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This technical brief provides an assessment of progress on this indicator set and presents a way forward to improve child survival. It is organized into four sections: Section 1 reviews child mortality trends and causes of child deaths; Section 2 provides a snapshot of child nutritional status; Section 3 examines coverage of select child health and nutrition interventions, with a focus on countries that are of track for SDG 3.2.1; Section 4describes how accelerations in child survival can be achieved through a primary health care approach and renewed global and country commitment to children.

This brief outlines critical actions necessary to accelerate progress for MNCH, emphasizing the urgent need for action and investment in equitable coverage of effective interventions and quality care to achieve the SDGs.

This year’s United Nations Inter-agency Group for Child Mortality Estimation (UN IGME)’s findings represent a noteworthy moment in the ongoing campaign to end all preventable child deaths: The annual number of under-five deaths has fallen to 4.9 (4.6–5.4) million in 2022.  The report reveals that more children are surviving today than ever before, with the global under-5 mortality rate declining by 51 per cent since 2000. And several low- and lower-middle-income countries have outpaced this decline. This is a testament to the commitment of governments, organizations, local communities, health-care professionals and families to the survival of the most vulnerable members of our global community.

Yet millions of children still died before seeing their fifth birthday – a loss that serves as a crucial reminder that threats to newborn and child health and survival persist around the world, particularly among the most marginalized children.  In addition to the 4.9 million lives lost before the age of 5 – nearly half of which were newborns – the lives of another 2.1 million children and youth aged 5-24 were also cut short. Most of these deaths were concentrated in sub-Saharan Africa and Southern Asia. There is still a long road ahead to end all preventable child and youth deaths.

Ending preventable child deaths in every community will require targeted investments in available, accessible quality health care, including skilled health personnel at birth, antenatal and postnatal care, care for small and sick newborns, preventive services such as vaccination, and diagnostic, preventive and curative measures to treat the key causes of childhood death. Data systems must also be strengthened to track and monitor survival by age and to help address underlying inequalities. This will enable us to move closer to achieving the Sustainable Development Goals and ensure that every child has the opportunity to thrive.

Summary: This module describes a core set of indicators for Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) that can be captured through routine health management information systems (HMIS). It includes possible analyses and visualizations of the indicators, references on how to assess the quality of the data, and considerations for using the data for decision-making.

The Modular Health Facility Assessment (HFA) and user guide provide the MOMENTUM suite of awards with a tool focusing on reproductive, maternal, newborn, child and adolescent health/family planning care and services, including seven modules that collect information on the following: service availability; service readiness; quality and safety of patient care; experience of care; availability of register; community services and mobilization; health facility oversight; quality improvement; and use of data.

Highlights

• The MOMENTUM Modular HFA draws from a number of existing tools, including those developed by MOMENTUM awards, and informs most of the quality of care indicators included in the MOMENTUM Measurement, Evaluation, and Learning (MEL) Framework.
• Guidance for how to construct these indicators is included in the HFA User Guide.
• The tool also includes new maternal health clinical vignettes (French version available) developed by MKA, a section focusing on readiness to provide services for small and sick newborn care as well as additional sections on nutrition, adolescent health and others.

How to Use

The assessment tool is designed to collect relevant information at various levels of health facilities, from community health centers to tertiary or national level referral hospitals. The tool is designed in a modular manner, which allows flexibility and adaptability to different country contexts to relate to the needs of the country and the specificities of its health system.

Summary

Born too soon: decade of action on preterm birth looks to the future, setting an ambitious agenda to reduce the burden of preterm birth by addressing factors outside of the health system that affect preterm birth; and, within health systems, by providing high-quality, respectful care for women and babies so that they can survive and thrive, no matter where they are born. 

Highlights

• Of every 10 babies born, 1 is preterm – and every 40 seconds, 1 of those babies dies
• Preterm birth rates have not changed in the past decade in any region of the world
• The impacts of conflict, climate change, COVID-19 are increasing risks for women and babies everywhere
• Action is needed urgently to improve the prevention of preterm birth, alongside better care for affected babies and their families

How to Use

This report is intended to inspire and support country-led action: politicians, policy-makers and leaders of all stakeholder groups are its primary audience. However, leadership “from the top” often emerges in response to a unified call to action by a broad-based coalition of committed advocates “from the bottom”.

The strategy chronicles the progress made across 25 countries since 2012, and lays out an action plan for country-led programs to measurably improve health outcomes for women and children through an intensified focus on coverage, quality, and equity. USAID’s new framework calls on the international community to draw from lessons learned, renew momentum towards the 2030 Sustainable Development Goals, and work together to improve global maternal and child survival.

Highlights

• Since the 2012 Call to Action, USAID has enabled 44 million women to give birth in a health facility, reached 33 million newborns with care after delivery, and trained 14 million health workers in maternal and child health and nutrition.
• In this new framework, USAID envisions a world where all women, newborn and children survive, are healthy and are able to develop and reach their full potential.
  • Objective 1: Reduce preventable child and maternal mortality in 25 priority countries to 12 percent or lower of total deaths by 2030
  • Objective 2: Increase coverage levels of lifesaving interventions across priority countries to a level of 68 by 2030, as measured by the reproductive, maternal, newborn, and child health (RMNCH) service coverage sub index.
• Strategic approaches will anchor response in primary health care systems, reach the hardest-to-reach populations, catalyze country commitment and mutual accountability, invest in the health workforce as the foundation of health systems, identify bottlenecks and tailor solutions through locally led development and generate and use data, evidence, and learning for decision-making.

