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India - U.S. Joint Statement on Maternal and Children's health and human development research

Signed Minister for Health and Family Welfare of the Republic of India and Secretary, Department of Health & Human Services of the United States of America
Washington D.C.
June 13, 2000

The Republic of India and the United States of America share a strong commitment to improve the health and well being of women, children and adolescents through the expansion of cooperative biomedical and behavioral research. Although the health of women, children and adolescents has improved significantly in both countries, it is recognized that important research question remain to help achieve additional reductions in morbidity and mortality. Building on a thirty-year history of maternal and child health research cooperation, India and the United States now agree to enhance this cooperation through an expanded program of Maternal and child Health and Human Development Research (MCHDR).

Over 45 percent of females in India today are in the reproductive age group and the population of India is expected to continue increasing during the next several decades, as is the number of children and adolescents within the population. While fewer women in India have pregnancy and birth complications than in the past, mortality rates associated with unwanted and planned pregnancies, unsafe abortion, and childbirth remain higher than those found in more developed countries. Similarly, during the last decade, oral rehydration strategies, mass immunizations, the appropriate assessment and treatment of pneumonia and other evidence-based interventions have contributed significantly to improved child survival in India. Nevertheless, according to the Ministry of Health and family Welfare, Government of India, maternal, neonatal infant and pediatric mortality and morbidity rates remain unacceptably high, often due to preventable or treatable conditions, and new interventions are required.

In the United States, there are also ongoing concerns about further improving the health of women of childbearing age, children and adolescents. While the infant mortality rate in the United States has steadily declined over the last decade, the percentage of women who die during childbirth, although very low, has remained essentially unchanged. Particular concerns include the prevention and treatment of birth defects and developmental disabilities, reducing maternal mortality, understanding normal and abnormal development and genetic susceptibility to disease, addressing the major causes of perinatal and neonatal morbidity and mortality (including low birth weight) and prevention and treatment of infectious diseases which affect woman and children.

Many of the above mentioned problems are common to both the countries and hence collaborative research in these areas will be of benefit to people of both countries. To address shared women and children's health and developmental research concerns, Indian and United States Scientists will undertake a coordinated program which will involve participation in cooperative peer reviewed research projects, scientific workshops and conferences, research training and technology transfer. Building on a history of productive biomedical and behavioral research collaboration, this MCHDR will be based on mutual benefit, trust and a shared commitment to the advancement of scientific knowledge and its application to improve health.

Specific areas to be addressed within this program include but are not limited to:

• Prevention and treatment of leading causes of maternal, neonatal and pediatric morbidity and mortality (including toxemia, hemorrhage, sepsis, birth asphyxia and trauma, accidents, diarrhea and other infectious diseases, etc.);
• Prevention and treatment of low birth weight and intrauterine growth retardation;
• Maternal and child nutrition and the role of micronutrients in healthy child bearing and pediatric and adolescent health and development;
• Birth defects, genetic disorders and development research;
• Improved understanding of pathophysiology, prevention and treatment of infectious diseases in women and children including childhood asthma, acute respiratory tract infections, gastrointestinal infections, reproductive tract infections and malignancies and HIV/AIDS;
• Reproductive health including socio-behavioral aspects, birth practices and development and evaluation of newer contraceptives;
• Traditional systems of medicine and practices which have an important impact on the health and well-being of women and children adolescents;
• Emergency obstetric care for miscarriages and other problems of pregnancy, including severe preeclampsia, hemorrhage and embolism;
• Relationship between maternal nutrition, fetal growth/development and degenerative diseases in later life; and
• Analysis, consensus building and policy formulation on public health benefits and cost-effectiveness of new approaches to improve maternal and child health.

This expanded program will be closely coordinated with other Indo-U.S. cooperative biomedical, behavioral and public health activities. These include the Vaccine Action Program, the Contraception and Reproductive Health Research Program, the initiative on Emerging and Re-emerging Infectious Diseases and Disease Surveillance and the collaboration on prevention of sexually Transmitted Diseases and HIV/AIDS. It also will be implemented keeping in mind the activities of the World Health Organization, UNICEF, the Global forum on Health Research, UNAIDS, and other regional and international organizations concerned with the health of women, children and adolescents.

Under this joint statement participating institutions in India will include the Indian Council of Medical Research (ICMR) (with its network of Institutes and Human Reproduction Research Centers), Ministry of Health and Family Welfare, Department of Women and Child Development, Department of Biotechnology, National AIDS Control Organization and other Indian agencies, academic institutions, research facilities, and non-governmental organizations, as appropriate. The participating institutions in the United States will include; the National Institutes of Health (NIH) (the National Institute of Child Health and Human Development (NICHD), National Institute of Allergy and Infectious Diseases, Fogarty International Centers, and other NIH Institutes), Centers for Disease Control and Prevention, United States Agency for International Development, and other United States Government agencies, academic institutions, research facilities and non-government organization, as appropriate.

Activities carried out under this joint statement will operate on a principle of reciprocity and joint support. Both parties agree to make their best efforts to identify appropriate sources of funds to provide shared support for all aspects of this collaboration. Research proposals developed collaboratively will be submitted to appropriate agencies and/or foundations in both countries for peer-review and subsequent support. When funds are identified and approved for a collaborative project, workshop or other activity, the respective scientific and administrative responsibilities (including funding) of each party will be clearly specified in each project agreement.

Steps for implementing this initiative will be developed through consultations after the Joint Statement is signed. On the India side, the ICMR shall serve as the nodal agency, assuring the involvement of other interested Indian governmental and non-governmental organizations. Similarly, on the United States (DHHS) and other collaborating agencies, shall serve as the nodal agency, with the cooperation and involvement of other interested United States governmental and non-governmental organizations.