Despite substantial progress in recent decades, the WHO European Region1 still shows unacceptable disparities in maternal and child health between and within countries. Mortality in children under 5 years of age in the country with the highest rate is 40 times that in the country with the lowest rate. A child born in the Commonwealth of Independent States (CIS) is three times as likely to die before age 5 as a child born in the European Union (EU).
The main causes of death in infants and children under 5 in the countries with the Region's higher mortality rates - particularly the central Asian republics, other CIS countries and some countries in southern Europe - are neonatal conditions, respiratory infections, malformations and diarrhoeal diseases. External causes, such as injuries, are another important cause of death, particularly in the eastern half of the Region.
In 2001, the officially reported maternal death rate in the central Asian republics was 42 per 100 000 live births, in contrast to an average of 5 per 100 000 in EU countries. Over 70% of maternal deaths have the same group of causes: haemorrhage, eclampsia, sepsis and unsafe abortion. Conditions such as HIV/AIDS, tuberculosis, heart disease and malaria can aggravate complications of pregnancy and childbirth.
Inequalities also exist within countries. The poorest segments of the population have higher rates of infant mortality and underlying conditions such as malnutrition. The data show large differences in infant mortality between urban and rural populations, with rural rates twice as high as urban ones in some countries.
Although mortality is often mentioned as the primary measure of health, here it is only the tip of the iceberg. For every mother or child who dies, many more will suffer ill health with lifelong consequences.
Saving lives with existing knowledge
Lowering maternal and child mortality is easy. Relatively simple measures - such as keeping newborn babies warm; providing essential drugs; treating diarrhoeal diseases, respiratory infections and meningitis; and improving nutrition - can save infants' lives. Providing skilled care at birth, emergency obstetric care in case of complications and a referral system to ensure access to emergency care when needed can dramatically reduce maternal deaths.
"Many lives can be saved with the knowledge we have today; the challenge is to transform this knowledge into action. By the year 2015, WHO aims to reduce the under-five mortality rate by two thirds, and reduce the maternal mortality rate by three quarters, compared to the levels of 1990," states Dr Marc Danzon, WHO Regional Director for Europe. "The challenge is to scale up effective interventions to reduce mortality and decrease inequities. The main barrier to achieving this is the limited access to services for those most in need. Targeted interventions are needed for poor and vulnerable population groups that are often difficult to reach. A small investment in the right place can yield a great return."
"The evidence shows that partial solutions cannot improve maternal and child health and that success is mainly due to the systematic strengthening of integrated health systems that provide care and support to every mother and child," says Dr Gudjón Magnússon, Director, Division of Technical Support, Reducing Disease Burden, WHO Regional Office for Europe.
