A report from GHTC and Policy Cures Research examines how US federal funding for global health R&D is delivering impact both abroad and at home.

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R&D across health areas | Maternal, Newborn & Child Health

R&D for Maternal, Newborn & Child Health

How new tools can transform the fight

The chances of a mother and her child surviving and thriving are vastly different depending on where in the world they live. For example, around 83% of all global maternal and child deaths occur in sub-Saharan Africa and southern Asia, yet these regions only account for 57% of live births. Having the right intervention or tool at the right time is one of the most crucial factors for survival. Thanks to global efforts to develop and scale up health solutions, child deaths have declined worldwide by 62% and maternal deaths by nearly 46% since 1990. But vast challenges remain. Intensified research and development (R&D) efforts are needed to deliver pediatric versions of existing and novel medicines and to ensure products are suitable for use in pregnant and lactating women and individuals, as well as to create low-cost, easy-to-use technologies to address common causes of maternal and child deaths in the world’s poorest places.

  • 4.9 million
    children under five die each year
  • 287,000 women
    die each year in pregnancy and childbirth
  • 218 million
    women have an unmet need for contraception

Research successes

New technologies have driven significant improvements in maternal, newborn, and child health (MNCH):

  • Vaccines against childhood diseases, including polio, measles, diphtheria, tetanus, pneumonia, and other illnesses, have saved more than 150 million children over the past 50 years.
  • Contraceptive innovations, from decades-old tools like oral pills and implants to newer technologies like self-insertable, three-month and one-year vaginal rings, as well as discreet, self-injectable, and long-acting contraception options, have helped millions of women meet their unique family planning (FP) needs.
  • Tools to prevent and treat malaria in mothers and children—including insecticide-treated bednets, chemoprevention for children and pregnant women, child-friendly medicines, and vaccines—have significantly reduced maternal and child deaths.
  • Interventions to treat and prevent diarrhea—including oral rehydration solutions, zinc supplements, and low-cost vaccines against rotavirus, cholera, and typhoid—have helped reduce child mortality from diarrheal disease by more than half since 2000.
  • Nutrition innovations, like biofortified crops and vitamin supplements, are helping more children thrive.
  • Approaches to prevent maternal-to-child transmission of HIV have contributed to a 62% decline in new infections in children since 2010.

Key missing tools Key missing tools

New tools that are designed specifically for low-resource settings are needed to advance MNCH, including:

  • Better tools to manage respiratory disorders and pneumonia in facilities without high-tech equipment, including low-cost, durable, and easy-to-use neonatal resuscitators and ventilators to help babies breathe and affordable, easy-to-operate tools to monitor respiratory rates and oxygen levels in children.
  • Vaccine innovations to improve immunization coverage for vulnerable, hard-to-reach populations, such as heat-stable versions of vaccines that can be stored without refrigeration or easy-to-use, pain-free oral formulations.
  • Child-friendly formulations of existing and new medicines that are appropriately dosed, dissolvable, and more palatable.
  • Better tools to prevent postpartum hemorrhage, the leading cause of maternal death, including new, easily administered, and heat-stable formulations of the drug oxytocin for use in settings without reliable electricity and low-cost, simple devices to control and monitor the severity of bleeding after childbirth.
  • Simple, low-cost tools to detect preeclampsia, a dangerous pregnancy complication, including handheld blood pressure monitoring devices and other improved point-of-care diagnostics.
  • New contraceptive options with minimal side effects that are suitable for people living in remote areas with limited access to health care services, including multipurpose products for women that simultaneously prevent HIV and sexually transmitted infections while providing contraception and novel contraceptive options for men.
  • Better treatments and prevention options for pregnant and lactating women and individuals across a range of health areas.
  • New lost-cost and easy-to-administer tools to address other leading MNCH challenges, including obstructed labor, preterm birth, diarrheal disease, malaria, HIV/AIDS, and malnutrition.

Continued progress is possible, not inevitable Continued progress is possible, not inevitable

Continued progress is possible, not inevitable
Continued progress is possible, not inevitable

Breakthroughs on the brink Breakthroughs on the brink

  • An oxytocin inhaler designed to manage postpartum hemorrhage after childbirth, even in settings with no electricity and refrigeration and limited access to trained health workers, is under development. The product, which received support from USAID, could save the lives of almost 20,000 new mothers each year.
  • A first-of-its-kind malaria treatment designed specifically for babies less than ten pounds has completed Phase 2/3 trials. There is no approved treatment for babies in this weight group, who are currently treated with a partial dose of medicines made for larger children, which can heighten risk of overdose among this very vulnerable population.
  • The OdonAssist™, a promising new tool previously supported by USAID, that uses air pressure and suction to gently assist with delivery during obstructed labor, is advancing through clinical trials.
  • Vaccines against shigella and enterotoxigenic Escherichia coli, two leading causes of diarrheal disease, are in clinical development with DoD support. To date, no effective vaccines are available against these pathogens.
  • New contraceptive innovations, including a microneedle contraceptive patch lasting six months supported by USAID, a male contraceptive gel now in clinical trials supported by NIH, and a vaginal ring and dual-use prevention pill that combine contraception with antiretroviral treatments to prevent HIV infection supported by USAID and NIH.
  • Zoliflodacin, a new antibiotic that completed Phase 3 trials, which, if approved, would become the first new antibiotic for treating gonorrhea in decades. In addition to causing health issues in women, gonorrhea can be passed from a pregnant person to their baby, leading to serious problems, including blindness and a life-threatening blood infection.
  • Affordable, rapid, and point-of-care urine tests to diagnose preeclampsia, including a simple paper urine test supported by USAID, are now undergoing validation testing. These tools, designed for low-resource settings, will improve the detection of this deadly condition that impacts 1 in 20 women during pregnancy.
US Government R&D efforts US Government R&D efforts

