1. A G8 plan that works: Reducing maternal, newborn and child mortality Dr. André Lalonde, FRCSC SOGC Executive Vice President FIGO Executive Board Member PMNCH Executive Board Member Dr. Heather MacDonnell, FRCPC, FAAP, DTMH(UK) Co-Head International Adoption Clinic Division of Pediatric Medicine, CHEO Assistant Professor of Pediatrics, U Ottawa Dr. Mark Walker, FRCSC Associate Professor University of Ottawa Senior Scientist OHRI Scientific Director BORN Ontario

2. Canada to host the 2010 G8 Summit This year, Canada is presented with an important opportunity to reaffirm itself as a global humanitarian leader, as we welcome world leaders to the 2010 G8 and G20 Summits.

3. G8 to focus on Maternal and Child Health Prime Minister Harper’s announcement is a step in the right direction. But what exactly is included in the mother and child initiative? And will promises be met?

4. Millennium Development Goals

5. Millennium Development Goals 4. Reduce Child Mortality Target: – Reduce by 2/3, between 1990 and 2015, the mortality rate of children under 5 Indicators: – Under-five mortality rate – Infant mortality rate – Proportion of one-year-old children immunized against measles

6. Target 5.A: – Reduce by 3/4, between 1990 and 2015, the maternal mortality ratio Indicators: – Maternal mortality ratio – Proportion of birth attended by skilled health personnel Millennium Development Goals 5. Improve Maternal Health Target 5.B:  Achieve, by 2015, universal access to reproductive health Indicators:  Contraceptive prevalence rate  Adolescent birth rate  Antenatal care coverage  Unmet need for family planning

7. Global Situation 180-210 million pregnancies every year 80 million unwanted pregnancies 50 million induced abortions 20 million unsafe abortions 68,000 deaths from unsafe abortion 20 million women suffer from maternal morbidity Estimated 536,000 maternal deaths 3 million babies are born dead Almost 10 million children under 5 die Of which 3 million newborns die within the first week of life 500,000 infants are infected with HIV

8. Progress toward MDG 4: Source: Progress for children. A world fit for children. Statistical tables on MDG4. Available at http://www.unicef.org/progressforchildren/2007n6/index_41854.htm http://www.unicef.org/progressforchildren/2007n6/index_41854.htm No progress Insufficien t On track Countries with increasing U5MR 15 countries 'on track' 25 countries 'no progress'

9. Progress toward MDG 5 12 of 13 countries with highest Maternal Mortality Ratios are in sub-Saharan Africa Pattern of contextual factors differs from that of MDG4.  High HIV prevalence (>5%, 1/13)  Conflict (8/13)

10. Coverage failures across the continuum of care Coverage estimates for interventions across the continuum of care in the 68 priority countries (2000-2006). Vertical bars indicate the range in coverage across countries. For some interventions: Family planning Exclusive breastfeeding Clinical care for newborn and child illnesses In some countries: Wide gaps in coverage across countries

11. Key strategies to reduce maternal mortality Access to contraceptives, to avoid unintended pregnancies Access to skilled care at the time of birth Timely access to emergency obstetric care in the event of complications

12. Skilled attendance at birth saves mothers and babies Skilled attendance at childbirth is the most effective intervention World Health Organization April 05

13. 1.Political leadership and community engagement and mobilization 2.Delivering high quality services 3.Removing financial, social, and cultural barriers to access 4.Ensuring skilled and motivated health workers 5.Accountability at all levels for credible results The Global Consensus for Maternal, Newborn and Child Health:

14. Lives that can be saved and investment required:

15. Global Child Mortality: Key Messages Globally, 1 in 7 children die before the age of 5 = 9.2 million children in 2007 = 15 filled school buses crashing per hour Most under-5 deaths are preventable pneumonia, newborn causes, diarrhea, malaria, measles Simple strategies prevent deaths and are not necessarily expensive!

16. Sub-Saharan Africa South Asia Latin America East Asia Under- Five Mortality Rate (per 1000 live births) 244 188 171 62 206 129 92 42.6 122 54 31 17.8 123 58 36 19.1 1970 1990 2004 2015 MDG-4 Goals Under 5 (Child) Mortality Reduction Rates UNICEF State of the World’s Children

17. Child Mortality Rate /1000 live births 6130 Infant Mortality Rate /1000 live births 584 Stillbirth Rate /1000 total births 332 UNICEF State of the World’s Children

18. Preventable Conditions Cause Most Child Deaths Infection 36% Prematurity 27% Asphyxia 23% } Malnutrition 55% WHO data

19. What can be done to save the children? Postpartum Clean cord care Skin to skin with mother (kangaroo care) Antibiotics for suspected sepsis Early breastfeeding, exclusive x 6 months.

20. . Early Infancy and Beyond Routine immunizations Regular growth measurements Health education to mothers – Hygiene, clean water, sanitation Antibiotics for pneumonia Iron, Zinc, Vitamin A supplementation Insecticide treated bed nets What can be done to save the children?

21. Save a child’s life for a pittance Estimated cost of interventions: Insecticide-treated bed net $6 Full WHO EPI immunizations (Africa) $14 Oral rehydration solution (ORS) < $1 Total cost $887 per life saved Save 800,000 African newborns at $1.39 per person per year

22. Recommendations Focus on essential interventions that will prevent or reduce maternal, newborn and child mortality and morbidity Increase capacity with training of skilled birth attendants and health care providers at all levels Improve and strengthen physical infrastructure of health care facilities and supply of commodities Embed surveillance into programs to drive process with measureable outcomes and send feedback on progress made back to the community

23. 3 + 3 + 3 Maternal Health -Post partum hemorrhage -Eclampsia -Dystocia Maternal Health -Post partum hemorrhage -Eclampsia -Dystocia Newborn Health -Infection -Prematurity -Asphyxia Newborn Health -Infection -Prematurity -Asphyxia Child Health -Acute respiratory illness -Diarrhea -Malaria Child Health -Acute respiratory illness -Diarrhea -Malaria By focusing efforts on the 3 main causes of death, we can make real progress to improve the health of women, newborns and children

24. The way forward for Canada to lead in the area of Maternal and Child Health Increased funding for maternal and child health programs Focus on the main causes of mortality and morbidity Capitalize on Canada’s expertise in the field of maternal and child health to strengthen programs and improve health outcomes Use a rights-based approach Ensure family planning Upgrade the skills of health professionals, especially in the area of Emergency Obstetric Care Ensure programs are directed at all levels of service delivery (local, regional, national) Use the three delays model to influence program design and fund allocation Allocate funding in a way that addresses gaps along the continuum of care

25. Conclusion Maternal survival and health is essential for the economic development of nations Survival and health of the world’s newborns and children depends on their mothers Parliamentarians need to play their part for Canada to assume a leadership role

26. There is no better time to raise your voice for women and children worldwide