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  1. 1

    State of inequality: Reproductive, maternal, newborn and child health.

    World Health Organization [WHO]. Department of Health Statistics and Information Systems

    Geneva, Switzerland, WHO, 2015. 124 p.

    The report delivers both promising and disappointing messages about the situation in low- and middle-income countries. Within-country inequalities have narrowed, with a tendency for national improvements driven by faster improvements in disadvantaged subgroups. However, inequalities still persist in most reproductive, maternal, newborn and child health indicators. The extent of within-country inequality differed by dimension of inequality and by country, country income group and geographical region. There is still much progress to be made in reducing inequalities in RMNCH.
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  2. 2

    One is too many: ending child deaths from pneumonia and diarrhoea.

    Amouzou A; Velez LC; Tarekegn H; Young M

    2016 Nov; New York, New York, UNICEF, 2016 Nov. 77 p.

    Pneumonia and diarrhoea are responsible for the unnecessary loss of 1.4 million children each year. This report highlights current pneumonia and diarrhoea related mortality, and illustrates the startling divide between the children being reached and the considerable number of those left behind. By developing key protective, preventative and treatment interventions, collectively we are now equipped with the knowledge and the tools required to preventing child deaths due to these leading childhood killers. The report also provides recommendations to further accelerate progress in effective interventions and bridge the greatest gaps in equity.
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  3. 3

    Child mortality decreases globally and immunization coverage increases, despite unequal access.

    Zuehlke E

    Washington, D.C., Population Reference Bureau [PRB], 2009 Dec. [2] p.

    Lack of access to quality health care and clean water and sanitation, undernutrition, and other preventable or treatable causes lead to the deaths of tens of thousands of children worldwide every day. But new estimates from UNICEF, WHO, the World Bank, and the UN Population Division show that under-5 mortality has declined steadily since 1990, and that progress has accelerated this decade. In 1990, nearly 13 million children died before their fifth birthday. By 2008, that number had been cut to 9 million.
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  4. 4

    Last chance for the world to live up to its promises? Why decisive action is needed now on child health and the MDGs. A World Vision policy briefing.

    World Vision

    Milton Keynes, United Kingdom, World Vision International Policy and Advocacy, 2008 Sep. 15 p. (World Vision Policy Briefing)

    Now is the window of opportunity to ensure that 2015 will be remembered as the year the world lived up to its promise to the world's poorest and most vulnerable people. This short briefing paper considers child health in the context of the three health-focused MDGs, identifies concrete steps needed in the coming months to put the MDGs back on track, and summarises World Vision's own efforts to contribute to their achievement. (Excerpt)
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  5. 5

    The state of the world's children 2008. Child survival.


    New York, New York, UNICEF, 2007 Dec. [160] p.

    Child mortality is a sensitive indicator of a country's development and telling evidence of its priorities and values. Investing in the health of children and their mothers is not only a human rights imperative, it is a sound economic decision and one of the surest ways for a country to set its course towards a better future. Impressive progress has been made in improving the survival rates and health of children, even in some of the poorest countries, since 1990. Nonetheless, achieving Millennium Development Goal 4 (MDG 4), which aims to reduce the global under-five mortality rate by two thirds between 1990 and 2015, will require additional effort. Attaining the goal is still possible, but the challenge is formidable. Reaching the target means reducing the number of child deaths from 9.7 million in 2006 to around 4 million by 2015. Accomplishing this will require accelerated action on multiple fronts: reducing poverty and hunger (MDG 1), improving maternal health (MDG 5), combating HIV and AIDS, malaria and other major diseases (MDG 6), increasing the usage of improved water and sanitation (MDG 7) and providing affordable essential drugs on a sustainable basis (MDG 8). It will also require a re-examination of strategies to reach the poorest, most marginalized communities. Every child has the right to live a healthy life. A group of children at a community child centre, Malawi. The remarkable advances in reducing child deaths achieved by many developing countries in recent decades provide reason for optimism. The causes of and solutions to child deaths are well known. Simple, reliable and affordable interventions with the potential to save the lives of millions of children are readily available. The challenge is to ensure that these remedies - provided through a continuum of maternal, newborn and child health care - reach the millions of children and families who, so far, have been passed by. (excerpt)
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  6. 6

    New estimates of global under-5 mortality [letter]

    Wardlaw T

    Lancet. 2007 Oct 20; 370(9596):1413.