The US government is advancing MNCH research through a whole-of-government approach:

  • US Agency for International Development (USAID) develops and distributes affordable vaccines, treatments, and other tools to improve MNCH globally and address FP and reproductive health (RH) needs, leading implementation of the US government’s MNCH and FP/RH activities.
  • National Institutes of Health (NIH) conducts basic science and implementation research to develop and improve tools to advance MNCH and FP/RH.
  • Centers for Disease Control and Prevention operates immunization programs, conducts surveillance and epidemiological research to inform the use of existing MNCH tools, and provides technical assistance to country partners to strengthen public health capacity.
  • Department of Defense (DoD) supports research against diseases like malaria and diarrheal diseases that pose a risk to service members stationed abroad and that are also leading killers of children.
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Introduction

Percentage of maternal deaths in sub-Saharan Africa and southern Asia: World Health Organization. Maternal mortality. Updated April 26, 2024. Accessed July 23, 2024. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality

Percentage of under five deaths in sub-Saharan Africa and southern Asia, 62% reduction in child deaths, 57% of live births: United Nations Inter-agency Group for Child Mortality Estimation. Levels & Trends in Child Mortality: Report 2023, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation. UNICEF; 2024. https://data.unicef.org/resources/levels-and-trends-in-child-mortality-2024/

46% reduction in maternal deaths:

World Health Organization, UNICEF, United Nations Population Fund, World Bank Group, United Nations Population Division. Trends in Maternal Mortality: 1990 to 2015. Work Health Organization; 2015. https://iris.who.int/bitstream/handle/10665/193994/WHO_RHR_15.23_eng.pdf

UNICEF. Maternal mortality. Accessed July 26, 2024. https://data.unicef.org/topic/maternal-health/maternal-mortality/

4.9 million children die: United Nations Inter-agency Group for Child Mortality Estimation. Levels & Trends in Child Mortality: Report 2023, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation. UNICEF; 2024. https://data.unicef.org/resources/levels-and-trends-in-child-mortality-2024/

287,000 women die: World Health Organization. Maternal Health. Accessed July 23, 2024. https://www.who.int/health-topics/maternal-health#tab=tab_1

218 million women with unmet need for contraception: Guttmacher Institute releases family planning investment impact calculator, a new online tool for estimating health benefits of investing in family planning in low- and middle-income countries. News release. Guttmacher Institute; September 26, 2022. Accessed July 23, 2024.https://www.guttmacher.org/news-release/2022/guttmacher-institute-releases-family-planning-investment-impact-calculator-new

Research successes

Vaccines against childhood diseases: Ritchie H. Vaccines have saved 150 million children over the last 50 years. Our World in Data. May 6, 2024. Accessed July 23, 2024. https://ourworldindata.org/vaccines-children-saved

Contraceptive innovations, overall: World Health Organization. Family planning/contraception methods. Updated September 5, 2023. Accessed July 23, 2024. https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception

Three-month vaginal ring: Undie CC, RamaRao S, Mbow FB. Choosing and using the progesterone vaginal ring: Women's lived experiences in three African cities. Patient Preference and Adherence. https://pubmed.ncbi.nlm.nih.gov/33061318/

One-year vaginal ring: Population Council. The Nestorone®/Ethinyl estradiol one-year vaginal contraceptive system. Accessed July 23, 2024. https://popcouncil.org/project/the-nestorone-ethinyl-estradiol-one-year-vaginal-contraceptive-system

Discreet, self-injectable, long-acting contraception: PATH. The power to prevent pregnancy in women’s hands: DMPA-SC injectable contraception. PATH. September 12, 2018. Accessed July 23, 2024. https://www.path.org/our-impact/articles/dmpa-sc/

Tools to prevent and treat malaria, insecticide-treated bednets: US Centers for Disease Control and Prevention. Insecticide-treated nets. Updated April 2, 2024. Accessed July 23, 2024. https://www.cdc.gov/malaria/php/public-health-strategy/insecticide-treated-nets.html

Tools to prevent and treat malaria, chemoprevention for children and pregnant women: Updated WHO recommendations for malaria chemoprevention among children and pregnant women. World Health Organization. June 3, 2022. Accessed July 23, 2024. https://www.who.int/news/item/03-06-2022-Updated-WHO-recommendations-for-malaria-chemoprevention-among-children-and-pregnant-women

