Findings from the Field

A Decade of Tracking Progress for Maternal, Newborn and Child Survival: The 2015 Report

Countdown launched its 2015 Report on October 19, 2015, at the first Global Maternal & Newborn Health Conference, held in Mexico City.

The 2015 ReportA Decade of Tracking Progress for Maternal, Newborn and Child Survival, includes an updated country profile for each of the 75 Countdown countries, which together account for more than 95% of the world’s maternal, newborn, and child deaths. This final Countdown to 2015 report provides a summary of results from 2015 based on the data presented in country profiles, and builds on a companion article that was published simultaneously inThe Lancet. It examines trends in mortality and nutrition; intervention coverage (including inequality); financial flows to reproductive, maternal, newborn and child health; and supportive policy and systems measures. The report also assesses changes in data availability and their implications for program managers and decision makers. Finally, it turns critical lens on the Sustainable Development Goals framework and future accountability efforts, drawing from Countdown’s 10 years of monitoring experience.

In short, the 2015 Report shows that, although some health issues and some countries have seen considerable progress, important gaps remain that must not be forgotten in the transition to the Sustainable Development Goals. Highlights of the report show:

There is good news on maternal and child survival, but MDGs 4 & 5 have mostly not been achieved.

  • Maternal and child survival have improved markedly during the MDG era: Both maternal and under-five mortality have been reduced by about half since 1990, and the rate of improvement has accelerated after 2000.
  • Many countries have ‘graduated’ from Countdown: More than half of the 68 countries that were included in Countdown because they exceeded specified ‘threshold’ levels of child or maternal mortality have succeeded in reducing mortality levels below those thresholds.
  • MDGs 4 and 5 remain mostly unfulfilled: Fifty Countdown countries will fail to achieve the child mortality reductions promised in MDG 4, and 69 of 75 countries will not achieve the maternal mortality reductions required to fulfill MDG 5. Only 4 of the 75 Countdown countries – Cambodia, Eritrea, Nepal, and Rwanda – will achieve both MDGs 4 and 5.

Newborn survival and child nutrition are two key, continuing challenges that must be addressed.

  • Newborns account for 45% of all under-5 deaths: Neonatal conditions cause an increasing share of all child deaths as interventions are successful in reducing deaths of older children
  • Nutrition is crucial – and far too many children are still hungry: In more than half of all Countdown countries, stunting (a sign of inadequate diet and repeated illness) affects at least 30%, and wasting (a marker of acute malnutrition) 5% or more, of all children under age 5. Undernutrition is an underlying cause of almost half of all child deaths.

Coverage of key interventions is still unacceptably low, and varies greatly across countries.

  • Higher intervention coverage means lower mortality: New analysis confirms the clear association of increased coverage of essential interventions with reduced child mortality, even when adjusted for economic growth and other factors.
  • Universal coverage remains a distant target for most interventions in most countries:  Vaccines and many malaria and HIV interventions have been prioritized and achieved significant improvements, but most other interventions still fail to reach a third or more of the women and children who need them.
  • Services requiring contact with a working health system have lagged the most: Family planning, pregnancy and childbirth services, and childhood disease management still have large coverage gaps.

Equity has improved, but not nearly enough.

  • Across the Countdown countries, there are systematic pro-rich inequalities for virtually all coverage indicators: These equity gaps are widest for interventions requiring access to health facilities.
  • Globally, coverage has increased more for the poor than for the rich, so the equity gap is gradually shrinking: Coverage equity is improving in both absolute and relative terms, but it remains a pressing challenge in virtually every Countdown country.
  • Countries succeed in improving overall coverage when they focus on reducing inequity: Rapid progress in coverage came when countries effectively reached the poorest families.

High, equitable coverage requires financial investment, supportive policies, and strengthened health systems.

  • Donor funding has increased, but countries’ reliance on out-of-pocket spending is a concern: Aid for MNCH tripled from 2003 to 2012, and recent attention to neonatal survival has led to increased newborn health commitments.
  • Many countries have made progress in adopting supportive policies: More research is needed to better understand the strength of countries’ implementation after policies are adopted.
  • Most Countdown countries have a severe shortage of skilled health workers: Countdown countries have a median of 10.2 skilled health workers per 10,000 population, and ¾ are below the WHO benchmark of 22.8 per 10,000.

More data are now available; more and better data are still needed.

  • More countries are conducting more frequent household surveys: Countries can use this data to support evidence-based decision making about policies and programs.
  • Better data are needed for assessing quality of care: Coverage data often measure service contacts, but don’t tell what occurred during that service contact.