(June 2014) Recent research by a group of health systems experts details how a 2 percent increase in current spending for maternal and child health can save 147 million children, prevent 32 million stillbirths, and avert 5 million maternal deaths by 2035.1

The Global Investment Framework for Women's and Children's Health estimates the health and economic returns on increasing health expenditures by just $5 per person per year up to 2035 in the 74 developing countries that have 95 percent of the global maternal and child mortality burden.

Investment Has Numerous Health Benefits

Karin Stenberg and colleagues looked at six packages of interventions that have been proven to save lives across a continuum of care—maternal and newborn health, child health, immunization, family planning, HIV/AIDS, and malaria—and added nutrition as a cross-cutting theme. Although maternal mortality declined by 47 percent between 1990 and 2010, and under-5 mortality by 47 percent between 1990 and 2012, the Millennium Development Goals (MDGs) are far from being met. Preventable communicable, maternal, and neonatal deaths, along with nutritional reasons, are responsible for 25 percent of deaths in sub-Saharan Africa. Searching for a post-2015 development plan to replace the MDGs, these experts contend that the new investment framework is affordable enough to guide national health and development planning for the next 20 years.

In addition to the lives saved, the proposed investments would result in a reduction in the worldwide total fertility rate (from 2.7 children per women in 2010 to 2.0 in 2035), by decreasing the number of unintended pregnancies. The experts estimate that family planning is one of the most cost-effective interventions: 47 percent of the reduction in child deaths and 53 percent of the reduction in maternal deaths would be due to fewer births.

Intervention Success Needs Strong Health Systems

Many health problems are preventable if health systems are strong. More than one-third of the proposed initial investments are in infrastructure to improve the physical accessibility to quality health care, which in turn should expand access to skilled care at birth, including emergency obstetric care. Down the line, investments are focused on outpatient care and commodities, and are concurrent with the increase in treatment of diarrhea, pneumonia, and malaria in children; newborn care; immunization; and nutrition counseling. The health system workforce is a crucial component of health system strengthening: The investment proposal would add 675,000 nurses, doctors, and midwives along with 544,000 community health workers by 2035.

Women of childbearing age and children represent more than 50 percent of the population in most countries. Investing in rural facilities and the health workforce to provide around-the-clock comprehensive obstetric emergency care and better referral systems will benefit women and children and strengthen the health system more broadly, especially in areas where health burdens are often greatest and services minimal. Access to prenatal care and infant immunization can be an entry point to the wider health system for poor and at-risk women and children, as well as a discovery point for risk factors for otherwise undiagnosed health problems, including sexually transmitted infections, micronutrient deficiencies, diabetes, and hypertension.

The expert group argued that improvements in maternal health, reduction of low birth weight and stunting through better nutrition, and expansion of a range of preventive child and adolescent health services are increasingly recognized as an investment with economic returns in productivity and potential lifetime earnings. In 27 of the countries with current high fertility, investments to increase access to contraceptives could result in a decline in fertility and a possible demographic dividend, where the rates of return on the investment could exceed 8 percent of GDP by 2035.

Heidi Worley is a senior writer/editor at Population Reference Bureau.


  1. Karen Stenberg et al., "Advancing Social and Economic Development by Investing in Women's and Children's Health: A New Global Investment Framework," Lancet 383, no. 9925 (2014): 1333-54.