Tools to prevent and treat malaria, child-friendly malaria medicines: Medicines for Malaria Venture. Artemether-lumefantrine dispersible. Accessed July 23, 2024. https://www.mmv.org/mmv-pipeline-antimalarial-drugs/artemether-lumefantrine-dispersible

Tools to prevent and treat malaria, vaccines:

Wadman M. First malaria vaccine slashes early childhood mortality. Science. October 24, 2023. Accessed July 23, 2024. https://www.science.org/content/article/first-malaria-vaccine-slashes-early-childhood-deaths

WHO prequalifies a second malaria vaccine, a significant milestone in prevention of the disease. News release. World Health Organization; December 21, 2023. https://www.who.int/news/item/21-12-2023-who-prequalifies-a-second-malaria-vaccine-a-significant-milestone-in-prevention-of-the-disease

Reduced child mortality from diarrheal disease: Child mortality, stillbirth, and causes of death estimates. United Nations Inter-agency Group for Child Mortality Estimation; 2023. Accessed July 23, 2024. https://childmortality.org/causes-of-death/data?causes=DIARRHOEAL&d_refArea=WORLD&type=DEATHS

62% decline in new maternal-to-child HIV infections: Global HIV & AIDS statistics — Fact sheet. UNAIDS; 2024. Accessed August 13, 2024. https://www.unaids.org/en/resources/fact-sheet

Continued progress is possible, not inevitable

Bill & Melinda Gates Foundation. Goalkeepers 2024 Report. The Race to Nourish a Warming World. Bill & Melinda Gates Foundation; 2024. https://www.gatesfoundation.org/goalkeepers/report/2024-report/

Key missing tools

Based on consultation with experts from GHTC member organizations.

Breakthroughs on the brink

Oxytocin inhaler: Monash University. The project. Accessed July 23, 2024. https://www.monash.edu/iop/home/the-project

Malaria treatment for babies under 10 pounds: Medicines for Malaria Venture and Novartis announce positive efficacy and safety data for a novel treatment for babies <5 kg with malaria. Press release. Medicines for Malaria Venture; April 24, 2024. Accessed July 23, 2024. https://www.mmv.org/newsroom/news-resources-search/medicines-malaria-venture-and-novartis-announce-positive-efficacy

OdonAssist: Maternal Newborn Health Innovations. OdonAssist™. Accessed July 23, 2024. https://www.mnhi.com/odonassist-tm

Vaccines for diarrheal diseases: When it comes to vaccines, bigger isn’t always better. PATH. November 9, 2021. Accessed July 23, 2024. https://www.path.org/our-impact/articles/when-it-comes-to-vaccines-bigger-isnt-always-better/

New contraceptive innovations, microneedle patch: Georgia Institute of Technology. Long-acting contraceptive designed to be self-administered via microneedle patch. Medical Xpress. January 14, 2019. Accessed July 23, 2024.  https://medicalxpress.com/news/2019-01-long-acting-contraceptive-self-administered-microneedle-patch.html

New contraceptive innovations, male contraceptive gel: Population Council. Nestorone®/Testosterone transdermal gel for male contraception. Accessed July 23, 2024. https://popcouncil.org/project/nestorone-testosterone-transdermal-gel-for-male-contraception/

New contraceptive innovations, vaginal ring: Population Council. The dapivirine-levonorgestrel vaginal ring for HIV prevention and contraception. Accessed July 23, 2024. https://popcouncil.org/project/the-dapivirine-levonorgestrel-vaginal-ring-for-hiv-prevention-and-contraception/

New contraceptive innovations, dual use prevention pills

Population Council. Dual prevention pill for the prevention of HIV and unintended pregnancy. Accessed July 23, 2024. https://popcouncil.org/project/dual-prevention-pill-for-the-prevention-of-hiv-and-unintended-pregnancy/

PrEPWatch. Dual prevention pill. Updated July 19, 2024. Accessed July 23, 2024. https://www.prepwatch.org/products/dual-prevention-pill/

Affordable, rapid point-of-care urine tests to diagnose preeclampsia: Research finds simple urine test allows for rapid diagnosis of preeclampsia. Press release. The Ohio State University Wexner Medical Center; March 13, 2019. Accessed July 23, 2024. https://wexnermedical.osu.edu/mediaroom/pressreleaselisting/preeclampsia-test.

US government R&D efforts

The US government and international family planning & reproductive health efforts. KFF. January 2, 2024. Accessed July 23, 2024. https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and-international-family-planning-reproductive-health-efforts/. 

The US government and global maternal & child health efforts. KFF. September 29, 2022. Accessed July 23, 2024. https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and-global-maternal-and-child-health/. 

The US Department of Defense & global health. KFF. September 29, 2012. Accessed July 23, 2024. https://www.kff.org/global-health-policy/report/the-u-s-department-of-defense-global/. 

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