    Christopher Murray and colleagues publish the results of an analysis of under-5 mortality data. They note several issues they believe limit the quality and usefulness of evidence on child mortality estimates produced by the Inter-agency Child Mortality Estimation Group (IACMEG), which includes WHO, UNICEF, the World Bank, the UN Population Division, Harvard University, the US Bureau of the Census, and others. Developing the best possible method is important, and we repeat the invitation previously extended to Murray to join the Inter-agency group. However, we wish to note that many of the issues raised have already been recognised by the IACMEG and incorporated into its work plan. Additionally, we take issue with several of the technical arguments and conclusions of the article. First, UNICEF and members of the IACMEG have recognised the issue of the completeness of databases and significant work has already been completed in the development of a new and updated database, which will go live in thecoming months. This public-access database will allow ready access to the IACMEG child mortality estimates, in addition to information on how they are calculated and the data sources used. (excerpt)
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  7. 7
    Peer Reviewed

    Research challenges to improve maternal and child survival.

    Costello A; Filippi V; Kubba T; Horton R

    Lancet. 2007 Apr 14; 369(9569):1240-1243.

    Every year, 11 million mothers and newborn infants die, and a further 4 million infants are stillborn. Much is known about the efficacy of single interventions to increase survival under well-managed conditions, much less about how to integrate programmes at scale in poor populations. Funds for maternal, neonatal, and child health are limited, and research is needed to clarify the most cost-effective solutions. In 2003, the Bill & Melinda Gates Foundation?s grand challenges in global health focused on scientific and technological solutions to prevent, treat, and cure diseases of the developing world. The disappointing progress towards the Millennium Development Goals (MDGs) 4 and 5 to reduce child and maternal mortality led us to do a similar exercise to engage creative minds from development and health professionals-ie, those who work in the front line-about how research might accelerate progress towards meeting these MDGs. (excerpt)
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  8. 8
    Peer Reviewed

    Human resources in developing countries.

    Lanata CF

    Lancet. 2007 Apr 14; 369(9569):1238-1239.

    More than 10 million children are dying every year, mainly in developing countries, from causes that could be mostly prevented by available cost-effective interventions. Governments worldwide have committed themselves to improve this reality by adopting the Millennium Declaration, in which one of the ten Millennium Development Goals (MDGs) calls for a two-thirds reduction in the number of deaths for children younger than 5 years from the 1990 baseline. From a group of 20 proven interventions that could reduce child mortality by more than 60% (if their coverage could be improved from estimates made in 2000 to 99% of those who need them), three include vaccines: Haemophilus influenzae type B vaccine, measles vaccine, and tetanus toxoid. However, these effective interventions, including vaccines, were not delivered in a way that could reach children who need them most,4 and when delivered, they usually tend to serve the rich and privileged first, leaving the poor to the end. (excerpt)
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  9. 9
    Peer Reviewed

    Tracking progress towards the Millennium Development Goals: reaching consensus on child mortality levels and trends.

    Child Mortality Coordination Group

    Bulletin of the World Health Organization. 2006 Mar; 84(3):225-232.

    The increased attention to tracking progress towards the Millennium Development Goals (MDG), including Goal 4 of reducing child mortality, has drawn attention to a number of interrelated technical, operational and political challenges and to the underlying weaknesses of country health information systems upon which reliable monitoring depends. Assessments of child mortality published in 2005, for almost all low-income countries, are based on an extrapolation of the trends observed during the 1990s, rather than on the empirical data for more recent years. The validity of the extrapolation depends on the quality and quantity of the data used, and many countries lack suitable data. In the long run, it is hoped that vital registration or sample registration systems will be established to monitor vital events in a sustainable way. However, in the short run, tracking child mortality in high-mortality countries will continue to rely on household surveys and extrapolations of historical trends. This will require more collaborative efforts both to collect data through initiatives to strengthen health information systems at the country level, and to harmonize the estimation process. The latter objective requires the continued activity of a coordinating group of international agencies and academics that aims to produce transparent estimates -- through the consistent application of an agreed-upon methodology -- for monitoring at the international level. (author's)
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  10. 10

    'The silent emergencies:' 1987 State of World's Children - UNICEF report.

