Women’s, Children’s, and Adolescents’ Health

open access

Towards a new Global Strategy for Women’s, BMJ: first published as 10.1136/bmj.h4414 on 14 September 2015. Downloaded from Children’s and Adolescents’ Health We know what needs to be done, say Marleen Temmerman and colleagues, but we need to push hard now to create a world in which every women, every child, and every adolescent is able to survive, thrive, and transform

he year 2015 marks a defining tary general called on the world to develop a important is the protection and sustenance moment for the health of women, strategy to improve maternal and child of often fragile gains in some countries, the children, and adolescents. It is the health in the world’s poorest and high bur- importance of which became clear with the end point of the United Nations’ den countries, starting with 49 low income Ebola virus disease epidemic and its results: millennium development goals, countries. weak health systems for maternal and child andT their transition to the sustainable devel- The 2010 Global Strategy for Women’s and health in west Africa became further opment goals, and also the 20th anniversary Children’s Health was a bellwether for a weakened.­ of the International Conference on Popula- global movement and led to significant prog- tion and Development’s plan of action and ress worldwide in women’s and children’s Successes, lessons, gaps, and emerging the Beijing Declaration and platform of survival and health. The Every Woman Every priorities action. Child movement that grew out of the Global The 15 papers in this collection are the bed- This is a moment of reflection as well as Strategy mobilised stakeholders in all sec- rock on which the new strategy is developed. celebration. Although great strides have tors to work towards shared goals. It fostered They summarise the current state of evidence been made in reducing maternal and child national leadership, attracted new resources and underscore successes as well as critical mortality, showing that change is possible, and financial commitments, and created a gaps in progress, emerging priorities, and the many countries are lagging behind in reach- worldwide movement of champions for the key interventions needed for a new genera- ing millennium development goal 4 (to health and wellbeing of every woman and tion of women, children, and adolescents. reduce the under 5 mortality rate by two every child. Based on a life course approach of inter- thirds between 1990 and 2015) and goal 5 (to Good progress has been made towards ventions and a goal of universal health cov- reduce the maternal mortality ratio by three realising the vision to end all preventable erage, the papers highlight the critical quarters between 1990 and 2015 and achieve maternal, newborn, and child deaths within interventions needed to ensure that women, http://www.bmj.com/ universal access to reproductive healthcare a generation. Millions of lives have been children, and adolescents are able to sur- by 2015), and there are vast inequities saved, and progress towards the health vive, thrive, and transform. Their analysis is between and within countries. In 2010, con- related millennium development goals was based on a synthesis of evidence from epide- fronted with unacceptably high rates of accelerated. Child mortality fell by 49% and miological and health data on effective strat- maternal and child mortality, the UN secre- maternal mortality by 45% between 1990 and egies and interventions to realise the health 2013. Strides forward were made in areas and human rights of women, children, and

such as access to contraception and maternal adolescents around the world. on 2 October 2021 by guest. Protected copyright. Stages in updating the Global Strategy and child health services, skilled attendance A key success of the past two decades has • Initiative was led by the UN secretary general at births, reduced malnutrition, newborn been the global reduction of child mortality and World Health Organization, together with interventions, management of childhood ill- by 49% and maternal mortality by 45%. Health 4+ (the joint UN agency partnership to nesses, immunisations, and combating HIV However, much more needs to be done. Each improve women’s and children’s health) and and AIDS, malaria, and tuberculosis. day 800 women and 7700 newborns die from the Partnership on Maternal, Newborn and complications during pregnancy and child- Child Health The new strategy birth and from other neonatal causes, and • WHO led the development of papers by expert working groups in key areas The new Global Strategy for Women’s, Chil- 7300 women experience a stillbirth. While • Fifteen working papers were developed dren’s and Adolescents’ Health, released important gains have been registered since through online consultation and input from this month (see box), builds on lessons the launch of the 2010 Global Strategy, experts learnt and new evidence and focuses on crit- women, children, and adolescents around • A multistakeholder writing group was ical population groups, such as adolescents the world continue to experience serious vio- constituted and women and children living in fragile and lations of their health and of health related • Consultations took place with member states conflict settings. Its key objectives are to sup- human rights.1 and stakeholders in Geneva, New Delhi, and port the resilience of health systems, to One of the key factors behind the reduc- Johannesburg improve the quality of health services and tion of maternal and child mortality has • Online consultation with public on zero draft ensure equitable coverage, and to work with been improved access to essential interven- of the Global Strategy health enhancing sectors (such as educa- tions and services. Family planning, antena- • New Global Strategy launched at UN General tion, water and sanitation, and nutrition). tal care, delivery at facilities, and skilled Assembly in September 2015 As we start to define the sustainable birth attendance have all increased over the • Operational framework for the new Global development goals and related targets, we past two decades. However, huge inequities Strategy due to be presented at World Health Assembly in May 2016 must increase the momentum in women’s, in coverage and quality continue, and fur- children’s, and adolescents’ health. Equally thermore stronger effort is needed to remove

