Reducing inequities in reproductive, maternal, and child health

Origins of the global A Promise Renewed (APR) movement

Over the last 50 years, the world has witnessed an extraordinary 70 percent decline in child mortality and a reduction in the number of under-5 deaths from nearly 12 million in 1990 to fewer than 7 million in 2011. There has also been a nearly 50 percent reduction in maternal deaths as the global maternal mortality ratio declined from 400 deaths per 100,000 live births to 210, an annual rate of reduction of 2.3 percent between 1990 and 2010. Despite this progress, significant work lies ahead to end the millions of preventable child and maternal deaths that still occur each year, mostly in the world’s developing countries. Achieving this goal will require increased use of high-impact, affordable interventions, strengthening the health systems that support those interventions, and addressing major equity gaps in maternal, neonatal, and child health, both within and among countries.

On 14-15 June 2012, more than 80 governments and partners from civil society, faith-based organizations, and the private sector gathered at the Child Survival Call to Action in Washington, D.C., to launch a re-energized and sustained global effort to end preventable child deaths. This high-level forum was convened by UNICEF and the governments of the United States, Ethiopia, and India because, for the first time in history, we have the knowledge to reach this goal. The new global movement is called “A Promise Renewed” and it encompasses child, maternal, and reproductive health. As of 2 November 2012, 175 governments world-wide, including 32 in Latin America and the Caribbean, have signed the Promise Renewed pledge, and several regional and country-specific conferences have been held to develop country- or region-specific roadmaps to realize these commitments. The APR movement recognizes that improving the health of mothers and children is central for economic and social development; furthermore, ending preventable maternal and child deaths would be a great moral victory.

A Promise Renewed for the Americas: Focusing on the region’s own challenges and resources

The Region of the Americas has been highly successful in reducing both child and maternal mortality in recent decades, and has contributed an array of successful interventions and approaches to the international understanding of how to effectively reduce deaths and promote health. However, the goals of eliminating preventable child and maternal deaths, and ensuring that all children receive the support they need to thrive, are far from being met in the Region. Indeed, some of the most difficult challenges lie ahead precisely because the most vulnerable children and mothers are often the hardest to reach with quality health care services and with improvements in the underlying socioeconomic determinants of health.

A regional conference for Latin America and the Caribbean was held on 10-12 September 2013 in Panama City, Panama to assess the child and maternal health challenges specific to the Americas and galvanize commitment to address them. It brought together high level representatives from throughout the region to define a way forward for addressing the major child, maternal, and reproductive health inequalities that persist in the Americas. The conference was sponsored by an unprecedented partnership of seven agencies that is committed to reduce these inequities in the region. PAHO/WHO acted as Coordinating Secretariat for this meeting in collaboration with the Government of Panama.

In Latin America and the Caribbean, rapidly diminishing funding from donor agencies makes it especially critical to mobilize the region’s own significant capacity and resources to address long-standing, major disparities in reproductive, maternal, and child health. Top priorities include reduction of maternal and infant mortality in disadvantaged populations, strengthening national routine information systems to monitor effectiveness and target investment, and expanding the political and financial support for these efforts.

The A Promise Renewed for the Americas conference provided a regional forum to celebrate successes, review trends in reproductive, maternal, neonatal, child, and adolescent health in the Region of the Americas, and to identify key interventions and strategic shifts needed to reduce persisting inequalities in health. The meeting helped galvanize regional efforts to accelerate achievement of Millennium Development Goals (MDGs) 4 and 5 by 2015, and contribute to development of the post-MDG development agenda. The meeting also formally linked the Americas to the global “A Promise Renewed” movement to eliminate preventable child and maternal deaths by 2035.