A Quasi-Success Story: Maternal and Child Health Millennium Development Goals

Is it better to set achievable goals or ambitious ones?  The frequent critique of the Millennium Development Goals (MDGs) is that they provide an ambitious destination with very little by way of roadmap or funding. This is the equivalent of sending someone on a mission to Timbuktu via camel, with the instruction “turn left at the sand-dune." The UN will convene at the end of the month to take stock of where member states' wandering camels are on the path toward reaching these eight goals, and how to best to guide them to their destination by the 2015 deadline.

The countries that have made the most progress across the board are those that have had major economic growth, namely China and India.  Unsurprisingly, the countries that are least likely to achieve the goals are those with fewer financial resources, especially sub-Saharan Africa.

The UN and the World Health Organization are notorious for setting unachievable goals, and sadly "failing" to achieve a goal can belie the extraordinary progress that has been made.  MDGs 4 and 5 on maternal and child health are no exception. While astounding progress has been made, few countries will make it to the destination by 2015.

The child health goal is to reduce by two-thirds the under-age-5 mortality rate between 1990 and 2015.  Almost every part of the developing world has shown progress in achieving this goal, but only Latin America and Northern Africa will likely accomplish it. Overall, the developing world has shown a 28% decrease in child mortality in the past 20 years, which is commendable.  Unlike many of the other MDGs, the biggest gains have often been in the poorest countries, where a small difference in healthcare provision makes an enormous difference in survival.

The majority of these gains have come from providing more care for malaria, AIDS, measles, and antenatal clinic visits. The areas that can be greatly improved-upon are the treatment and prevention of pneumonia, diarrhea, and malnutrition. Indeed, malnutrition is the indirect cause of death in one-third of child death: a malnourished child does not have the immune response to effectively fight disease. This is an example of how the MDGs interact: malnutrition would technically fall under the rubric of Goal #1, eradicating hunger, but it has a big impact on child survival. Similarly, one of the biggest predictors of a child’s survival is his mother’s education. Thus goals #2 and 3, about education and women’s equality, also have a big role to play in goal #4.

The maternal health goals are to reduce the maternal mortality ratio by three-quarters and achieve universal access to reproductive health services.  The results for this MDG are much more varied than the results for child health: sub-Saharan Africa has made no progress on maternal mortality, but North Africa and parts of Asia are on target to achieve it.  There are striking inequalities between different regions, and between rural and urban households. Maternal mortality and reproductive health services require access to a clinic, whereas vaccination and health education can be conducted in the field. Interesting, one of the biggest failings on this particular goal is changing teen pregnancy rates. Neither the developed nor the developing world has seen any significant changes, though again a striking correlation with female education levels is noted.

Goals #4 and 5 remind us of the highly interconnected nature of these discrete aims. The new MDG summit would be wise to consider not only the progress toward achieving these goals, but the interstices between them.  Would the child health goal be better served by pulling out all the stops against malnutrition? Would our failure on teen pregnancy be best addressed through reinforcing general education?  The roadmaps are increasingly complex.

Photo credit: Caitlin Cohen