14 The World Health Report 2005 Figure 1.3 Changes in under-5 mortality rates,1990-2003: countries showing progress,stagnation or reversal 150 100 50 50 50 200 250 300 350 Under-5 mortality 0 rate in 1990 50 100 ●On track for MDG goal ●Reversal ●Slow progress ●Stagnation Figure 1.4 Patterns of reduction of under-5 mortality rates,1990-2003 On track Slow progress Reversal Stagnation No data More than 2 years of humanitarian crisis between 1992 and 2004
14 The World Health Report 2005 Figure 1.4 Patterns of reduction of under-5 mortality rates, 1990–2003 On track Slow progress Reversal Stagnation No data More than 2 years of humanitarian crisis between 1992 and 2004 Figure 1.3 Changes in under-5 mortality rates, 1990–2003: countries showing progress, stagnation or reversal % increase in under-5 mortality On track for MDG goal Reversal Slow progress Stagnation % decrease in under-5 mortality 150 100 50 0 50 100 50 100 150 200 250 300 350 Under-5 mortality rate in 1990
mothers and children matter-so does their health 15 Figure 1.5 Maternal mortality ratio per 100 000 live births in 2000 <50 50-299 300-549 ≥550 No data Figure 1.6 Neonatal mortality rate per 1000 live births in 2000 <12.5 12.5-24.9 25-37.4 not be the sa 237.5 estimates.They haveno ben submitted to No data
mothers and children matter – so does their health 15 Figure 1.5 Maternal mortality ratio per 100 000 live births in 2000 < 50 50–299 300–549 ≥ 550 No data Figure 1.6 Neonatal mortality rate per 1000 live births in 2000a < 12.5 12.5–24.9 25–37.4 ≥ 37.5 No data a These data are estimates from various international sources and may not be the same as Member States’ own estimates. They have not been submitted to Member States for consideration
16 The World Health Report 2005 Table 1.1 Neonatal and maternal mortality in countries where the decline in child mortality has stagnated or reversed Decline No.of Population Average Under-5 Under-5 No.of Neonatal No.of Maternal No.of of child countries (2003)3 live births mortality mortality under-5 mortality newborn mortality maternal mortality per year rate rate deaths rate deaths ratio deaths (1990-2003) (2000-2005)(1990)° (2003) (2003)° (2000) (2000)° (2000)9 (2000) On track 30 1155219 14980 22 13 190.5 110.5 29 4.3 (OECD) (18%) (11%) (2%) (3%) (1%) 63 1386579 30782 78 39 1200.5 19 591.6 216 65 (non-OECD) (22%) (23%) (12%) (15%) (12%) Slow progress 51 3011922 58858 92 72 4185.5 35 2069.5 364 212.9 (48%) (44%) (40%) (52%) (40%) In reversal 241209 7643 111 139 1046.9 41 305.4 789 59.9 (4%) (6%) (10%) (8%) (11%) Stagnating 29 487507 20678 207 188 3773.9 47 921.3 959 185.8 (8%) (16%) (36%) (23%) (35%) aNumbers in thousands. Per 1000 live births. Per 100 000 live births. References 1.Loudon I.Childbirth.In:Bynum WF,Porter R,eds.Companion encyclopedia of the history of medicine.London and New York,NY,Routledge,1993:1050-1071. 2.Haines A,Cassels A.Can the Millennium Development Goals be attained?BMJ.2004. 329:394-397. 3.Nullis-Kapp C.The knowledge is there to achieve development goals,but is the will? Bulletin of the World Health Organization,2004,82:804-805. 4.Dwork D.War is good for babies and other young children.London,Tavistock,1987. 5.Budin P.La mortalite infantile de 0 a 1 an [Infant mortality from 0 to 1 year].L'Obstetrique. 1903:1-44. 6.Ungerer RLS.Comecar de novo:Uma revisao historica sobre a crianca eo alojamento conjunto mae-filho [Starting afresh:a historical overview of children and keeping mothers and newboms together in hospitalj.Rio de Janeiro,Papel Virtual Editora,2000. 7.Baker SJ.Fighting for life.New York,NY.Macmillan,1939. 8.Van Lerberghe W,De Brouwere V.Of blind alleys and things that have worked:history's lessons on reducing maternal mortality.In:De Brouwere V,Van Lerberge W.,eds.Safe motherhood strategies:a review of the evidence.Antwerp,ITG Press,2001(Studies in Health Organisation and Policy,17:7-33). 9.United Nations Universal Declaration of Human Rights.New York,NY,United Nations, 1948. 