Level & Trend in Child and Maternal Mortality, UNICEF's Approach

Level & Trend in Child and Maternal Mortality, UNICEF’s Approach

Dr Mehmet Ali TORUNOGLU,

THE COMCEC POVERTY ALLEVIATION WORKING GROUP MEETİNG, 06 November 2019, ANKARA

1 The United Nations Maternal Mortality Estimation Inter-Agency Group (UN MMEIG), together with its independent external Technical Advisory Group (TAG), collaborated in developing these maternal mortality estimates. From each of the constituent agencies that form the UN MMEIG, the following individuals worked on the compilation of this report:1 World Health Organization (WHO) United Nations Children’s Fund (UNICEF) United Nations Population Fund (UNFPA) United Nations Population Division (UNPD) The World Bank Group

2 THE 17 HEADLINE GOALS OF THE SDGS

Link to report: https://sustainabledevelopment.un.org/post2015/transformingourworld

#EVERYCHILD 2030 3 Maternal Mortality Ratio (MMR)

Definition: The (MMR) is defined as the number of maternal deaths during a given time period per 100,000 live births during the same time period. It depicts the risk of maternal death relative to Goal 3. Ensure healthy the number of live births and essentially lives and promote well- captures the risk of death in a single pregnancy being for all at all ages or a single live birth. Maternal deaths: The annual number of female Target 3.1: By 2030, reduce the global deaths from any cause related to or aggravated maternal mortality ratio to less than 70 by pregnancy or its management (excluding per 100,000 live births accidental or incidental causes) during •Indicator 3.1.1: Maternal mortality ratio pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, expressed per 100,000 live births, for a specified time period. Key facts

• Every day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth. • Between 2000 and 2017, the maternal mortality ratio (MMR, number of maternal deaths per 100,000 live births) dropped by about 38% worldwide. • 94% of all maternal deaths occur in low and lower middle- income countries. • Young adolescents (ages 10-14) face a higher risk of complications and death as a result of pregnancy than other women. • Skilled care before, during and after childbirth can save the lives of women and newborns.

https://www.who.int/news-room/fact-sheets/detail/maternal-mortality 5 6 MMR by WHO Region, 2017 MMR by UNICEF’s regions and sub-regions, 2000-2017

Why do women die?

Women die as a result of complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy and most are preventable or treatable. Other complications may exist before pregnancy but are worsened during pregnancy, especially if not managed as part of the woman’s care. The major complications that account for nearly 75% of all maternal deaths are : • severe bleeding (mostly bleeding after childbirth) • infections (usually after childbirth) • high blood pressure during pregnancy (pre-eclampsia and eclampsia) • complications from delivery • unsafe abortion. • The remainder are caused by or associated with infections such as malaria or related to chronic conditions like cardiac diseases or diabetes.

https://www.who.int/news-room/fact-sheets/detail/maternal-mortality 10 11 Conclusion Maternal Mortality • Despite the ambition to end preventable maternal deaths by 2030, the world will fall short of this target by more than 1 million lives with the current pace of progress. In the context of efforts to achieve UHC, improving maternal health is critical to fulfilling the aspiration to reach SDG 3. • There is a continued urgent need for maternal health and survival to remain high on the global health and development agenda; to improve the accessibility and quality of care. • The 2018 Declaration of Astana repositioned primary health care as the most (cost) effective and inclusive means of delivering health services to achieve the SDGs. Primary health care is thereby considered the cornerstone for achieving universal health coverage (UHC), which only exists when all people receive the quality health services they need without suffering financial hardship • Efforts to increase the provision of skilled and competent care to more women, before, during and after childbirth, even in the context of external forces (climate change, migration and humanitarian crises) • Governments are called upon to establish well functioning CRVS (civil registration and vital statistics) systems with accurate attribution of cause of death. • We need to expand horizons beyond a sole focus on mortality, to look at the broader aspects – country and regional situations and trends including health systems, UHC, quality of care, morbidity levels and socioeconomic determinants of women’s empowerment and education – and ensure that appropriate action is taken to support family planning, healthy pregnancy and safe childbirth. 12 About UN-IGME The United Nations Inter-agency Group for Child Mortality Estimation or UN IGME was formed in 2004 to share data on child mortality, harmonise estimates within the UN system, improve methods for child mortality estimation report on progress towards child survival goals and enhance country capacity to produce timely and properly assessed estimates of child mortality. IGME is led by UNICEF and includes the World Health Organization, the World Bank Group and the United Nations Population Division of the Department of Economic and Social Affairs.

