Of all the important actions the United Nations has taken over the years, the Millennium Development Goals (MDGs) have been one of the most successful. Guided by this framework, a broad coalition of developing countries, donor governments, development partners institutions, the private sector, and civil society have made good progress tackling big challenges: Extreme poverty, child and maternal mortality, infectious diseases, and gender equity in education.
But significant challenges remain. In 2013, 17,000 children under age five died every day, many from preventable causes. Nearly 300,000 women died during pregnancy and childbirth. And 162 million young children suffer from chronic undernutrition. The MDGs showed that progress is possible. With the next global development framework — the Sustainable Development Goals (SDGs), which will guide human development investments through 2030 — we have a once-in-a-generation opportunity to go the last few miles and accelerate progress where it has fallen short.
One of the great successes of the MDGs is a dramatic reduction in child mortality. Every year, over more than four decades, child mortality rates have fallen. In 1990, 10% of children globally died before age five. Today, that number is down to 5%. This is tremendous progress, but the numbers are not going down fast enough.
If our previous successes in driving down child mortality have proven anything, it is that each and every one of us can do more, and we can do better. As a global community, we know what works. Vaccines that safeguard children against deadly diseases play a large role. So too do cost-effective solutions like insecticide-treated mosquito nets that protect children from malaria, oral rehydration solutions that prevent children with diarrhoea from dying of dehydration, and better nutrition in the first 1,000 days of a child’s life. Based on past progress, we believe it is possible to reduce under-five child mortality in every country — to no more than 2.5% by 2030.
While the world has made impressive progress overall reducing child mortality, sadly, progress on newborn health has lagged. Each year, nearly 3 million newborns die within their first month of life, most of them of preventable causes.
The vast majority of these deaths could be averted with cost-effective solutions that can be used everywhere. By increasing the use of just a few proven interventions — like the right resuscitation techniques to help babies struggling to breathe; immediate breast-feeding to provide newborns with essential nutrition and protective antibodies; and skin-to-skin contact between a mother and newborn to regulate the baby’s temperature, heart rate, and breathing — we can save hundreds of thousands of newborn lives each year.
In 2014, the World Health Assembly endorsed the Every Newborn Action Plan to accelerate progress in newborn health. In recent months, countries with some of the highest rates of newborn deaths — India, Nigeria, and Ethiopia — have announced ambitious efforts to reduce newborn mortality. These efforts have just begun, but building on this momentum, we are optimistic the global newborn mortality rate can be brought down to 1.2% by 2030.
Among women and adolescents of childbearing age, pregnancy and childbirth remain the leading causes of death and disability. Reducing child and early marriage and making modern contraceptives more accessible are some of the ways to tackle this. When women have access to family planning resources, and can plan and space the births of their children, health outcomes improve for both women and their children. In fact, if the world extended contraceptive access to only a quarter of the women with unmet need, it could save the lives of 25,000 women and 250,000 newborns each year. There is also clear evidence that when complications occur during labour and delivery, the presence of a trained health workers can make the difference between life and death. Reaching rural women is critical: While overall, rates for women getting such assistance have gone up, rural women’s access to health workers during childbirth has barely budged in two decades. We believe it is possible to bring the maternal mortality rate down to less than 1% by 2030, which would be a two-thirds reduction globally from the current rates, and even more than that in Sub Saharan Africa, which has the highest mortality rates currently.
Reflecting on the progress we have seen over the last 15 years, we are optimistic about the future. In fact, we believe that if the world is deliberate about putting women and children at the centre of the development agenda, we will see the lives of millions of people improve faster in the next 15 years than at any other time in history.
Melinda Gates is co-chair of the Bill & Melinda Gates Foundation. Graça Machel is founder of the Graça Machel Trust
The views expressed by the authors are personal