Breaking Barriers to Health: Advancing Universal Coverage for Maternal, Newborn, and Child Health

This article was exclusively written for The European Sting by Ms. Sadia Khalid, a dedicated professional with an extensive academic background, holding an MBBS and an MD degree. She is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

The health of mothers, newborns, and children is a vital indicator of a nation’s overall well-being. Despite global efforts spanning decades, millions of people in low-income nations continue to face substantial health risks due to insufficient healthcare coverage. Although significant progress has been made, the road to universal coverage remains fraught with challenges, especially in regions burdened by high mortality rates.

In 2009, an estimated 8.1 million children under five died globally, a decrease from 9 million in 2005. While regions like Europe and the Americas achieved annual mortality reductions of 5.1% and 4.3%, respectively, others, particularly Africa (1.8%) and the Eastern Mediterranean (1.9%), have lagged. This stark disparity underscores the difficulty in meeting global health targets such as Millennium Development Goal 4 (MDG 4), which aimed to reduce child mortality by 4% annually.

A 2010 report titled Countdown to 2015 identified 68 countries with the highest child mortality rates. Of these, only 19 were on track to meet MDG 4, with 17 countries halving their child mortality rates. While 47 countries managed to improve child mortality reduction rates from 2000 to 2008, much of the global effort still fell short of the necessary scale and speed.

Progress in maternal health mirrored these challenges. Maternal deaths decreased from 546,000 in 1990 to 358,000 in 2008, reflecting a 34% reduction. Countries in the South-East Asia and Western Pacific regions saw the greatest improvements, achieving maternal mortality reductions of 5% annually. However, regions like Africa (1.7%) and the Eastern Mediterranean (1.5%) continued to face sluggish progress—far from the 5.5% annual reduction required to meet MDG 5. Egypt, Iran, Morocco, and Nepal demonstrated that substantial reductions in maternal mortality are achievable through focused strategies and investment in health systems.

However, despite these advances, global healthcare coverage for reproductive, maternal, newborn, and child health interventions remains inconsistent. High coverage was achieved for scheduled interventions like immunization (over 80%) and vitamin A supplementation (85%). Yet, essential interventions requiring immediate access—such as diarrhoea treatment (41%), pneumonia treatment (27%), skilled birth attendance (54%), family planning (31%), and caesarean sections (less than 5%)—remained under-utilized. A major consequence of this is the unmet need for family planning, which stands at a median of 24%, continuing to fuel high rates of unintended pregnancies, particularly among adolescents. This poses serious public health concerns.

There have been bright spots, however. Countries have made significant strides in distributing insecticide-treated bed nets to combat malaria and preventing mother-to-child transmission of HIV. Notably, 12 countries have seen a 20% or more increase in exclusive breastfeeding rates over the last two decades, highlighting that change is possible with the right policies and interventions.

Nevertheless, the quality of healthcare often falls short, especially in maternal and newborn health. Access to antenatal care or skilled birth attendance is not enough when the quality of care is poor. Low-quality care can lead to medical complications or death. Improving the quality of care during pregnancy, childbirth, and the postnatal period is essential for reducing maternal and newborn mortality. Postnatal care, especially for babies born outside healthcare facilities, remains an area of concern. Only 4% of babies born at home received care within the first two days—a critical window for newborn survival.

National data on healthcare coverage frequently obscures inequalities between different population subgroups. Access to healthcare services is often influenced by gender, income, urban versus rural location, and ethnicity. Wealthier households typically enjoy better intervention coverage, while marginalized populations face significant barriers. Countries like Bangladesh, Brazil, Egypt, Swaziland, and Zambia are working to close these gaps, but challenges persist.

Furthermore, too few countries have adopted evidence-based policies to ensure universal access to maternal, newborn, and child health interventions. Among the 68 countries studied in the *Countdown to 2015* report, only 26 had midwives performing all seven essential life-saving tasks, and just 29 allowed community health workers to treat pneumonia in children. Without widespread policy adoption, progress in improving health outcomes will remain limited.

Despite these challenges, global initiatives continue to pave the way for progress. The United Nations Secretary-General’s *Global Strategy for Women’s and Children’s Health*, launched in 2010, aims to make comprehensive healthcare for women and children accessible to all. This strategy emphasizes the vulnerability of pregnant women, newborns, and adolescents, calling for greater investments in health systems and holding governments accountable for their commitments.

To support these efforts, the World Health Organization’s Human Reproduction Programme (HRP) provides invaluable research and guidance on sexual health and reproduction. Resources such as HRP’s *Global Infertility Prevalence Estimation* and the *E-MOTIVE* treatment package for postpartum haemorrhage prevention offer practical solutions to improve maternal health outcomes. HRP has also contributed to the development of tools for improving access to comprehensive abortion care and self-administered contraceptives, empowering individuals to take control of their reproductive health.

Achieving universal healthcare coverage for maternal, newborn, and child health is crucial for reducing mortality and improving overall well-being. By addressing disparities in access, quality, and equity, the global community can ensure that women and children everywhere receive the care they deserve.

For further resources and information, outlets like the World Health Organization (WHO), HRP, and Countdown to 2030 provide continuous updates and action plans on maternal and child health progress. As we strive toward a future of health equity, breaking barriers to access is the key to saving millions of lives globally.

About the author

Sadia Khalid is a dedicated professional with an extensive academic background, holding an MBBS and an MD degree. She is an Early-stage Researcher (ESR), accomplished Medical Writer, and Research Engineer based at Tallinn University of Technology (TalTech) in Estonia. Sadia’s research interests span a wide spectrum within the realm of medical sciences, including Molecular Medicine, Cell Biology, Infectious Diseases, Bacteriology, Hepatology, and Gastroenterology. Her work is underpinned by a strong belief in the mission of promoting public health, safety, and awareness./