Investments in evidence-based interventions throughout the life course, from birth through childhood and adolescence and into adulthood, are bolstered by an enabling environment both within the health system and from other sectors (see Figure 1, with details in Annexes 2-4). The particular interventions to be prioritized and how they are best delivered depend on the specific health needs, development priorities, health system capacities and legal and other considerations of each country.
Investing in such interventions for the health and well-being of women, children and adolescents has many benefits: first and foremost, it keeps them alive and healthy. In addition, it reduces poverty, stimulates economic productivity and growth, creates jobs and is cost-effective (see Box 1).
The economic and social case for investing in women, children and adolescents is clear and evidence-based.13-17 The legal imperative of upholding their human rights to the highest attainable standard of health, as protected by international law, is indisputable.
Almost one quarter of full income growth in low- and middle-income countries between 2000 and 2011 resulted from improved health outcomes overall.14
*See Annexes 2-4 for a more detailed list of essential interventions throughout the life course as supported by current evidence.
The provision of all interventions depends on the country context, including health needs, supply of related goods and commodities and legal considerations.
The examples below should be read in the context of the need to ensure access to all essential interventions and supplies across the life course,
to strengthen health systems and to address all major determinants of health (see Annexes 2-4).
If all women who want to avoid a pregnancy used modern contraceptives and all pregnant women and newborns received care at the standards recommended by the World Health Organization (WHO), the benefits would be dramatic. Compared with the situation in 2014, there would be a reduction in: unintended pregnancies by 70 per cent; abortions by 67 per cent; maternal deaths by 67 per cent; newborn deaths by 77 per cent; and transmission of HIV from mothers to newborns would be nearly eliminated. The return on investment would be an estimated US$120 for every US$1 spent.15,24 Population stability would enhance economic sustainability and reduce the risks of climate change.25
This produces a triple return on investment, saving mothers and newborns and preventing stillbirths. The provision of effective care for all women and babies at the time of birth in facilities could prevent an estimated 113,000 maternal deaths, 531,000 stillbirths and 1.3 million neonatal deaths annually by 2020 at an estimated running cost of US$4.5 billion per year (US$0.9 per person).19,20
This is among the most cost-effective of health interventions. Ten vaccines, representing an estimated cost of US$42 billion between 2011 and 2020, have the potential to avert between 24 and 26 million future deaths as compared with a hypothetical scenario under which these vaccines have zero coverage during this time.26
Promoting and supporting breastfeeding in the first two years of life could avert almost 12 per cent of deaths in children under five, prevent undernutrition and ensure a good start for every child.27 Scaling up nutrition interventions has a benefit-cost ratio of 16.28 Eliminating undernutrition in Asia and Africa would increase gross domestic product (GDP) by 11 per cent.29
Enabling children to develop their physical, cognitive, language and socioemotional potential, particularly in the three first years of life, has rates of return of 7-10 per cent across the life course through better education, health, sociability, economic outcomes and reduced crime.16
If countries in demographic transition make the right human capital investments and adopt policies that expand opportunities for young people, their combined demographic dividends could be enormous. In sub-Saharan Africa, for example, they would be at least US$500 billion a year, equal to about one third of the region’s current GDP, for as many as 30 years.17
With enhanced investments to scale up existing and new health interventions—and the systems and people to deliver them—most lowincome and lower-middle-income countries could reduce rates of deaths from infectious diseases, as well as child and maternal deaths to levels seen in the best-performing middle-income countries in 2014. A “grand convergence” in health is achievable by 2035.14
For women’s and children’s health, health system investments alongside investments in high-impact health interventions for reproductive, maternal, newborn and child health, at a cost of US$5 per person per year up to 2035 in 74 high-burden countries, could yield up to nine times that value in economic and social benefits. These returns include greater GDP growth through improved productivity and preventing 32 million stillbirths and the deaths of 147 million children and 5 million women by 2035.13
The health workforce is a critical area for investment. An ambitious global scale-up would require at least an additional 675,000 nurses, doctors and midwives by 2035, along with at least 544,000 community health workers and other cadres of health professionals.13 Other key health systems investments include: programme management; human resources; infrastructure, equipment and transport; logistics; health information systems; governance; and health financing.14
Investments to ensure girls complete secondary school yield a high average rate of return (around 10 per cent) in low- and middle-income countries. The health and social benefits include, among others, delayed pregnancies and reduced fertility rates, improved nutrition for pregnant and lactating mothers and their infants, improved infant mortality rates and greater participation in the political process. School curricula should include elements to strengthen the self-esteem of girls and increase respect for girls among boys.30
Closing the gender gap in workforce participation by guaranteeing and protecting women’s equal rights to decent, productive work and equal pay for equal work would reduce poverty and increase global GDP by nearly 12 per cent by 2030.24
A 10 per cent reduction in child marriage could contribute to a 70 per cent reduction in a country’s maternal mortality rates and a 3 per cent decrease in infant mortality rates.31 High rates of child marriage are linked to lower use of family planning, higher fertility, unwanted pregnancies, higher risk for complications during childbirth, limited educational advancement, and reduced economic earnings potential.
Investments in these sectors return US$4 for every US$1 invested and would result in US$260 billion being returned to the global economy each year if universal access were achieved.32
Globally, more than 3 billion people cook with wood, dung, coal and other solid fuels on open fires or traditional stoves. If 50 per cent of people who use solid fuels indoors gained access to cleaner fuels, health-system cost savings would amount to US$165 million annually. Gains in health-related productivity would range from 17 to 62 per cent in urban areas and 6 to 15 per cent in rural areas.33