Many countries with the highest mother and child death rates continue to fall short, a decade after pledging to improve the problem.
Substantially reducing child mortality and improving maternal health by 2015 are two of the Millennium Development Goals that United Nations member states agreed to strive for 10 years ago.
But most of the 68 countries with the highest rates of maternal and child deaths are falling short of the goal, and progress in 12 countries is slowing down.
That's the finding of a new report by a group called Countdown to 2015, a collaboration of researchers, UN agencies, governments, non-governmental organizations and others.
Shortage of skilled health workers, cost of health care to blame
The report, published in The Lancet, says one of the key reasons for the lack of progress in maternal and child health is a severe shortage of doctors, nurses and midwives.
"The countries that have made the least progress are the ones where the shortage and maldistribution of human resources has been the largest," says The World Health Organization's Flavia Bustreo, one of the report's authors.
Bustreo says only 15 of the countries have the minimum number of skilled health workers to serve the population. And in many countries, those workers are concentrated in the cities, leaving the rural areas underserved.
Another barrier is the cost of health care. "When countries basically charge out-of-pocket payments for assessing services, this has been a major impediment," says Bustreo, noting that when countries such as Brazil and Rwanda removed that impediment and provided free access to health care, they made significant improvements in child and maternal health.
The report found 19 countries are on target to reduce child mortality by two-thirds, and progress is accelerating in 47 others. And Bustreo adds that there are examples of success from every region, from Latin America to South Asia.
"Bangladesh has been a country that, despite a very low income and very difficult situations, has managed to reduce maternal and child deaths and is on track," she says.
Child deaths are down, in part, because Bangladesh put policies in place that improved access to treatment for diarrhea and pneumonia, two major child killers. And the country has improved the rate at which girls receive lifesaving medical treatment, narrowing the gender gap.
Bustreo credits a combination of factors for the change, including outreach by community workers to improve vaccination and nutrition services, as well as women's empowerment initiatives such as micro-credit and education programs.
Global funding for maternal and child health programs doubled from 2003 to 2008, to $4 billion.
However, Bustreo says, "what we see is that still, [it] is not very well targeted in terms of the need that countries have."
She says development assistance often goes to countries that don't need it as much. And only five target countries are spending 15 percent or more of their own budgets on health.