maternal deaths both have decreased globally by around 50%, and contraception prevalence has increased from 55% to 63%.
While progress has been sustained globally, it has been inequitable across and within countries and has been hampered by limited access to quality services. Despite some success stories, many developing countries, especially in sub-Saharan Africa, still did not achieve MDGs 4 & 5. Progress varies widely across countries even when levels of income are the same. As a doctor in Nigeria, I want to share from the health worker perspective why many developing countries did not meet the MDGs 4 and 5 goals. It is very important to understand why progress was delayed in these countries in order to inform post-2015 strategies.
In 2013, 2.8 million newborn babies died in their first month of life and 2.6 million babies were stillborn. More than 75% of newborn deaths occur in South Asia and sub- Saharan Africa. More than 80% of neonatal deaths in sub-Saharan Africa and South Asia occur in babies and could be prevented with simple newborn care. At present rate of progress, it will be more than a century before a baby born in Africa has the same chance of survival as one born in a high income country.
Globally, there were an estimated 289,000 maternal deaths in 2013, a decline of 45% from 1990. The sub-Saharan African region alone accounted for 62% (179,000) of global deaths, followed by Southern Asia at 24%. At the country level, the two countries that accounted for one-third of global maternal deaths are India at 17% (50,000) and Nigeria at 14% (40,000).
As a health worker working in a public hospital in Nigeria, I believe many developing countries did not achieve MDGs 4 & 5 due to the lack of a continuum of care, or sufficient skilled health workers during pregnancy, at the time of delivery, and shortly after the baby is born. Skilled providers include doctors, nurses, midwives or auxiliary nurses.
The majority of women in developing countries live in rural areas. Women in these areas face greater obstacles in accessing care as those living in urban areas at every point on the continuum. In Nigeria, 74% of women living in the urban areas received at least four antenatal care visit from a frontline health worker, while 38.2% of the women living in rural areas received at least four antenatal care visits. Also, 67% of women in urban areas had their birth assisted by a skilled provider, while 22.7% of women in rural areas had their births assisted by a skilled provider.
Having a skilled attendant at delivery is very important because most maternal deaths arise from complications during or shortly after delivery. Even if antenatal care is received, any delivery can become a complicated one and the presence of a skilled provider makes a huge difference.
Countries who did not achieve MDG 4 and 5 face serious health system challenges, particularly in financing their health workforce when there is low health workforce density of doctors and midwives. Efforts should be made to strengthen existing health systems to improve access and quality of care. There should be opportunities for doctors, nurses, midwives and auxiliary nurses to upgrade specific skills, such as management of preterm births, in-patient care of ill and small newborn babies, and management of severe infections. There should be incentives for quality health workers, especially those in rural areas.
As we set goals in the post-2015 development framework, countries who could not achieve MDGs 4 & 5 should focus on improving care at birth for women and their babies, targeting small and ill newborn babies. Health care bottlenecks, especially the shortage of midwives and neonatal nurses on the frontlines, should be addressed. This way, the post -2015 agenda will not be another empty rhetoric for developing countries.