1. MDG #4: Reduce Under 5 Mortality Rate by 2/3 1990 - 2015

2. Made progress U5M rate has dropped by ~1/3 since 1990 Highest rates remain in Sub-Saharan Africa (1 in 8) > 50% deaths due to malaria, diarrhea, pneumonia Second highest Southern Asia (1 in 14) Most/many of deaths are in the first 28 days of life % U5M due to neonatal death rising

3. Leading causes under 5 mortality globally – Pneumonia (18%) – Diarrheal diseases (15%) – Pre-term birth complications (12%) – Birth asphyxia (9%) Africa (excluding N. Africa) - malaria major cause child mortality (16%) Under-nutrition is an underlying cause of ~1/3 U5M

4. Disparities Within Regions Within a country/region see increased U5M – Rural – Poor – Less educated mother

5. REGIONRisk Factor – RuralRisk Factor – Poorest Quintile Latin America, Caribbean1.72.9 E. Asia, SE Asia, excluding China 1.62.8 S. Asia1.52.7 N. Africa, W. Asia1.42.6 Sub-Saharan Africa1.41.8

6. REGIONRisk Factor – Mother no education vs primary education Risk Factor – Mother no education vs. secondary or higher Latin America, Caribbean1.63.1 E. Asia, SE Asia, excluding China 1.93.0 S. Asia1.32.1 N. Africa, W. Asia1.22.0 Sub-Saharan Africa1.22.0

8. “Life-Saving Six” 1.Iron (mother and child) and folate (mom) 2.Breastfeeding – 1 st 6 months exclusively 3.Complementary feeding – 6 mos + 4.Vitamin A ( 2 doses /year, child) – Sight, measles, 5.Zinc (child) – Diarrhea (give Zn w/ORS as treatment) 6.Hygiene, water, sanitation

9. Skilled birth attendant present Well nourished mom reduces chance pre-term LBW baby – Both increase risk neonatal death Start breastfeeding within first hour of birth Hygienic cord care Keep baby warm at birth – skin to skin Breast feed exclusively for 1 st 6 months – Decreases infant’s risk of dying six-fold

10. Access to – immunizations – antibiotics for pneumonia – ORS and Zn – Vitamin A supplemenation at 6 mos – Bed nets, anti-malaria treatments

11. MDG #5: Reduce Maternal Mortality Rate by 75% 1990 - 2015

12. Not making enough progress in meeting this goal – In spite of proven interventions – Women have a 1 in 150 risk of dying from pregnancy or pregnancy related complications in developing countries See gains where births are attended by skilled birth attendants

13. Leading Causes Maternal Death 80% of all maternal deaths are due to: – severe bleeding (mostly bleeding after childbirth) – infections (usually after childbirth) – high blood pressure during pregnancy (pre- eclampsia and eclampsia) – unsafe abortion Other causes primarily related to complications due to malaria and AIDS

14. MM higher in – Rural areas – Poor – Adolescent mothers highest for adolescent girls under 15 years old – Malnourished, anemic mothers

15. Country Stats Female Life Expectancy (2010) – Haiti – 64 – Zambia – 50 – Togo – 59 – Somalia – 53 Lifetime risk maternal mortality – Haiti – 1 in 93 – Zambia – 1 in 38 – Togo – 1 in 67 – Somalia – 1 in 14

16. Country Stats % Births attended by a skilled attendant (2010) – Haiti – 26% – Zambia – 47% – Togo – 60% – Somalia – 33% U5M Rates – per 1000 live births (2010) – Haiti – 165 – Zambia – 111 – Togo – 103 – Somalia - 180

17. Country Stats % women using modern contraception (2010) – Haiti – 24% – Zambia – 47% – Togo – 11% – Somalia – 33%

18. Goals 1.Minimum 4 antenatal visits with health care provider – Nutritional interventions – PMTCT if mother HIV+ – Malaria interventions – Educate about and monitor pre/eclampsia 2.Skilled birth attendants 3.Access to meds and knowledge of techniques to stop bleeding at birth

19. Goals 1.Access to contraceptives and family planning – Decrease adolescent pregnancies – Decrease transmission STD – Space pregnancies – Decrease abortions (many unsafe)