Child death rates are plummeting and child health overall is improving, according to a study published yesterday in The Lancet.
Maternal health and mortality statistics are also showing steady improvement globally, though with one perhaps surprising aberration: Maternal deaths in the United States are actually on the increase, rising from 17 deaths for every 100,000 live births in 2000 to 25 deaths per 100K births in 2015.
Why the U.S. is such a poor performer and global outlier when it comes to maternal health is unclear, as experts expressed to the New York Times.
Humanosphere has reported before on maternal death rates increasing in the U.S. while declining in most other parts of the world, as in this 2014 Global Burden of Disease report. One possible explanation is that in the U.S., unlike most rich nations, a significant number of low-income women and families still have reduced access to basic health services.
The new study examining the overall world trends in child and maternal health, performed by the Global Burden of Disease (GBD) research consortium run out of Seattle, found that between 2000 and 2015 the number of child deaths globally dropped by 3.5 million every year.
The GBD study, administered by the University of Washington’s Institute for Health Metrics and Evaluation, benchmarks the state of progress toward the health-related U.N. Sustainable Development goals in 2015 in 188 countries around the world. Data collected from many sources for numerous diseases and disorders are constantly being analyzed and updated by the Global Burden of Diseases study. The recent results show substantial improvements in health in many countries from all over the development spectrum.
More children are thriving and going on to live productive lives than ever before. In 2000, 9.3 million children under 5 died. By 2015, that number had dropped to 5.8 million. There are many reasons for this decline, including increased funding for child health, improved access to health care and better access to adequate nutrition.
For example, Ethiopia’s under-5 mortality rate dropped from 202 to 60 per 1,000 between 1990 and 2015 (see Figure 1). At the same time, its funding for child health rose from $13 million in 2000 to $190 million in 2013. The country improved access to care, too: in 1990, 14 percent of Ethiopians who needed a health intervention received it, while in 2015, 47 percent did. The prevalence of childhood stunting in Ethiopia decreased from 59 percent in 1990 to 41 percent in 2015. Changes like these drove broad improvements in Ethiopia’s overall health-related SDG performance leading up to 2015.
Figure 1: Ethiopia’s SDG progress, 1990 to 2015
Worldwide, efforts to improve maternal health have also paid off. Between 2000 and 2015, the global maternal mortality ratio, which measures the number of maternal deaths per 100,000 live births, dropped 32 percent – from 288 to 196. That global measure, however, obscures the fact that 60 percent of countries in the world had, as of 2015, already met the 2030 goal of reducing their maternal mortality ratio to 70 per 100,000 live births – those countries appear in gray in Figure 2.
Several countries recorded immense progress in maternal mortality ratio during that time: China’s maternal mortality ratio declined from 84 to 17, Burundi’s from 1,027 to 387, and India’s from 419 to 249.
Many factors contributed to these drops, including increased funding for and access to family planning services, reductions in the number of adolescents giving birth and increases in levels of education among women.
Despite the overall trend of improvement, a handful of countries reported increases in maternal-mortality ratio between 2000 and 2015. That group includes the United States, where the maternal-mortality ratio rose from 17 to 25 per 100,000 live births. That relatively large number, along with the size of its increase, made the U.S. highly unusual among rich countries.
Figure 2: Maternal-mortality ratio, 2015
Researchers also ranked countries’ performances in 33 health-related Sustainable Development Goal indicators. They also generated a composite index of countries’ overall progress across all of the health-related SDG indicators.
Country performance varied among the different indicators. Iceland, for example, had the highest overall health-related SDG progress ranking (85), but its ranking for prevalence of overweight children ages 2 to 4 was much lower at 43.
Countries with low overall health-related SDG scores, such as the Central African Republic (20 out of 100) conversely often had indicators for which they scored well. For example, the Central African Republic’s score for the prevalence of wasting, or low weight-for-height, among children under 5 was 71.
Several countries stood out for the extent of their overall improvement between 2000 and 2015. Timor-Leste improved its health-related SDG performance more than any other country in the study, followed by Bhutan, Colombia and Venezuela. Some highly developed countries, such as Iceland and Malaysia, improved substantially, but so, too, did some countries at lower levels of development, such as Senegal and Rwanda. More information on countries’ performance is available at vizhub.healthdata.org/sdg.
These examples of progress toward the health-related SDGs indicate that development drives, but does not determine, population health. While countries with higher levels of socio-demographic development generally did better in achieving health-related SDGs, there are plenty of examples of substantial and sustained progress among countries at lower levels of socio-demographic development. The latter group includes countries such as China, India, Nigeria, Guatemala and Liberia – all of which made excellent progress in health between 2000 and 2015.
That progress opens up an opportunity for the international community.
“As the SDG period begins, we have several clear examples of maternal and child health improvement from countries at different levels of socio-demographic development,” said Dr. Steven Lim, lead author on the study. “We now need to look to those countries that have seen strong progress to find out what they are doing right and how it can be applied more broadly.”