Intended for healthcare professionals

Education And Debate

Why has so little changed in maternal and child health in south Asia?

BMJ 2000; 321 doi: (Published 30 September 2000) Cite this as: BMJ 2000;321:809
  1. Zulfiqar A Bhutta, Husein Laljee Dewraj professor of paediatrics (
  1. Department of Paediatrics, Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan

    “Fate has allowed humanity such a pitifully meagre coverlet that in pulling it over one part of the world, another has to be left bare”

    Rabindranath Tagore, who won the Nobel Prize for literature in 1913, uttered these prophetic words almost a century ago.1 He might have said this as he witnessed the plight of the starving multitudes in Bengal. As I write this piece at the turn of the new millennium, I am painfully aware of the masses of people in western India and Pakistan who are caught once again in the grips of an unprecedented drought and an acute shortage of food. Yet, while much has remained unchanged, in many ways the subcontinent has made tremendous strides since securing independence almost 50 years ago. It boasts a modern industrial infrastructure; globally, it exports the bulk of people with expertise in computer software and information technology; and it has nuclear weapons capability. But recent policies of structural adjustment have led to an increase in poverty and social inequity and comparatively few resources have been allocated to health care and health related research.2 In south Asia, especially in India and Pakistan, indicators of the health of mothers and children remain poor, and statistics on health and nutrition in the area rank among the worst in the world (table 1).3-6

    Summary points

    Despite south Asia's nuclear capability and technological skills, indicators of maternal and child health rank among the worst in the world

    The health of mothers and children is intertwined with the poor status of women in society and with economic inequity

    Few research programmes are aimed at understanding and tackling the basic determinants of health, and there is little applied research

    Funds available for health care and health related research are limited and subject to structural adjustments …

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