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WHA77.5

WHA77
WHA77.5 Accelerating progress towards reducing maternal, newborn and child mortality in order to achieve Sustainable Development Goal targets 3.1 and 3.2 1
The Seventy-seventh World Health Assembly,
Having considered the consolidated report by the Director-General; 2
Recognizing that universal health coverage is fundamental for achieving the Sustainable Development Goals related to health and well-being, including Sustainable Development Goal targets 3.1 and 3.2 on maternal, newborn and child mortality, and will contribute to realizing the enjoyment of the highest attainable standard of physical and mental health and well-being, and achieve a more equitable and sustainable world; 3
Recalling the global commitment to achieve by 2030 Sustainable Development Goal targets 3.1, on maternal mortality (reduce the global maternal mortality ratio to less than 70 per 100 000 live births, with no country having a maternal mortality rate of more than twice the global average), and 3.2, on newborn and child mortality (end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births);
Acknowledging that the Sustainable Development Goals are aimed at realizing the human rights of all, leaving no one behind and reaching those farthest behind first by, inter alia, achieving gender equality and empowerment of women and girls; 4
Underscoring that, based on current trends, it is likely that more than four out of five countries (80%) will not achieve their national maternal mortality target, 64 countries will miss the neonatal mortality target and 59 countries will miss the under-5 mortality target by 2030; and that focused, urgent and coordinated course-correcting, country-led action is needed in these countries for maternal, newborn and child survival to achieve the Sustainable Development Goals;
Deeply concerned that, despite significant improvements in health outcomes for women, children and adolescents over recent decades, progress has stalled and the trend is further exacerbated by worsening rates of malnutrition; poor water supply, sanitation and hygiene; low health literacy for young people; and the impacts of conflict, climate change and the coronavirus disease (COVID-19) pandemic, as well as other social determinants of health, 5 impeding efforts to fulfil relevant commitments made to advance the objectives and targets of the Global Strategy for Women's, Children's and Adolescents' Health (2016–2030) and the related road maps 6 to guide and support countries' efforts to measure and accelerate improvements in maternal, newborn and child health outcomes;
Deeply concerned also by the preventable tragedies of maternal, newborn and child deaths, and cognizant of the leading direct causes of maternal mortality, identified as postpartum haemorrhage, eclampsia and pre-eclampsia, sepsis, embolism, and unsafe abortion, 7 which, as per the WHO definition, is demonstrated to be responsible for the majority of abortion-associated maternal mortality; while  recognizing indirect causes of maternal death, including HIV/AIDS, anaemia, malaria, diabetes, cardiorespiratory conditions, tuberculosis and malnutrition, are steadily increasing as a proportion of maternal deaths, and consequently the need to strengthen national health infrastructure and institutions, and improve access to emergency care; that prematurity, birth trauma and asphyxia, acute respiratory infections, malaria, diarrhoea and congenital anomalies are the leading direct causes of mortality in children under 5 years of age; and that we will not progress towards universal health coverage by 2030 unless we provide effective interventions with quality where and when they are most needed;
Recognizing that universal access to sexual and reproductive health care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes (Sustainable Development Goal target 3.7) contribute to maternal, newborn, child and adolescent survival;
Noting Sustainable Development Goal target 5.6 to ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences;
Recalling Sustainable Development Goal target 5.3 to eliminate child, early and forced marriage and female genital mutilation; and recognizing child marriage as a driver of adolescent pregnancy; that adolescent mothers face higher risks of eclampsia, puerperal endometritis and systemic infections; and that babies of adolescent mothers face higher risks of low birth weight, preterm birth and severe neonatal conditions;
Recognizing that pregnancy and the first two decades of life provide a unique window of opportunity for supporting healthy growth and development, addressing health-related risk factors and promoting health and well-being across the life course;
Cognizant that children and adolescents should have equitable opportunities to thrive, thereby building human capital that will effectively reduce inequities and benefit current and future generations in line with the “Survive”, “Thrive” and “Transform” objectives of the Global Strategy for Women's, Children's and Adolescents' Health (2016–2030);
