Why USAID is shifting maternal health funds toward Africa, Asia

The US Agency for International Development announced today that 26 countries have done so well at achieving maternal and child health goals that they’re now on their own. Their funding will instead go to 24 countries where mothers and children are still dying at alarming rates.

The countries losing their funding, many in Latin America, are those who have made significant progress on maternal and newborn health, family planning, and similar efforts. Peru, for example, has reduced its newborn mortality rate by 77 percent and maternal mortality rates by 70 percent.

“We see phasing out of funding as a success,” says Kelly Saldana, deputy director of the office of health infectious diseases at USAID. “The burden of disease really shifted away from Latin America to Africa and Asia.”

Indeed, five of USAID’s “high priority” countries – Ethiopia, India, the Democratic Republic of the Congo, Pakistan, and Nigeria – account for 50 percent of child deaths worldwide, and maternal mortality rates don’t look good, either.

The so-called realignment of $2.9 billion – about 15 percent of USAID’s overall budget –was announced today in Washington at the “Acting on the Call: Ending Preventable Child and Maternal Deaths” forum. USAID Administrator Rajiv Shah said that the funding change is expected to save 500,000 children in the next two years, and set the world on a path to ending all preventable child and maternal deaths by 2035. 

Ethiopia is both a model  and a case study in the challenges of achieving this goal. In 2012, together with India, the US, and the UN children’s agency, it hosted “Child Survival: Call to Action” summit to spur worldwide action on child and maternal deaths and generate buy-in from individual countries.

Ethiopia has managed to more than halve deaths of children under five since 1990, from 204 for every 1,000 live births to 68 per 1,000 in 2012. Its maternal mortality rate per 100,000 births has dropped from 950 to 420 in 2013. It listed the sixth-fastest decline in under-five deaths, and the fourth in childbirth deaths for mothers.

But births at home without a skilled birth attendant still account for 60 percent of all births in Ethiopia today, despite the rapid construction of health facilities in even the most remote areas of this predominantly rural country. The government is up against such constraints as cultural traditions that favor home births, far-flung communities miles from the nearest health facility, and an unwillingness to breastfeed children long enough to achieve certain health benefits.

One effort to address this is Ethiopia’s health extension program, which has deployed 34,000 young women to health posts across the country to provide basic health services – antibiotics, immunizations, family planning, and prenatal care for mothers, among others – and to persuade women to travel to a larger health center for childbirth.

The two-room, dirt-floor health posts, one for every 5,000 people, often lack electricity and running water, but the humble facilities can prevent many of the problems Ethiopia’s children and mothers face, underscoring the fact that there isn’t always a need for a hospital or attendant with a medical degree.

Ariel Zirulnick is in Ethiopia with the International Reporting Project.