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.
Progress since 1990 in cutting maternal mortality has been impressive. Globally, the maternal mortality rate (MMR), fell by 44 per cent over the period. However, while progress was substantial, it was not sufficient to constitute achievement of the MDG 5 target of a three-quarters decline.
In 2015, it is estimated that about 800 girls and women died every day as a result of pregnancy and child birth-related complications. Maternal deaths are now increasingly concentrated in sub-Saharan Africa, where high fertility rates combine with inadequate access to quality antenatal care and skilled attendance at birth to substantially elevate the risk of death in this region.
Antenatal care and skilled health attendance at delivery are essential for eliminating every preventable maternal death. The world, as a whole, has improved access to these services, with 71 per cent of women delivering with the support of a skilled birth attendant in 2014, compared to 59 per cent in 1990, progress has not been fast enough. What is more, very substantial disparities exist in levels of access to services, with poorer, less educated women receiving unacceptably low levels of access to services. Women in the richest quintile are almost three times as likely to deliver with a skilled health attendant as those in the poorest quintile. This disparity has not changed in 15 years. Little progress has been made in closing the gap in antenatal care between urban and rural women.
While the world has achieved impressive reductions in mortality of children aged under five since 1990, the survival of newborns (young infants in the first month of life) has lagged behind. It is estimated that in 2015, about 1 million newborns died, equivalent to 2,740 per day A child born in 2015 was approximately 500 times more likely to die on the first day of life that at one month of age. The high burden of still births is also an increasingly recognized problem, with 2.6 million estimated still births in 2015.
A significant proportion of maternal, newborn and under five deaths are in zones of conflict and displacement (probably between 10 and 20% but difficult to estimate exactly due to lack of data). UNICEF’s health strategy also aims at building resilient and prepared health systems and to provide service delivery in crisis context.”
As the world begins work on the SDG agenda, it will be essential to bring about significant improvements in levels of coverage, and quality of care provided before, during and after birth, if we are to achieve the goal of ending preventable maternal, newborn and child deaths.
The most recent data on maternal health and mortality and newborn health and mortality are available on UNICEF’s data pages.
The period around birth constitutes a critical window of opportunity for prevention and management of maternal and newborn complications, which can otherwise prove fatal. Availability and accessibility of skilled birth attendants, basic and comprehensive emergency obstetric care, around the time of birth is therefore critical. A large proportion of newborn illnesses and deaths can also be prevented using simple, low-cost interventions during delivery and during the week following birth partum, provided both in the facility and at home (where currently 50 per cent of newborn deaths occur). Regular visits by community health workers at the time of delivery and following birth can be instrumental in preventing complications and post-natal mortality.
Essential life-saving interventions include immediately drying the newborn and keeping the baby warm, skin to skin contact, delayed cord clamping, initiating breastfeeding as soon as possible after delivery, supporting the mother to breastfeed exclusively, giving special care to low-birth weight infants, and diagnosing and treating newborn complications such as asphyxia and sepsis.
Strengthening referral mechanisms and linkages between different levels of facility-based care, and between health facilities and the community, must be a top priority. Empowering women, families and communities by supporting their involvement and proactive care-seeking for pregnancy care, nutrition, birth preparedness, use of a skilled attendant at birth, recognition of maternal and newborn danger signs, early initiation and exclusive breastfeeding, postnatal care and support for optimal birth spacing is important. In addition, identification of pregnant women by community health workers and continued follow-up and support during antenatal and postnatal period can promote healthy practices and timely care-seeking in case of complications.
UNICEF programming around maternal and newborn health seeks to reduce inequities of care, strengthen health systems, incorporate resilience and risk-informed planning, and focus attention on reduction of adolescent pregnancies. UNICEF promotes a holistic, rights-based approach of maternal and child health. To this end, UNICEF seeks to enhance the role of women, prevent child marriage, increase girls’ education, educate, and eliminate female genital mutilation/cutting (FGM/C), and support the development of adolescent life skills.
With a combination of adequate investment in the most disadvantaged communities and committed leadership, great progress is possible. Greater investment and strategic planning is required in order to reach the most marginalized with better, more inclusive, disaggregated data, systems strengthening, innovation and local engagement, in order to overcome the last barriers and reach the millions of excluded mothers and their babies.
At the global level, UNICEF is a co-chair of the Every Newborn Partnership and a key member of the Partnership for Maternal Newborn and Child Health and other partner networks for Every Woman Every Child and Ending Preventable Maternal Mortality. UNICEF works closely with sister UN agencies through the H6 Partnership (UNFPA, UNICEF, WHO, World Bank, UNAIDS and UN Women), the Global Financing Facility (World Bank), Safe Motherhood (UNFPA) and the Making Pregnancy Safer Initiative (WHO).
Around the world, UNICEF works with governments and partners to improve the quality of care for newborns and mothers in health facilities and in the community. UNICEF is also supporting the development of home-based maternal and newborn care programmes based on successful models which incorporate CHWs, and community women’s groups, while strengthening health facilities and the referral linkages between communities and hospitals providing emergency care. Different approaches are taken based on the specific needs and realities of each country.
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