Women and children first

DELHI

This year's World Health Report highlights maternal and child health

Safdarjung Hospital, in Delhi, is a typical health-care facility in the developing world, teeming with humanity at va­rious stages of life and death. But for the 23,000 women a year who come here to deliver their babies, Safdarjung is unusual in one very important respect. For the past few years, the hospital has been tracking the deaths of pregnant women within its walls, trying to understand at exactly what point things go wrong.

This information is helping to change medical practice, says Sudha Salhan, head of obstetrics at Safdarjung. For example, the hospital now does more partial blood transfusions to its pregnant patients than before, to help tackle the anemia which dangerously complicates deliveries. Such improvements mean there were just over 100 maternal deaths at the hospital last year – low by Indian standards.

Such close attention to maternal, and child, mortality is still rare in many poor countries, according to the World Health Organization (WHO), which launched its flagship World Health Report in Delhi this week. While great improvements have been made in some places-such as Egypt and Sri Lanka-many others, particularly in sub-Saharan Africa, are struggling to keep their women and children healthy. Approximately 300m women in poor countries currently suffer from some sort of illness due to pregnancy or childbirth. According to the report, roughly 530,000 died in pregnancy or delivery last year-and that is undoubtedly an underestimate.

In addition, there were more than 3m stillbirths and 4m infants who did not survive their first month of life.

The tragedy, according Joy Phumaphi, assistant director-general for family and community health at the WHO, is that saving many of these lives would not be difficult. While a complex set of factors, from AIDS to poor educational and economic opportunities of women, contribute to the problem, the technical solutions are well-known and relatively cheap – for example, immunization to protect infants, and simple drugs such as magnesium sulphate for pre-eclampsia to deal with some of the complications of childbirth.

But the key to solving the problem is not so much technology as organization. The biggest challenge, says Ms Phumaphi, is to find the political will – and the re-sources-to create primary-health care systems that bring together the public, private and informal sectors and to make a concerted effort to include the needs of moth­ers and children in the process. Given the ramshackle state of much of the poor world's medical infrastructure, and severe shortages of trained health-care workers, this is a tall order.

The WHO reckons it will cost an additional $6.1 billion a year by 2015 to provide better access to maternal and new-born care in 75 hard-pressed countries-not a trivial amount to raise at a time when donor aid for reproductive health has been falling. But without more effort, the Millennium Development Goals of reducing maternal mortality by three-quarters and child mortality by two-thirds by 2015, will remain a hurdle, not a target.

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