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 Tand 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 the bmj | BMJ 351:Suppl1 1 Women’S, Children’S, AND ADOLESCENTS’ HEALTH 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