    UN Chronicle. 1987 May; 24:[5] p..

    While the media focus on Africa from 1984 to 1986 brought extraordinary assistance to that crisis-ridden continent, it may have tended to obscure everyday emergencies wrought by disease and malnutrition elsewhere in the world. Recent events in Africa have alerted United Nations agencies once again that ways must be found to sensitize politicians as well as the press to what the United Nations Children's Fund (UNICEF) Executive Director James P. Grant has called the "silent emergencies'--the less dramatic continuum of death and human suffering imposed by poverty and ignorance. In the UNICEF State of the World's Children Report for 1987, Mr. Grant notes that over the past two years, more children died in India and Pakistan than in most nations of Africa combined. "In 1986, more children died in Bangladesh than in Ethiopia, more in Mexico than in the Sudan, more in Indonesia than in all eight drought stricken countries of the Sahel', he says. (excerpt)
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  11. 11

    UNICEF pushes efforts to cut child deaths, hunger - United Nations Children's Fund.

    UN Chronicle. 1991 Jun; 28(2):[3] p..

    The United Nations Children's Fund (UNICEF) has made a "promise to children"--to try to end child deaths and child malnutrition on today's scale by the year 2000. The Fund estimates that a quarter of a million children die every week from common illnesses and one in three in the world are stunted by malnutrition. That broad goal, declared on 30 September 1990 by 71 Presidents and Prime Ministers attending the first World Summit for Children, includes 20 specific targets detailed in the Plan of Action for implementing the World Declaration on the Survival, Protection and Development of Children in the 1990s, adopted at the Summit. Among them are: one-third reduction in under-five death rates; halving maternal mortality rates; halving of severe and moderate malnutrition among the world's under-fives; safe water and sanitation for all families; and measures covering protection for women and girls, nutrition, child health and education. Other goals include making family planning available to all couples and cutting deaths from diarrhoeal diseases--which kill approximately 4 million young children annually--by one half, and pneumonia--which kills another 4 million a year--by one third. (excerpt)
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  12. 12

    Child mortality in developing countries: challenges and policy options.

    Oloo JA

    Eastern Africa Social Science Research Review. 2005 Jun; 21(2):1-17.

    The objective of this study is to understand determinants of mortality rates of children under the age of five years in developing countries. The study uses secondary data to investigate the relationship between under-five mortality rates and such socioeconomic variables as fertility, literacy, immunization, access to clean drinking water, HIV/AIDS prevalence, and human and material resources using linear regression analysis. Results show that while most of these variables have a significant relationship with under-five mortality rate, the proportion of doctors for every 100,000 population, and health expenditure per capita have an insignificant predictive value. Conclusion: Reducing child mortality rates requires multiple intervention strategies, such as access to safe drinking water, improvement in education opportunities, family planning, and tackling HIV/AIDS. (author's)
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  13. 13
    Peer Reviewed

    How does progress towards the child mortality Millennium Development Goal affect inequalities between the poorest and least poor? Analysis of Demographic and Health Survey data.

    Moser KA; Leon DA; Gwatkin DR

    BMJ. British Medical Journal. 2005 Nov 19; 331(7526):1180-1182.

    The millennium development goals (MDGs) have been widely accepted as a framework for improving health and welfare worldwide. Child mortality is one of the most crucial and avoidable global health concerns. In many low income countries, 10-20% of children die before reaching 5 years (compared with, for example, 0.7% in England and Wales). The child mortality MDG (to reduce the under 5 mortality rate by two thirds between 1990 and 2015) is formulated as a national average. The World Health Report 2003 posed an important question: how does progress towards the MDGs affect equity? We investigated this by examining, across a range of settings, how inequality in the under 5 mortality of the poorest and least poor changes as progress is made towards the MDG. (excerpt)
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  14. 14
    Peer Reviewed

    Poor shooting at the Millennium Development Goals.

