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We analyzed Brazil's efforts in reducing child mortality, improving maternal and child health, and reducing socioeconomic and regional inequalities from 1990 through 2007. We compiled and reanalyzed data from several sources, including vital statistics and population-based surveys. We also explored the roles of broad socioeconomic and demographic changes and the introduction of health sector and other reform measures in explaining the improvements observed. Our findings provide compelling evidence that proactive measures to reduce health disparities accompanied by socioeconomic progress can result in measurable improvements in the health of children and mothers in a relatively short interval. Our analysis of Brazil's successes and remaining challenges to reach and surpass Millennium Development Goals 4 and 5 can provide important lessons for other low- and middle-income countries. (Am J Public Health. 2010;100:1877-1889. doi: 10.2105/AJPH.2010.196816)

Objective To describe the declining trend in maternal mortality observed in Mongolia from 1992 to 2007 and its acceleration after 2001 following implementation of the Maternal Mortality Reduction Strategy by the Ministry of Health and other partners. Methods We performed a descriptive analysis of maternal mortality data collected through Mongolia's vital registration system and provided by the Mongolian Ministry of Health. The observed declining mortality trend was analysed for statistical significance using simple linear regression. We present the maternal mortality ratios from 1992 to 2007 by year and review the basic components of Mongolia's Maternal Mortality Reduction Strategy for 2001-2004 and 2005-2010. Findings Mongolia achieved a statistically significant annual decrease in its maternal mortality ratio of almost 10 deaths per 100 000 live births over the period 1992-2007. From 2001 to 2007, the maternal mortality ratio in Mongolia decreased approximately 47%, from 169 to 89.6 deaths per 100 000 live births. Conclusion Disparities in maternal mortality represent one of the major persisting health inequities between low- and high-resource countries. Nonetheless, important reductions in low-resource settings are possible through collaborative strategies based on a horizontal approach and the coordinated involvement of key partners, including health ministries, national and international agencies and donors, health-care professionals, the media, nongovernmental organizations and the general public. Objectif Decrire la tendance a la baisse de la mortalite maternelle observee en Mongolie entre 1992 et 2007 et son acceleration apres 2001, suite a la mise en oeuvre de la Strategie de reduction de la mortalite maternelle par le Ministere de la sante et d'autres partenaires. Methodes Nous avons realise une analyse descriptive des donnees de mortalite maternelle collectees par I'intermediaire du systeme mongol d'enregistrement de l'etat-civil et fournis par le Ministere de la sante mongol. Nous avons analyse la tendance a la baisse de la mortalite pour evaluer sa significativite statistique par regression lineaire simple. Nous presentons les ratio de mortalite maternelle annuels de 1992 a 2007 et passons en revue les composantes de base de la Strategie de reduction de la mortalite maternelle mongole pour les periodes 2001-2004 et 2005-2010. Resultats La Mongolie a obtenu une baisse annuelle statistiquement significative de son ratio de mortalite maternelle de pres de 10 deces pour 100 000 naissances vivantes sur la periode 1992-2007. De 2001 a 2007, le ratio de mortalite maternelle mongol a diminue d'environ 47 %, passant de 169 a 89,6 deces pour 100 000 naissances vivantes. Conclusion Les disparites en termes de mortalite maternelle representent I'une des principales sources d'inegalites persistantes entre les pays a faible revenu et les pays riches. Neanmoins, des diminutions importantes de cette mortalite sont possibles dans les regions demunies si l'on fait appel a des strategies collaboratives reposant sur une approche horizontale et sur la participation coordonnee de partenaires des, dont les ministeres de la sante, les agences et les donateurs nationaux et internationaux, les professionnels de sante, les medias, les organisations non gouvernementales et la population generale. Objetivo Describir la tendencia decreciente de la mortalidad materna observada en Mongolia entre 1992 y 2007 y su aceleracion a partir de 2001, despues de que el Ministerio de Salud y otros asociados aplicaran la estrategia de reduccion de la mortalidad materna. Metodos Realizamos un analisis descriptivo de los datos de mortalidad materna reunidos a traves del sistema de registro civil de Mongolia y proporcionados por el Ministerio de Salud. La tendencia observada de reduccion de la mortalidad fue analizada mediante regresion lineal simple para determinar la significacion estadistica. Presentamos las razones de mortalidad materna entre 1992 y 2007 para cada ano y examinamos los componentes basicos de la estrategia de reduccion de la mortalidad materna de Mongolia en 2001-2004 y 2005-2010. Resultados Mongolia logro una disminucion anual estadisticamente significativa de su razon de mortalidad materna de casi 10 muertes por 100 000 nacidos vivos durante el periodo 1992-2007. Entre 2001 y 2007, la razon de mortalidad materna disminuyo aproximadamente un 47%, de 169 a 89,6 defunciones por 100 000 nacidos vivos. Conclusion Las disparidades de la mortalidad materna son una de las principales inequidades en salud que aun persisten si se comparan los pa[ses de bajos recursos y los que cuentan con altos recursos. Sin embargo, es posible lograr reducciones importantes en los entornos con recursos escasos aplicando estrategias de colaboracion basadas en un enfoque horizontal y coordinando la participacion de asociados clave, como los ministerios de salud, los organismos y donantes nacionales e internacionales, los profesionales de la salud, los medios de comunicacion, las organizaciones no gubernamentales y el publico en general., Introduction Global disparities in women's reproductive health represent one of the starkest health inequities of our times and a major social injustice. Each year approximately 530 000 women die from [...]