Recognizing the critical importance of prioritizing measures to protect, promote and support breastfeeding and strengthen nutrition services 8 as an integral part of essential maternal, newborn and child health services and policies, given that almost half of all deaths among children under 5 years of age are attributable to undernutrition, as well as the detrimental intergenerational impacts of poor maternal nutrition, which contributes to low birth weight in newborns;
Recognizing also that about 50% of global maternal, stillbirth, newborn and child deaths occur in fragile and humanitarian settings, highlighting the urgent need in fragile contexts to step up investments, including through enhanced international cooperation, to expand coverage and improve quality of primary health care services; and  noting that primary health care services, including nutrition services, should be high quality, safe, comprehensive, integrated, accessible, available and affordable for everyone, everywhere, to accelerate progress to achieve the Sustainable Development Goals;
Acknowledging that lack of access to essential emergency, critical, surgical, anaesthesia and nursing services for injuries; structural birth defects, which will proportionally increase as child survival improves; and other acute emergencies will result in unacceptable disparities in survival and disability, and a high prevalence of neglected surgically treatable conditions in lower- and middle-income countries, and that people accessing surgical care in lower- and middle-income countries will endure catastrophic health expenditure;
Acknowledging also the critical importance of government leadership and a whole-of-government and whole-of-society approach to improving maternal, newborn and child health, and expanding the coverage of, and equitable access to, integrated primary health care services with strong referral linkages to high-quality secondary care services with ensured legislative and domestic budgetary support and oversight; and the need to regularly update national health and financing policies, strategies and plans to accelerate progress in improving women's, children's and adolescents' health,
1.
INVITES Member States, in accordance with national context and priorities:
(1)
to take measures to significantly reduce maternal, neonatal and child mortality and morbidity, and increase access to quality health care services for newborns, infants and children, as well as all women before, during and after pregnancy and childbirth, including through providing antenatal and postnatal care, sufficient numbers of skilled health personnel 9 and adequately supplied birthing facilities;
(2)
to reorient health systems towards a primary health care approach that is supported by strong country leadership and management capacity to improve health and well-being of women, children and adolescents along the life course, with adequate financial risk protection, involving communities and multisectoral collaborations such as water, sanitation and hygiene; education; and nutrition;
(3)
to scale up, as appropriate, evidence-based, cost-effective interventions to achieve the current and forthcoming service coverage targets of relevant global and regional strategies and action plans needed to achieve Sustainable Development Goal targets 3.1 and 3.2, including access to quality prevention services, testing, treatment, care and support;
(4)
to promote access to affordable quality and respectful care for normal birth and obstetric complications, including timely antenatal, intrapartum and postnatal care; quality labour monitoring; and emergency obstetric care, including implementation of the postpartum haemorrhage road map, by providing the required human resources, including through midwifery models of care, equipment, supplies, data systems and maternal death reviews, in order to achieve national programmatic targets;
(5)
to scale up affordable quality essential newborn care services for every newborn, and invest in special care units for small and sick newborns at district level, including the required human resources, equipment, supplies and data systems in order to achieve national programmatic targets; 10
(6)
to consider implementing a universal newborn screening programme including comprehensive birth defect screening, including specific needs and considerations for diagnosis, management and long-term care of children with birth defects;
(7)
to scale up quality integrated child health services for every child at district, facility and community levels, including the required human resources, equipment, supplies and data systems in order to achieve national programmatic targets, also supporting recovery of lost gains in childhood vaccinations and achieving Immunization Agenda 2030 goals;
(8)
to invest in establishing networks of care with strong referral mechanisms, including supporting services such as functional national referral transportation systems and functional pre-hospital services, laboratories and blood banks;
(9)
to facilitate universal access to sexual and reproductive health care services (Sustainable Development Goal target 3.7), including for family planning, information and education, and the integration of reproductive health as contributing factors to maternal, newborn, child and adolescent survival; 11
