Till a few years back, many of the developing and under-developed countries figured dismally when it came to health and mortality of poor women and children. But specific interventions such as early immunization and better childbirth care have resulted in dramatic improvements in some of these nations.

New research assessing the impact of these interventions in 142 countries across the world has found that they have resulted in 50 percent reduction in under-5 child mortality. The other 50 percent improvements are due to socioeconomic changes, such as right to education for girls, greater stress on sanitation, and incorporation of women in political and work scenario. These improvements were highlighted as part of the Success Factors For Women's and Children's Health, studies published in The Lancet Global Health and the Bulletin of the World Health Organization.

The low- and middle-income countries also called "fast-track" countries, because of the rate at which they have achieved their goals, include: Bangladesh, Cambodia, China, Egypt, Ethiopia, Lao PDR, Nepal, Peru, Rwanda, and Vietnam. Their success did not depend on their GNP but due to implementation of the "triple planning approach" — to address immediate needs, work toward a long-term vision, and adapt quickly to change.

“They used robust evidence to make smart investments and mobilize national and international resources to achieve their objectives. These countries are charting their own destiny,” said Shyama Kuruvilla, lead researcher for the success factors studies at the Partnership for Maternal, Newborn & Child Health, in a statement.

China leads the pack and has shown remarkable progress such as reduction in under-5 child mortality by 74 percent from 54 per 1000 live births to 14 per 1000 live births in 2012. Maternal mortality has fallen by 67 percent from 97 deaths per 100,000 live births in 1991 to 32 deaths per 100,000 live births in 2013. Along with high-impact health sector interventions progress across all boards along with political and social commitment contributed to these successes.

"The findings of the Success Factors studies are an important addition to the findings and recommendations of the Global Investment Framework for Women's and Children's Health launched in November last year, which reported that with the right investments toward women's and children's health, benefits of up to nine times the value can be generated in social and economic terms,” said Flavia Bustreo from the World Health Organization.

A more streamlined collaboration across sectors can further accelerate this progress, according to the researchers who say that donor agencies and international organizations need to work with governments to support this. Citing the example of India's polio eradication drive, the researchers stated that a strategic, coordinated approach across sectors made this feat possible.

"India was declared polio-free in March 2014. One of the last barriers we had to cross was in underserved areas where children were administered several doses of polio vaccine and yet polio outbreaks continued. Data showed that frequent diarrheal diseases were preventing children from retaining the polio vaccine in their gut. The health department then worked closely with the water and sanitation departments, and together with other development partners and communities we were able to cross this barrier to polio eradication,” researcher Anuradha Gupta said.

Another example of collaboration across sectors is Cambodia, where multi-stakeholder partnerships were used to promote maternal and child health through the importance of breast feeding. The result of this coordinated approach was that breastfeeding rates increased from 11 percent in 2000 to 74 percent in 2010. 

Skilled birth attendance and access to health care even in remote areas has ensured a 50 percent reduction in child mortality in Peru. 

Economic independence in women is also a huge driver, say researchers, whereby women can take care of their own and their children’s health. Examples of this are the following countries: China, Bangladesh, Cambodia, and Vietnam, which employ a huge women workforce. 

More women representatives in politics also ensured better health care policies for women and children. For example, in Lao PDR, where there was a decrease in the total fertility rate from six in 1990 to three in 2012 with the increase in the number of women politicians.

In Rwanda, another fast-track country, 64 percent of the parliamentarians are women, the highest percentage in the world.

A comparative study of the progress factors of the fast track countries that helped them achieve their goals include skilled birth attendance, measles immunization, prenatal care, health expenditure per capita, girls' education, access to sanitation, clean water, decrease in fertility rate, women in parliament, and infrastructure improvements.

But there are countries that are still not on track for improvements in child mortality. Leaders of these 27 sub-Saharan countries should follow the model of improvement adopted by other fast-track African countries like Botswana, Liberia, Niger, and Rwanda. Responsible leadership is the key to getting back on track, say the researchers.

Source: The Lancet Global Health and the Bulletin of the World Health Organization. 2014.