This posting is by Rabita Aziz, Program Associate at the IDSA/HIVMA Global Center
The new report by the Center for Strategic and International Studies (CSIS) Commission on Smart Global Health Policy calls for the U.S. to double contributions to better maternal and child health, to $2 billion a year. Such investments should be focused on a few core countries in Africa and South Asia where there is a clear need, where partner governments are willingly engaged, and where concrete health gains can be made along with increasing a country’s capacities.
The report demonstrates that maternal mortality is a profound problem by offering this data: a woman’s risk of dying in pregnancy or childbirth is 1 in 7,300 in the industrialized world, 1 in 120 in Asia, and 1 in 22 in sub-Saharan Africa. Although there are clear preventative solutions in many of these cases, accessing such measures is problematic.
The report states that improving maternal mortality requires an interlinked set of interventions that are supported and sustained over time, including heightened efforts to improve local transport. In addition to addressing maternal mortality, it is imperative that efforts to end child and infant mortality are undertaken. The report states that it is estimated that a package of 16 simple and cost-effective measures could prevent nearly 3 million of the estimated 4 million deaths in the first month of life. Additionally, expanding access to immunizations can save the lives of 2 million children under the age of five.
Although the report clearly states that maintaining America’s commitment to fighting against HIV/AIDS is one element in a global health strategy, it fails to integrate this commitment within the framework of strengthening maternal and child health.
Globally, HIV/AIDS is the leading cause of death among women of reproductive age. When half of the 31.3 million people living with HIV worldwide are women, and 98 percent of them reside in developing countries, the importance of envisioning HIV/AIDS as a maternal and child health issue is clear. Integrating HIV/AIDS efforts within efforts to improve maternal and child health, and scaling them up, is key to a rights-based approach to health.
Among pregnant women in Johannesburg, South Africa’s most populous city, HIV is the main cause of death, according to a five-year study of maternal mortality at one of the city’s largest public hospitals
It is also important to recognize that HIV-negative children born to HIV-positive mothers still face high mortality risks as long as their mothers are not receiving treatment. A Ugandan study found that not only is there a 95% reduction in mortality among HIV infected adults after 16 weeks of antiretroviral treatment, but there is an 81% reduction in mortality in their uninfected children younger than 10, and an estimated 93% reduction in orphan hood.
Unfortunately, there is no mention in the report of undertaking initiatives to reduce the prevalence of HIV/AIDS among women and ensure access to treatment as a key maternal health strategy, even though it is clear that taking such measures will greatly strengthen families and communities. Prevention of mother to child transmission of HIV is imperative, as well as ensuring access to ongoing treatment for the mother.
 Mermin et al (2008) Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: a prospective cohort study Lancet 371: 752-759.