By Suzanne Stalls, CNM, MA, FACNM, ACNM Vice President of Global Outreach
The Millennium Development Goals (MDGs) draw to a close this year, and maternal and child health providers have much to reflect on for numbers 4 and 5.
Millennium Development Goal 5 is to reduce maternal mortality by 75%. Unfortunately, the global rate of maternal mortality has been falling annually at less than half of what would be required to achieve the goal. While the number of deaths has fallen significantly, there are countries, such as the United States, where the maternal mortality rate has actually risen.
MDG #4 will not be met either. This goal is to reduce the mortality rate of children under the age of 5 by two-thirds. Again, some progress has been made: in 1990, deaths of children under age 5 numbered 12.7 million worldwide. By 2013, the rates had declined 47% for a total of 6.3 million deaths. The rate of decline has largely been attributed to intensive, vigorous interventions in the areas of pneumonia, diarrhea, and immunizations.
Since child deaths from pneumonia, diarrhea, and infectious diseases have dramatically declined, newborn deaths now contribute a proportionally higher amount to mortality in children under 5 – 45%, in fact. And of those newborn deaths, prematurity is the leading cause. Prematurity is not exclusive to the developing world. The United States, Brazil, India, and Nigeria all have a place in the top 10 countries with highest rate of prematurity.
In the majority of health care settings of the world, midwives are the frontline health workers for women and children.
Because of this reality, midwives, more than any other cadre, have the greatest opportunity to provide family centered, evidence-based care and improve outcomes for women and newborns. In the United States, for example, midwife-attended births have a much lower incidence of prematurity and low birth weight. As the world’s attention is focusing more strongly on mothers and premature infants in preparation for the post-MDG era, midwives throughout the world will be essential to addressing gaps in quality of care, access, and availability.
In September 2014, USAID awarded a 5-year, $9 million Cooperative Agreement to ACNM, Project Concern International (PCI), and the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS). The project is called Every Preemie-SCALE, and is designed to provide practical, catalytic approaches for expanding uptake of preterm birth and low birth weight interventions in the 24 USAID priority countries in Africa and Asia. ACNM will be leading the effort to build health provider capacity and performance improvement activities, working with nurses, midwives, and other providers in Ethiopia, Malawi (where the highest rates in the world of preterm birth occur), and India. We will be supporting efforts to improve maternal well-being before, during, and after pregnancy by addressing prematurity prevention, pregnancy complications which lead to prematurity, and effective postpartum practices such as birth spacing and care of the preterm infant. By focusing on the maternal-newborn dyad as an inseparable unit of care, we can improve the health and wellbeing of both mother and child.