Millennium Development Goals 4 and 5: progress and challenges
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Medicine for Global Health
COMMENTARY
Open Access
Millennium Development Goals 4 and 5: progress and challenges Jennifer Bryce1*, Robert E Black1 and Cesar G Victora2
Abstract The Millennium Development Goals have galvanized efforts to improve child survival (MDG-4) and maternal health (MDG-5). There has been important progress on both MDGs at global level, although it now appears that few countries will reach them by the target date of 2015. There are known and efficacious interventions to address most of the major causes of these deaths, but important gaps remain. The biggest challenge is to ensure that all women and children have access to life-saving interventions. Current levels of intervention coverage are too low, representing missed opportunities. Providing services at the community level is an important emerging priority, but preventing maternal and neonatal deaths also requires access to health facilities. Readers of the Medicine for Global Health collectiona in BMC Medicine are urged to make maternal and child health one of their key concerns, even if they work on other topics. Keywords: Child survival, Child mortality, Maternal survival, Maternal health, Maternal mortality, Neonatal mortality, Nutrition, Millennium Development Goals
Background The eight Millennium Development Goals (MDGs) arose out of the United Nations Millennium Declaration of 2000, and set targets for levels of achievement for the period from 1990 to 2015 [1]. MDG-4, “Reduce child mortality”, has a target of reducing the under-five mortality rate by two-thirds. MDG-5, “Improve maternal health”, has a target of reducing the maternal mortality ratio by three-quarters. Despite important limitations [2], the MDGs have galvanized and focused global attention and monitoring. MDGs 4 and 5 are important for global health as a whole, because they represent the mortality endpoints for women and children across specific diseases, nutritional and environmental risk factors, and more distal determinants including inequalities in economic resources and education. Under-five mortality is also one of the major determinants of life expectancy across the globe. In this brief commentary, we review progress regarding MDG-4 and MDG-5 in the 75 low- and middle-income countries (LMIC) that account for over 95% of maternal and child deaths [3]. * Correspondence: [email protected] 1 Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA Full list of author information is available at the end of the article
The changing epidemiology of women’s and children’s health
Progress on MDG-4 for child survival has been impressive at the global level, although it now appears clear that the global target will not be reached [4]. The number of deaths among children under five worldwide has decreased from 12.4 million [1] in 1990 to 7.6 million in 2010 [5], a reduction of nearly 40% in spite of an increase in the number of births. Child deaths continue to be concentrated in LMICs, and in
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