This post is part of the Maternal and Newborn Integration Blog Series, which shares themes of and reactions to the “Integration of Maternal and Newborn Health: In Pursuit of Quality” technical meeting
Ninety-nine percent of all maternal and newborn deaths in the world occur in low- and middle-income countries. That inequity is unacceptable. Furthermore, 46% of all maternal deaths occur during the time of labor and the day of birth. In a tragic alignment, as much as 45% of all newborn deaths occur within the first 24 hours of a child’s life. The parallels between the timing of maternal and newborn deaths is no accident. Both women and their babies are in dire need of high-quality, skilled care. Following are four key steps toward improved integration of maternal and newborn care.
- The mother-newborn dyad is inextricable. Program design, service provider training, and public and private sector funding mechanisms must be crafted in acknowledgment of the mother-baby pair. Sadly, current efforts to address health needs of these two groups are often conducted in siloes. This compartmentalization of care is reflected in the unfortunate persistence of high neonatal mortality rates in contrast to recent reductions in maternal mortality. In spite of recent gains, high rates of maternal mortality persist in certain regions of the globe. In order to cover the final mile and begin to tackle the challenge of neonatal mortality, programs and health systems must take into account the inter-reliance of a mother and her newborn.
- A high-quality, robust continuum of care is the only way the world will meet its goals of reducing maternal and neonatal mortality and morbidity. A strong mother-baby focused continuum of care begins with comprehensive access to contraception since would prevent an additional 79,000 maternal deaths and more than 1.1 million infant deaths each year. Furthermore, it is essential that the continuum of care includes access to skilled health care workers at all levels of the health systems, from community to hospitals. It is also essential that all clients have access to life-saving commodities such as oxytocin to prevent postpartum hemorrhage and ART to prevent mother-to-child transmission of HIV. Pathfinder International’s Clinical and Community Action model for addressing post-partum hemorrhage has demonstrated the value of a robust continuum of care approach, resulting in significant reductions in associated deaths.Pathfinder International’s model builds on the Three Delays Model while encouraging stronger health systems that ensure a provider’s ability to be equipped with up-to-date knowledge and skills as well as a women’s ability to access respectful, high-quality care for herself and her family.
- Community engagement: Women do not become mothers nor are babies born in isolation. Entire communities—especially partners, fathers, aunties, and grandmothers—play a role. Many of the most common complications affecting women and newborns must be addressed through preventative behavior change at the community-level and through quality improvement in the services offered at traditional health facilities. By engaging an entire community, it becomes possible to not only increase uptake of priority health services and behaviors, but to engender change in beliefs and behaviors essential to maternal and newborn health.
- Advocacy: At all levels of society, it is essential to mobilize resources and attract political support for integration of maternal and newborn care. Furthermore, advocacy is key to prioritizing quality of care in all health system services. Quality of care goes far beyond dissemination and application of evidence-based technical guidelines, although that is imperative. As we move toward high-quality integrated maternal and newborn care, we must also ensure community-based conversations and ownership; empowered midwives armed with livesaving competencies; and family-centered, respectful care.