How to Use

Stakeholders can use this framework as an a blueprint to improve health outcomes for women and children, incorporating components into implementation plans and policies.

The report presents internationally comparable global, regional and country-level estimates and trends for maternal mortality between 2000 and 2020. The estimates represent the most up to date, internationally-comparable MMEIG estimates of maternal mortality, using refined input data and methods from previous rounds. The resource includes access to the complete input dataset and estimates, model codes, country profiles, and data visualizations.

Highlights

• Every day in 2020, approximately 800 women died from preventable causes related to pregnancy and childbirth – meaning that a woman dies around every two minutes. In 2020, about 70% of all maternal deaths were in sub-Saharan Africa.
• Despite the ambition to end preventable maternal deaths by 2030, the world will fall short of this target by more than 1 million lives with the current pace of progress.
• Earlier positive trends in the decline in maternal mortality during the MDG period have stalled on a global level, MMRs stagnated or worsened in most regions between 2016 and 2020.
• Progress is uneven, and large inequities persist both between and within regions and settings with different levels of resources. In nine countries facing severe humanitarian crises, maternal mortality rates were more than double the world average (551 maternal deaths per 100 000 live births, compared to 223 globally).

The Global Scales for Early Development (GSED) provides a standardized method for measuring development of children up to 36 months of age at population and programmatic level globally. The GSED measures (Short Form and Long Form) capture child development holistically through a common unit, the Developmental score (D-score). The package includes comprehensive materials to support implementation and a technical report that summarizes the creation process of the GSED, the validation methodology and psychometric properties.

Highlights

• The D-score is a unit of measurement with an interval scale representing child development by a single number (12,13). The D-score is calculated from Yes/No responses on a set of age-appropriate developmental items (e.g. “Can the child stack two blocks”, or “Does the child use two-word sentences?”).
• The GSED measures capture the underlying construct of child development which includes the motor, language, cognitive and socio-emotional domains. The measures comprise a caregiver report Short Form and a direct administration Long Form.
• The D-score approach may be used to harmonize measurements across ages and instruments. Scores from multiple instruments can be translated into D-scores and compared to scores from a different instrument.

How to Use

If used effectively, GSED data can impact lives of children, especially those most vulnerable, by informing prioritization of the most effective child development interventions. Data from the GSED will be useful for policy-makers and governments in deciding priorities for funding. Global organizations will be able to use the data for cross-country comparisons and trend analyses. The GSED measures are expected to provide countries with an indication of how the youngest children are developing and become a motivation to invest in and promote healthy development.

While some progress has been made in reducing the global stillbirth rate, gains are uneven; substantial inequities in stillbirth rates persist among regions and countries. The United Nations Inter-agency Group for Child Mortality Estimation launched the second report on stillbirth mortality rates that includes the most up-to-date data and estimates for stillbirth from 195 countries. The report highlights the immense and continued annual burden of stillbirths, and calls attention to the fact that when pregnant women have access to quality care, most stillbirths can be prevented.

Highlights

• In 2021, an estimated 1.9 million babies were stillborn at 28 weeks of pregnancy or later, with a global stillbirth rate of 13.9 stillbirths per 1,000 total births.
• The report reveals huge differences in stillbirth rates across the globe, with the highest burdens in sub-Saharan Africa and Southern Asia. Stillbirths were concentrated in a few countries, with the greatest number found in India, followed by Pakistan, Nigeria, the Democratic Republic of the Congo, Ethiopia and Bangladesh.
• The unequal burden of stillbirths is also observed within countries, as access to health care, maternal education and other socioeconomic factors differs.
• Compared to the annual rates of reduction (ARR) for other mortality indicators, the gains made in stillbirths have been much slower, with progress lagging behind across all regions since 2000. The ARR 2000-2021 in mortality for children aged 1–59 months, for example, was double the ARR in stillbirths for the same period (4.0 per cent to 2.0 per cent, respectively).

How to Use

These wide discrepancies reiterate the need for all countries to take action and understand who carries the heaviest burden so that we can end preventable stillbirths for all women and families. Stakeholders can use this report to inform national stillbirth reduction targets and incorporate stillbirth prevention into public health planning and communication platforms.

Summary: This paper summarizes a WHO-led global initiative to develop and scale up a sexual, reproductive, maternal, newborn, child, and adolescent monitoring and evaluation framework for humanitarian settings. Researchers propose 17 maternal health indicators and 14 newborn health indicators aligned with global monitoring frameworks, split into core vs context-specific lists.

Highlights

• For maternal health, researchers identified seven core, six context-specific, and 4 service readiness indicators for humanitarian settings. 
• For newborn health, researchers identified seven core, five context-specific, and two service readiness indicators for humanitarian settings.

How to Use: Implementing agencies and partners can collaborate to scale up this agreed-upon set of SRMNCAH framework to enhance accountability and transparency in humanitarian settings. Through cross-sector coordination, stakeholders can improve existing data collection and reporting systems in humanitarian settings that are generally fragmented and inconsistent.

This report provides an assessment of the situation of women’s, children’s, and adolescent’s health in 2022, highlighting persistent inequities and the direct and indirect effects of the COVID-19 pandemic. The report also provides six recommendations to accelerate necessary progress for all women, children, and adolescents.

Current data shows stagnation and drops in intervention coverage despite great progress in reducing maternal and child mortality. Priority actions for stakeholders include:

• Strengthening primary health care systems
• Improving multisectoral collaborations
• Emphasizing women’s empowerment
• Leveraging public-private partnerships
• Increasing financial investments
• Securing global food supplies and humanitarian assistance