Happy Mother’s Day everyone in advance! In commemoration of this day, Save the Children has released its 14^th annual State of the World’s Mothers report. This report is entitled “Surviving the First Day” and focuses on the plight of new born children and mothers throughout the world. At the launch of this report at the UN yesterday, the President and CEO of Save the Children, Carolyn Miles, said that:

"It was here at the U.N. that all countries agreed to the Millennium Development Goal to reduce child mortality by two thirds…We've come a long way, but we won't get there without new focus on saving the youngest lives. This report presents the growing evidence that the world today has the low-cost tools to prevent millions of newborn deaths once considered inevitable." Here in New Zealand the report is creating a little bit of angst as Kiwiland was found to be one of the most dangerous places in the industrialised world for mothers and newborns:

“New Zealand women face a one in 3300 chance of dying during pregnancy or childbirth, the fourth worst odds among 34 industrialised countries included in Save the Children's annual State of the World's Mothers report.

New Zealand children fared slightly better than their mothers. At 5.9 child deaths per 1000 live births, New Zealand ranked fifth worst in the industrialised world.” This is particularly galling as Australia ranks above us. The only explanation must be some skewing of the numbers:

“New Zealand Perinatal and Maternal Mortality Review Committee chairwoman Cindy Farquhar disputed the figures, with the committee's own report showing about one in 8000 women died in pregnancy or childbirth.

New Zealand had a comprehensive data collection system, unlike Australia, which may account for why they rated better in the report.” Leaving this aside, the report details the huge strides that the world has made since 1990 and the huge strides that are still to be made.  Melinda Gates, writing the foreword to the report (the Gates Foundation provided a grant for the Save the Children Saving Newborn Lives program in 2000) mentions this progress:

“Globally, since 1970, the number of children dying has declined by more than half, even though the population has almost doubled. If the rate of death had stayed constant, more than 31 million children would have died in 2011. Instead, that number was 6.9 million. In many individual countries, progress has been even more dramatic. Barely a decade ago, in 1999, 1 in 5 Rwandan children died before turning 5. In 2011, the child mortality rate in Rwanda had fallen to 1 in 20. Other lowincome countries, such as Malawi, Bangladesh and Nepal have also made significant progress against enormous odds. It is now possible that all four countries will meet the 2015 United Nations’ Millennium Development Goal (MDG 4) of reducing child deaths by two-thirds since 1990.” However, as Gates states, there is work to be done:

“Each year, 3 million newborns die, making up nearly half (43 percent) of the world’s under-5 child deaths. And yet almost all newborn deaths originate from preventable and treatable causes: we already have the tools available to save about three-quarters of the newborns who needlessly die each year.” About two-thirds of the way into the Foreward, Gates mentions a list of measure to save the lives of newborns including “access to contraceptives”. I was waiting for that one, and still cannot understand how not conceiving (or removing the result of conception) results in saving newborns? Doesn’t this just mean fewer newborns conceived to die? By the same logic, wouldn’t wiping out all of humanity result in saving newborns (as then their death rate would be zero??) However, later on, Gates says something that could have been lifted out of many of my blogposts:

“Saving newborn lives will prevent incalculable suffering. It is also a vital piece of the global development agenda. The long-term economic prospects of poor countries depend on investments in the health, nutrition and education of the people, particularly the women and young children living there. Children surviving and staying healthy means more children in school and able to learn, which in turn means productive adults who can drive sustained economic growth.” Read that, leaders of the Western world? Anaemic economic growth and little-to-no demographic growth – do you see the connection?
Next in the report, Carolyn Miles provides the Introduction, with this heart-rending paragraph:

“Every year, 287,000 women die during pregnancy or childbirth, and 6.9 million children die before reaching their fifth birthday. Almost all these deaths occur in developing countries where mothers, children and newborns lack access to basic health care. While child mortality rates have declined in recent decades, 19,000 mothers still mourn the loss of a child each and every day – an unthinkable number of heartbreaks. This is especially tragic since most of these deaths could be prevented at a modest cost.” However, as the report notes, despite an increase in global population, the tragedy has reduced:

“The world has made unprecedented progress since 1990 in reducing maternal and child deaths. Working together, governments, communities, nongovernmental organizations and families have reduced the annual number of children under 5 who die each year by over 40 percent – from 12 million to 6.9 million. Progress for mothers has been even greater, with deaths declining almost 50 percent since 1990 – from 543,000 to 287,000 per year.” Much more can be done to help newborn babies in the first day of their lives since:

“More than 1 million babies die on the first day of life – making the birth day the most dangerous day for babies in nearly every country, rich and poor alike.” Of course, a guilty verdict in the Gosnell trial will help a little bit (as would more stringent control of those dark, satanic abortion mills in the USA) but the report lists some other cheap ways to protect newborns:

“An original analysis by Save the Children estimates that within the first month of life, more than 1 million babies could be saved each year with universal access to these products, which cost between 13 cents and $6 each and are ready for rapid scale-up now. The products are: •• steroid injections for women in preterm labor (to reduce deaths due to premature babies’ breathing problems); •• resuscitation devices (to save babies who do not breathe at birth); •• chlorhexidine cord cleansing (to prevent umbilical cord infections); and •• injectable antibiotics (to treat newborn sepsis and pneumonia).” Aside from these easy to take steps, the report has five recommendations, which are:

• Address the underlying causes of newborn mortality, especially gender inequality.
• Invest in health workers – especially those working on the front lines – to reach the most vulnerable mothers and babies.
• Invest in low-cost, low-tech solutions which health workers can use to save lives during pregnancy, at birth and immediately after birth.
• Strengthen health systems and address demand-related barriers to access and use of health services.
• Increase commitments and funding to save the lives of mothers and newborns.

While these are all laudable aims, one problem I see is that most of these recommendations are targeted at “the world”.  That is fine, but many of these problems have to be done at the state level, there is no point in throwing aid money at the problem if internal political willingness is not there in these poor nations. Nor is maternal and newborn health going to be helped if there is a war raging in a particular country. (Hence the DR Congo being found to be the worst country for a mother and child by the report).  Aid is all well and good, and I am deeply supportive of *most* of what Save the Children and Melinda Gates are doing. I am certainly supportive of their goals. I hope that the downward trend in mother and infant mortality continues. But I am not sure that foreign aid by itself is the answer.
PS Thank you Mum!