(10)
to reinvigorate, through laws and regulations, their commitment to Sustainable Development Goal target 5.6;
(11)
to identify and remove barriers that limit access to safe, quality and affordable sexual, reproductive, maternal, newborn, child and adolescent health care services at both health system and societal levels, such as, inter alia, mistreatment during childbirth, poverty, air pollution, lack of education and lack of access to clean water and sanitation, effects of climate events, and harmful social norms and/or inequalities in pursuit of achieving gender equality and the empowerment of all women and girls;
(12)
to invest in country-led effective health information management systems, including through enhanced international cooperation in fragile settings, to support evidence-based planning and delivery of health services, and monitor implementation of, measure progress towards and strengthen accountability for national and subnational targets through routine monitoring of health facility and/or population-based surveys of sexual, reproductive, maternal, newborn and adolescent health key relevant indicators;
(13)
to invest in the education, employment, regulation and retention of the health and care workforce, including midwives and nurses, that is required to provide universal access to, and coverage of, the nationally determined package of sexual, reproductive, maternal, newborn and adolescent health care services that are aligned with the principle of decent work;
(14)
to enable access to essential, safe, quality medicines for pregnant women, lactating women, mothers, newborns and children through accelerating implementation of the actions laid out in resolutions WHA69.20 (2016) and WHA75.8 (2022), and by promoting, supporting and financing accelerated investigation, development, manufacturing, registration and supply of age-appropriate, quality-assured formulations of medicines for diseases that affect mothers, newborns and children;
(15)
to consider, in the instance of malaria endemic countries and in view of the increased availability of malaria vaccines, prioritizing the introduction of malaria vaccines into routine immunization programmes as part of their comprehensive malaria control plans, as well as scaling up malaria testing and treatment and other effective interventions, such as insecticide-treated nets and chemoprevention in pregnant women and children, in order to reduce malaria illness and child deaths;
2.
INVITES relevant stakeholders, as appropriate, to support, coordinate and align investments and technical assistance in support of the effective implementation of national plans, and contribute to the acceleration of progress towards Sustainable Development Goal targets 3.1 and 3.2;
3.
REQUESTS the Director-General:
(1)
to prioritize this unfinished agenda; provide, upon request, intensified technical support to Member States in respect of updating sexual, reproductive, maternal, newborn, child and adolescent health legislation, policies, strategies and national plans as part of a primary health care approach; and promote the implementation of evidence-based health interventions to accelerate progress towards the relevant Sustainable Development Goal targets for sexual, reproductive, maternal, newborn, child and adolescent health, and help mobilize resources towards their implementation to achieve Sustainable Development Goal targets 3.1 and 3.2;
(2)
to develop relevant guidance to improve sexual and reproductive health care services, and maternal well-being, to prevent stillbirths, reduce low birth weight and prematurity, and address birth defects;
(3)
to provide support to Member States, upon request, in respect of models of care, including midwifery models of care, and the education, employment, regulation and retention of the health and care workforce; strengthen risk differentiated approaches to prevent child mortality; address priority health needs of children 5–9 years of age; promote well child care services for childhood development; and invest in adolescent well-being through school health, school health services and digital solutions for adolescent-responsive primary care;
(4)
to enhance guidance for services for pregnant and lactating women, women of reproductive age and adolescent girls, and for infants and young children, while specifically addressing the needs of underserved groups, including pregnant adolescents and adolescent mothers; to strengthen integration of nutritional services, particularly during the first 1000 days, and mental health interventions into sexual, reproductive, maternal, newborn and adolescent health care services; and to work synergistically with the implementation of WHO's triple elimination efforts for HIV, syphilis and hepatitis B;
(5)
to accelerate implementation of the workforce actions laid out in resolutions WHA69.19 (2016), WHA74.14 (2021), WHA74.15 (2021) and WHA75.17 (2022) to enhance capacity of the health workforce at all levels to deliver quality sexual, reproductive, maternal, newborn and adolescent health care services;
