King Henry VIII, Jean-Jacques Rousseau, and Mary Shelley, author of Frankenstein, all lost their mothers to infections following childbirth, and literature abounds with tragic stories of maternal death, from A Christmas Carol to Wuthering Heights, Far From the Madding Crowd, A Farewell to Arms, Revolutionary Road, Lolita, and Harry Potter.
But maternal and infant mortality is not confined to the past, much less to fiction. More than 30,000 women and 400,000 newborns die each year from infections around the time of birth. Most of these deaths occur in low-income countries, and the situation will only worsen as the antibiotics available for treating infections become less effective, owing to the emergence of antibiotic-resistant bacteria.
According to current estimates, more than 200,000 newborns die each year from infections that do not respond to available drugs. And studies using data from larger hospitals - where microbes are more likely to develop antibiotic resistance - estimate that about 40% of infections in newborns resist standard treatments.
Childbirth can be risky. Infants - especially if they are premature - do not have fully developed immune systems, so they are more susceptible to illnesses, either from bugs their mother is already carrying, or from infections they pick up in the hospital. That likelihood naturally increases when health facilities lack toilets, running water, and other basic sanitary conditions, as is often the case in low-income countries. While these countries have made some progress, through clean-water and sanitation initiatives, immunization, and antibiotic use, the gains are fragile.
In high-income countries, maternal and infant mortality is now rare, owing to a century of improvements in hygiene and infection control. For example, when antibacterial sulphonamides became available after 1934, infections could be treated quickly and easily on the spot, and mortality rates plummeted.
However, antibiotics' effectiveness led many healthcare providers to overprescribe them, and people now frequently take them when they shouldn't, such as when they have a viral infection like the flu. Antibiotics are also being fed indiscriminately to livestock and fish to boost food production. According to some estimates, less than half of all the antibiotics taken by humans are actually needed, and there is even more needless use in animals.
As we now know, this is a recipe for disaster. More frequent antibiotic use accelerates the process whereby exposed microbes build resistance. Soon enough, the antibiotic becomes ineffective. Worse still, very few pharmaceutical companies are developing new antibiotics to replace those that are losing their effectiveness.
This points to the dual nature of the problem. While antibiotics are used excessively in some places, they are unavailable in others. More children in Africa die from a lack of access to antibiotics than from antibiotic-resistant infections. Indeed, many still die from infections, such as bacterial pneumonia, that should be easily treatable.
Saving the lives of mothers and infants will require us to address the problem of access as well as excess. Simply put, those who need lifesaving antibiotics must get them, and those who do not must not.
The most important step is to stop the spread of infection, so that antibiotics don't have to be used in the first place. All health-care facilities, at a minimum, must have clean running water and sanitation services, and health-care professionals must follow good hygienic practices such as hand washing.
Facilities should also implement policies to discharge mothers and newborns sooner rather than later, in order to reduce the potential for exposure to infectious microbes, and to educate mothers on the importance of breastfeeding in strengthening newborns' immune systems. Finally, when antibiotics are used, health-care providers should confirm that they are truly needed and prescribe responsible doses.
Fortunately, policymakers around the world have started to pay attention to this issue. In 2015, the World Health Assembly, the World Health Organization's decision-making body, adopted a global action plan to address antimicrobial resistance. The plan establishes a framework for raising awareness of the problem, collecting more data, developing new drugs and diagnostic tools, encouraging practices to reduce infections, optimizing antibiotic usage, and investing in countries' health-care and sanitation capacities.
World leaders will address antibiotic resistance at next month's Group of Twenty (G20) summit in China, and then at a high-level United Nations General Assembly meeting. This is as it should be, because no border or wall will keep out drug-resistant bacteria. A real commitment from all governments is necessary for tackling a problem that threatens the lives and health of mothers and infants worldwide.
Anthony Costello is Director of Maternal, Newborn, Child, and Adolescent Health at the World Health Organization. Stefan Swartling Peterson is Chief of Health at UNICEF. Project Syndicate, 2016.