Editor’s note: This is part 3 of a series about how we can ensure that very young children have the nutrients they need to grow up healthy. Read part 1, Nourish Our Future: The Youngest Children, and part 2, Newborn Lives: It Takes a Village.
In our last piece on protecting the lives of the very youngest children, those in the “neonatal” period between birth and four weeks old, we listed some factors that have enabled Bangladesh to make significant progress on newborn survival and health. Among the most important were investing in better roads and more healthcare facilities. In fact, by 2016, nearly all women of reproductive age could reach a healthcare facility within an hour. This contributed to a large increase in the percentage of births taking place with the support of a trained provider—another key factor in safer motherhood and protecting newborn lives.
Despite fewer material resources, the world’s lowest-income countries have made progress on health indicators such as maternal mortality. Between 2000 and 2020, the group reduced its maternal mortality rate by nearly half, to 409 maternal deaths per 100, 000 live births (the standard way of reporting these statistics) in 2020.
On the other hand, progress has slowed, even stalled, in many countries over the past few years. While certainly broad problems such as the worldwide economic downturn during and after the COVID-19 pandemic and increasing levels of armed conflict are major reasons for this, the fact is that many goals become more difficult to reach as progress continues. The “easier” parts of the problem are naturally solved first, which leaves conditions and barriers that pose the most difficulty for the end. This is sometimes known as the “last mile” problem.
The Sustainable Development Goals emphasize that “leaving no one behind” is critical to meeting the 17 goals, which include ending hunger and all forms of malnutrition. When it comes to complex problems such as maternal and newborn survival and health, this calls for political commitment, resources, and creative solutions.
A closer look at the threats to mothers and babies in one of the world’s poorest countries, Chad, illustrates some of the difficult decisions that face public health authorities, healthcare providers, and people who want to start a family.
Chad is a large, very poor country whose northern border is the Sahara Desert. Geographic isolation is one of the major problems. Without a strong network of roads suitable for vehicles, many people must walk for several hours to reach the nearest health clinic—including women on the verge of giving birth.
Without easy access to skilled healthcare providers, itfollows that one of the leading causes of death among women in Chad is complications of pregnancy and childbirth. The risk of death during pregnancy, childbirth, and the weeks after birth in Chad is one of the highest in the world. In 2020, the World Health Organization (WHO) reported a maternal mortality rate of 1,063 per 100,000 live births (Source: WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division (eds)., Geneva, World Health Organization, 2023).
The difficulties of reducing the maternal mortality rate are summed up in the results of research supported by the U.N. Global Fund and the Liverpool School of Medicine. Very limited resources are available, with annual healthcare spending at $29 per person. There is a significant shortage of doctors and nurses/midwives—compared with other countries in Africa, there are 80 to 85 percent fewer healthcare providers. Nearly half of the country’s skilled health workforce is in the capital city of N’Djamena, although less than 10 percent of the population lives there (source: Ministere de la Santé Publique, Plan Stratégique de Santé Communautaire 2015-2018, government of Chad).
Underreporting of maternal deaths is another significant problem. There appears to be little to no recent data on newborn survival and health. Perhaps the most striking difficulty the researchers identified was lack of the information essential to setting priorities and making decisions. Their report, published in December 2024, contains statements such as “… but data on individual interventions in Chad were seldom available” and “As cause-specific maternal mortality data are limited in Chad…”.
Despite all the limitations, the researchers were able to use qualitative interviews, site visits, and data that was available to identify the regions of the country most in need and make a list of the highest-priority actions. As a result, health planners can begin to “develop more equitable frameworks and allocate their resources in ways that have a greater impact.”
Michele Learner is managing editor, Policy and Research Institute, with Bread for the World.