13 Under 5 Mortality (U5MR)

Under-five mortality is the probability of a child born in a specific year or period dying before reaching the age of 5 years, if subject to age specific mortality rates of that period, expressed per 1000 live births.

Goal 3. Ensure healthy Neonatal Mortality Rate (NMR) lives and promote well- The neonatal mortality rate is the probability being for all at all ages that a child born in a specific year or period will die during the first 28 completed days of life if Target 3.2: By 2030, end preventable subject to age-specific mortality rates of that deaths of newborns and children under 5 period, expressed per 1000 live births. Neonatal years of age, with all countries aiming to deaths (deaths among live births during the first reduce neonatal mortality to at least as 28 completed days of life) may be subdivided low as 12 per 1,000 live births and under- into early neonatal deaths, occurring during the 5 mortality to at least as low as 25 per first 7 days of life, and late neonatal deaths, 1,000 live births occurring after the 7th day but before the 28th completed day of life. CHILD SURVIVAL: KEY FACTS AND FIGURES

Tremendous progress in child survival has been made over the past two decades. The total number of deaths among children and young adolescents under 15 years of age dropped by 56 per cent from 14.2 (14.0, 14.5.5)million in 1990 to 6.2 (6.0, 6.7) million in 2018. Still, one child or young adolescent died every five seconds in 2018.

Globally, 85 per cent of deaths among children and young adolescents in 2018 occurred in the first five years of life:

• 6.2 million deaths U15 years old • 5,3 million deaths U5 years old (U5MR: 39/1000 LB) • 2.5 million neonatal period (first month of life) (NMR: 18/1000 LB) • additional 0.9 million deaths occurred among children aged 5−14 years (7/1000)

Conclusion Child Mortality • Every child’s death is a tragedy: As the numbers show, the world is suffering this tragedy at enormous scale. Every single day of 2018, the world saw, on average, 15,000 deaths of children under age 5 – including 7,000 newborn deaths – and 2,500 deaths of children and young adolescents between age 5 and 14. Special attention is needed for sub-Saharan Africa, where child mortality rates are the highest in the world while population growth continues at a rapid pace. • Most of these deaths were due to preventable and treatable causes. • The good news; concerted actions have led to dramatic reductions in child mortality over the past few decades. • Despite the progress, the unfinished business of ending preventable child deaths looms large. If current trends continue without acceleration, some 52 (49, 58) million children under 5 years of age will die from 2019 to 2030. About half of them will be newborns. Another 10 million children aged 5–14 years will die. The total number of 62 million deaths of children under age 15 is roughly equivalent to the current population of Italy. 23 Conclusion • Accelerating the reduction in child mortality is possible by expanding high- impact preventative and curative interventions that target the main causes of child deaths and the most vulnerable population. • Globally, pneumonia, diarrhoea and malaria remain the leading causes of death for children under age 5. Injuries play a more prominent role in the deaths of older children and young adolescents. – Pneumonia-related deaths have fallen, thanks to the rapid roll-out of vaccines, better nutrition and improved care-seeking behaviour and treatment for symptoms of pneumonia, among other measures. – Diarrhoea related deaths have declined in large part due to improvements in drinking water, sanitation and hygiene, the roll-out of a rotavirus vaccine and widespread access to and use of treatment with oral rehydration salts solutions and zinc. – Prevention, treatment and elimination efforts have averted millions of under-five deaths from malaria. • Expanding inexpensive and cost-effective prevention and quality treatment for these causes will improve child survival.

24 Conclusion

• Greater attention to saving newborn lives can accelerate reductions in the under-five deaths burden. • To accelerate progress, greater investment is needed in building stronger health systems and services and improving coverage, quality and equity of care in the antenatal period; care at birth and in the first week of life; and care for small and sick newborns, which gives a triple return on investment by saving maternal and newborn lives and preventing stillbirths and disability. • Securing national-level priority for newborn health and survival and implementation of the Every Newborn Action Plan, the UNICEF WHO- led evidence-based action plan to prevent newborn deaths and stillbirths, are critical to accomplishing the unfinished global agenda for newborns.