Maternal and child health: is South Asia ready for change?

doi:10.1136/bmj.328.7443.816

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Zulfiqar A Bhutta (zulfiqar.bhutta@aku.edu), Husein Lalji Dewraj professor of paediatrics and child health1,
Indu Gupta, professor of obstetrics and gynaecology2,
Harendra de'Silva, professor of paediatrics3,
Dharma Manandhar, professor of paediatrics4,
Shally Awasthi, professor of paediatrics5,
S M Moazzem Hossain, project officer6,
M A Salam, director7

¹ Aga Khan University, Karachi 74800, Pakistan
² Institute of Postgraduate Education and Research, Chandigarh, India
³ Sri Lanka College of Paediatricians, Colombo 7, Sri Lanka
⁴ Department of Paediatrics, Kathmandu Medical College, Kathmandu, Nepal
⁵ Institute of Clinical Epidemiology, King George's Medical University, Lucknow (UP), India
⁶ MCHC Section, Unicef, Saudi Pak Tower, Blue Area, Islamabad, Pakistan
⁷ Clinical Sciences Division, ICDDR, B: Centre for Health and Population Research, Dhaka 1212, Bangladesh

Correspondence to: Zulfiqar A Bhutta

Accepted 8 March 2004

South Asia still has a long way to go to meet the United Nations' millennium development goals for maternal and child mortality

A review of maternal and child health in South Asia a few years ago revealed a sorry picture.1 The region had persistently high rates of maternal and infant mortality that had largely remained resilient to change. In recent years, several countries in the region have seen relative prosperity, middle class affluence, and unprecedented economic development.^w1 It is uncertain, however, whether this has been associated with improvements in health, especially that of women and children, and whether the underlying determinants of ill health have changed. We review current maternal and child health in South Asia and suggest interventions that may make a difference.

Methods

We reviewed all available information on maternal and child health indicators in the South Asian region (Bangladesh, Bhutan, India, Nepal, Pakistan, Sri Lanka, and the Maldives). We also included Afghanistan, which is technically not part of the South Asian Association for Regional Cooperation, because of its strategic and geographical location. In addition to locally available published data and reports, we reviewed the available information from the World Health Organization, Unicef, and the World Bank. We also reviewed data on mortality and interventions from the Bellagio Child Survival Group and other recent intervention studies in the region.

Situational analysis

A global review of child deaths by the Bellagio Child Survival Group showed that 34% of child deaths occur in South Asia and that the region has almost two thirds of the global burden of malnutrition.2 Of an estimated half a million maternal deaths worldwide, almost half occur in South and Southeast Asia.3 Maternal mortality ratios range from 23/100 000 live births in Sri Lanka to 539/100 000 in Nepal.4 Given the close relation between …