There has been substantial progress toward improving health across the reproductive, maternal, newborn, and child health (RMNCH) continuum of care in recent years. Although child survival has improved with under-five mortality falling dramatically from 12.6 million in 1990 to 6.6 million in 2012 progress toward reducing late-term miscarriage, stillbirth and newborn mortality has lagged. For instance, 2.9 million newborns die each year, while more than 2.5 million stillbirths continue to occur.
While newborn health has been neglected in global health and development discussions in the past, momentum has grown in recent years as a group of researchers, advocates and others have sought to raise the priority of newborn health. Throughout, this work has underscored the fundamentally linked nature of newborn and maternal health and the need for integration. As product of this new focus, the World Health Organization created detailed care guidelines for both mother and newborn throughout the Reproductive, Maternal, Newborn and Child Health (RMNCH) continuum of care-from adolescence and pre-pregnancy through infancy and childhood.
In the landmark 2005 Lancet neonatal survival series, experts documented a need to integrate high quality newborn care throughout the RMNCH continuum of care. The series highlighted the need to direct specific attention to newborn health in research, policy, programming and investments, while reinforcing the fundamental connections with other dimensions of the RMNCH continuum. As with maternal mortality, the causes of newborn deaths are well-known: the vast majority of newborn deaths are attributable to prematurity, complications during labor and delivery and infections. Further, expanding access to a package of established interventions throughout the RMNCH continuum would create a substantial reduction in this burden.
Key interventions include:
- Preconception care includes delaying the age of first pregnancy, family planning, healthy inter-pregnancy intervals, treating chronic conditions and infections (diabetes, etc) and ensuring a healthy pre-pregnancy nutritional status.
- Antenatal care to ensure maternal immunization, screening and management of infections (malaria, HIV/AIDS, STIs), the management chronic conditions (diabetes and hypertension), monitor fetal development and to detect, prevent and treat a range of common conditions, such as anemia, as well as nutrition and psychosocial health interventions.
- Skilled care during labor and delivery to monitor labor well and provide skilled vaginal or caesasrean delivery and manage preterm labor and post-term pregnancies.
- Interventions for immediate care for every newborn baby include drying and stimulation, ensuring thermoregulation, resuscitation if needed, hygienic care, support for breastfeeding initiation, and administration of vitamin K.
- Interventions for small and ill newborn babies, if needed, include, but are not limited to kangaroo care, respiratory support, therapeutic hypothermia for hypoxic ischemic encephalopathy, continuous positive airway pressure, surfactant, identification and treatment of neonatal infections,
- And postnatal care in the hours and days after birth, through practices such as warming, providing chlorhexidine for clean cord care, and initiating exclusive breastfeeding
In particular, treatment models and tools, such as the Evidence-Based Management of Postpartum Hemorrhage and Pre-Eclampsia and Eclampsia, Integrated Management of Pregnancy and Childbirth, and Essential Newborn Care have been developed to improve the survival chances of women and their babies in the hours and days surrounding birth, when both women and newborns are most at risk. While these evidence-based approaches to providing medical care are well-known and, in many cases, are well-suited to low resource settings, the question of how to ensure that such comprehensive care is universally accessible has been a major challenge.
Since 2005, new investments, policies and initiatives have built on the points raised in the 2005 Lancet series have signaled the growing momentum among researchers, health program planners, policy makers and donors alike. Global efforts A Promise Renewed and the Every Woman Every Child Initiative have helped to generate new commitments by governments, non-governmental organizations and the private sector to various components of the RMNCH continuum of care and, in particular, to ensure that maternal and newborn health are at the center of efforts to improve health systems. Further, since 2005, new evidence on preterm birth and stillbirth has been compiled, as has evidence on which interventions, policies and investments can effectively improve newborn health. As with efforts to promote maternal health, research and evaluations in recent years have often identified priorities that reach beyond health service delivery to highlight a need to address geographic, social and political barriers to access to essential services.
One research effort, the INTERGROWTH-21st initiative, an eight-country study forms the basis for international standards for monitoring fetal growth and newborn size. This collaborative has contributed to the increasing evidence that all babies have similar inherent potential for growth, development and health, regardless of their race or ethnicity, which underscores the degree to which risk factors for neonatal mortality and morbidity vary greatly depending on the mother’s health, education, and socioeconomic status and the setting of birth. These findingsserve as the basis for new, internationally validated standards and tools for fetal and newborn growth.
