Maternal versus child health
Despite the name "maternal and child health" (MCH), most MCH programmes in the 1980s focused on the child (State of the World's Children 1996). Maternal programming was primarily limited to family planning. Some in the child survival movement even discussed the woman as if she were just another intervention to improve child survival.
The influential call of "where is the M in MCH?" (Rosenfield and Maine) was part of a new movement for the rights of the woman, calling for attention to maternal survival, that gained momentum in the 1990s. The need for more attention to the woman led to the downplaying of linkages between maternal and child health - the 10 action points for safe motherhood in 1997 do not mention the newborn. Most child health programmes focused on causes of child death such as malaria, pneumonia, diarrhoea and measles which are important after, but not during, the neonatal period.
the structure of many funding agencies sets maternal and child health in competition
The gap between maternal health and child health programmes contributed to a lack of action for newborn health (Lancet neonatal survival 4). The convention on the Rights of the Child champions child rights, while the Cairo and Beijing conferences and the subsequent policy agenda for reproductive health focus on the rights of women. Advocates have tended to be in one or other camp, rather than supporting the rights of both mother and child.
Current position
Funding for child survival globally has fallen during the last decade, particularly if special programmes such as malaria and vaccines are not included. The structure of many funding agencies sets maternal and child health in competition, rather than prioritising long term investment in a health system which benefits both.
Partnerships founded between 2000 and 2004 were established to support the rights of one party or another: Safe Motherhood, Newborn Health or Child Survival. Disparate voices and multiple partnerships focusing on separate outcomes (maternal, newborn, child) are less likely to get global attention. Supporting action at national level is more difficult if three partnerships are trying to reach all the high-mortality countries themselves; and if ministries of health are being pulled in different directions by apparently competing agendas.
- Coping with paediatric referral: Ugandan parents’ experience
- This article, published in The Lancet, reports on a study examining the constraints faced by caretakers in completing referrals of severely ill children to hospital in Uganda. The study found that only 28 per cent of children had completed referral after two weeks, and at an average cost of US$8.85.
A win-win for the future
Mothers, newborns and children all benefit from a health system that functions to deliver interventions across the continuum of care from pre-pregnancy through pregnancy, childbirth and the postnatal period into infancy and childhood (Tinker et al). How the health system will achieve this and what stages it needs to go through to get there may vary between countries (Lancet neonatal survival 3). Maternal, neonatal and child deaths represent a major burden of mortality. However, attention and funding for maternal, newborn and child health (MNCH) are much less than for other high profile causes such as HIV and AIDS (World Health Report 2005).
A united voice to call for investment in MNCH systems would be more effective than internally competing voices. Strengthening the same health system at the crucial points in the continuum of care, particularly around childbirth, will reduce the competition between the various outcomes. This will benefit mothers, newborns, children and also those babies who are stillborn and who remain invisible in current policy. The three Partnerships (Safe Motherhood, Newborn Health or Child Survival) are working closely together (Tinker et al) and closer formal links will strengthen global messages and should enable greater synergy and more effective support at national level.
