Accountability for women’s, children’s and adolescents’ health in the Sustainable Development Goal era

Abstract

Background: Commitment to the Millennium Development Goals (MDGs) in 2000 resulted in political momentum, new investments and mobilisation to implement practical steps needed to meet the framework of eight MDG goals. MDG 5 (improve maternal health) and MDG 4 (reduce child mortality) focused on improving women’s and children’s health, with newborn health not added until the mid-2000s. The MDG era saw vast improvements in maternal and child survival, with global under-five mortality rates declining by more than half, from 90 to 43 deaths per 1000 live births between 1990 and 2015, and a 45 % decline in maternal mortality ratio worldwide, with more reductions occurring since 2000 [1]. However, as the MDGs draw to a close, the annual death toll, most of which could have been prevented, remains unacceptably high with 303,000 maternal deaths, 2.6 million stillbirths, 5.9 million deaths in children under the age of five - including 2.7 million newborn death - and 1.3 million adolescent deaths [2, 3, 4, 5, 6, 7]. It also remains very unequally distributed, with poor countries and poor individuals in middle income countries shouldering the largest burden. The Sustainable Development Goals (SDGs) launched in September 2015, have received commitment from all governments to implement an ambitious agenda of 17 goals over the next 15 years, with SDG 3 focused on ensuring healthy lives and promoting well-being for all. SDG 3 retains a focus on survival, but also sets goals to reduce disability and illnesses that hinder people from reaching their full potential, resulting in enormous loss and costs for countries, and importantly includes an equity parameter with universal health coverage and leave no-one behind. The new Global Strategy for Women’s, Children’s and Adolescents’ health (Global Strategy) and its operational framework are aligned with the SDGs, and provide an evidence-based roadmap for ending preventable deaths of women, children and adolescents by 2030 (Fig. 1) [8]. The three pillars of the Global Strategy – survive, thrive and transform - aim to go beyond ending preventable mortality, to ensure that all women, children and adolescents’ health and well-being are transformed to shape a more prosperous and sustainable future.