    Lancet Infectious Diseases. 2005 Sep; 5(9):529.

    It is 5 years since the member states of the UN adopted the Millennium Development Goals (MDGs). Progress towards achieving the goals by the target date of 2015 will be reviewed at a meeting of the UN General Assembly on September 14–16. Of the eight MDGs, three relate—to a greater or lesser extent—to infectious diseases: goal 4, reduce the under-5 mortality rate by two-thirds from its 1990 level; goal 5, reduce by three-quarters from its 1990 level the maternal mortality ratio; and, most directly, goal 6, combat HIV/AIDS, malaria, and other diseases. Goal 6 is broken down into two targets: halt and begin to reverse the spread of HIV/AIDS, and halt and begin to reverse the spread of malaria and other major diseases (tuberculosis in particular). Sadly, for large parts of the world there is little prospect of these MDGs being reached by 2015. In 2003, under-5 mortality, to which pneumonia, diarrhoea, malaria, and sepsis are major contributors, was around nine per 1000 live births in high-income countries compared with 172 per 1000 live births in sub-Saharan Africa. Regionally, northern Africa, Latin America and the Caribbean, and southeast Asia have made rapid improvements since the 1990s, but at the current rate of progress the reduction in under-5 mortality worldwide by 2015 will be one-quarter rather than two-thirds. (excerpt)
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  15. 15

    The role of the World Bank.

    Claeson M; Wagstaff A

    Global HealthLink. 2003 May-Jun; (121):14-15.

    In 2000, roughly 11 million children died before their fifth birthday, almost all of them in the developing world. An estimated 140 million children under the age of five were underweight, almost half of them living in South Asia. In 1995, 515,000 women died during pregnancy or childbirth, only 1,000 of whom died in the industrialized world. Tuberculosis claimed another 2 million lives. As these numbers might well suggest, death and illness act as a brake on economic growth, and contribute to income poverty: health and demographic variables account for as much as half of the difference in growth rates between Africa and the rest of the world over the period 1965-1990. Nearly half of the Millennium Development Goals (MDGs) concern, directly or indirectly, health, nutrition and population issues. But based on present trends, relatively few low-income countries will achieve these goals. Only 17 percent of countries are on target for the under-five mortality goal (a two-thirds reduction between 1990 and 2015). Also, on present trends, sub-Saharan African as a whole will take 100 years to achieve the under-five mortality MDG. In all regions other than the Europe and Central Asia region, the under-five mortality rate declined faster during the 1980s than it did during the 1990s. The slowdown was particularly pronounced in Africa and the Middle East. In many countries, improvements in child mortality and malnutrition have been smallest among the poor. (excerpt)
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  16. 16

    The progress of nations, 1998. The nations of the world ranked according to their achievements in fulfillment of child rights and progress for women.


    New York, New York, UNICEF, 1998. [41] p.

    The Progress of Nations is a clarion call for children. It asks every nation on earth to examine its progress towards the achievable goals set at the World Summit for Children in 1990 and to undertake an honest appraisal of where it has succeeded and where it is falling behind. This year’s report highlights successes attained and challenges remaining in efforts to register each child at birth, to immunize every child on earth and to help adolescents, particularly girls, as they set out on the path towards adulthood. With its clear league tables, The Progress of Nations is an objective scorecard on these issues. Commentaries by leading thinkers and doers stress the need for an approach to development based on child rights, calling on governments to fulfill the promises they made in ratifying the Convention on the Rights of the Child. The Progress of Nations reminds us annually that rhetoric about children must be backed up with action. I would commend it to anyone concerned about the status of our most vulnerable citizens. (excerpt)
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  17. 17

    Evidence Base for the Community Management of Pneumonia, June 11-12, 2002, Stockholm, Sweden.

