TORONTO -- Prime Minister Stephen Harper called on the international community to renew commitments it made to improving maternal and child health around the world, as he opened a summit on the issue that has become a hallmark of his government.

Harper opened his three day Maternal, Newborn and Child Health summit Wednesday afternoon by acknowledging that the international community “may well fall short” of the Millennium Development Goals agreed to in 2000 on reducing infant, child and maternal mortality rates.

But “dramatic progress” over the past few years means those commitments must be renewed because it is possible to meet those objectives, Harper said.

“It’s the right thing to do, it’s essential to be done, and they are very doable, and we can measure that we are doing them,” Harper said. “We know what the interventions are that can reduce maternal and child mortality.”

In 2000, some 189 countries endorsed the Millennium Declaration, which included eight goals to be and a deadline of 2015. The so-called Millennium Development Goals (MDGs) included reducing mortality rates of children under five by two-thirds, and reducing maternal mortality rates by three-quarters.

But in progress reports issued in 2012 and 2013, the WHO warns that significant gains have been made in both areas, but the MDGs have not been met.

The number of women who died in 2013 due to complications during pregnancy or childbirth was 289,000, down from 523,000 in 1990, or a reduction of 45 per cent. While that is less of a reduction in maternal mortality than called for in the MDG, the WHO acknowledges that tracking statistics is a "challenge” because in many countries data is incomplete, or non-existent.

"It has been a challenge to assess the extent of progress due to the lack of reliable and accurate maternal mortality data -- particularly in developing-country settings where maternal mortality is high," the WHO says.

"Less than 40 per cent of countries have a complete civil registration system with good attribution of cause of death, which is necessary for the accurate measurement of maternal mortality."

Meanwhile, child mortality rates have been cut nearly in half since 1990, from 12.6 million then to 6.6 million in 2012.

But the fact remains that nearly 18,000 children under age five die each day around the world.

The average annual reduction in child mortality remains "insufficient" to reach the MDG, the WHO says, particularly in Oceania, sub-Saharan Africa, the Caucasus and Central and Southern Asia.

"The world has made substantial progress," the WHO notes. "However, this progress has not been enough, and the target risks being missed at the global level."

This week’s summit is an extension of a commitment Harper made back in June 2010, when he closed the G8 Summit with his announcement of the Muskoka Initiative.

At the time, the prime minister committed $1.1 billion in new money over five years, in addition to a commitment to maintaining $1.75 billion in funding over the same period, for a total investment of $2.85 billion for maternal, newborn and child health initiatives.

The Department of Foreign Affairs and International Trade says that 80 per cent of the funding has been disbursed, and appears ready to make further funding commitments by the close of this week's conference.

A press conference with Harper, Queen Rania of Jordan and Melinda Gates of the Bill and Melinda Gates Foundation is scheduled for Thursday afternoon.

On Wednesday, Harper noted that it’s often through low-cost interventions, from vaccination to nutrition programs, that maternal and child mortality rates can be vastly improved.

“We don’t have to have North American or European living standards to have much better child and maternal health outcomes,” he said.

Sitting next to Harper at the opening session was President Jakaya Kikwete of Tanzania, who noted that his country met the MDG target of reducing deaths in children under five last September.

His country boosted immunization rates to 90 per cent, cut deaths from malaria by 60 per cent by distributing free bed nets to children under age five, and introduced comprehensive food fortification and nutrition programs.

But, Kikwete said, “We are not so successful with their mothers.”

Maternal mortality rates are only down by 45 per cent, because women are still largely giving birth with only the help of an unskilled birth attendant.

“In my view, it’s not fair, it’s not right for a woman to die while giving life to another human being,” Kikwete said. “It’s supposed to be an act of celebration, and at the end of the day it turns out to be an act of mourning. In the developing world…we have a serious problem.”

What to do?

This week's summit has attracted big names in the maternal and child health and development fields including the Aga Khan, WHO director general Dr. Margaret Chan and the heads of several NGOs.

The WHO notes that work has already begun on establishing new goals beyond 2015, and some of those ideas will no doubt be bandied about at this week's summit.

One topic up for discussion is how to address the WHO's concern about lack of data on deaths and births, or civil registration.

Dr. Tanjina Mirza, Plan Canada's vice president of international programs, said proper civil registration is "hugely important" when designing programs aimed at reducing maternal and child mortality.

"Millions of children are not registered," Mirza told before the summit opened, which means it's impossible to allocate resources, from medication to the amount of health care workers, when you don't know how many patients you have.

"You cannot provide care to those who do not exist in your books," she said.

Mirza is hopeful that Canada and other nations will renew their funding commitments beyond 2015 because, while a lot has been achieved, "work remains."

"I hope the summit will draw attention to the fact that a lot of work needs to be done, especially in reaching the poorest most vulnerable marginalized women,” Mirza said.

Plan operates in some 50 countries, but after the Muskoka Initiative was announced, it targeted maternal and child health programs for poor and vulnerable women in seven countries. Between January 2013 and March of this year alone, the agency provided more than 256,000 pregnant women with pre- and post-natal care.

Plan also vaccinated 640,000 children against measles and other diseases.

Mirza notes that "there is no rocket science" to delivering basic care to women and children in the developing world in order to reduce mortality rates.

"It's very basic," she says of pre- and post-natal care, vaccinations and other services.

"To say in this day and age that women are dying and children are dying, it's totally unethical and unacceptable."