Editorial: [Challenges on the Improvement of Global Maternal Health]

In this issue a striking article by P. Barate and M. Temmerman gives valuable information about the silent tragedy of maternal mortality worldwide showing that the Millennium Development Goal (MDG) 5, i.e. reduction of maternal mortality, is the most “off track” goal of the MDGs. These authors mentioned that since the launch of the Safe Motherhood Initiative in 1987, most of the appalling statistics on number of maternal deaths have remained relatively unchanged for 20 years; according to facts, which are deeply shocking, almost all cases of maternal mortality are preventable. Furthermore, information about the indicator is so poorly collected that we are faced to deal with a relative uncertainty in the estimates. Barate and Temmerman mentioned that too many actors have been trying to guide or influence policymaking in developing countries, with lack of cohesion and loss of performance as a consequence; and that donors often dictate the rules, since most governments and organisations lack the necessary resources, mandate or full-range expertise to deal comprehensively with the maternal and neonatal health issues. The provision of appropriate maternal care is a human right. We know that lack of provision of effective interventions is a violation of human rights. E. Silva Miranda and C. Garcia Serpa Osorio-de-Castro provide a thoughtful review about malaria in pregnancy. Advances have been achieved in the control of the mosquito but still research is needed in the development of safe, effective and affordable drugs that are acceptable to pregnant women and in adequate training and encouragement for adherence to treatment guidelines by health professionals. We are very grateful to Dr. Watanabe for the work on leading and assembling articles in such a relevant subject as maternal nutrition. This subject has been a steady concern for obstetrician and midwives. We remember a period about counselling restriction of maternal weight increase based on misconception about the prevention of preeclampsia. Authors of the articles in this issue show the complexity of the situation, since maternal malnutrition is a current problem. Transition shows an increase in women obesity as data provided by Li and Haung in China and the peculiar situation in Japan of lean women in young age showed by Itoh and Kanayama. Around 27 million children are born every year with intrauterine growth restriction, 97% of them in low-and-middle income countries (LMIC) [1]. The possibility of being born with a below-standard weight in LMICs is 24%, compared to 7% in high income countries. These children have a higher risk of death, health complications, impairment in growth and mental development, and when women higher risk of having children with fetal growth restriction and metabolic impairment in the next generation. Also, they have a higher risk of suffering chronic health problems like hypertension, diabetes and obesity. In their article Itoh and Kanayama gave valuable information about the consequences and mechanisms linking poor fetal nutrition and chronic consequences, mainly obesity. Maternal nutrition previous and during pregnancy is a major determinant of fetal growth. Watanabe et al. and Everette articles in this issue provide relevant information about how to improve maternal nutrition previous and during pregnancy. In their comprehensive reviews information is provided to better manage women nutrition and consequently ameliorate consequences in the progeny of such malnutrition. An issue of the Journal showing the relevance of the need to improve maternal health, the diversity of situations in the countries of the world and the need of conjunction of basic, clinical and epidemiological researchers looking for feasible interventions to improve maternal health. But also the need of joining global actors to work together with similar approaches and objectives.