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Maternal and Child Health
The international community commemorated World Health Day in 2005 by selecting maternal and child health as its focus topic – the slogan being "Every mother and child counts". The importance of improving maternal and child health for development is emphasized by the pivotal role maternal and child health is assigned as part of the Millennium Development Goals: separate and specific goals have been postulated for the reduction of child mortality and improving maternal health.

Every year, more than 500,000 women die from complications of pregnancy and childbirth. Women in high-fertility countries in Sub-Saharan Africa have a 1-in-16 lifetime risk of dying from maternal causes, compared with women in low-fertility countries in Europe, who have a 1-in-2,000 risk, and in North America, who have a 1-in-3,500 risk of dying. In the area of child health, the developing world loses 10 million children each year with one child in 10 dying before its fifth birthday, compared with 1 in 143 in high-income countries. Although mortality rates for children under five have dropped by 15 percent since 1990, the rates remain high in developing countries. At current rates of progress, only a few countries are likely to achieve the Millennium Development Goal of reducing child mortality to one-third of their 1990 levels. With regard to the Latin America and Caribbean region, maternal health figures from 2000 show the region with a 1/160 lifetime risk of maternal death, which even though not at the levels of other regions, still remains high. In the area of child health, although significant progress has been made, child malnutrition remains a problem in the low-income countries and in poorer regions of some middle-income countries.

Overall, Latin America is halfway along the road to achieving its Millennium Development Goals regarding Maternal and Child Health by 2015. The Latin America and Caribbean region is the only region on track to achieve the target of reducing, by 2015, the under-five mortality rates by two thirds of their 1990 levels. From 1990 to the present, rates have fallen from 53 to 34 deaths per 1000 lives and this rate is expected to continue to fall to 18 by 2015. With regard to maternal health, in Latin America and the Caribbean, where the share of births attended by skilled health personnel is high, maternal mortality is relatively low. From the 1990-2015 period, above 80% of births were attended by skilled health staff. The Bank stands ready to further support countries in the region to meet the ambitious target in the next decade – and to contribute to improve the health and life of mothers and their children in the whole region.

From 1990 onwards, in the Latin America and the Caribbean region, significant advances have been made to address maternal and child health with notable progress taking place in the area of reducing child mortality rates. Below is information regarding what the Latin America and Caribbean region has done; what projects and initiatives are currently being carried out, and what challenges will be faced in going forward.

Bank financial assistance for maternal and child health
Lending for Maternal and Child Health in Latin America and the Caribbean is high and growing. Of total IBRD/IDA lending commitments in this area from 1990 to 2004, LAC represented 26%, second only to South Asia, which represented 28% of the total commitments. In absolute numbers, such lending in LAC amounted to US$2,883 millions. The number of commitments made in these areas was derived from projects with components in the areas of Population and Reproductive Health (27 Projects); Child Health (32 projects), and Nutrition and Food Security (24 Projects). Accounting the fact that certain projects included more than one of the above mentioned components, a total of 53 projects related to maternal and child health were implemented in the region. The list of countries that has implemented World Bank financed Maternal and Child Health investment projects is long. Projects were implemented in Argentina, Barbados, Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, El Salvador, Grenada, Guyana, Honduras, Mexico, Nicaragua, Jamaica, Panama, Paraguay, Peru, St. Kitts and Nevis, Trinidad and Tobago, and Venezuela.
Source: World Bank Business Warehouse, Health and Population Advisory Services, Operations and Delivery Management (OPCDM).

Not only did these projects strengthen the traditional methodologies and systems used to combat maternal and infant mortality such as the construction of hospitals and health facilities, provision of medicines, training and other activities geared towards improving the health status of mothers and children, they also helped open a "new frontier" for these countries in their battle against maternal and infant mortality. In particular, this involved implementing widespread reforms such as essential changes to "guarantee the rights of the mother and child" in various areas such as financing priority maternal and child care services, payment mechanisms for service providers, health care models, the creation of new and improved incentives for health care providers particularly in rural areas, improvements in management efficiency and above all, reducing inequities in access and coverage of health care services for the poorest populations, particularly in a region in which socioeconomic inequalities are one the most critical impediments to development.

These reforms are exemplified by the introduction of the so called "Public Health Insurances" in the Region, such as Bolivia's Universal Maternal and Child Insurance (SUMI), Peru's Comprehensive Health Insurance (SIS), Argentina's "Birth Plan" (a Maternal and Child Health Insurance program), Nicaragua's Maternity Fund (and the Extension of Coverage Program for Basic Health Services) and its recent Maternal and Child Health Care Modernization Project, as well as the Paraguay's imminent Maternal and Child health Insurance. These new "public health insurances", have been assisted by the Bank, and demonstrate the commitment of countries throughout the region to explore new avenues to meet their Millennium Development targets in the areas of maternal and child health. At present, recent results demonstrate significant advances in this area, and a faster rate of reduction in infant mortality in all afore mentioned countries

However, these advances could still be threatened by the large inequalities in both service access and maternal and child health outcomes within many countries. Further, particular challenges are posed by HIV/AIDS and especially the vertical transmission of the HIV virus from mother to child. Also, neonatal mortality continues to be the major contributor to infant mortality and high abortion indexes, often conducted in unsafe environments, have raised maternal mortality rates in some countries in LAC.

Co-authors:  Fernando Lavadenz, Sr. Health Specialist and Carmen Carpio, Knowledge Management Officer, World Bank Latin America and Caribbean Region