10.Constitution of the World Health Organization,Article 2.Geneva,World Health Organization,1948(http://policy.who.int/cgi-bin/om_isapi.dll?infobase=Basicdoc& softpage=Browse_Frame_Pg42,accessed 22 November 2004). 11.Walsh JA,Warren K.Selective primary health care:an interim strategy for disease control in developing countries.New England Joumal of Medicine,1979,301:967-974. 12.Mahler H.The Safe Motherhood Initiative:a call to action.Lancet,1987,1:668-670. 13.Jaffre Y,Olivier de Sardan JP.Une medecine inhospitaliere:les difficiles relations entre soignants et soignes dans cing capitales d'Afrique de I'Ouest [Inhospitable medicine: difficult relations between carers and cared for in five West African capital cities].Paris. Karlhala,2003
16 The World Health Report 2005 References 1. Loudon I. Childbirth. In: Bynum WF, Porter R, eds. Companion encyclopedia of the history of medicine. London and New York, NY, Routledge, 1993:1050–1071. 2. Haines A, Cassels A. Can the Millennium Development Goals be attained? BMJ, 2004, 329:394–397. 3. Nullis-Kapp C. The knowledge is there to achieve development goals, but is the will? Bulletin of the World Health Organization, 2004, 82:804–805. 4. Dwork D. War is good for babies and other young children. London, Tavistock, 1987. 5. Budin P. La mortalité infantile de 0 à 1 an [Infant mortality from 0 to 1 year]. L’Obstétrique, 1903:1–44. 6. Ungerer RLS. Comecar de novo: Uma revisao historica sobre a crianca e o alojamento conjunto mae-filho [Starting afresh: a historical overview of children and keeping mothers and newborns together in hospital]. Rio de Janeiro, Papel Virtual Editora, 2000. 7. Baker SJ. Fighting for life. New York, NY, Macmillan, 1939. 8. Van Lerberghe W, De Brouwere V. Of blind alleys and things that have worked: history’s lessons on reducing maternal mortality. In: De Brouwere V, Van Lerberge W., eds. Safe motherhood strategies: a review of the evidence. Antwerp, ITG Press, 2001 (Studies in Health Organisation and Policy, 17:7–33). 9. United Nations Universal Declaration of Human Rights. New York, NY, United Nations, 1948. 10. Constitution of the World Health Organization, Article 2. Geneva, World Health Organization, 1948 (http://policy.who.int/cgi-bin/om_isapi.dll?infobase=Basicdoc& softpage=Browse_Frame_Pg42, accessed 22 November 2004). 11. Walsh JA, Warren K. Selective primary health care: an interim strategy for disease control in developing countries. New England Journal of Medicine, 1979, 301:967–974. 12. Mahler H. The Safe Motherhood Initiative: a call to action. Lancet, 1987,1:668–670. 13. Jaffré Y, Olivier de Sardan JP. Une médecine inhospitalière: les difficiles relations entre soignants et soignés dans cinq capitales d’Afrique de l’Ouest [Inhospitable medicine: difficult relations between carers and cared for in five West African capital cities]. Paris, Karlhala, 2003. Decline No. of Population Average Under-5 Under-5 No. of Neonatal No. of Maternal No. of of child countries (2003)a live births mortality mortality under-5 mortality newborn mortality maternal mortality per year rate rate deaths rate deaths ratio deaths (1990–2003) (2000–2005)a (1990)b (2003)b (2003)a (2000)b (2000)a (2000)c (2000)a On track 30 1 155 219 14 980 22 13 190.5 7 110.5 29 4.3 (OECD) (18%) (11%) (2%) (3%) (1%) 63 1 386 579 30 782 78 39 1200.5 19 591.6 216 65 (non-OECD) (22%) (23%) (12%) (15%) (12%) Slow progress 51 3 011 922 58 858 92 72 4 185.5 35 2 069.5 364 212.9 (48%) (44%) (40%) (52%) (40%) In reversal 14 241 209 7 643 111 139 1 046.9 41 305.4 789 59.9 (4%) (6%) (10%) (8%) (11%) Stagnating 29 487 507 20 678 207 188 3 773.9 47 921.3 959 185.8 (8%) (16%) (36%) (23%) (35%) a Numbers in thousands. b Per 1000 live births. c Per 100 000 live births. Table 1.1 Neonatal and maternal mortality in countries where the decline in child mortality has stagnated or reversed
