State of the World's Children

Introduction

2013: Children with Disabilities

2012 : Children in an urban world

2011: Adolescence

Special: Child rights

2009: Maternal + newborn health

2008: Child survival

2007: Gender equality

 

Continuum of care

A continuum of care which integrates maternal, newborn and child health care will help reduce maternal and newborn mortality and morbidity.

Essential services for mothers, newborns and children are most effective when they are delivered in integrated packages at critical points in the life cycle of mothers and children, in a dynamic health system that spans key locations, underpinned by an environment supportive of the rights of women and children.

The critical points for service delivery are adolescence, pre-pregnancy, pregnancy, birth, post-partum, neonatal, infancy and childhood.

Quality family planning services
Access to effective contraception contributes to maternal health by averting disabilities and death. It is estimated that the promotion of family planning could prevent about one third of maternal deaths in countries where birth rates are high. Spacing pregnancies by at least two years also increases the chance of child survival. Contraception can also prevent women from seeking unsafe abortions; resulting in reduced maternal deaths and disabilities.

The World Health Organisation (WHO) has identified five key priorities for action on reproductive health-care services: strengthening health systems capacity; improving information for setting priorities; mobilising political will; creating supportive legislative and regulatory frameworks; and strengthening monitoring, evaluation and accountability.

Enhancing nutrition for mothers and newborns
Programs targeted towards improving maternal health are increasingly focusing on enhancing the nutrition of girls and women across the life cycle. Along with increased food intake, folic acid and iron supplementation are being encouraged during pre-pregnancy and pregnancy, and vitamin A supplementation during the postpartum period. In addition, dietary diversification, the use of iodised salt and deworming are key interventions to strengthen the nutritional status of pregnant women and mothers.

Gaining the confidence of pregnant women through such programs of micronutrient supplementation can be a useful way to encourage their continued attendance for other forms of professional antenatal care.

Antenatal care
The antenatal period is an important time for reaching women with interventions and information that foster their health, well-being and survival – and that of their infants.

UNICEF, the United Nations Population Fund (UNFPA) and WHO recommend a minimum of four antenatal care visits during pregnancy, the minimum needed to provide the most important services, which can include treatment of hypertension to prevent eclampsia, tetanus immunisation, intermittent preventive treatment for malaria and distribution of insecticide-treated nets, prevention of mother-to-child transmission of HIV, micronutrient supplementation, and birth preparedness, including information about danger signs during pregnancy and childbirth.

HIV prevention services
Prevention of mother-to-child transmission of HIV should include a comprehensive package that includes testing, counselling and antiretroviral prophylaxis, as well as antiretroviral treatment for women in need, in every antenatal and delivery facility, according to each country’s HIV prevalence rate. Raising levels of comprehensive knowledge of HIV among young women and men aged 15–24 is vital to averting infection.

Skilled health personnel
One of the most critical interventions to prevent maternal mortality and morbidity is to ensure that women receive appropriate care during delivery. The quality of care provided by health personnel is crucial: all deliveries should be attended by personnel with the skills to handle typical deliveries safely and to recognise the onset of complications and either provide the necessary treatment if within their capacities or refer the woman to emergency care if treatment is beyond their capacities.

Particularly when complications occur, skilled personnel need access to essential drugs, supplies, equipment and emergency obstetric care. They should receive training on required competencies. And they need supervision that helps ensure high standards of care, which is vitally important. When emergency-care referrals are needed, these skilled personnel must have access to a well-functioning health system.

Emergency obstetric care
When complications such as haemorrhage, sepsis and obstructed labour arise at birth, women need timely care in a clinic or hospital. A facility equipped to provide basic emergency obstetric care offers seven signal functions: the administration of parenteral antibiotics, oxytocic drugs and anticonvulsants; manual removal of the placenta; removal of retained products; assisted vaginal delivery; and neonatal resuscitation. A facility capable of comprehensive emergency obstetric care will be able to provide these seven signal functions as well as perform Caesarean sections and blood transfusions.

Comprehensive emergency obstetric care should be available at a minimum of one facility in every district or one per 500,000 population.

Post natal visits
Effective post-natal care requires care and attention during the immediate post-partum period and also several follow-up visits. A post-natal visit for every mother and newborn should take place as soon as possible after delivery, ideally within 24 hours, with additional visits towards the end of the first week and at four to six weeks. The post-partum period continues for 42 days after birth.

These visits can provide essential information and guidance on maternal and newborn health – especially on the care and feeding of babies, the danger signs of illness, referral processes and improved hygiene practices. Studies show that fewer neonatal deaths occur when mother and baby are visited within 48 hours of birth. Mothers who are HIV-positive and babies born prematurely need particular attention. Low birthweight infants require special attention, particularly for temperature management.

Healthy practices for newborn care
Prevention of newborn deaths requires skilled care more than technology, and demands flexible and responsive systems of intervention.

The state of the health system, social context and local practices matter just as much as epidemiological risks. Neonatal health can be improved, for example, by practices that do not have high costs attached, such as clean delivery conditions and the promotion of early and exclusive breastfeeding, and by ensuring that the mother is healthy when she gives birth.

It must be highlighted that many women in the developing world – and most women in the world’s least developed countries – do give birth at home without skilled attendants, yet their newborns are usually healthy and survive past their first few weeks of life until their fifth birthday and beyond. Despite the multitude of risks associated with pregnancy and childbirth, the majority of mothers also survive.

 

 

 

 

SOWC 2009 Video: Reducing mortality

Dr Peter Salama
UNICEF Chief of Health

VIDEO: Interventions to reduce maternal and neonatal mortality.  View


Maternal and Newborn Health






State of the World's Children's 2009







SOWC 2009 - Special Guests Essays

Creating a supportive environment for mothers and newborns
H. M. Queen Rania Al Abdullah of Jordan
Eminent Advocate for Children, UNICEF


Working together for maternal and newborn health
Sarah Brown
Wife of Prime Minister United Kingdom


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