Skip to content

When you choose to publish with PLOS, your research makes an impact. Make your work accessible to all, without restrictions, and accelerate scientific discovery with options like preprints and published peer review that make your work more Open.


The Global Development Framework in Transition: Where are Mothers and Newborns in the Post-2015 Era?

By Dr. Koki Agarwal, Dr. Ana Langer  & Joy Riggs-Perla

While the Millennium Development Goals (MDGs) underlined the necessity of better policies and programs to improve maternal and child health, HIV and AIDS, malaria, and other health conditions, the approach had significant flaws. Having separate goals for mothers and children may have been a disservice, fostering the persistent segmentation of service delivery.


The era of the Sustainable Development Goals (SDGs) recently started.  With their focus on universal health care, equity, and integration, the new policy framework represents a historic opportunity to build on progress, while addressing the limitations of the MDGs. It is critical, however, not to let an emphasis on maternal and newborn health wane in this new broad agenda.


The maternal health landscape is rapidly evolving, mostly for good.  Evidence shows substantial decline in maternal mortality[1] and growing utilization of maternal health services.[2] But in some countries, the challenge of limited progress or even a reversal of progress casts a shadow. Large inequalities in the coverage of maternal health interventions persist and poor quality of care is the only option for far too many women.[3]


Between 2000 and 2012, the newborn mortality rate declined at a slower pace than maternal and child mortality and the stillbirth rate remained stagnant.[4] These trends require attention to reduce deaths during the first month of life. Furthermore, the high number of preventable stillbirths is a clarion call to improve the quality of antenatal and intrapartum care.


In October 2015, the global maternal newborn health community gathered to share emerging evidence, ask hard questions, and learn from those doing vital work within countries.[5] A thousand delegates from more than 75 countries reflected on the newly adopted SDGs,[6] and shared critical lessons about successes and persistent challenges in maternal newborn health. Researchers, implementers, advocates and representatives from the development and donor communities outlined a roadmap for maternal newborn health in the post-2015 era that included ten critical actions:


  1. Countries where political leadership acts on strong scientific evidence and the public demands better maternal newborn survival make progress. Governments and societies of countries lagging behind are morally obliged to embrace and implement an active and evidence- based maternal newborn health agenda and continuously monitor its progress.
  2. Global and national health communities must integrate strategies, services and funding streams to avoid unnecessary and harmful silos. Maternal newborn health offers a proven platform to strengthen the entire health system.[7]
  3. Weak national healthcare systems fail too many individuals; reaching the most vulnerable, including adolescents, is an urgent priority.
  4. Efforts to improve maternal newborn survival should include attention to maternal morbidities, stillbirths, and child development outcomes; they are essential proxies for inequality and poor quality care.
  5. Increasing the investment in better quality maternal newborn health services is a fundamental response to health and rights imperatives.
  6. Care with dignity does not cost any more. At any resource level, a provider has the opportunity and the obligation to treat clients with compassion and respect.
  7. Universal access to integrated sexual and reproductive health care, including contraception, is essential to ensure maternal newborn health.
  8. It is time to address the gap in measurement, information, and accountability. In order to assess progress in the next 15 years, countries and the global community need to address these complex challenges now.
  9. Sharing good news in human development is not a risk, but an opportunity to build stronger health programs.[8]This is the time to acknowledge important gains made as strategies are created to implement the SDGs.
  10. Supporting all providers, including midwives, to address maternal newborn health is imperative to realize the ambitious post-2015 agenda.

Collective action, with a renewed commitment to accountability and governance, is needed to deliver sustainable solutions and give mothers and newborns the central place they deserve in all efforts to achieve sustainable development. Now is the time to stop the injustice of needless deaths and deliver integrated, quality, and equitable care that reaches all women and newborns.


Featured Image Credit: Raphael Goetter, Flickr


[1] Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, Fat DA, Boerma T, Temmerman M, Mathers C, Say L, United Nations Maternal Mortality Estimation Inter-Agency Group collaborators, technical advisory group. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet. 2015; available online 13 November 2015.

[2] Victora C, Requejo J, Barros A, Berman P, Bhutta Z, Boerma T et al. Countdown to 2015: a decade of tracking progress for maternal, newborn, and child survival. The Lancet. 2015.

[3] Chou D, Daelmans B, Jolivet R, Kinney M, Say L. Ending preventable maternal and newborn mortality and stillbirths. BMJ. 2015;h4255.

[4] Darmstadt G, Kinney M, Chopra M, Cousens S, Kak L, Paul V et al. Who has been caring for the baby?. The Lancet. 2014;384:174-188.

[5] Horton R. Offline: The Mexican revolution. The Lancet. 2015;386: 1718.

[6] United Nations. Sustainable Development Goals., (accessed 2 November 2015).

[7] Sepúlveda J, Bustreo F, Tapia R, Rivera J, Lozano R, Oláiz G et al. Improvement of child survival in Mexico: the diagonal approach. The Lancet. 2006;368: 2017-2027.

[8] Rosling, Hans. Global Maternal Newborn Health: An Overview. 2015. (accessed 3 February 2016).


Koki Agrawal
Dr. Koki Agarwal is an internationally recognized expert in safe motherhood, reproductive health, and family planning policies and programs, as well as promoting policy dialogue and advocacy for policy reform. She has more than 25 years of service delivery experience in reproductive health, family planning, and maternal health, and for over two decades has led, managed, and implemented large-scale USAID-funded global health projects. Since June 2014, Dr. Agarwal had directed USAID’s flagship Maternal and Child Survival Program (MCSP), which works in 24 USAID priority countries and is the principal follow-on to the Maternal and Child Health Integrated Program (MCHIP).

Ana Langer
Dr. Ana Langer joined the Harvard T. H. Chan School of Public Health in July 2010 as a Professor of the Practice of Public Health (Department of Global Health and Population), and director of the Women and Health Initiative and Maternal Health Task Force. Dr. Langer, a physician specializing in pediatrics and neonatology and a reproductive health expert, is respected as a leader in using research findings to influence policy and improve the overall quality of health care for women and families. Dr. Langer has conducted research and published extensively on maternal mortality; psychosocial support during pregnancy, labor, and the post-partum period; quality of maternal health care; unsafe abortion; emergency contraception; the introduction of evidence-based practices in maternal health services; and strategies to improve quality care in low and middle income countries

Joy Riggs-Perla
Joy Riggs-Perla joined Save the Children in June 2013 as the Director of SNL 3. Her long career in global health began with a two-year Peace Corps assignment in the Philippines in the early 1970s working in public health nutrition. After graduate school, she joined USAID as a foreign-service officer and spent the next 23 years, primarily overseas, developing and managing health programs in the areas of maternal and child health, infectious disease, HIV/AIDS and health systems strengthening. She lived and worked in Swaziland, Philippines, Indonesia, Egypt and Cambodia. Joy served as Director of USAID’s Global Bureau Office of Health and Nutrition office from 1997 to 2001. After her USAID career, she worked as an independent consultant, leading teams to conduct health program design and evaluation work for USAID in Asia, Africa and the Middle East. Ms. Riggs-Perla has an MPH in health services administration.


Back to top