mothers and children matter-so does their health 17 14.Jowett M.Safe Motherhood interventions in low-income countries:an economic justification and evidence of cost effectiveness.Hea/th Policy,2000,53:201-228 15.The world health report 2002-Reducing risks,promoting healthy life.Geneva,World Health Organization,2002. 16.Musgrove P.Public spending on health care:how are different criteria related?Hea/th Policy,1999,47:207-223. 17.Strong MA.The effects of adult mortality on infant and child mortality.Unpublished paper presented at the Committee on Population Workshop on the Consequences of Pregnancy. Maternal Morbidity and Mortality for Women,their Families,and Society.Washington,DC 19-200 ctober1998. 18.Ainsworth M,Semali I.The impact of adult deaths on the nutritional status of children. In:Coping with AlDS:the economic impact of adult mortality on the African household. Washington,DC.World Bank,1998. 19.Reed HE,Koblinsky MA,Mosley WH.The consequences of matemal morbidity and matemal mortality:report of a workshop.Washington,DC,National Academy Press,1998. 20.Kramer MS.Determinants of low birth weight:methodological assessment and meta- analysis.Bulletin of the World Health Organization,1987,65:663-737. 21.Prada JA,Tsang RC.Biological mechanisms of environmentally induced causes of IUGR. European Joumal of Clinica/Nutrition,1998,52(Suppl.1):S21-S27. 22.Murphy JF,O'Riordan J,Newcombe RG,Coles EC,Pearson JF.Relation of haemoglobin levels in first and second trimesters to outcome of pregnancy.Lancet,1986, 1(8488):992-995. 23.Zhou LM,Yang WW.Hua JZ,Deng CO,Tao X,Stoltzfus RJ.Relation of hemoglobin measured at different times in pregnancy to preterm birth and low birth weight in Shanghai,China.American Joumal of Epidemiology,1998,148:998-1006. 24.Merialdi M,Caulfield LE,Zavaleta N,Figueroa A,DiPietro JA.Adding zinc to prenatal iron and folate tablets improves fetal neurobehavioral development.American Joumal of Obstetetrics and Gynecology,1999,180:483-490. 25.Ferro-Luzzi A.Ashworth A.Martorell R,Scrimshaw N.Report of the IDECG Working Group on Effects of IUGR on Infants,Children and Adolescents:immunocompetence,mortality. morbidity,body size,body composition,and physical performance.European Jouma/of Clinica/Nutrition,1998,52(Suppl.1):S97-S99. 26.Grantham-McGregor SM.Small for gestational age,term babies,in the first six years of life.European Joumal of Clinical Nutrition,1998,52(Suppl.1):S59-S64 27.Grantham-McGregor SM,Lira Pl,Ashworth A,Morris SS,Assuncao AM.The development of low-birth-weight term infants and the effects of the environment in northeast Brazil. Joumal of Pediatrics,1998,132:661-666. 28.Goldenberg R.Hack M.Grantham-McGregor SM,Schurch B.Report of the /DECG/IUNS Working Group on IUGR:effects on neurological,sensory,cognitive,and behavioural function.Lausanne,IDECG Secretariat,c/o Nestle Foundation,1999. 29.Barker DJP.Mothers,babies and health in later life,2nd ed.Sydney,Churchill Livingstone, 1998. 30.Grivetti L,Leon D,Rasmussen K,Shetty PS.Steckel R,Villar J.Report of the IDECG Working Group on Variation in Fetal Growth and Adult Disease.European Joumal of Clinical Nutrition,1998,52(Suppl.1):S102-S103. 31.Bhargava A.Nutrition,health and economic development:some policy priorities.Geneva. World Health Organization,2001 (Commission on Macroeconomics and Health,CMH Working Paper Series,Paper No.WG1:14). 32.Scrimshaw NS.Malnutrition,brain development,learning,and behavior.Nutrition Research,1998,18:351-379. 33.Grantham-McGregor SM.Ani CC.Undemutrition and mental development.Lausanne. Nestle,2001 (Nutrition Workshop Series,Clinical Performance Programme,5:1-14) 34.Alderman H,Behrman JR,Lavy V,Menon R.Child nutrition,child health,and school enrollment:a longitudina/analysis.Washington,DC,World Bank(Policy Research Department,Poverty and Human Resources Division),1997. 35.Glewwe P,Jacoby HG,King EM.Early childhood nutrition and academic achievement: A longitudinal analysis.Joumal of Public Economics,2001,81:345-368
