SEATTLE — The Reach Every Child and Mother Act, is gaining support in Congress, with an ambitious goal of “ending preventable maternal, newborn and child deaths by 2035.” With the promise of an effective financing mechanism and evidence-based interventions, is this goal attainable?
In her introductory speech for the REACH Act, Republican Senator Susan Collins of Maine spoke about the importance of the U.S. government’s ability to gain support from NGO’s, multinational corporations and other countries. Collins highlighted the positive change that has been happening in this health sector, but how much U.S. involvement is necessary to increase momentum in this movement? Collins stated that transparency, strategy, accountability, collaboration and a goal-oriented, evidence-based approach is the key to success.
The REACH Act has some of the most prolific bipartisan support for a global health-related bill in recent history, with 200 cosponsors in the House of Representatives. Supporters affirm that over 600,000 mothers and 15 million children could be saved in the coming years with the approval of this bill. The REACH Act would not function in isolation, but rather enhance already proven methods of intervention.
USAID’s 2016 “Acting on the Call” report highlighted the department’s work in recent years to end maternal and child deaths. Progress does not come from one perfected approach that will work in all regions but is rather community specific and equity-based. Resources must be targeted at the lowest two wealth quintiles to provide poor populations with the same care that is available to wealthier populations.
For example, USAID has helped with the implementation of Ethiopia’s successful Community-Based Health Insurance (CBHI) program. This program has expanded by 700 percent since its inception (15 poor communities were included in the pilot program), and now provides 6.5 million people with health insurance that is financed by both the national health ministry and the local community members.
Other examples of USAID’s work include creating community-based maternal and newborn health guidelines in 16 communities in Malawi and ensuring diarrhea treatment of 1.73 million children in Bangladesh (of which 775,000 were in the lowest two income quintiles). USAID helped provide antenatal health care coverage to 175,000 women in Rwanda through community-based providers that coordinated outreach and information sharing.
All of this work and more has ensured that Bangladesh, India, Indonesia, Malawi, Nepal, Rwanda, Senegal, Tanzania and Uganda are on track to reduce their childhood mortality rates to 25 deaths per 1,000 live births by 2030.
Progress has been steady, but there is still much work to be done. In the “A Promise Renewed Report”, UNICEF declared that breastfeeding vastly lowers the risk of childhood diarrhea, the main cause of malnutrition and death in children, yet only 40 percent of children worldwide are breastfed during the first six months of life. Having skilled attendants at birth drastically decreases birth complications, yet 36 million births occurred in the world last year without a skilled attendant. Half of deaths under five still occur due to infectious diseases such as malaria, cholera or pneumonia.
UNICEF also declared the importance of an equity-based approach. Children from the poorest households are 1.9 times as likely to die before the age of five compared to the richest children, and children of an uneducated mother are 2.8 times as likely to suffer the same fate.
There is no singular solution that will eradicate these preventable maternal and childhood deaths. However, If the REACH Act generates an effective, multifaceted and interdisciplinary approach that incorporates treatment, prevention and education, the current evidence suggests that eradicating preventable childhood and maternal deaths by 2035 may not simply be a goal, but a reality.
– Patrick Tolosky