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Healthy mothers, healthy kids, healthy societies

Ano Lobb | Thursday 29th October 2009

How do we reduce infant mortality? In a nutshell: Take better care of mothers. In two nutshells: Gender equality and reproductive self-determination.

Several recent postings have discussed the global death toll among children and youth from malaria, diarrheal disease, and accidents. Such staggering numbers could crush the spirit if we had no ideas about how best to improve them. Exhaustive research, including a recent 100-page review of the literature by researchers at Aga Khan University, Save the Children and Johns Hopkins University, has provided evidence of what works.

From a social and political perspective, increased maternal autonomy (recognition of gender equality, and women's rights), and increased maternal education have both been proven to decrease infant mortality and increase health. Societies that are matriarchal, for example, have lower infant mortality than equivalent societies that are patriarchal. Mothers in full control of their reproductive rights are healthier. And there's a dose response relationship between a mother's education level and reduced infant mortality: Each added year of maternal education increases survival for her children. Such steps are ideal in that they address underlying causes of ill-health while strengthening human rights and social development. But they can be difficult to improve in a timely fashion, since they require changing social mores and developing an educational infrastructure.

Improvements in healthcare and public health can be implemented more rapidly, but often have large price tags. A recent analyses estimated that delivering 16 interventions proven to reduce childhood mortality to 90% of the population in the 60 countries with greatest need would save an estimated 35%-66% of deaths among children under 5, that's somewhere between 1.33 and 2.45 million children a year. The cost: $3.89 billion. (Or about 3% of the $123 billion that the US government used to rescue investment giant AIG.)

What types of interventions are proven to reduce death and increase health among children? Many are surprisingly basic: Anti-malaria treatment for mothers could reduce 10%-20% of neonatal deaths, clean childbirth practices (such as hand washing and clean umbilical-cord cutting) could prevent another 60%-80% of death due to infection, keep the room warm and dry the baby immediately and you save another 40%.

Tricia Edgar recently talked about the sustainability concerns surrounding breast feeding, and the neonatal consequences are equally great: exclusive breastfeeding could reduce deaths by 10%, while kangaroo care, having mothers carry the baby close to their skin, cuts infection rates in half.

Implementing other interventionssuch as having a trained midwife present at birth, access to emergency obstetric care, appropriate medications, and quality nutritionfurther enhances the health of mother and child. Once again there are opportunities among the despair. We don't need to find the one solution that saves every child. Provide weatherproofand therefore warmerhousing, some way to clean water and medical-scissors, ways to promote breastfeeding or kangaroo care. Encourage human rights and education. Breed a better seed or sustainable protein source. These steps are as life- saving as anything a doctor provides.

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