    World Health Organization [WHO]. Department of Child and Adolescent Health and Development

    Geneva, Switzerland, WHO, Department of Child and Adolescent Health and Development, 2002. 28 p. (WHO/FCH/CAH/02.23)

    Although the past 15 years have seen a decline in child mortality due to pneumonia, it remains a very important cause of death in developing countries. In Africa in particular, pneumonia and malaria are by far the most important causes of death for children under 5. The overall aim of this meeting was to help to define practical community approaches which could deliver a rapid reduction in this preventable mortality. WHO has developed and supported the use of case management of pneumonia through the ARI Programme and later as a part of IMCI. The main focus for these initiatives has been the health facility, although much of the demonstration of the efficacy of the clinical interventions was carried out at community level, using community health workers. IMCI uses the same clinical methodology. Although IMCI stresses the promotion of care-seeking by families with sick children, in general, the clinical management of such children is offered at the first level health facility. The importance of providing care without delay for children with malaria has led to the development and introduction, so far on a small scale, of interventions based in the community, either through a community health worker or directly by families, who are provided with packs of antimalarials. These two diseases in childhood, pneumonia and malaria, have major overlaps in terms of clinical presentation, the requirements for their effective management and the feasibility of providing standardised care in the community. Technically sound and operationally manageable community interventions that tackled both conditions would offer a most valuable tool for use in the reduction in child mortality in developing countries. (excerpt)
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  18. 18

    WHO / UNICEF joint statement: Clinical management of acute diarrhoea.

    World Health Organization [WHO]; UNICEF

    Geneva, Switzerland, WHO, 2004. 7 p. (WHO/FCH/CAH/04.7; UNICEF/PD/Diarrhoea/01)

    Though the mortality rate for children under five suffering from acute diarrhoea has fallen from 4.5 million deaths annually in 1979 to 1.6 million deaths in 2002, acute diarrhoea continues to exact a high toll on children in developing countries. Oral rehydration salts (ORS) and oral rehydration therapy (ORT), adopted by UNICEF and WHO in the late 1970s, have been successful in helping manage diarrhoea among children. It is estimated that in the 1990s, more than 1 million deaths related to diarrhoea may have been prevented each year, largely attributable to the promotion and use of these therapies. Today, however, there are indications that in some countries knowledge and use of appropriate home therapies to successfully manage diarrhoea, including ORT, may be declining. (excerpt)
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  19. 19

    Global health improvement and WHO [letter]

    Shatenstein S

    Lancet. 2004 Apr 3; 363(9415):1162.

    I commend Lee Jong-Wook for his Public health article, the most shocking statistic of which highlights the fact that almost a fifth of all deaths across the world occur in developing countries in children younger than 5 years. Efforts by WHO to alleviate this terrible burden are to be acclaimed. I find it disheartening, however, that a 5000-word essay on global health improvement makes only a few general references to noncommunicable diseases and fails to mention the Framework Convention on Tobacco Control (FCTC), one of WHO’s signal achievements. In fact, the words smoking and tobacco do not appear anywhere in the article, despite WHO’s acknowledgment that 4·9 million people are dying each year from tobacco use—a figure that will double within a generation. According to WHO’s own statistics, the burden of disease is currently shared evenly by developed and developing countries, but 70% of this risk will be borne by those in developing countries by the 2020s. (excerpt)
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  20. 20
    Peer Reviewed

    Health-related millennium development goals out of reach for many countries.

    Bulletin of the World Health Organization. 2004 Feb; 82(2):156-157.

    Many developing countries will not be able to reach the health-related Millennium Development Goals (MDGs) unless clear and immediate action is taken combined with a concerted effort over the next 12 years, warned the World Bank and WHO in Geneva at a meeting on 8 and 9 January. The meeting brought together representatives from concerned countries, development agencies and UN organizations to assess progress towards the healthrelated goals and to map out a future strategy for their achievement. The World Bank and WHO noted that the health goals are particularly difficult to meet and that progress towards them is slower than towards some of the other goals. Four of the eight MDGs, set at the United Nations Millennium Summit in September 2000, relate to health: to reduce maternal mortality by threequarters and child mortality by twothirds, halve the proportion of people who suffer from hunger, combat HIV/ AIDS, malaria and other diseases, and improve access to safe drinking-water and essential drugs. (excerpt)
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  21. 21

    How to accelerate progress toward the millennium development goals.

