The Gates Foundation Urges Action on Maternal and Newborn Health

The foundation is using its yearly report card on the world’s progress against the U.N.’s 17 Sustainable Development Goals, or SDGs, this year to highlight worldwide shortcomings in funding healthcare, emphasizing that failure to provide care results in preventable deaths and takes away the potential for millions of children to thrive as productive, healthy adults. 

“Saving a child’s life and saving a mother’s life is not remotely political—it’s a shared goal that every country in the world did sign up to join as part of the Sustainable Development Goals,” Mark Suzman, CEO of the Gates Foundation said in a news briefing about the report ahead of its release.

The interventions the foundation outlined are practices “which we know work,” he said. “They’re not ‘maybe’ interventions, they are very concrete interventions that actually, literally save lives in a measurable way, relatively cheaply.” 

At current rates of progress, the world won’t meet the U.N.’s 2030 goal of cutting maternal mortality to less than 70 deaths out of every 100,000 births, or ending all preventable child deaths, according to the foundation. The annualized rate of decline in maternal deaths has slowed to only 0.5% since 2016 from an annualized 3% from 2000-15; meanwhile, the 2% annualized rate of decline in neonatal death per 1,000 live births “isn’t fast enough” to reach the goal, the report said. 

“It’s true, there are so many new and complex issues confronting the world, from climate change-induced heat waves to recent breakthroughs in artificial intelligence,” the report said. “Still, we believe our most ancient public health problem—the survival of mothers and babies—remains the most urgent.”

The Gates Foundation’s focus is South Asia and sub-Saharan Africa, but Suzman noted that maternal and newborn health is a widespread issue. Black women in the U.S. have a mortality rate three times the rate of white women, and in the U.K., the mortality rate for Black women is four times that of their white peers, he said.

“As is so often the case in global health, innovations aren’t making their way to the people who need them most—women in low-income countries, as well as Black and Indigenous women in high-income countries like the United States, who are dying at three times the rate of white women. That needs to change,” Melinda French-Gates, co-chair of the foundation said in the report. “We have seen over and over again that when countries actually prioritize and invest in women’s health, they unleash a powerful engine for progress that can reduce poverty, advance gender equality, and build resilient economies.”

International aid to healthcare has been flat since 2016 after years of steady progress from new interventions and initiatives such as GAVI, the Vaccine Alliance—a partnership with Gates, the World Health Organization, UNICEF, and the World Bank—which were spurred by the U.N’s Millennium Development Goals set in the year 2000. Those efforts assisted in cutting preventable child mortality from 10 million deaths a year to less than five million.

“It was arguably one of the greatest achievements in human history,” Suzman said. But those interventions took care of the “low-hanging fruit.” That has left 5 million children still dying each year before they turn 5 years old, the report said. About three-quarters of these deaths happen in a child’s first year. Maternal mortality rates have also stalled in the last eight years, even rising in some countries—including in the U.S., according to the report. 

“What this requires is much larger resources than the Gates Foundation alone can put in,” Suzman said, adding the organization is “actively working with multiple stakeholders to try and generate that.”

The Gates Foundation spends about US$370 million a year on maternal and newborn and child health work, in addition to financing that provides for research into some specific programs. Child Health and Mortality Prevention Surveillance, or Champs, for instance, is a program funded by the foundation since 2015 to study the root causes of child mortality. The program is currently in eight countries in Africa and East Asia that have high levels of childhood death. 

The foundation’s approach is to work alongside global groups, such as WHO and UNICEF, and on regulatory frameworks with national governments. “We provide obviously catalytic funding, but the key funding has to be integrated into the mainstream services of the healthcare systems and structures of each of the countries,” Suzman said. 

Funding to healthcare has slowed since the pandemic and in the face of widespread global challenges including the war in Ukraine, and fiscal crises in wealthy countries. Aid to Africa fell 8% overall last year, and health aid dropped proportionately, Suzman said. “We’ve seen a sort of overall move away from funding in these kind of high-impact interventions like health.” 

A purpose of the Goalkeepers report is to show that the practical interventions it recommends could save 2 million lives, and the real costs of not funding such interventions. 

“We’re a little biased at the Gates Foundation, but we think there really is no greater return on investment than these investments in health,” Suzman said. Providing iron through an IV drip in one sitting a month, instead of requiring mothers to make multiple visits to a healthcare facility to receive iron tablets, can help a child’s neurodevelopment, for instance, meaning he or she is more likely to grow up a productive member of society. 

“That’s the long-term return on investment that all these countries need,” he said. “It should be both a national priority for countries allocating their national budgets, and we think it should be a much higher priority for international aid and support.”

Overall, the foundation paints a grim picture of worldwide progress against all of the U.N. goals, which include ending poverty, ensuring clean water and sanitation, gender equality, and climate action. 

“The world has lost a lot of focus and energy around the SDGs,” Suzman said. “This was a shared commitment adopted by every country on the planet as a commitment to their own citizens about a global set of goals that we want to achieve at [the] national, and global, and regional level.” 

The foundation would like to see a refocusing of attention by government leaders at the upcoming U.N. General Assembly later this month, including “commitments around funding and broader interventions,” he said. 

In addition to the seven measurable interventions outlined in its annual report, Suzman said there are also innovations in the treatment of HIV, tuberculosis, and malaria that are significant causes of both child and adult mortality. 

“In the entire health space, which is one of the few areas where we do have very concrete interventions which we know have very measurable outcomes, that action has been dwindling and much less evident in the last few years than it was before,” he said. “We’re hoping to see that reversed.”