A research assistant from Aga Khan University (AKU) talks with a mother participating in the SEEM project, a study of environmental enteropathy and malnutrition in in Sindh province, Pakistan.
our goal:
Ensure that women and newborns survive and remain healthy before, during, and after childbirth by identifying and addressing underlying biological vulnerabilities.
The Challenge
At A Glance
We believe addressing underlying biological vulnerabilities such as malnutrition and pre-term birth is the best way to help women have healthy pregnancies and healthy babies. This also disrupts the transfer of risk from mom to baby.
To do this, we need a bold new research and development agenda that moves beyond developing tools for single diseases and focuses on growth and resilience. Our strategy creates knowledge and tools that combat biological vulnerability in pregnancy and early childhood.
Our investment aim to reduce adverse birth outcomes and improve growth, neurodevelopment, and resilience to infection.
Our MNCH Discovery & Tools portfolio is co-led by Rasa Izadnegahdar and Sindura Ganapathi and is part of the foundation’s Global Health Division.
Improvements in maternal, newborn, and child survival are among the most significant achievements in global health during the 21st century. Since 2000, childhood deaths have decreased by 43 percent and maternal deaths have decreased by 29 percent.
Despite this decrease, residual deaths among children are now concentrated earlier in life and their causes are more complex to address. For instance, between 2000 and 2015, neonatal mortality as a fraction of mortality rates for children under 5 increased from 26 percent to 35 percent in Sub-Saharan Africa and from 49 percent to 57 percent in South and Southeast Asia. Outside of the neonatal period, the relative proportion of deaths due to diarrhea, pneumonia, measles, and malaria decreased in that same time period. This means that the highest risk periods occur during pregnancy, the perinatal period, and the first few months of life. It also means the traditional “big killers,” for which we have treatments and vaccines, are less likely to be causing deaths.
Against this backdrop, we need to make faster progress—particularly if we are to achieve the 6 to 9 percent annual reduction in mortality rate that is required to meet the Sustainable Development Goal targets by 2030. By comparison, during the Millennium Development Goal era, the average annual decline in mortality rate for children under 5 was between 2 percent and 4 percent in Sub-Saharan Africa.
To make the progress needed, we must address underlying risks such as intrauterine growth restriction, preeclampsia, prematurity, stunting, and wasting. These biological vulnerabilities often begin with the mother, compound under the physical stress of pregnancy, and are tragically transferred to her newborn, perpetuating an intergenerational cycle of vulnerability.
The Opportunity
We believe it’s possible to interrupt the cycle of vulnerability by addressing the risk factors for both mom and baby.
To do this, we need a bold research and development agenda to build the knowledge and tools needed to combat biological vulnerabilities in pregnancy and early childhood.
We think it’s possible to identify, target, and ultimately reverse underlying biological vulnerabilities, which will help more women have healthy pregnancies and deliver healthy babies. For example, early investments show that deficiencies in selenium are linked to preterm birth prevention and combinations of pre-and-probiotic therapies have been shown to reduce sepsis in neonates.
Our Strategy
There are two primary principles underpinning our strategy. First, our investments are focusing more on biological vulnerability, rather than on disease- specific conditions. Second, we are focusing our investments on conception to 2 years of age, the key stage of life where addressing biological vulnerabilities has a disproportionate impact. We believe focusing on these principles are critical to the growth and resilience of mothers and babies.
To accompany these principles, we have aggregated funding and management of all research and development investments pertaining to mothers, newborns, and children, into a single portfolio called Discovery & Tools. Previously, seven teams across the foundation were responsible for this work.
Areas of Focus
Upstream: Developing Innovative Tools to Address Root Causes of Poor Health
We are investing in non-vaccine tools targeting the time between conception to 2 years of age to shift the mother-fetus and mother-infant trajectory from the vulnerable to the ideal. We focus our investments on three initiatives:
- Optimizing birth outcomes for mothers and newborns.
- Supporting thriving in the community.
- Optimizing prevention and treatment of acute illness.
We use a variety of tools and technologies outside of vaccines, including diagnostics, devices, therapeutics, treatment algorithms and nutritional supplements to support healthy pregnancies and babies. We invest in research and development for vaccines via our other Global Health teams, including Enteric and Diarrheal Diseases; Pneumonia, Malaria, Vaccine Development & Surveillance; and Discovery & Translational Sciences.
In addition to the three initiatives above, our Strategic Data Analysis & Synthesis initiative aggregates all of the data and knowledge generated across our portfolio of investments to inform our priorities and track progress. This initiative helps us understand burden, analyze crosscutting quantitative questions, and model the impact and cost-effectiveness of new tools.
Downstream: Maximizing Investments and Strengthening Systems
Looking downstream, we focus on aligning programmatic and advocacy investments to maximize health outcomes and strengthen primary health care systems. This work includes testing new interventions that target maternal and newborn morbidity and mortality; increasing coverage of key interventions through strengthened primary health care systems; and advancing evidence-based recommendations to accelerate the adoption of innovations by global and country decision-makers.
Our partners help gather, assess, and share critical data on maternal and newborn health to inform policies, and we look for opportunities to maximize health financing to support program implementation. We are also helping develop a standardized set of indicators for health targets and measurements to guide planning, monitoring, and decision-making.
For more about our downstream work, please visit Maternal, Newborn & Child Health.
