General Health Situation on MCN (worldwide)

Conditions in the places where people live, learn, work, and play affect a wide range of

health risks and outcomes. Environmental and social factors such as access to health care and

early intervention services, educational, employment, and economic opportunities, social

support, and availability of resources to meet daily needs influence maternal health behaviors

and health status. Recent efforts to address persistent disparities in maternal, infant, and child

health have employed a “life course” perspective to health promotion and disease prevention. At

the start of the decade, about half of all pregnancies were unplanned. Unintended pregnancy is

associated with a host of public health concerns such as delayed initiation of prenatal care, poor

maternal health, and preterm birth. In response, perinatal health initiatives have been aimed at

improving the health of women and infants before and during pregnancy through a variety of

evidence-based interventions and attention to emerging public health concerns.

Every day in 2017, about 808 women died due to complications of pregnancy and child

birth. Almost all of these deaths occurred in low-resource settings, and most could have been

prevented. The primary causes of death are haemorrhage, hypertension, infections, and indirect

causes, mostly due to interaction between pre-existing medical conditions and pregnancy. The

risk of a woman in a low income country dying from a maternal-related cause during her lifetime

is about 130 times higher compared to a woman living in a high income country. Maternal

mortality is a health indicator that shows very wide gaps between rich and poor and between

countries.

In 2012, the World Health Organization adopted a resolution on maternal, infant and

young child nutrition that included a global target to reduce by 40% the number of stunted under‐
five children by 2025. The target was based on analyses of time series data from 148 countries

and national success stories in tackling undernutrition. The global target translates to a 3.9%

reduction per year and implies decreasing the number of stunted children from 171 million in

2010 to about 100 million in 2025. However, at current rates of progress, there will be 127

million stunted children by 2025, that is, 27 million more than the target or a reduction of only

26%. The translation of the global target into national targets needs to consider nutrition profiles,

risk factor trends, demographic changes, experience with developing and implementing nutrition

policies, and health system development.

Stunting often begins in utero, although the proportion that occurs prior to vs. after birth

is not well understood and will likely vary across populations. For example, in Malawi it is

estimated that ∼20% of the 10‐cm deficit in height (compared to WHO Child Growth Standards)

at 3 years of age is already present at birth (Dewey & Huffman 2009). This may be an

underestimate of the influence of prenatal factors, however, as some of the stunting that occurs

after birth may have been ‘programmed’ in utero (Martorell & Zongrone 2012). In a study in

Indonesia (Schmidt et al. 2002), newborn length was a stronger determinant of height‐for‐age at

12 months than any other factor examined.

Attained height is an accepted summary measure of children's nutritional well‐being and

the success of interventions/programs aiming to improve maternal, infant and young child

nutrition. Because the causes of stunting are embedded in a complex web of contextual and

immediate influences (Stewart et al. 2013), its reduction requires multisectoral action (Casanovas

et al. 2013). The key windows for reducing this legacy of intergenerational deprivation include

the preconception, prenatal and post‐natal periods, with interventions targeted at women and

their infants and young children.

 https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.12075

https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-

health

https://www.who.int/data/gho/publications