Women Deliver post–2015

Abstract

The theme for today's Lancet is the third Women Deliver conference in Kuala Lumpur, Malaysia on May 28–30. To document progress, barriers, and opportunities in reproductive, maternal, newborn, and child health, the journal's research section has been expanded to accommodate six studies; more will be published online. The studies use different methods to show the multidimensional nature of reproductive health and the influence of social determinants and health systems. Kuala Lumpur is an inspiring venue. As Raj Karim and Siti Hasmah Mohamad Ali observe in their Comment, Malaysia's 65% reduction in maternal mortality followed an emphasis on education for women, in the realisation that investment in young people is an investment in the future of the country. Some of the shared—although disproportionately borne—challenges for Women Deliver are summarised in “Surviving the first day” State of the World's Mothers 2013 published by Save the Children on May 7. The report examines circumstances surrounding the deaths of 1 million children on the day they were born (15% of all deaths in the first 5 years of life). The familiarity of the facts makes them no less striking: ten countries account for both 65% of the 3 million deaths of children aged younger than 1 month and 59% of maternal deaths. Many countries with the highest maternal mortality ratios are fragile states, which reinforces the relation of birth outcomes with women's empowerment, health systems, and social factors. To emphasise these points, a Mothers' Index is derived from maternal mortality, child mortality, formal schooling, economic status, and political engagement. Of the ten best performing countries, eight are in Europe; whereas all of the ten countries serving women least well are in sub-Saharan Africa. The report makes recommendations to address the underlying causes of newborn mortality, to invest in health workers and low-technology perinatal interventions, and to strengthen health systems and improve access to care. These ongoing challenges feature in today's issue. Mortality in pregnancy and childhood is exacerbated by poor nutrition, infection, and the lack of control over fertility that shadows limited education, early marriage, and barriers to family planning. A longitudinal study of HIV data in eastern and southern Africa by Basia Zaba and colleagues shows that pregnant women infected with HIV have an eight-fold greater risk of death than their uninfected peers. Such new information supports the efforts of countries like Malawi to treat HIV beyond the puerperium. Effective family planning is needed to space births optimally. Jacqueline Darroch and Susheela Singh report that although use of contraception has kept pace with population growth, the reduction in the proportion of unmet need is modest. In a Viewpoint, Sarah Hawkes and Kent Buse consider other gender-related barriers to care. Greater participation by women in education, work, and government are as necessary for improved outcomes as access to family planning and skilled birth attendants. Likewise, strengthening health systems requires a change in culture, as well as organisation. In João Paulo Souza and co-authors' study, the mere presence of essential interventions did not translate into reduced maternal mortality. To save more lives, hospital-based interventions for mothers and newborns must be universally accessible and supported by comprehensive emergency care of good quality. Investment has a key role in improving outcomes. Official development assistance must be broad to address the many factors that influence reproductive outcomes. Justine Hsu and colleagues express concern that discrete needs may be overshadowed by big-ticket items such as HIV care. Therefore, a more granular assessment of aid might help guide evidence to target additional important interventions. Of particular interest are low-resource projects that mobilise communities to improve care, as in the meta-analysis of women's groups by Audrey Prost and coworkers. Throughout this issue, a sense of shared passion is palpable. Thanks to a multitude of committed people in diverse roles and locations, reproductive health outcomes are improving. Nowhere is this affirmed more clearly than in the Art of Medicine by Kristin Solberg from Afghanistan. The question for Women Deliver is how to best harness passion and hard work to accelerate progress efficiently. That the fifth Millennium Development Goal to reduce the maternal mortality ratio by three quarters before 2015 will be missed should not dull aspirations, but rather, sharpen resolve. