International health priority receives $1.5 billion pledge from Gates Foundation

Melinda Gates announced yesterday that the Gates Foundation was dedicating $1.5 billion in international health funding towards the goal of reducing mother and child mortality.  Gates made a point of emphasizing that it's a lack of priorities, not a lack of knowledge about how to solve the problem, that's leading to the unnecessary deaths of millions of mothers and babies each year. International health research supports this assertion.

A special edition of The Lancet this week lists 10 keys to raise women and their children up the priority list. Briefly summarized, they are:

1. Increased sense of social mission behind health advancement. Efforts to de-politicize health and development have reduced the call for social justice.

2. Increase awareness of the conditions faced by others. In some cases we harbor the discriminatory assumption that poor health is just inevitable among some populations.

3. Create systematic, sound methods for evaluating what actually works in international health.

4. Back up physical-science solutions with the policies needed to implement them.

5. Agree that the determinants of health for mothers and children should be core humanitarian and national concerns.

6. More fully integrate sciences, policy, and advocacy.

7. Empower women to take control of their own health and advocate for their own well being and that of their children.

8. Establish organizational structures that allow personal empowerment to turn into local and national actions for change.

9. Advocacy. And more of it.

10. Increase coordination between groups representing maternal, newborn, child, and reproductive health.

Other new research asserts that increasing the number of skilled birthing attendants could reduce unnecessary deaths by 2 million each year, especially in sub-Saharan Africa where approximately 50% of women give birth without one.

The proximity of a mother's health to her child's survival is also underlined by a new study from Matlab Bangladesh, a community that has served as a living international health "laboratory" for many decades. Researchers from the London School of Hygiene and Tropical Medicine, and the US CDC found that a child's probability of surviving to age 10 was 24% if their mother died, but 89% when their mothers remained alive. A fathers death had no impact on child survival.

In addition to enabling efforts that are, hopefully, backed by evidence that they actually reduce mortality, the Gates Foundation should certainly help raise the stature of efforts to reduce mother and child mortality. Placing that amount of money on the table next to such an international health priority has a way of doing that. However, with mother-child mortality, the best improvement method involves strengthening health systems (which also reduces deaths among other populations as well). Hopefully the huge financial emphasis on this one international health priority doesn't result in a "siloized" response, such as shifting towards the training of skilled birth attendants at the expenses of a strengthened pharmaceutical supply chain.