To Save The Lives Of Babies And Mothers, Ask For Advice From Peru

The developing world can take a lesson from Peru.

In 1995, 43 out of every 1,000 Peruvian babies died before they reached their first birthday. In 2015, the number of infant deaths in Peru is expected to drop to 13 per 1,000 births. And in 1995, 220 of their mothers died of pregnancy complications for every 100,000 births. In 2013, the number of maternal deaths for every 100,000 births dropped to 89, according to World Bank statistics and a new World Health Organization report released this week: Countdown to 2015: Maternal, Newborn and Child Survival.

Since 2008, when Peru was added to the countries monitored in the Countdown report, the country has cut maternal deaths by an annual average rate of 4.4 percent and childhood deaths by an average rate of 6.2 percent a year.

It wasn't magic. It was, in no small part, money.

Peru extended health care to rural areas and urban slums. And it offered cash to families if women went for prenatal care and if their children received vaccinations and other health care. The cash allowed poor women and their children to travel distances from home and to take time away from work and other responsibilities for prenatal care, infant care and preventive care.

"If they use the services, the family gets a bonus — maybe $30 or $50 a month," says Dr. Cesar Victora, of the Federal University of Pelotas in Brazil. "It's a small amount, but these are very poor families, and a small amount makes a difference."

It wasn't just the cash bonuses that made a difference. According to the new report, Peru boosted per capita spending on reproductive, maternal, newborn and child health programs from $72 per person in 1999 to $2,135 in 2012. But the country also incorporated health and nutrition components within all national anti-poverty programs, including housing, education and water quality. "To reduce the mortality of mothers and children, they tackled inequality," Victora says. "It paid off. In seven years, they reduced by half the cases of malnutrition among children."

Peru isn't the only country saving lives of women and children. The world has become a safer place for them in the past couple of decades. But it still has a long way to go to reduce rates of death among mothers, infants and children. After tracking health information from 75 of the poorest countries on earth, the World Health Organization, working with 42 other international organizations, released its report — the first ever accounting of the progress poor and middle-income countries are making in reducing rates of death among mothers, infants and young children.

Much of the news is good. Since 1990, the number of children who died each year before the age of 5 dropped by 53 percent. And maternal deaths — women who die during pregnancy, childbirth and soon after — have fallen by 45 percent. But authors of the report agree that much remains to be done. Today, 5.9 million children still die of preventable and treatable causes including diarrhea, pneumonia and malnutrition and 289,000 women still die each year of complications of pregnancy and childbirth.

The report was released at the first Global Maternal Newborn Health Conference in Mexico this week, where Melinda Gates, co-founder of the Bill and Melinda Gates Foundation, was a keynote speaker. "We all know the headlines. Maternal deaths cut by nearly half, childhood deaths cut by half. For hundreds of millions in the developing world, life is better," she said. "But we can't stop. It's up to us to finish the job. Eight hundred women are still dying needlessly every day." (The Gates foundation is a supporter of NPR.)

Even some very poor countries, while still struggling with high rates of maternal and child deaths, are making progress. "Rwanda and Tanzania, to name two, are managing to reduce mortality among the very poor," says Victora. "They're delivering vaccines and vitamin supplements at the community level and training health workers to treat diarrhea, pneumonia and malaria. The success we've seen in African countries is due to expansion of programs like these."

But preventing and treating diseases like diarrhea — long conquered in wealthier countries — is just a first step, he says.

"I think we have been doing relatively well with the lifesaving things that can be delivered, like vaccines and vitamins," says Victora. "But we haven't been doing well in providing quality health services, open seven days a week, 24 hours a day. If a mother has an OB emergency in rural Nigeria, can she be seen by a trained worker? That's where you really find the inequalities, in the care provided around the time of birth."

Further reducing mortality rates means reducing inequality, he says, and one of the surprises of by the report is that a lot of countries are striving to do just that by providing more comprehensive health care. "Many countries are doing a very good job delivering services to the poor, in rural areas and in the slums," he says. "Conventional wisdom says the gap between rich and poor is increasing. But it's not always true. In many places, the gap is decreasing in the provision of health services."