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI1MzQ2MDkyMzFiOTVhN2UwODlkOWZlNjY4ZmFmYjU2ZSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc5NDAyMjE2fQ.aqDQ02JjsUozt4W21AT7BcIRldQ6RMH4k0mTaq3wy41pi9k2qiAELg2YGXDO7ri7gTJxdUpLx4Dtlrb94VlRTuO3J5-tTqnSE8xxi7dnN3KSCGiNSz9rQ8lR-nZj0qZ76VQDD_HsKOqs453xxvEtBzeoSAHKQcQp5cIoqT_JhDcSo_KCLVHEvSaEtTxTnQys5oren-bKI8l6_iDqtqxxGdItNAEqIXW8jdgM4zUx18uYELQhg7xGa3hgta9i9eHAR5zPlobUkkOnPoncXy5TWUWx2UPkiwdszM7vsFbIQwKl8Lo6Tj7wzq21cORb-L6qOXfiL89lzIhoIvnIqGsqew Download .mp4 (18.87 MB) Help with .mp4 files Supplementary videoAna Langer discusses key issues in women's health, focusing on progress since the inaugural Women Deliver meeting in 2007, and the role of women's health in the post 2015 agenda. Maternal health in Malaysia: progress and potentialThe third Women Deliver conference, on May 28–30, 2013, in Kuala Lumpur, Malaysia, marks a new chapter for maternal health in Malaysia and worldwide. We have witnessed national maternal mortality rates in Malaysia decrease from 540 per 100 000 livebirths in 1957 to just 28 in 2010.1 The percentage of women delivering in national institutional settings rose from 10% in 1957 to 98·7% in 2005.2 We hope that Malaysia's successes and the struggles that we continue to face will be useful to countries working to improve maternal and reproductive health. Full-Text PDF Running a school of lifeThe doctor entered the classroom with a stethoscope around her neck, and a purple veil neatly tied over her white coat. There, she watched as her students practised a breech delivery on a plastic doll. “Careful with the neck”, she said, as a student wiggled a baby doll out, legs first. The women in the classroom were midwifery students, there to learn how to save lives in the impoverished Afghan countryside, where death is ever present, even as life begins. Full-Text PDF Effect of women's groups and volunteer peer counselling on rates of mortality, morbidity, and health behaviours in mothers and children in rural Malawi (MaiMwana): a factorial, cluster-randomised controlled trialCommunity mobilisation through women's groups and volunteer peer counsellor health education are methods to improve maternal and child health outcomes in poor rural populations in Africa. Full-Text PDF Open AccessWomen's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysisWith the participation of at least a third of pregnant women and adequate population coverage, women's groups practising participatory learning and action are a cost-effective strategy to improve maternal and neonatal survival in low-resource settings. Full-Text PDF Open AccessMoving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional studyHigh coverage of essential interventions did not imply reduced maternal mortality in the health-care facilities we studied. If substantial reductions in maternal mortality are to be achieved, universal coverage of life-saving interventions need to be matched with comprehensive emergency care and overall improvements in the quality of maternal health care. The MSI could be used to assess the performance of health facilities providing care to women with complications related to pregnancy. Full-Text PDF Trends in contraceptive need and use in developing countries in 2003, 2008, and 2012: an analysis of national surveysAchievement of the desired number and healthy timing of births has important benefits for women, families, and societies. To meet the unmet need for modern contraception, countries need to increase resources, improve access to contraceptive services and supplies, and provide high-quality services and large-scale public education interventions to reduce social barriers. Our findings confirm a substantial and unfinished agenda towards meeting of couples' reproductive needs. Full-Text PDF Effect of HIV infection on pregnancy-related mortality in sub-Saharan Africa: secondary analyses of pooled community-based data from the network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA)HIV-infected pregnant or post-partum women had around eight times higher mortality than did their HIV-uninfected counterparts. On the basis of this estimate, we predict that roughly 24% of deaths in pregnant or post-partum women are attributable to HIV in sub-Saharan Africa, suggesting that safe motherhood programmes should pay special attention to the needs of HIV-infected pregnant or post-partum women. Full-Text PDF Open AccessReproductive health priorities: evidence from a resource tracking analysis of official development assistance in 2009 and 2010Donors are prioritising reproductive health, and the slight increase in funding in 2009–10 is welcome, especially in the present economic climate. The large share of such funding for activities related to HIV infection in women of reproductive age affects the amount of ODA received by priority countries. It should thus be distinguished from resources directed to other reproductive health activities, such as family planning, which has been the focus of recent worldwide advocacy efforts. Tracking of donor aid to reproductive health should continue to allow investigation of the allocation of resources across reproductive health activities, and to encourage donor accountability in targeting aid flows to those most in need. Full-Text PDF Gender and global health: evidence, policy, and inconvenient truths“Gender is probably the most restricting force in American life”Gloria Steinem (American journalist, social activist and feminist), 2008 Full-Text PDF