    Baird M; Shetty S

    Finance and Development. 2003 Dec; 40(4):14-19.

    With just 12 years left to achieve the W Millennium Development Goals, a greater sense of urgency is needed by all sides if the targets are to be met. Many developing countries are making substantial progress toward the MDGs as a result of improved policies, better governance, and the productive use of development assistance. But they could do more with the right mix of policy reforms and additional help. Scaling up efforts to meet the MDGs by 2015 presents both opportunities and challenges. By acting now, developed countries can hasten progress by providing more and better aid and by allowing greater access to their markets. Developing countries, for their part, will need to continue to improve their policies and the way they are implemented. Without greater impetus, there is a serious risk that many countries will fall far short on many of the goals. (excerpt)
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  22. 22
    Peer Reviewed

    New and underused technologies to reduce maternal mortality.

    Tsu VD

    Lancet. 2003 Dec 31; 363(9402):75-76.

    In July, 2003, maternal health specialists from around the world gathered in Bellagio, Italy, to develop a list of proven and promising technologies, appropriate for low resource settings, to reduce maternal mortality. We defined technologies as equipment, consumable supplies including medicines, and techniques. While technology, especially in health care, often provokes thoughts of complex, costly interventions, the technologies identified at the Bellagio meeting are mostly simple and inexpensive. What is lacking are resources, human and financial, to scale-up and put proven technologies into widespread use and to assess and document the effectiveness of promising new interventions. There is an urgent need to accelerate the appropriate use of technologies and to reduce the inequitable burden of pregnancy-related mortality borne by women in poor countries. The 2003 Lancet series on child survival highlighted the interventions needed to ensure the health of children worldwide. We would add that saving the life of the mother is one of the best ways to prevent the death of a child. The half million women who die from pregnancy-related and childbirth-related causes every year leave behind at least 1 million motherless children who are all at increased mortality risk. (excerpt)
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  23. 23
    Peer Reviewed

    UNICEF gloomy on child development goals.

    Kapp C

    Lancet. 2003 Dec 13; 362(9400):1986.

    The Millennium Development Goals of eradicating extreme poverty and hunger, reducing child mortality, improving maternal health, and combating diseases such as HIV/AIDS and malaria by 2015 are looking increasingly unrealistic because the war against terror is diverting resources away from development, according to the UN Children’s Fund. In its annual report State of the world’s children, issued on Dec 11, UNICEF said that one of the most crucial goals—to achieve gender equality in education by 2005—was slipping away. (excerpt)
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  24. 24

    Achieving the millennium development goals. Population and reproductive health as critical determinants.

    United Nations Population Fund [UNFPA]

    New York, New York, UNFPA, 2003. ix, 24 p. (Population and Development Strategies No. 10)

    The ICPD goal of universal access to quality reproductive health services by 2015 is not one of the Millennium Development Goals (MDGs). Yet, as this publication demonstrates, the attainment of reproductive health and reproductive rights are fundamental for development, for fighting poverty, and for meeting the MDG targets. Conversely, reproductive ill-health undermines development by, inter alia, diminishing the quality of women’s lives, weakening and, in extreme cases, killing poor women of prime ages, and placing heavy burdens on families and communities. (excerpt)
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  25. 25
    Peer Reviewed

    WHO urges developing countries to invest in health.

    Lancet. 2003 Nov; 362(9395):1557.

    In a follow up to demands by the 2001 Commission on Macroeconomics and Health (CMH) for a massive increase in health investment, ministers in charge of health, finance, and planning from 40 developing countries met on Oct 29–30 to discuss progress and priorities. Aside from lip service paid to recent achievements, the assessment from the WHO-convened conference was bleak. “Two years on, the world still has not shown determination to increase health investment enough to measurably impact major diseases that affect the world’s poor”, said WHO. (excerpt)
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