(6)
to accelerate implementation of the actions laid out in resolutions WHA69.20 and WHA75.8; strengthen and expand collaborative efforts, such as those promoted by WHO technical departments and the Global Accelerator for Paediatric formulations network, to secure better access to medicines for children, including antiretroviral therapy for HIV; and report to the Seventy-eighth World Health Assembly, and subsequent Health Assemblies, as appropriate, on progress achieved, remaining gaps and specific actions needed to further promote better access to age-appropriate, quality-assured, affordable medicines and commodities for pregnant and lactating woman, and for maternal, adolescent, child and newborn health services;
(7)
to provide, upon request, recommended water, sanitation and hygiene; waste management; and energy indicators for health care facilities to use in health systems monitoring, and to encourage countries to incorporate data on water, sanitation and hygiene; waste management; and energy in health facilities into health systems monitoring, and regularly analyse and share data to inform planning, investment and programming efforts;
(8)
to continue to raise further awareness among legislators about sexual and reproductive, maternal, newborn, child and adolescent health, based on quality data and evidence, and fully engage them both in pursuing advocacy and in providing sustained legislative and political support towards achieving, in accordance with their national plans and priorities, the goals and targets in the Global Strategy for Women's, Children's and Adolescents' Health;
(9)
to report back to the Health Assembly on the present resolution as part of the biennial substantive reporting on the Global Strategy for Women's, Children's and Adolescents' Health, 12 with a special focus on efforts to accelerate progress towards the reduction of maternal, newborn and child mortality in countries currently off-track to achieve the goals by 2030.
(Eighth plenary meeting, 1 June 2024 –
Committee A, third report)
See Annex 4 for the financial and administrative implications for the Secretariat of this resolution.
Document A77/4.
Political declaration of the high-level meeting on universal health coverage. New York: United Nations; 2019 ( https://www.un.org/pga/73/wp-content/uploads/sites/53/2019/07/FINAL-draft-UHC-Political-Declaration.pdf, accessed 27 August 2024).
See resolution WHA72.4 (2019).
The social determinants of health are the nonmedical factors that influence health outcomes. The following list provides examples of the social determinants of health, which can influence health equity in positive and negative ways: income and social protection; education; unemployment and job insecurity; working life conditions; food insecurity; housing, basic amenities and the environment; early childhood development; social inclusion and non-discrimination; structural conflict; and access to affordable health services of decent quality.
These include: the Ending Preventable Maternal Mortality initiative; A roadmap to combat postpartum haemorrhage between 2023 and 2030; the Every Newborn Action Plan; the Immunization Agenda 2030; the Nurturing Care Framework; the Global Accelerated Action for the Health of Adolescents; and the Programme of Action of the International Conference on Population and Development, and the Beijing Declaration and Platform for Action, and the outcomes of their review conferences, as well as resolution WHA72.7 (2019) on water, sanitation and hygiene in health care facilities. WHA Agenda Item 11.7 – Accelerate progress towards reducing maternal, newborn and child mortality in order to achieve SDG targets 3.1 and 3.2. Geneva: World Health Organization; 2024 (https://www.who.int/publications/m/item/wha-agenda-item-11.7---accelerate-progress-towards-reducing-maternal--newborn-and-child-mortality-in-order-to-achieve-sdg-targets-3.1-and-3.2, accessed 1 June 2024).
WHO defines “unsafe abortion” as an abortion that is carried out by a person lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both. To ensure that “unsafe abortion” is correctly interpreted, we recommend always providing an explanatory note along with the definition, as follows: “The persons, skills and medical standards considered safe in the provision of abortion are different for medical and surgical abortion and also depend on the duration of the pregnancy. What is considered “safe” should be interpreted in line with current WHO technical and policy guidance.”.
Nutrition services cover health- system based essential nutrition actions for assessing, promoting, maintaining and improving optimal nutrition for individuals throughout the life course.
Definition of skilled health personnel providing care during childbirth: the 2018 joint statement by WHO, UNFPA, UNICEF, ICM, ICN, FIGO and IPA. Geneva: World Health Organization; 2018 (https://iris.who.int/handle/10665/272818, accessed 1 June 2024).
Document A67/21.
See resolution WHA72.4.
Resolution WHA69.2 (2016).
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