Ahead of next week’s United Nations Summit on the Social Development Goals, a new report asserts that a few simple measures could slash the deaths of mothers and babies

A series of relatively simple interventions could save the lives of millions of mothers and babies and put the world on course to achieve the Sustainable Development Goals (SDG) related to child deaths and maternal mortality.

This is according to the Bill & Melinda Gates Foundation’s (BMGF) Goalkeepers 2023 report, which was released on Tuesday.

The COVID-19 pandemic seriously disrupted the SDGs’ progress, including the goals of ending all preventable child deaths, cutting child deaths to 12 per 1000 live births, and cutting the maternal mortality rate to less than 70 deaths per 100,000 births by 2030. 

The United Nations has convened a special SDG summit in New York on Monday and Tuesday next week to review progress and accelerate the implementation of the 2030 Agenda for Sustainable Development.

The draft political declaration for the summit concedes that the achievement of the 17 SDGs “is in peril”, declaring that progress is “either moving much too slowly or has regressed below the 2015 baseline”. 

Every year, five million children die before they turn five – three-quarters of these deaths in the child’s first year – while almost two million babies are stillborn. 

“For new mothers, progress has hit a brick wall. Globally, maternal mortality rates have remained stubbornly static over the past eight years, and in some countries, from the United States to Venezuela, they have risen,” according to the Goalkeepers report.

This is not just a problem for low and middle-income countries. In the United Kingdom and the United States, the death rates for Black mothers have doubled since 1999.

“For nearly all of human history, we simply didn’t know enough about preventing or treating the common childbirth complications that lead to death, such as postpartum haemorrhage or infection,” according to Melinda French Gates, BMGF co-chair.

“Today, we know a great deal. Yet, as is so often the case in global health, new breakthroughs aren’t making their way to the people who need them most: women in low-income countries like Malawi, as well as Black and Indigenous women in high-income countries like the United States, who are dying at three times the rate of white women, even when holding for economic and education levels.”

According to the report, in the 2010s doctors “uncovered revolutionary information about maternal and child health—everything from the exact diseases that are killing children; to the role anaemia can play in increasing blood loss during childbirth; to previously unknown ways in which a baby’s health is linked to their mother’s”. 

By applying this information, the BMGF estimates that nearly 1,000 mothers and babies could be saved every day to the end of the decade – a total of two million lives. 

Postpartum haemorrhaging

The first intervention involves addressing postpartum haemorrhage, the number-one cause of maternal death. 

The World Health Organization (WHO) defines postpartum haemorrhage as losing more than half a litre of blood within 24 hours of childbirth, something that kills 70,000 women annually, primarily in low-income countries, and leaves many others with disabling heart or kidney failure. 

Research conducted in four African countries by Dr Hadiza Galadanci, a Nigerian obstetrician, found that many healthcare workers struggled to recognise how much blood loss is too much – and over half the women who experienced it were never diagnosed.

“There is a simple, low-cost way to identify when blood loss is dangerously excessive: a drape that looks like a V-shaped plastic bag. When this calibrated obstetric drape is hung at the edge of the bed collected blood rises like mercury in a thermometer. And in a busy hospital ward, that visual gauge tells providers which patients are in danger in just a single glance,” according to French Gates.

Five treatments are conventionally used to stop the bleeding – uterine massage, oxytocic drugs, tranexamic acid, IV fluids, and genital tract examination. 

“But those interventions were being delivered sequentially—and far too slowly,” according to the report.

So Galadanci’s researchers asked healthcare providers to administer all five at once and this, combined with the use of the V-shaped blood bags, decreased severe bleeding by 60%. 

Anaemia affecting pregnancies

A common cause of haemorrhaging is anaemia, or severe iron deficiency, which affects 37% of pregnant women around the world – and in some places in South Asia, is as high as 80%. “Every pregnant woman should have access to maternal micronutrient supplements – high-quality prenatal vitamins that include iron—which can prevent most mild maternal anaemia cases,” according to the report.

Screening for anaemia during antenatal care is important – but some women dislike the unpleasant side effects of taking iron.

Nigerian obstetrician Dr Bosede Afolabi is working on a one-off, 15-minute intravenous infusion of iron to replenish women’s iron reserves during pregnancy.

Preventing infections, boosting nutrients

Another leading cause of maternal death and disability is an infection that leads to sepsis, something that can easily be treated by a common antibiotic, azithromycin.

When given during labour, azithromycin reduces maternal infections, and during a trial across sub-Saharan Africa, it reduced sepsis cases by a third, according to the report.

“It could also be a game-changer in the US, where 23% of maternal deaths are from sepsis,” according to French Gates. “The United States has some of the most abysmal—and most inequitable—maternal mortality rates among high-income countries.”

“American women are more than three times more likely to die from childbirth than women in almost every other wealthy country,” she added, and the “biggest crisis is among Black and Indigenous women”. 

Recalling tennis star Serena Williams’s account of how close she came to dying after giving birth and the death in April of Olympic track and field star Tori Bowie from treatable childbirth complications in her home, French Gates said that “azithromycin has the potential to address the cause of nearly a quarter of American maternal deaths”.

The report also advocates for giving Bifidobacteria (B. Infantis), a new probiotic supplement to infants at risk of malnutrition alongside breastmilk and multiple micronutrient supplements for breastfeeding mothers to replenish their nutrient stores in pregnant women and ensuring those vital nutrients are transferred to the baby 

In addition, the report proposes giving antenatal corticosteroids (ACS)  to women who will give birth prematurely to accelerate foetal lung growth, and AI-enabled portable ultrasounds to enable nurses to monitor high-risk pregnancies in low-resource settings.

“Of course, these interventions aren’t silver bullets on their own—they require countries to keep recruiting, training, and fairly compensating health care workers, especially midwives, and building more resilient health care systems. But together, they can save the lives of thousands of women every year,” asserted French Gates.

Causes of babies’ death

Meanwhile, BMGF co-chair Bill Gates spoke of the importance of data about the causes of babies’ deaths, recalling how the BMGF supported the Child Health and Mortality Prevention Surveillance (CHAMPS) initiative since 2015. 

“Even 10 years ago, public health officials had only the vaguest information about why babies were dying,” said Gates.”Back then, any record of a child’s death would generally list one of the four most common causes: diarrhoea, malnutrition, pneumonia, or premature birth. But each was a vast ocean of different illnesses, each with scores of different causes and cures. Pneumonia, for example, is linked to more than 200 types of pathogens.”

The Foundation funded three studies to fill in the gaps – CHAMPs to uncover the most inscrutable causes of death, PERCH, which examined the causes of childhood pneumonia, and GEMS which looked at diarrhoeal diseases. 

“As doctors compiled and compared case after case, a clearer, and often surprising, picture of child death emerged. For instance, some pathogens were less likely than was expected, like pertussis which causes whooping cough, but others were more likely than we expected, like Klebsiella which can be harder to treat,” said Gates.

“Over the past eight years, the field of child health has moved faster and farther than I thought I’d see in my lifetime. And if our delivery can keep pace with our learning – if researchers can keep developing new innovations and health workers can get them to every mother and child that needs them – then doctors could all but guarantee a baby would survive their crucial first days,” he added.

However, the report asserts that lives will only be saved “if all mothers and babies have access to both quality healthcare services and [these] innovations”.

“We need policy changes, political will, more investment into women’s health, and health care workers – including midwives.”

Image Credits: BMGF.