mothers and children matter – so does their health 17 14. Jowett M. Safe Motherhood interventions in low-income countries: an economic justification and evidence of cost effectiveness. Health Policy, 2000, 53:201–228. 15. The world health report 2002 – Reducing risks, promoting healthy life. Geneva, World Health Organization, 2002. 16. Musgrove P. Public spending on health care: how are different criteria related? Health Policy, 1999, 47:207–223. 17. Strong MA. The effects of adult mortality on infant and child mortality. Unpublished paper presented at the Committee on Population Workshop on the Consequences of Pregnancy, Maternal Morbidity and Mortality for Women, their Families, and Society, Washington, DC, 19–20 October 1998. 18. Ainsworth M, Semali I. The impact of adult deaths on the nutritional status of children. In: Coping with AIDS: the economic impact of adult mortality on the African household. Washington, DC, World Bank, 1998. 19. Reed HE, Koblinsky MA, Mosley WH. The consequences of maternal morbidity and maternal mortality: report of a workshop. Washington, DC, National Academy Press, 1998. 20. Kramer MS. Determinants of low birth weight: methodological assessment and metaanalysis. Bulletin of the World Health Organization, 1987, 65:663–737. 21. Prada JA, Tsang RC. Biological mechanisms of environmentally induced causes of IUGR. European Journal of Clinical Nutrition, 1998, 52(Suppl. 1):S21–S27. 22. Murphy JF, O’Riordan J, Newcombe RG, Coles EC, Pearson JF. Relation of haemoglobin levels in first and second trimesters to outcome of pregnancy. Lancet, 1986, 1(8488):992–995. 23. Zhou LM, Yang WW, Hua JZ, Deng CQ, Tao X, Stoltzfus RJ. Relation of hemoglobin measured at different times in pregnancy to preterm birth and low birth weight in Shanghai, China. American Journal of Epidemiology, 1998, 148:998–1006. 24. Merialdi M, Caulfield LE, Zavaleta N, Figueroa A, DiPietro JA. Adding zinc to prenatal iron and folate tablets improves fetal neurobehavioral development. American Journal of Obstetetrics and Gynecology, 1999, 180:483–490. 25. Ferro-Luzzi A, Ashworth A, Martorell R, Scrimshaw N. Report of the IDECG Working Group on Effects of IUGR on Infants, Children and Adolescents: immunocompetence, mortality, morbidity, body size, body composition, and physical performance. European Journal of Clinical Nutrition, 1998, 52(Suppl. 1):S97–S99. 26. Grantham-McGregor SM. Small for gestational age, term babies, in the first six years of life. European Journal of Clinical Nutrition, 1998, 52(Suppl. 1):S59–S64. 27. Grantham-McGregor SM, Lira PI, Ashworth A, Morris SS, Assuncao AM. The development of low-birth-weight term infants and the effects of the environment in northeast Brazil. Journal of Pediatrics, 1998, 132:661–666. 28. Goldenberg R, Hack M, Grantham-McGregor SM, Schürch B. Report of the IDECG/IUNS Working Group on IUGR: effects on neurological, sensory, cognitive, and behavioural function. Lausanne, IDECG Secretariat, c/o Nestlé Foundation, 1999. 29. Barker DJP. Mothers, babies and health in later life, 2nd ed. Sydney, Churchill Livingstone, 1998. 30. Grivetti L, Leon D, Rasmussen K, Shetty PS, Steckel R, Villar J. Report of the IDECG Working Group on Variation in Fetal Growth and Adult Disease. European Journal of Clinical Nutrition, 1998, 52(Suppl. 1):S102–S103. 31. Bhargava A. Nutrition, health and economic development: some policy priorities. Geneva, World Health Organization, 2001 (Commission on Macroeconomics and Health, CMH Working Paper Series, Paper No. WG1:14). 32. Scrimshaw NS. Malnutrition, brain development, learning, and behavior. Nutrition Research, 1998, 18:351–379. 33. Grantham-McGregor SM, Ani CC. Undernutrition and mental development. Lausanne, Nestlé, 2001 (Nutrition Workshop Series, Clinical Performance Programme, 5:1–14). 34. Alderman H, Behrman JR, Lavy V, Menon R. Child nutrition, child health, and school enrollment: a longitudinal analysis. Washington, DC, World Bank (Policy Research Department, Poverty and Human Resources Division), 1997. 35. Glewwe P, Jacoby HG, King EM. Early childhood nutrition and academic achievement: A longitudinal analysis. Journal of Public Economics, 2001, 81:345–368