Objective To analyse preterm birth rates worldwide to assess the incidence of this public health problem, map the regional distribution of preterm births and gain insight into existing assessment strategies, Methods Data on preterm birth rates worldwide were extracted during a previous systematic review of published and unpublished data on maternal mortality and morbidity reported between 1997 and 2002. Those data were supplemented through a complementary search covering the period 2003-2007. Region-specific multiple regression models were used to estimate the preterm birth rates for countries with no data. Findings We estimated that in 2005, 12.9 million births, or 9.6% of all births worldwide, were preterm. Approximately 11 million (85%) of these preterm births were concentrated in Africa and Asia, while about 0.5 million occurred in each of Europe and North America (excluding Mexico) and 0.9 million in Latin America and the Caribbean. The highest rates of preterm birth were in Africa and North America (11.9% and 10.6% of all births, respectively), and the lowest were in Europe (6.2%). Conclusion Preterm birth is an important perinatal health problem across the globe. Developing countries, especially those in Africa and southern Asia, incur the highest burden in terms of absolute numbers, although a high rate is also observed in North America. A better understanding of the causes of preterm birth and improved estimates of the incidence of preterm birth at the country level are needed to improve access to effective obstetric and neonatal care. Objectif Analyser les taux de prematurite dans le monde pour evaluer l'incidence de ce probleme de sante publique, cartographier la distribution par regions des naissances avant terme et mieux connaftre les strategies d'evaluation existantes. Methodes Les donnees relatives aux naissances avant terme dans le monde ont ete extraites dans le cadre d'une revue systematique anterieure des donnees publiees et non publiees sur la mortalite et la morbidite maternelles, produites entre 1997 et 2002. Ces donnees ont ete completees par une recherche supplementaire couvrant la periode 2003-2007. Des modeles de regression multiple specifiques aux differentes regions ont ete utilises pour estimer les taux de prematurite dans les pays ne disposant pas de donnees. Resultats Nous avons estime qu'en 2005, 12,9 millions de naissances, soit 9,6 % de la natalite mondiale totale, etaient intervenues avant terme. Environ 11 millions (85 %) de ces naissances prematurees etaient concentrees en Afrique et en Asie, tandis que l'Europe et l'Amerique du Nord (Mexique inclus) accueillaient chacune 0,5 million de naissances de ce type et l'Amerique latine et les Carafbes 0,9 million. Les taux de prematurite les plus eleves etaient releves en Afrique et en Amerique du Nord (11,9 % et 10,6 % de l'ensemble des naissances, respectivement) et les plus bas en Europe (6,2 %). Conclusion La naissance avant terme constitue un important probleme de sante perinatale partout dans le monde. Les pays en developpement, en particulier ceux d'Afrique et du Sud de l'Asie, subissent la pius forte charge en termes absolus, bien qu'un taux de prematurite eleve soit aussi observe en Amerique du Nord. Une meilleure comprehension des causes de naissance prematuree et de meilleures estimations de l'incidence des naissances avant terme a l'echelle des pays sont necessaires pour ameliorer l'acces a des soins obstetricaux et neonatals efficaces. Objetivo Analizar las tasas de prematuridad a nivel mundial para evaluar la incidencia de este problema de salud publica, determinar la distribucion regional de los partos prematuros y profundizar en el conocimiento de las actuales estrategias de evaluacion. Metodos Los datos utilizados sobre las tasas de prematuridad a nivel mundial se extrajeron a lo largo de una revision sistematica anterior de datos publicados e ineditos sobre la mortalidad y morbilidad maternas notificados entre 1997 y 2002. Esos datos se complementaron mediante una busqueda que abarco el periodo 2003-2007. Las tasas de prematuridad de los paises sin datos se estimaron mediante modelos de regresion multiple especificos para cada region. Resultados Estimamos que en 2005 se registraron 12,9 millones de partos prematuros, lo que representa el 9,6% de todos los nacimientos a nivel mundial. Aproximadamente 11 millones (85%) de ellos se concentraron en Africa y Asia, mientras que en Europa y America dei Norte (excluido Mexico) se registraron 0,5 millones en cada caso, y en America Latina y el Caribe, 0,9 millones. Las tasas mas elevadas de prematuridad se dieron en Africa y America del Norte (11,9% y 10,6% de todos los nacimientos, respectivamente), y las mas bajas en Europa (6,2%). Conclusion El parto prematuro es un problema de salud perinatal importante en todo el mundo. Los paises en desarrollo, especialmente de Africa y Asia meridional, son los que sufren la carga mas alta en terminos absolutos, pero en America del Norte tambien se observa una tasa elevada. Es necesario comprender mejor las causas de la prematuridad y obtener estimaciones mas precisas de la incidencia de ese problema en cada pais si se desea mejorar el acceso a una atencion obstetrica y neonatal eficaz., Introduction Preterm birth, defined as childbirth occurring at less than 37 completed weeks or 259 days of gestation, is a major determinant of neonatal mortality and morbidity and has long-term [...]

