Delivery in a health facility is a key strategy for reducing maternal and neonatal mortality, yet increasing use of facilities has not consistently translated into reduced mortality in low- and middle-income countries. In such countries, many deliveries occur at primary care facilities, where the quality of care is poor. We modeled the geographic feasibility of service delivery redesign that shifted deliveries from primary care clinics to hospitals in six countries: Haiti, Kenya, Malawi, Namibia, Nepal, and Tanzania. We estimated the proportion of women within two hours of the nearest delivery facility, both currently and under redesign. Today, 83–100 percent of pregnant women in the study countries have two-hour access to a delivery facility. A policy of redesign would reduce two-hour access by at most 10 percent, ranging from 0.6 percent in Malawi to 9.9 percent in Tanzania. Relocating delivery services to hospitals would not unduly impede geographic access to care in the study countries. This policy should be considered in low- and middle-income countries, as it may be an effective approach to reducing maternal and newborn deaths.
Annually, 303,000 women die from pregnancy-related complications, and almost all of them occur in developing countries, particularly in Africa and Asia. Approximately 60% of the maternal deaths are due to sepsis, hemorrhage, hypertensive disorders, obstructed labor, and unsafe abortion. In addition, for each woman who dies as the direct or indirect result of pregnancy, a significantly higher number experience a life-threatening complication that will require attention of skilled obstetric caregivers to prevent morbidity and mortality. Nearly 10% of mothers suffer a maternal complication during pregnancy or in the intra-partum period, and up to 40% may have morbidities post-birth that are attributable to the pregnancy or birth. Most of these complications are treatable and preventable during antenatal care (ANC) and if births are overseen by skilled birth attendants. Furthermore, neonatal and maternal mortality and morbidity are closely linked. About one-third of neonatal deaths occur during the first twenty-four hours of birth.
Somali women suffer from one of the highest maternal mortality rates in the
world. Somalia characterises a specific low-income country situation with a mix of newly
urbanized and nomadic culture combined with a frail health care infrastructure set in a postconflict
era. Very little is known about the effects that these contextual factors can have on
The maternal health agenda is undergoing a paradigm shift from preventing maternal
deaths to promoting women’s health and wellness. A critical focus of this trajectory
includes addressing maternal morbidity and the increasing burden of chronic and noncommunicable
diseases (NCD) among pregnant women. The WHO convened the
Maternal Morbidity Working Group (MMWG) to improve the scientific basis for defining,
measuring, and monitoring maternal morbidity. Based on the MMWG’s work, we
propose paradigms for conceptualizing maternal health and related interventions, and
call for greater integration between maternal health and NCD programs. This integration
can be synergistic, given the links between chronic conditions, morbidity in pregnancy,
health. Pregnancy should be viewed as a window of opportunity
into the current and future health of women, and offers critical entry points for women
who may otherwise not seek or have access to care for chronic conditions. Maternal
health services should move beyond the focus on emergency obstetric care, to a
broader approach that encompasses preventive and early interventions, and integration
with existing services. Health systems need to respond by prioritizing funding for
developing integrated health programs, and workforce strengthening. The MMWG’s
efforts have highlighted the changing landscape of maternal health, and the need to
expand the narrow focus of maternal health, moving beyond surviving to thriving.
Kenya’s progress towards reducing maternal
and neonatal deaths is at present ‘insufficient’. These
deaths could be prevented if the three delays, that is,
in deciding to seek healthcare (delay 1), in accessing
formal healthcare (delay 2) and in receiving quality
healthcare (delay 3), are comprehensively addressed. We
designed a mobile phone enhanced 24 hours Uber-like
transport navigation system coupled with personalised
and interactive gestation-based text messages to address
these delays. Our main objective was to evaluate the
impact of this intervention on women’s adherence to
recommended antenatal (ANC) and postnatal care (PNC)
regimes and facility birth.
A strategy of childbirth in facilities close
to home has been in place for almost two
decades, but given numerous reports of
low quality of care, the recent review of
the strategy is timely. The Lancet Commission
on High-Quality Health Systems in the
Sustainable Development Goal Era suggests
that childbirth services should be centralised
to hospitals under the premise that larger
volumes will result in (1) more efficient
delivery care, (2) more skillful maternity
providers and (3) more timely emergency
care interventions including blood transfusion
and caesarean section.
Maternal and neonatal mortality remain high in southern Tanzania despite an increasing number of births occurring in health facilities. In search for reasons for the persistently high mortality rates, we explored illness recognition, decision-making and care-seeking for cases of maternal and neonatal illness and death.
The recommended management for neonates with a possible serious bacterial infection (PSBI) is hospitalisation and treatment with intravenous antibiotics, such as ampicillin plus gentamicin. However, hospitalisation is often not feasible for neonates in low‐ and middle‐income countries (LMICs). Therefore, alternative options for the management of neonatal PSBI in LMICs needs to be evaluated.