Dr. Flavia Bustreo is the Assistant Director-General - Family, Women's and Children's Health, World Health Organization

The Millennium Development Goals (MDGs) brought needed and increased attention to child survival.  Globally, significant progress has been made in reducing child mortality.  The number of under-five deaths declined from 9.6 million in 2000 to 7.6 million in 2010. Under-five mortality fell from 73 per thousand in 1990 to 57 per thousand in 2010. On average, under-five mortality has been falling at a rate of 2.5 per cent per year compared with 1.9 per cent per year over 1990–2000.

The rate of reduction doubled in Sub-Saharan Africa when compared with the previous decade.  There is evidence that this rate of decline is accelerating as we approach 2015.  New initiatives, such as the UN Secretary General’s Global Strategy for Women’s and Children’s Health, have added guidance and resources to the achievement of the goals.  The subsequent establishment of  the Commissions on Information and Accountability and on Life-Saving Commodities will add to the benefits for women’s and children’s health.

Still, despite accelerated progress, the global burden of maternal and child mortality is still unacceptably high.  Over 280,000 maternal lives and 7.6 million under-fives’ lives were lost in 2010.  Most of these losses would have been preventable with interventions that already exist.  We know what these interventions are and what they require to be implemented. Unfortunately, we still fail to reach a large proportion of mothers and children with them, particularly in sub-Saharan Africa and South Asia, where most of maternal and child deaths occur. We need to find the ways to ensure that every mother and child has access to these interventions and can benefit from them. 

Newborn deaths today account for 40% of all deaths in under-fives.  Most of the conditions that lead to neonatal death are linked to the health of the mother and to the care she and her baby receive before, during and after birth. Ensuring access to a continuum of care throughout pregnancy, delivery and the postnatal period is essential to reduce both maternal and newborn mortality. As an additional benefit, this will also prevent stillbirths. For care to reach a larger proportion of mothers and babies and bring the highest benefits, this continuum of care must be delivered in families and communities, at health centers and at referral-level facilities.

The highest risk of mortality for mothers and an their newborns in developing countries concentrates in the twenty four hours around birth.  Over a third of the stillbirths and newborn deaths occur during this period.  This is also the period of highest risk of maternal mortality. Preventing these deaths will require that births be conducted by skilled attendants, newborns initiate breastfeeding in the first hour after birth, and be kept warm and protected from infection. Infants born very small or pre-term will need special attention and may require additional hospital care.

The past decade saw a major success in reducing child deaths due to pneumonia, diarrhea and malaria. Success can now be enhanced by new vaccines that protect against pneumonia and diarrhea.  They will reduce deaths from these diseases but will not end them altogether.  Every child with diarrhoea, pneumonia or malaria needs to be treated. Effective preventive and treatment measures for these diseases are well-known and best delivered through a primary health care approach that also addresses the broad range of health determinants, including social and environmental ones.

We approach 2015 with the knowledge and tools that promise success in ending preventable child deaths if we provide universal access to them.  As we move forward, let’s keep in mind that although survival is essential, our aim is to save a healthy child that grows and develops well.