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A patchwork of progress, stagnation and reversal

Table of Contents Introduction Mothers and children matter - so does their health The early years of maternal and child health Where we are now: a moral and political imperative Mothers, children and the Millennium Development Goals Uneven gains in child health The newborn deaths that went unnoticed Few signs of improvement in maternal health A patchwork of progress, stagnation and reversal The numbers remain high

The slowing down of improvement of global indicators that so worries policy-makers ( ⁶⁷ ) hides a patchwork of countries that are on track, show slow progress, are stagnating or are going into reverse. As most progress is being made in countries that already have relatively low levels of maternal and child deaths, while the worst-off stagnate, the gaps between countries are inevitably widening.

A total of 93 countries, including most of those in the high income bracket, are “on track” to reduce their 1990 under-five mortality rates by two thirds by 2015 or sooner. The on-track countries are those that already had the lowest rates in 1990 (taken together they had a rate of 59 in 1990).

A total of 51 other countries are showing slower progress: the number of deaths among children under five years of age is going down and the mortality rates are dropping, but not fast enough to reach one third of their 1990 level by 2015 unless they significantly accelerate progress during the coming 10 years. These countries started from a somewhat higher level than those that are on track: an average under-five mortality rate of 92 per 1000.

More problematic are the 29 countries where mortality rates are “stagnating” - where the number of deaths continues to grow, because modest reductions of mortality rates are too small to keep up with the increasing numbers of births. These are the countries that had the highest levels (207 on average) in 1990. Finally, there are 14 “reversal” countries, where under-five mortality rates went down to an average of 111 in 1990 but have increased since. During the 1990s there were more such countries than during the two previous decades combined. These reversals were also more pronounced than before. Countries that show reversal or stagnation are overwhelmingly in the African Region.

This grouping of countries,1 categorized according to progress in under-five mortality during the 1990s, roughly corresponds to what happened in terms of neonatal and maternal health in these same countries. Although trend data are not available, neonatal and maternal mortality is highest in the countries with reversal and stagnation in under-five mortality (see Table 1.1 and Figures 1.3-1.6).

Footnote

⁶⁷ Human development report 2003 - Millennium Development Goals: a compact among nations to end human poverty. New York, NY, Oxford University Press for the United Nations Development Programme, 2003.

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