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  • These results have to be interpreted

    2019-06-18

    These results have to be interpreted with respect to present trends in age at childbearing. Worldwide, adolescent fertility rates fell from 71 to 52 per thousand women aged 15–19 years between the 1970s and the 2000s. This (S)-(-)-Propranolol hydrochloride was seen in all regions, with the possible exception of Latin America. For birth rates in women aged 35 years and older, substantial reductions were seen in Africa, Asia, and Latin America, but slight increases were noted in high-income countries. These patterns, taken together with Nove and colleagues\' findings, suggest that existing trends in age-specific fertility will contribute to a reduction in maternal mortality in the near future. Irrespective of the size of the increased risk of maternal mortality for adolescents, many overwhelming reasons exist for adolescent women to avoid early childbearing, including the widespread adverse social, educational, and economic consequences for young mothers. However, the most striking finding from Nove and colleagues\' study is the very high risk for women older than 35 years. On the basis of these data, delaying 100 000 adolescent pregnancies until ages 20–24 years would prevent 70 maternal deaths, (S)-(-)-Propranolol hydrochloride whereas more than 1000 deaths would be prevented if 100 000 pregnancies currently in women aged 40 years or older occurred when the same women were in their early 20s. Whereas late motherhood in high-income and middle-income countries might be an unavoidable consequence of the broadly positive improvement of women\'s role in society, in low-income countries many maternal deaths could still be prevented by improving access to contraception to reduce unplanned, high-parity births.
    The estimated number of deaths of children younger than 5 years has dropped from more than 10 million in 2000 to fewer than 7 million at present—a reduction mainly associated with prevention of post-neonatal deaths due to diarrhoea, pneumonia, measles, and other infectious diseases. Deaths of newborn babies are proving to be harder to reduce. Even though neonatal mortality rates are falling, they are doing so at a slower pace than deaths of older children, and now represent more than 40% of under-5 mortality. Despite growing interest in neonatal mortality, very little is known about how these rates vary by socioeconomic position in low-income and middle-income countries. In this issue of , Britt McKinnon and colleagues present what are probably the first global-level analyses of how such inequalities are evolving over time. They rely on state-of-the-art analyses to describe absolute and relative changes in socioeconomic disparities in neonatal mortality. In most of the 24 countries with available information, both neonatal mortality rates and socioeconomic inequalities in these rates have fallen. McKinnon and colleagues\' results are somewhat surprising in light of what is known about under-5 mortality as a whole. A recent set of analyses showed that, in 38 countries with two surveys with a median interval of 11 years, relative socioeconomic inequalities—assessed through the concentration index—increased in 24 and decreased in 14 countries. However, the magnitude of changes tended to be small, with an average increase in concentration indices over time of only 0·02, indicating a slight upturn in inequalities. An earlier analysis of the 1991–2001 period also found no clear overall pattern of increase or decline over time in socioeconomic inequalities in under-5 mortality. Time trends in socioeconomic inequalities in child mortality are affected by several factors, including the baseline mortality levels and cause structure, the availability of effective interventions, and the delivery channels used to reach different social groups with such interventions. At the turn of the millennium, it was widely believed that high-technology, hospital-based approaches were essential for preventing neonatal deaths. We now know that, in high-mortality settings, a handful of cost-effective interventions delivered at community level could have a substantial effect on neonatal mortality rates. If these interventions are rapidly scaled up to reach the poorest children—who are still dying from easily preventable causes in many countries—then inequalities are likely to be reduced. Results on national changes in coverage of key interventions, however, have been quite disappointing in most countries, so it is not at all clear that increased coverage among the poor could explain the findings of McKinnon and colleagues\' article.