Table 1 Key messages

Key messages

1. MDG progress especially for child survival: seven of the 10 Countdown case study countries met Millennium Development Goal (MDG)-4 to reduce their under-5 mortality rate by two-thirds between 1990 and 2015. Key childhood interventions (e.g., immunisations and insecticide treated nets in malaria endemic countries) saw major increases in coverage, partly due to their delivery at community and primary health care level, as well as to global and national commitment to these interventions, which manifested in greater financial resources and focused attention on implementation.

2. Slower progress for neonatal and maternal mortality: these reductions were generally more modest, though newborn health did not receive attention until the mid-2000s. There was slower progress in the coverage of intrapartum interventions such as skilled birth attendance, with persisting large equity gaps. The case studies reported lower political commitment, less financing, and more health system constraints for implementing intrapartum interventions, partly because they must be delivered through middle- and higher-level facilities as part of a functioning health system.

3. Reproductive health: few case studies explored progress in improving reproductive health. Fertility levels did not reduce dramatically over the MDG era in most of the countries, and family planning received comparatively lesser funding than did child health, and particularly HIV/AIDS, although investments have increased since 2010.

4. Systematic methods to compare country progress: this portfolio of case studies demonstrates how mixed methods research can provide insights into the “how and why” of improving women’s and children’s health, by using a standard evaluation framework and engaging multidisciplinary, independent country teams in collecting and analysing data from a variety of sources. More data and further research advances are needed, including better understanding of the role of social, economic and political factors, including leadership and governance.

5. Future of women’s and children’s health: as the world transitions into the Sustainable Development Goals era, continued investment is crucial for the unfinished agenda of improving maternal, child and newborn survival, as well as for ensuring they thrive and transform into productive citizens. Improved data are required especially at subnational level and to drive these improvements in coverage and equity, but also quality, so no women or their children are left behind.