Resource Type: Published articles

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 maternal mortality.

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, and long-term 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.