The Millennium Declaration set out development aims that the world would strive to meet by 2015 which included the Millennium Development Goals (MDGs). MDG 4 set out to reduce by two-thirds, between 1990 and 2015, the under-five mortality rate.
The review states that between 1990 and 2010, the under-five mortality rate fell by just 35% and in 2010 approximately 7.7 million children died before their fifth birthday. Furthermore, the review notes some progress, currently thirty one countries are on target to reach their goals; however, twenty three countries in Sub-Saharan Africa are unlikely to achieve MDG4 before 2040.
Almost all regions have seen slower declines in their neonatal mortality rate (babies who die within 28 days of life) and annually there are approximately 2.1 million neonatal deaths. The proportion of deaths of children under the age of five who died in the neonatal period has risen from 37% in 1990 to 42% in 2010.
In addition, there is no mention of stillbirth in MDG4 and no global target for their reduction; however, every year 2.65 million babies are stillborn, with 98% of all stillbirths occurring in low and middle-income countries, highlights the paper.
The review states that obstetricians have a vital role to play in reducing the under-five mortality rate globally in order to meet MDG and recommends possible solutions to reduce intrapartum, perinatal and neonatal mortality including;
• Community mobilisation, covering interventions ranging from home visits to facilitation of local women’s groups to advocate for the local health resources required
• Skilled attendance at birth and training in neonatal resuscitation
• Access to emergency obstetric care and continuity of care
• Kangaroo care for preterm babies which involves thermal care, exclusive breast feeding and early recognition to illness
• Corticosteroids for promotion of lung maturation in preterm birth
• Promotion of breastfeeding
• Immunisation programmes
• Malaria reduction
• Birth spacing
Robert Fox, Consultant Obstetrician and Gynaecologist at Musgrove Park Hospital, Taunton, and co-author of the review said:
“Millennium Development Goal 4 has served to highlight the issue of child health globally, and despite a slow start, progress towards achieving the goal has recently accelerated. The task now is to ensure that the effective, affordable interventions that already exist are implemented consistently and evenly within and between countries.
“It remains a role of individual countries to identify and address local priorities, supported by the wider global community. The evidence for improving perinatal and neonatal exists; however, the challenge is in the implementation.”
Jason Waugh, TOG Editor-in-chief added:
“The causes of perinatal and neonatal death are multifactoral and also include social factors such as education, sanitation, improved nutrition and political will. However, access to healthcare is of extreme importance and effective key interventions exist to reduce intrapartum, perinatal and neonatal mortality.
“Obstetricians have a vital role in advocating for improvements in reproductive health – improvements that can save the lives of mothers and their children.”
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The Obstetrician & Gynaecologist (TOG) is published quarterly and is the Royal College of Obstetricians and Gynaecologists’ (RCOG) medical journal for continuing professional development. TOG is an editorially independent, peer reviewed journal aimed at providing health professionals with updated information about scientific, medical and clinical developments in the specialty of obstetrics and gynaecology.
A C Smith, W Mutangiri, R Fox, J F Crofts. Millennium Development Goal 4: reducing perinatal and neonatal mortality in low-resource settings.The Obstetrician & Gynaecologist 2013; http://dx.doi.org/10.1111/tog.12074