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barriers to access, which continue to impede communicable and non-communicable dis- outcomes. Low and middle income countries success.2 3 eases (including cancers), and mental can have2: BMJ: first published as 10.1136/bmj.h4414 on 14 September 2015. Downloaded from In particular, postpartum care for mothers health—all based on a life course approach. and newborns has not received due attention The targets identified in the sustainable • Up to three times more pregnancies among and remains a missed opportunity in repro- development goals,5 together with the trans- teenage girls in rural and indigenous pop- ductive, maternal, newborn, and child formative agenda envisioned in the new ulations than in urban populations health. Investments in women’s health Global Strategy to ensure that women, chil- • A difference of up to 80% between the beyond reproductive health needs greater dren, and adolescents survive, thrive, and richest and poorest people in the propor- attention, given the rise of effects on health transform, are the impetus to create a para- tion of births attended by skilled health related to non-communicable disease, such digm shift within a generation. personnel as cancer, obesity, and diabetes. This vision necessitates a comprehensive • A gap of at least 18% between the poorest But substantial progress has been made in approach that takes into account the struc- and richest people in the proportion who preventing HIV among neonates, thanks to tural determinants of health, tackles inequi- seek care for children with pneumonia programmes to prevent transmission from ties in access to healthcare, and encourages symptoms, and mother to child. Another success is the accountability. Despite decades of unprece- • A difference of least 25% in antenatal care increase in the prevalence of exclusive breast dented medical advances and innovations in coverage (of at least four visits) between feeding and of oral rehydration therapy, healthcare, the quality of care in general— the most and least educated and between though further effort is needed to increase and of women’s, children’s, and adolescents’ the richest and poorest. coverage. Deaths of children aged under 5 health in particular—is often weak. Building The papers in this supplement highlight years remain high in sub-Saharan Africa and on and extending this unfinished agenda, the three key areas of priorities for the new southern Asia, and many more children’s papers in this collection elaborate the actions Global Strategy: the health needs of adoles- lives could be saved through the equitable needed to improve health and wellbeing of cents, multisectoral response, and emer- scale-up of available, cost effective interven- women, children, and adolescents around the gency situations. tions. A broader and holistic global agenda world. on child health is needed that retains the aim A “grand convergence” is well within our Meeting health needs of adolescents to end preventable deaths among under 5s reach.6 Given political momentum, and with A critical new priority at the heart of the while being able to deal with emerging prior- the existing evidence, we now have the new Global Strategy is the focus on adoles- ities and to achieve sustainable gains among opportunity to end preventable deaths cents. Adolescents aged 10-19 years have school age children. among all women, children, and adoles- specific needs and require a responsive Evidence shows that interventions that are cents, to vastly improve their health, and to health system that takes into account their particularly effective in the areas of repro- bring about the transformative changes biological, emotional, and social develop- ductive, maternal, newborn, and child needed to fully realise their human rights ment. Ensuring their healthy development health are family planning, management of and build resilient and prosperous societies. means making the health system work for http://www.bmj.com/ labour and delivery, care of preterm births, We know what needs to be done. With a adolescents. But it also requires a focus on breast feeding, and treatment of serious concerted effort we can eliminate wide dis- social risk factors as well as on the factors infectious diseases and acute malnutrition parities in preventable mortality and mor- that can offer a protective effect across vari- The new Global Strategy also needs to bidity. In particular, by improving access to ous health outcomes. This focus includes pay attention to adverse experiences in essential health interventions and building the legal and policy environment. early childhood that can increase the risk resilient health systems, we can achieve the To realise the health and wellbeing of