18 The World Health Report 2005 36.Alderman H,Behrman JR.Estimated economic benefits of reducing low birth weight in low-income countries.Washington,DC,World Bank,2004 (Health,Nutrition and Population Discussion Paper). 37.Martorell R,Ramakrishnan U,Schroeder DG,Melgar P,Neufeld L.Intrauterine growth retardation,body size,body composition and physical performance in adolescence European Joural of Clinical Nutrition,1998,52(Suppl.1):S43-S52. 38.Islam MK,Gerdtham U-G.A systematic review of the estimation of costs-of-illness associated with matemal/newbom ill-health.Geneva,World Health Organization,2004. Maternal-Newborn Health and Poverty(MNHP)Project. 39.Legislator's Committee on Population and Development.Family planning saves lives and P303 million for the Philippine Government.People Count,1993,3:1-4. 40.Martinez Manautou J.Analisis del costo beneficio del programa de planificacion familiar del Instituto Mexicano del Seguro Social (impacto economico)[Cost-benefit analysis of the Mexican Social Security Institute's family planning programme (economic impact)].Mexico City,Academia Mexicana de Investigacion en Demografia Medica,1987. 41.Belli PC.Appaix 0.The economic benefits of investing in child health.Washington,DC World Bank,2003(Health,Nutrition and Population Discussion Paper). 42.Karoly LA,Greenwood PW.Everingham SS,Hoube J,Kilburn MR,Rydell CP et al.Investing in our children,what we know and don't know about the costs and benefits of early childhood interventions.Santa Monica,CA,RAND Corporation,1998. 43.Behrman JR.The economic rationale for investing in nutrition in developing countries. World Development,1993,21:1749-1771. 44.Behrman JR,Hoddinott J.Evaluacion del impacto de progresa en la talla del nino en edad preescolar [An evaluation of the impact of PROGRESA on pre-school child heightj. Washington,DC,International Food Policy Research Institute,2000. 45.Van der Gaag J,Tan JP.The benefits of early child development programs:an economic ana/ysis.Washington,DC,World Bank,1996. 46.Quisumbing AR.Haddad L,Pena C.Are women overrepresented among the poor? An analysis of poverty in 10 developing countries.Joumal of Developing Economics, 2001,66:225-269. 47.Borghi J,Hanson K,Acquah CA,Ekanmian G,Filippi V.Ronsmans C et al.Costs of near- miss obstetric complications for women and their families in Benin and Ghana.Hea/th, Policy and Planning,2003,18:383-390. 48.Sen A.Development as freedom.New York,NY,Anchor Books,1999. 49.Millennium Report of the Secretary-General of the United Nations.New York.NY.United Nations 2000(http://www.un.org/millennium/sg/report/,accessed 22 November 2004) 50.United Nations Millennium Declaration.New York,NY,United Nations,2000 (United Nations General Assembly resolution 55/2;http://www.un.org/millennium/declaration/ ares552e.pdf,accessed 22 November 2004). 51.Human development report 2004-Cultural liberty in today's diverse world.New York,NY. United Nations Development Programme,2004. 52.de Onis M.Blossner M.The World Health Organization Global Database on Child Growth and Malnutrition:methodology and applications.Intemational Joumal of Epidemiology, 2003,32:518-526 53.Maternal and child health:regional estimates of perinatal mortality.Week/y Epidemiological Record,1989,24:184-186. 54.Perinatal mortality.A listing of available information.Geneva,World Health Organization, 1996WH0/FRH/MSM/96.7). 55.State of the world's newboms:a report from Saving Newbom Lives.Washington,DC, Save the Children Fund,2004:1-28. 56.Hyder AA.Wali SA,McGuckin J.The burden of disease from neonatal mortality:a review of South Asia and Sub-Saharan Africa.BJOG:an interational joumal of obstetrics and gynaect0logy,2003,110:894-901. 57.Tinker A,Ransom E.Healthy mothers and healthy newborns:the vital link.Washington, DC,Save the Children/Population Reference Bureau,2002(Policy Perspectives on Newborn Health)