Objectives. We analyzed trends in maternal, newborn, and child mortality in Chile between 1990 and 2004, after the introduction of national interventions and reforms, and examined associations between trends and interventions. Methods. Data were provided by the Chilean Ministry of Health on all pregnancies between 1990 and 2004 (approximately 4000 000). We calculated yearly maternal mortality ratios, stillbirth rates, and mortality rates for neonates, infants (aged >28 days and Results. During the study period, the maternal mortality ratio decreased from 42.1 to 18.5 per 100000 live births. The mortality rate for neonates decreased from 9.0 to 5.7 per 1000 births, for infants from 7.8 to 3.1 per 1000 births, and for young children from 3.1 to 1.7 per 1000 live births. The stillbirth rate declined from 6.0 to 5.0 per 1000 births. Disparities in these mortality statistics between the poorest and richest district quintiles also decreased, with the largest mortality reductions in the poorest quintile. Conclusions. During a period of socioeconomic development and health sector reforms, Chile experienced significant mortality and inequity reductions. (doi:10.2105/AJPH.2008.143578)

Background: In the sub-Saharan Africa region, the adolescent birth rate is the highest in the world, estimated at 100.5 births per 1000 women aged 15 to 19 years, and 2.4 times greater than the global average. This analysis examines coverage levels and gaps in basic maternal health care for adolescent mothers living in this region.Methods: We used data from national Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between 2010 and 2016 in 22 of the sub-Saharan African Countdown to 2030 priority countries with adolescent birth rates above 100 in 2016. We analyzed 11 indicators of coverage of key services provided during the pre-pregnancy, pregnancy, delivery and postnatal period. We described the coverage level among adolescent girls aged 15-19 and women aged 20-49 for basic indicators in the continuum of care. We conducted a multilevel random effect logistic regression to quantify the association between the receipt of basic package of maternal care and woman's socio-demographic and socio-economic characteristics.Results: The median coverage of the basic package of maternal care among adolescents was extremely low, at 9.3%. Adolescent mothers who were in the highest household wealth quintile (odds ratio OR = 2.44, 95% confidence interval (CI) = 2.23-2.68), living in an urban area (OR = 1.25, 95% CI = 1.18-1.33) and having secondary education (OR = 1.61, 95% CI = 1.50-1.73) had greater odds of receiving the basic package of maternal health care as compared to those in the lowest wealth quintile, living in rural areas, and with no education respectively. Adolescent girls aged 15-17 and 18-19 had respectively 26% (OR = 0.74, 95% CI = 0.67-0.82) and 9% (OR = 0.91, 95% CI = 0.84-0.98) lower odds of receiving the basic package compared to women 20-49 years old. Child brides had 12% (OR = 0.88, 95% CI = 0.84-0.93) lower odds of receiving the basic package compared to women who were married after the age of 18.Conclusion: Coverage of basic maternal health care for adolescent mothers is inadequate in the countries with the highest adolescent birth rates in the world. Addressing the reproductive and maternal health needs of adolescents in sub-Saharan Africa is of critical importance, especially given projections that this region will experience the highest increases in adolescent births in the coming decades. [ABSTRACT FROM AUTHOR]

Global monitoring of intervention coverage is a cornerstone of international efforts to improve reproductive, maternal, newborn, and child health. In this review, we examine the process and implications of selecting a core set of coverage indicators for global monitoring, using as examples the processes used by the Countdown to 2015 for Maternal, Newborn and Child Survival and the Commission on Accountability for Women's and Children's Health. We describe how the generation of data for global monitoring involves five iterative steps: development of standard indicator definitions and measurement approaches to ensure comparability across countries; collection of high-quality data at the country level; compilation of country data at the global level; organization of global databases and rounds of data quality checking. Regular and rigorous technical review processes that involve high-level decision makers and experts familiar with indicator measurement are needed to maximize uptake and to ensure that indicators used for global monitoring are selected on the basis of available evidence of intervention effectiveness, feasibility of measurement, and data availability as well as programmatic relevance. Experience from recent initiatives illustrates the challenges of striking this balance as well as strategies for reducing the tensions inherent in the indicator selection process. We conclude that more attention and continued investment need to be directed to global monitoring, to support both the process of global database development and the selection of sets of coverage indicators to promote accountability. The stakes are high, because these indicators can drive policy and program development at the country and global level, and ultimately impact the health of women and children and the communities where they live., Introduction Global monitoring of coverage for maternal and child health interventions involves the collection and analysis of a limited set of quantitative indicators to assess progress, and is central to [...]

This article reviews formal and informal mechanisms through which the World Health Organization (WHO) is promoting policies for the advancement of women's health. Specific attention is given to select examples of innovative strategies the WHO has adopted in recent years to increase political commitment to women's and children's health and influence the development of policies supportive of country efforts to achieve Millennium Development Goals 4 (MDG4) and MDG 5 (to reduce child mortality and improve maternal health, respectively).