of poor social and health outcomes such as grand convergence within a generation and adolescents and protect their human on 2 October 2021 by guest. Protected copyright. low educational attainment, economic create a world in which no woman, child, or rights, countries need to adopt holistic dependency, increased violence, crime, adolescent faces a greater risk of preventable health policies and education programmes and substance abuse, poor mental health, death just because of where they live. about prevention of injuries, violence, and and a greater risk of adult onset non-com- The new Global Strategy is central to the self harm; good sexual and reproductive municable diseases such as obesity, cardio- realisation of this objective. It provides a plat- health outcomes; prevention of non-com- vascular disease, and diabetes. form for completing the unfinished work of municable disease; and other crucial the health related millennium development aspects of physical and mental health and Paradigm shift goals and to help countries implement the development. Such education will help The evidence is clear: investment in child- post-2015 development agenda and the health adolescents enhance judgment and learn birth and delivery can quadruple returns in related sustainable development goals and the skills to maximise their health and terms of women’s and newborn’s lives targets. wellbeing. saved and stillbirths and disabilities reduced.4 The papers in this supplement A vision for the future A multisectoral response underline the imperative to accelerate Despite some progress, societies are still fail- Another distinguishing feature of the new momentum and protect the gains made ing women, children, and adolescents, most Global Strategy is its explicit focus on the while also calling for innovative thinking acutely in poor countries and among the role of health enhancing and health enabling and cutting edge research and approaches poorest communities in all countries. We will sectors. The evidence provided throughout to meet the needs and aspirations of mil- fail in our endeavours if we do not compre- this supplement highlights the importance lions of women, children, and adolescents hensively address everyone’s health needs. of such interventions in the articulation of a around the world. Women, children, and adolescents who are comprehensive approach to health. Work on creating a new paradigm for marginalised suffer from various inequities Attention needs to be paid to strengthen- women’s, children’s, and adolescents’ health and discrimination, such as those based on ing health systems’ response. Weak capacity will need to be done in a range of areas, such gender, income, age, place of residence, and in health systems and the health workforce, as sexual and reproductive health and rights, education levels, resulting in worse health gaps in infrastructure, and a “verticalised”

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focus on biomedical aspects of health Conclusions Provenance and peer review: Not commissioned; externally peer reviewed. ­interventions hinder the attainment of health Implementation of the new Global Strategy The authors alone are responsible for the views BMJ: first published as 10.1136/bmj.h4414 on 14 September 2015. Downloaded from goals. Health system resilience, conversely, depends on effective and independent expressed in this article, which does not necessarily hinges on institutional capacity and human accountability. However, the reality is very represent the views, decisions, or policies of WHO or the capital to adapt and respond to emerging different. Several countries still do not have institutions with which the authors are affiliated. shocks and needs. And policy and systems of civil registration and vital statis- Marleen Temmerman, director, Department of Reproductive Health and Research, World Health ­operational systems need to ensure continu- tics monitoring or functioning national Organization, Geneva ing capacity to deliver essential health ser- health accounts and information systems. Rajat Khosla, human rights adviser, Department of vices equitably, even during an emergency, To ensure accountability, a minimum stan- Reproductive Health and Research, World Health including by building greater self reliance dardised reporting system is needed that Organization among communities. enables comparison of progress across coun- Zulfiqar A Bhutta, director, Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Innovation and financing are central to tries and regions. Such a system would also Canada, and Center of Excellence in Women and Child this new vision for women’s, children’s, and strengthen national capacity and ensure an Health, Aga Khan University, Pakistan adolescents’ health. There is an urgent need inclusive process for stakeholders. Further- Flavia Bustreo, assistant director general, Family, to scale up innovations in a sustainable more, indicators recommended by the 2011 Women and Child Health Cluster, World Health Organisation manner. Crucially, we also need to transform Commission on Information and Account- Correspondence to: R Khosla [email protected] the financing landscape, by supporting the ability need to be augmented to encompass © World Health Organization 2015. Licensee BMJ value for money agenda; to foster an inte- the much broader agenda of the 2015 strat- This is an open access article distributed under the grated approach to complete the unfinished egy, including human rights. The critical terms of the Creative Commons Attribution- agenda on child health; and to break down role played by UN agencies, academia, and Noncommercial IGO License (https://creativecommons. the silos separating the flows of financing consortiums such as Countdown to 2015 in org/licenses/by-nc/3.0/igo/), which permits use, distribution, and reproduction for non-commercial between women, children, and adolescents. the accountability process for millennium purposes in any medium, provided the original work is Better mechanisms are needed for financing development goals 4 and 5 must be rec- properly cited. In any reproduction of this article there the health of women, children, and ognised.8 In the new Global Strategy we should not be any suggestion that WHO or this article endorse any specific organisation or products. The use ­adolescents who live in conflict or post-­ need to further strengthen this process, with of the WHO logo is not permitted. This notice should be conflict settings. And we need to foster inno- an eye on country level accountability and preserved along with the article’s original URL. vative financing models at global, regional, action, and also ensure alignment between 1 Every Woman Every Child. Saving lives protecting futures. 2015. www.everywomaneverychild.org/ and national levels. global and national levels of accountability global-strategy-2/gs2-progress-report. and monitoring. 2 World Health Organization. State of inequality: Humanitarian crises and emergencies The new Global Strategy gives us a once in reproductive, maternal, newborn and child health. WHO, 2015. www.who.int/gho/health_equity/ Critical new evidence points to the impor- a lifetime opportunity to change the dis- report_2015/en. tance of paying urgent attention to emergen- course regarding the health of women, chil- 3 Guttmacher Institute. Adding it up: the costs and

