Introduction
At the end of 2015 the period of the Millennium Development Goals (MDGs) will end, and the 189 signatory countries will take stock of what has been achieved. The focus is already shifting to proposals for a new global framework for after 2015, centered on sustainable development. Now is therefore the time to take a hard look at how far women's and children's health has come, and at what more can and must be done. Efforts must not slow in the transition from the Millennium Development Goals to what will follow. The 2014 report1 from Countdown to 2015 for Maternal, Newborn and Child Survival (Countdown), released on June 30, 2014, has focused on the unfinished business of the MDGs and how best to sustain, focus, and intensify efforts for women and children as we move forward.
The MDGs, fixed in 2000, committed the global community to reduce extreme poverty and achieve a set of targets by 2015, relative to a starting point in 1990. At the heart of the MDGs are MDG4, which calls for a reduction of child mortality by two-thirds, and MDG5, which focuses on improvement of maternal health through a reduction of maternal mortality by three-quarters and universal access to reproductive health. Countdown tracks and stimulates progress toward these targets in the 75 countries that represent more than 95% of maternal and child deaths, and has published country-specific profiles at least every 2 years since 2005. Each profile features data on intervention coverage, equity in coverage, and policy, health systems, and financial factors that can affect whether every woman and child receives interventions that can save their lives (appendix pp 1–2).
We summarise Countdown results for 2014, examine the data supporting evidence-based decisions in women's and children's health, describe elements of the Countdown process that might inform ongoing efforts to hold the world to account for progress, and list concrete steps that can be taken now to ensure continued progress for women and children.
Key messages
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Achievement of high, sustained, and equitable coverage of life-saving interventions for women and children is insufficient.
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Although most countries will not achieve Millennium Development Goals (MDGs) 4 and 5, progress has accelerated in recent years, suggesting that further gains are possible with continued, intensified actions.
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Some of the most important coverage gaps are in family planning, interventions addressing newborn mortality, and case management of childhood diseases.
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Massive inequalities in intervention coverage and health outcomes, including stunting, must be tackled for progress to continue.
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Progress has occurred in country adoption of evidence-based policies and strategies to improve women's and children's health.
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Accountability cannot exist without data. Countries must continue to be supported to build capacity to collect high-quality data on intervention coverage and inequities, and to use it as a basis for decisions about how best to reach women and children with interventions. Baseline data must be collected now for the post-2015 era.
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Countdown will continue to monitor country-specific coverage and inequalities over the final days of the MDG era and into the future, to ensure that attention and focus are maintained during this transition period.