The World Health Report 2005 showed that almost 11 million children under five years of age will die from preventable causes. Among them are 4 million babies who will not survive the first month of life. Furthermore, 3.3 million babies are stillborn each year. Maternal deaths also continue unabated - the annual total now stands at 529 000 with 68 000 as a consequence of unsafe abortion. These deaths are often sudden and unpredicted. Families are frequently forced into poverty due to the cost of health care that arrived too late or was ineffective.

According to the World Health Report, reducing this death toll in line with the Millennium Development Goals depends largely on every mother and every child having the right to access health care during pregnancy, childbirth, the neonatal period and childhood.

The MDGs and time-bound targets for each of the goals were set up in September 2001. This was followed by a road map for implementation of the millennium declaration, which formalized the goals, and laid down progress monitor indicators.

The forte of the MDG concept is that it amalgamates the crucial aspects of healthcare with other critical sectors like education, water and sanitation, providing a common platform for the integrated development and overall progress. This kind of multifaceted approach in conjunction with the requisite financial and logistical support from different agencies, governments, and organizations, might create the resources necessary to truly make a difference. We too should look on these goals as an opportunity for us to make a difference.

Though the MDGs encompass a wide spectrum of problems, health is the most critical. Development in the healthcare and overall well-being of a population has a geometric effect on the progress and economic development of that country. A healthy population is a healthy work force. What could be a better starting point in the quest for a healthy population than the mother and her child? Pregnancy, parturition and the post-partum period are highly stressful for a mother, and this may be perpetuated by poor nutrition and health so rife in developing countries.

The solution lies not merely in better health care facilities, but also a drastic social change to create awareness about the importance of a healthy woman and consequently a healthy child. My personal experience in India offers a good insight to the general neglect shown towards the plight of women, with women's issues always confined to the backburner. Traditionally the male is regarded to be the all-powerful person in society, and female feticide is commonplace in villages, towns and cities.

Although the health of mothers, newborns and children have had been priorities for decades, the places that began with the highest burdens of mortality and ill-health have made the least progress during the 1990s. In some countries the situation has actually worsened, and worrying reversals in newborn, child and maternal mortality have taken place.

Even though technical knowledge exists to respond to many, if not most, of the critical health problems and hazards that affect the health and survival of mothers and newborns, they have not be well recognized, and corrective strategies have not been effectively applied in the developing world.

Prenatal care

Antenatal care is the mainstay of maternal and child health, as a healthy in-utero environment ensures a healthy and safe future for the child. Bringing care to patients via regular antenatal outreach programs can help provide quality care to individuals in underdeveloped and inaccessible areas of Asia, Africa and South America. In addition to dealing with the morbidity and mortality of pregnancy and birthing, antenatal care can also be used as a powerful platform for other health programmes such as family planning, HIV/AIDS and the prevention and treatment of sexually transmitted infections, tuberculosis and malaria.

Perinatal care

There are a total of 136 million births every year and each birth represents unprecedented danger and stress for the mother. Nearly all fatal outcomes and disabling sequelae can be averted with skilled and responsive care. For optimum safety, every woman, without exception, needs professional skilled care when giving birth, in an appropriate environment that is close to where she lives and that respects her birthing culture. As mentioned before outreach programs can best provide such care by bringing health care to the patients in form of a registered midwife or a health worker with midwifery skills. These health care workers should also be trained and equipped to provide the necessary antenatal care and screen the pregnant patient for hypertension, weight gain, glycosuria and proteinuria using simple bedside procedures. These simple measures can avert, contain or solve many of the life-threatening problems that may arise during childbirth, and reduce maternal mortality to surprisingly low levels. Skilled midwifery professionals also need the back-up of a hospital for women with problems that are beyond the competency or equipment available at the first level of care. All women need first-level maternal care and specialist care is only necessary for a minority, but to be effective both levels need to work in tandem and both must be put in place simultaneously.

Postnatal care

The need for care does not stop as soon as the birth is over. The hours, days and weeks that follow birth can be dangerous for women and constitute a majority of maternal deaths. This aspect of maternal health has been largely ignored and morbidity of post-partum infections and haemorrhage continue to push the numbers up on maternal mortality charts. There has been a welcome emphasis in recent years on improving skilled attendance at birth, but this should not divert attention from postnatal care.

Medical education is a vital building block in the life of a physician. It is imperative that at this point adequate emphasis is laid on the on the importance of maternal and child health. This can be done by appropriate initiative being taken on the part of the medical schools. As a part of their training, medical students must be taught the importance of Maternal and Child Healthcare. Obstetric training must be emphasised and all physicians must be proficient in handling basic obstetric emergencies and initiating initial treatment before referral to tertiary centers. Government and health care organizations in conjunction with medical schools should set up Emergency Obstetric and Childcare centers, which cater exclusively for obstetrics and paediatrics. These need not be very advanced facilities, but must be staffed by qualified personnel and cater for the local population. Medical students as a part of their training should work in these centers to pick up the primary skills associated with maternal and child health care.

In conclusion it is important to recognize issues concerning maternal and child health care and to implement measures in its improvement. A lot of work still needs to be done. After all, children of today are the future of tomorrow. To ensure a healthy tomorrow we should insure healthy mothers caring for healthy children.

Bikram Bal MD (USA) Yale School of Medicine, CT
Dilraj S. Grewal (India) IMSO-India
Mohit Singla MD (India) Treasurer IFMSA 04-06 treasurer@ifmsa.org