As we reflect on the work that we’ve accomplished through the Millennium Development Goals (MDGs) and plan for the next set of global commitments (the Sustainable Development Goals or SDGs), it’s important to talk about the inextricable link between mothers and their children. This link is both biological and social and has critical implications for health systems.
- Biological: We know from past and current research that the health, nutritional status, and general well-being of the mother strongly influences the chances of survival and well-being of the fetus during pregnancy, the newborn, and older children.
- Social: Mothers are the primary caretakers at home. So when a mother’s health is compromised or life is lost, the children and family suffer dire consequences.
- Health systems: A functioning health system able to provide integrated care is needed to address both a mother and her newborn’s needs. Without a good infrastructure, the necessary supplies and proper training for health workers, both moms and their newborns suffer.
With this knowledge, it is important that maternal and child health professionals work together and look at the continuum of maternal, newborn and child health in an integrated fashion, without forgetting any of these critical elements. But what is integration? Using a simple definition, integrated care means addressing simultaneously the needs of both the mother and the baby, ideally in the same place. Although that makes perfect sense from a conceptual perspective, we need more evidence about how to make it happen.
In fact, barriers at various levels make it difficult to implement integrated maternal, newborn, and child health efforts. Too often we see separate and siloed efforts, which include financing, policies, research and programs. These challenges start at the global level, which then prevents an enabling environment for those changes to occur at the country level.
Barriers in Policy
As the global policy community transitions from the MDGs to the SDGs, we’ve seen some wonderful initiatives. For example, the Every Newborn Action Plan offers a road map for raising the visibility of newborns’ health care needs—newborns were neglected in global efforts until recently—and how to address them in the context of ongoing efforts to reduce infant mortality and morbidity. Similarly, key national and global partners, including the Maternal Health Task Force, have been very involved in another initiative called Ending Preventable Maternal Mortality, or EPMM, that has defined the new goals for the reduction of maternal mortality by 2030 and the key strategies to achieve them. Both initiatives recognize the mother-baby dyad and the importance of addressing both mothers and babies in an integrated fashion. However, they have names that keep them somehow separate, one referring to newborns and the other to mothers. Now that we are recognizing the benefits of integration, we are calling attention to this artificial separation. Siloed approaches have also prevented health and development professionals from viewing the continuum of care of a woman’s health.
The continuum of care: It’s all women’s health
From a medical perspective, the health of the girl, the adolescent, and the woman before she gets pregnant is absolutely critical and influences what happens during a pregnancy and beyond. Women’s health shouldn’t be divided into little pieces; rather it should be seen as a continuum throughout the life cycle, as each stage of a woman’s life influences her health and well-being at the next stage. Very often the same social determinants that help or threaten a woman’s opportunities to achieve good health and well-being at one stage will influence her chances for health at later stages. However, the challenges are changing and we as the maternal, newborn, and child health community need to remain flexible to respond to these transitions. Even low-income countries are already facing an increased burden of non-communicable diseases and, as a result of that, many countries will have to address indirect causes of maternal mortality while still struggling with an unfinished maternal and newborn health agenda, which will require new infrastructure, new approaches, new training and new supplies. These will be critical issues to address for the maternal, newborn, and child health communities as we review our progress with the MDGs and evaluate the forthcoming SDGs.
Lessons learned from the MDGs
The MDGs have had some limitations, but they kept the attention targeted on maternal and child health for 15 years, which is unique. With the SDGs, we are facing the risk of losing focus. This new set of global goals—that the international community is likely to embrace in September of this year—will only have one overarching health goal: ensure healthy lives and promote well-being for all at all ages.
There are many aspects of this goal worth celebrating, as it speaks to health throughout the lifecycle and talks about health for all, somehow alluding to equity. And it talks in a positive way about health, and not in a negative way as maternal mortality or child mortality. But, unfortunately, the goal might be too vague.
Furthermore, this singular health goal will be one among many more development goals. To some extent, our golden moment in the maternal and child health community—from a global policy perspective—risks to be over soon. To avoid this from happening, we need to make a very important and focused effort now and in the years to come to keep maternal and newborn health high on the global policy agenda.
Innovation: More than technology
As we approach the future of maternal, newborn and child health, global and national policymakers and decision makers should support innovation defined in a broad way. Innovation does not only mean new technology. Innovation is needed to represent change and create new ways to think about and organize health systems. Looking at innovation from an integration perspective, we need to consider models that will allow us to integrate services on the ground and measure the impact they have. Our work does not stop once an innovation is implemented. If we don’t evaluate the effects, good and bad, of whatever we are introducing we will not move the agenda forward. So I would hope that policy makers commit to innovating for integrated maternal and newborn health care so that women and their children thrive in all societies.
Photo credit: DRC Clinic in Swakopmund, Namibia © 2014 Synergos Institute, used under a Creative Commons Attribution license: https://creativecommons.org/licenses/by/2.0/