18 The World Health Report 2005 36. Alderman H, Behrman JR. Estimated economic benefits of reducing low birth weight in low-income countries. Washington, DC, World Bank, 2004 (Health, Nutrition and Population Discussion Paper). 37. Martorell R, Ramakrishnan U, Schroeder DG, Melgar P, Neufeld L. Intrauterine growth retardation, body size, body composition and physical performance in adolescence. European Journal of Clinical Nutrition, 1998, 52(Suppl. 1):S43–S52. 38. Islam MK, Gerdtham U-G. A systematic review of the estimation of costs-of-illness associated with maternal newborn ill-health. Geneva, World Health Organization, 2004. Maternal-Newborn Health and Poverty (MNHP) Project. 39. Legislator’s Committee on Population and Development. Family planning saves lives and P303 million for the Philippine Government. People Count, 1993, 3:1–4. 40. Martinez Manautou J. Analisis del costo beneficio del programa de planificacion familiar del Instituto Mexicano del Seguro Social (impacto economico) [Cost-benefit analysis of the Mexican Social Security Institute’s family planning programme (economic impact)]. Mexico City, Academia Mexicana de Investigacion en Demografia Medica, 1987. 41. Belli PC, Appaix O. The economic benefits of investing in child health. Washington, DC, World Bank, 2003 (Health, Nutrition and Population Discussion Paper). 42. Karoly LA, Greenwood PW, Everingham SS, Houbé J, Kilburn MR, Rydell CP et al. Investing in our children, what we know and don’t know about the costs and benefits of early childhood interventions. Santa Monica, CA, RAND Corporation, 1998. 43. Behrman JR. The economic rationale for investing in nutrition in developing countries. World Development, 1993, 21:1749–1771. 44. Behrman JR, Hoddinott J. Evaluacion del impacto de progresa en la talla del nino en edad preescolar [An evaluation of the impact of PROGRESA on pre-school child height]. Washington, DC, International Food Policy Research Institute, 2000. 45. Van der Gaag J, Tan JP. The benefits of early child development programs: an economic analysis. Washington, DC, World Bank, 1996. 46. Quisumbing AR, Haddad L, Pena C. Are women overrepresented among the poor? An analysis of poverty in 10 developing countries. Journal of Developing Economics, 2001, 66:225–269. 47. Borghi J, Hanson K, Acquah CA, Ekanmian G, Filippi V, Ronsmans C et al. Costs of nearmiss obstetric complications for women and their families in Benin and Ghana. Health, Policy and Planning, 2003, 18:383–390. 48. Sen A. Development as freedom. New York, NY, Anchor Books, 1999. 49. Millennium Report of the Secretary-General of the United Nations. New York, NY, United Nations 2000 (http://www.un.org/millennium/sg/report/, accessed 22 November 2004). 50. United Nations Millennium Declaration. New York, NY, United Nations, 2000 (United Nations General Assembly resolution 55/2; http://www.un.org/millennium/declaration/ ares552e.pdf, accessed 22 November 2004). 51. Human development report 2004 – Cultural liberty in today’s diverse world. New York, NY, United Nations Development Programme, 2004. 52. de Onis M, Blossner M. The World Health Organization Global Database on Child Growth and Malnutrition: methodology and applications. International Journal of Epidemiology, 2003, 32:518–526. 53. Maternal and child health: regional estimates of perinatal mortality. Weekly Epidemiological Record, 1989, 24:184–186. 54. Perinatal mortality. A listing of available information. Geneva, World Health Organization, 1996 (WHO/FRH/MSM/96.7). 55. State of the world’s newborns: a report from Saving Newborn Lives. Washington, DC, Save the Children Fund, 2004:1–28. 56. Hyder AA, Wali SA, McGuckin J. The burden of disease from neonatal mortality: a review of South Asia and Sub-Saharan Africa. BJOG: an international journal of obstetrics and gynaecology, 2003, 110:894–901. 57. Tinker A, Ransom E. Healthy mothers and healthy newborns: the vital link. Washington, DC, Save the Children/Population Reference Bureau, 2002 (Policy Perspectives on Newborn Health)