benefits of investing in sexual and reproductive health http://www.bmj.com/ cies. Specific vulnerabilities of women, dren, and adolescents. It is clear that 2014. May 2015. https://www.guttmacher.org/pubs/ children, and adolescents living in humani- business as usual will not work. For women, AddingItUp2014.html. tarian crisis settings threaten their health children, and adolescents around the world 4 Stenberg K, Axelson H, Sheehan P, et al. Advancing social and economic development by and wellbeing and the realisation of the to survive, thrive, and transform, we need investing in women’s and children’s health: a new Global Strategy. Though it is clear that transformative actions that will result in global investment framework. Lancet 2014;383:1333-54. humanitarian crises put women, children, enormous social, demographic, and eco- 5 UN Open Working Group of General Assembly on SDGs. and adolescents at grave risk, national plan- nomic benefits. This is a vision that can unite Sustainable development goals. 2014. https://

ning processes often leave humanitarian us all: united we stand, divided we fall. sustainabledevelopment.un.org/content/ on 2 October 2021 by guest. Protected copyright. documents/1579SDGs%20Proposal.pdf. preparedness, response, and recovery out of 6 Global health 2035: a world converging within a their longer term development planning.7 Acknowledgment: Numerous partners from governments, generation. Lancet Dec 2013. www.thelancet.com/ commissions/global-health-2035. Increasing investment in women’s, chil- UN Agencies, CSOs, and academia have contributed to the development of this supplement and the overall Global 7 Partnership for Maternal, Newborn & Child Health, UN dren’s, and adolescents’ health has many Strategy, and the authors would like to express their Population Fund, World Health Organization, et al. Abu Dhabi declaration: for every woman every child thanks to all of them. benefits: it reduces poverty; it stimulates everywhere. 2015. www.who.int/pmnch/media/ economic productivity and growth; it creates Contributors and sources: All authors wrote the news/2015/abudhabi_declaration.pdf. jobs; it is cost effective; and it helps women, manuscript, and all have read and agreed to the final 8 Requejo J, Bryce J, Barros A, et al. Countdown to 2015 version. MT is guarantor. and beyond: fulfilling the health agenda for women children, and adolescents realise their basic and children. Lancet 2015;385:466-76. Competing interests: We have read and understood human rights to health, wellbeing, and a BMJ’s policy on declaration of interests and have no sustainable future. relevant interests to declare. Cite this as: BMJ 2015;351:h4414

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