Reaching the marginalized: EFA global monitoring report, 2010; 2010

PROGRESS TOWARDS THE EFA GOALSEarly childhood care and educationquality of public care. Whatever the underlyingcauses of health disadvantage, the consequencesinclude educational disadvantage later in life.The strength of the links between maternal healthand education is often overlooked. Some of thoselinks are very direct. Young women of middle tohigher secondary school age, 15 to 19, accountfor one in seven deaths related to pregnancy andchildbirth (WHO and UNICEF, 2003). The youngerthe age at pregnancy, the greater the health risksfor mother and child. Being born to a motherunder 18 increases the risk of infant mortality by60% and the children who survive are more likelyto suffer from low birth weight, undernutrition anddelayed cognitive development (Lawn et al., 2006;UNICEF, 2008b; WHO, 2005).Empowerment through education is one of thestrongest antidotes to maternal risk. Women withhigher levels of education are more likely to delayand space out pregnancies, and to seek healthcare support. In South and West Asia, almost halfof women with no education give birth withouthaving received antenatal care, compared withnearly 10% for women with secondary education(Figure 2.3). The ‘education advantage’ is evenmore pronounced when it comes to having askilled birth attendant present during delivery.In Burkina Faso, mothers with primary educationare twice as likely to have a skilled attendantpresent as those with no education, and womenwith secondary education are almost four timesas likely. While the association between educationand improved maternal and child indicators isnot evidence of causation, the strength of theassociation points to the importance of thetwo-way link between investment in healthand investment in education.Rapid progress is possibleSlow progress towards international goals inareas such as maternal health, child nutritionand survival is sometimes viewed as evidenceof the cost and complexity of effective measures.That assessment is flawed. Without understatingthe extent of the challenges, there is compellingevidence that rapid progress is possible.Cost-effective measures that work includecomplementary feeding and vitaminsupplementation, a continuum of care duringpregnancy and childbirth, immunization and widerstrategies to tackle killer diseases such as malariaand pneumonia (Black et al., 2008). To make suchFigure 2.3: Educated mothers have better access to antenatal careChildren under age 3 born without antenatal care, by maternal education,South and West Asia and sub-Saharan Africa, circa 2005% of children under 3 bornwithout antenatal care50403020100South and West AsiaSub-Saharan AfricaNotes: Figures presented are population weighted averages. The sample of countries used to estimatethe South and West Asia average represents more than 90% of the total population of the region andthe sample used to estimate the sub-Saharan Africa average more than 80%.Source: Macro International Inc. (2009).interventions available, countries need affordableand accessible health systems, allied to widermeasures for targeting vulnerable groups andcombating malnutrition. Bad news tends todominate the headlines, but there is positivenews too:Scaling up maternal and child health services.Experience from Bangladesh and Nepal showsthat maternal and child survival can be improvedin low-income settings by increasing access toskilled attendants, antenatal care and familyplanning advice (DFID, 2008b). In the UnitedRepublic of Tanzania, health spending has beenincreased and focused on diseases that affectthe poorest districts. Coverage of key maternaland child health services has expanded, witha marked increase in the recruitment ofcommunity-based midwives and health workers.Child nutrition is improving, as reflected in a 40%decline in child mortality between 2000 and 2004(Masanja et al., 2008).Achieving results through aid. The GAVI Alliance(formerly Global Alliance for Vaccines andImmunisation), formed in 2000, has supportedthe immunization of 213 million children, savingan estimated 3.4 million lives. From 2000 to 2006,deaths from measles in Africa fell by 90% (GAVIAlliance, 2009a). International partnerships onHIV and AIDS have increased the share of HIVpositivepregnant women receiving antiretroviraltherapy from 15% to 33%, helping preventtransmission to children (Global Fund, 2008a).No educationPrimarySecondary or higherRegional averageThe links betweenmaternal healthand education areoften overlooked47