With the post-2015 global development agenda estimated to be finalized in 2014, the year marks an important period for efforts to promote a global newborn health agenda. The Lancet published the Every Newborn series, a set of articles that built on the 2005 series, expanding the scope of research “beyond survival,” to a comprehensive view of perinatal health, and making a case for targets on stillbirths and newborn mortality to be included in the post-2015 global development framework. Also in 2014, the Every Newborn Action Plan (ENAP) was endorsed at the World Health Assembly and garnered commitments from a diverse set of 40 partners. ENAP includes specific plans for achieving the proposed targets for reducing newborn deaths to 10 per 1000 live births and stillbirths to 10 per 1000 births by 2035. The fundamental need to integrate maternal and newborn health is evident in the ENAP strategic objectives:
- Strengthen and invest in care during labour, birth and the first day and week of life
- Improve the quality of maternal and newborn care
- Reach every woman and every newborn; reduce inequities
- Harness the power of parents, families, and communities
- Count every newborn—measurement, programme-tracking and accountability
The Role of the MHTF
PLOS Medicine Collection Year 3: The theme for Year 3 of the MHTF’s ongoing collaboration with PLOS Medicine is “Integrating Health Care to Meet the Needs of the Mother–Infant Pair.” The collection reflects the breadth of challenges and opportunities for integration of maternal, newborn and infant health, and includes articles highlighting integrated approaches to delivering essential care such as PMTCT of HIV/AIDS and prevention, screening and treatment for malaria in pregnancy, as well as health worker training and supervision, community mobilization and evaluations.
INTERGROWTH 21st and Perinatal Health: The MHTF’s parent, the Women & Health Initiative (W&HI) is a partner in the dissemination and implementation of the INTERGROWTH-21st Project, a multi-phase, global project that has studied perinatal health over the past five years. As a result, the research team, led by our colleagues at the Oxford Maternal & Perinatal Health Institute and Nuffield Department of Obstetrics and Gynecology at the University of Oxford, is producing new, internationally-applicable, prescriptive standards for monitoring growth and development in the first 1,000 days of life. In collaboration with this global network of researchers and the Geneva Foundation for Medical Education and Research, the W&HI is identifying and pursuing strategic opportunities for the dissemination and implementation of these tools to improve the quality of care for mothers and newborns across the globe.
Integration of Maternal and Newborn Health Care: On September 9th and 10th, the MHTF, along with Save the Children’s Saving Newborn Lives, are convening a technical consultation that will bring key members of the maternal and newborn health communities together to identify opportunities for integrated quality care during the antenatal, intrapartum, and postnatal periods.
- Saving Newborn Lives (Save the Children)
- Healthy Newborn Network
- Every Woman Every Child
See more recent publications on newborn health >>
- (PDF)Every Newborn: An Action Plan to End Preventable Deaths by WHO
- Committing to Child Survival: A Promise Renewed by UNICEF
- Pregnancy, childbirth, postpartum and newborn care: A guide for essential practice by WHO
- IMPAC: Integrated Management of Pregnancy and Childbirth by WHO
- Knowledge Summary #13: Make Stillbirths Count by PMNCH
Water, Sanitation, and Hygiene Programs as a Strategy to Advance Maternal Health
Understanding fetal growth across populations towards a phenotypic classification of preterm birth and intrauterine growth retardation
Sustainable primary healthcare models focusing on maternal and infant health, information architecture for healthcare and high quality, low-cost hospital systems for developing countries
Malaria in Pregnancy
(English) Introducing the INTERGROWTH-21st Project
(en Français) L’introduction du Projet INTERGROWTH-21st
(en Español) Presentando el Proyecto INTERGROWTH-21
In an effort to build bridges between the maternal and newborn health communities, Saving Newborn Lives (SNL) at Save the Children and the Maternal Health Task Force (MHTF) at the Harvard School of Public Health convened a technical consultation that brought key members of the maternal and newborn health communities together to identify opportunities for integrated quality care during the antenatal, intrapartum, and postnatal periods.