Maternal and newborn health
© UNICEF/HQ99-0816/ LeMoyne|
A health worker measures the abdomen of a pregnant woman during an examination at a community health centre. Viet Nam.
Child mortality in most countries has been decreasing in past decades, however, both neonatal and maternal mortality have largely remained the same.
Neonatal mortality accounts for almost 40 per cent of estimated 9.7 million children under-five deaths and for nearly 60 per cent of infant (under-one) deaths. This means that a child is about 500 times more likely to die in the first day of life than at one month of age. The largest absolute number of newborn deaths occurs in South Asia – India contributes a quarter of the world total – but the highest national rates of neonatal mortality occur in sub-Saharan Africa.
A common factor in these deaths is the health of the mother. Each year more than 500,000 women die in childbirth or from complications during pregnancy. Babies whose mothers have died during childbirth have a much greater chance of dying in their first year than those whose mothers remain alive. Ninety nine percent (99 per cent), of maternal and newborn mortality occurs in the developing world, where more than 50 per cent of women still deliver without the assistance of skilled health personnel. This is a powerful statement about inequity and access to quality care.
Eighty percent of maternal deaths are caused by direct obstetric causes such as haemorrhage, infection, hypertensive disorders of pregnancy and complications of unsafe abortion. And for every woman who dies from complications related to childbirth, approximately 20 more suffer injuries, infections and disabilities that are usually untreated and ignored, and that can result in life-long pain and social and economic exclusion. Most of these complications cannot be predicted and prevented.
All pregnant women are at risk and can develop complications at any time during pregnancy, delivery and after delivery. However, women and families can learn how to avoid unplanned pregnancies, and if pregnant, they can learn the importance of receiving antenatal care, how to identify danger signs, plan for emergency referrals, and choose safe birthing options. When problems arise, and referral is timely, complications can be treated in health facilities that are adequately equipped with supplies, medications and fully staffed with competently trained health workers.
Improving the health and nutrition of mothers-to-be and providing quality reproductive health services are pivotal to addressing many underlying causes of child mortality.
With close to 50 per cent of all newborn deaths occurring within 24 hours of delivery, and up to 75 per cent in the first week post partum, strategies must center on a continuum of care approach. This approach includes improving access to antenatal care during pregnancy, improved management of normal delivery by skilled attendants, access to emergency obstetric and neonatal care (EmONC) when needed, and timely post natal care for both mothers and newborns. In addition to strengthening linkages between the different levels of care in health facilities, the continuum of care also refers to strengthening linkages between the community and health facilities.
It is a myth to assume that high cost neonatal care hospital units is the only way to treat sick newborns. There is now evidence proving that a large proportion of newborn death and disease can be reduced by implementing simple, low-cost interventions during delivery and in the vulnerable days and week post-partum, both in the facility and at home. These essential interventions include drying the newborn and keeping the baby warm; initiating breastfeeding as soon as possible after delivery and supporting the mother to breastfeed exclusively; giving special care to low-birth weight infants; and diagnosing and treating newborn problems like asphyxia and sepsis.
The majority of essential interventions are home care practices that families can provide themselves. Families can also use the help of a community health worker (CHW) who could be present at delivery to care for the newborn and/or visit within the first 24 hours and again 1-2 additional times during the first week. With more than 50 per cent of newborn deaths occurring at home, the long term goal of training sufficient numbers of skilled attendants to be present at all births will not be a reality in many countries for years to come. Experts estimate that providing these essential interventions at scale (over 90 per cent coverage) in the community and in health facilities can reduce the neonatal mortality rate by 70 per cent.
During the past decade, UNICEF has taken a holistic and rights based view of maternal health. To this end, UNICEF has been working to enhance the role of women, prevent child marriage, increase girls education, educate and abolish Female Genital Mutilation/Cutting (FGM/C), and support the development of adolescent life skills. UNICEF supports improved antenatal care (Tetanus Toxoid, Insecticide treated nets (ITN), Intermittent Presumptive Treatment (IPT), nutrition), Prevention of Mother to Child Transmission of HIV (PMTCT), increased women’s access to HIV treatment. Depending on country needs, UNICEF also supports training of skilled birth attendants (SBA), Emergency Obstetric Care programmes (EmOC) and more recently, improved newborn and post natal care initiatives.
Recent evidence, highlighted in the Lancet Series on child survival (2003), newborn survival (2005), maternal survival (2006) and on reproductive health (2006), reveal that a package of interventions, if implemented at scale, could substantially reduce both newborn and maternal mortality. Some of these interventions, particularly for saving mothers lives, need to take place in a Basic or Comprehensive Emergency Obstetric Care (BEmOC /CEmOC) facility, many, especially for the newborn, but also for the mother, can take place in the home by a community health worker or visiting nurse.
Global partnerships and initiatives
UNICEF, working with governments and partners, can assist in developing home-based maternal and newborn care programmes based on successful models of CHWs, and/or community women’s groups, while strengthening health facilities and the referral linkages between communities and hospitals providing emergency care. At country level, this may take different approaches depending on the needs and realities of each country.
At the global level, UNICEF is a key member of the Partnership for Maternal Newborn and Child Health (PMNCH), and works closely with sister UN agencies - UNFPA (Safe Motherhood) and WHO (Making Pregnancy Safer Initiative).