The Challenges and Opportunities for Maternal Newborn Integration

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By: Joy Riggs-Perla, Director, Saving Newborn Lives at Save the Children

This post is one in a series of five that explores the themes generated by a panel of global experts — who discussed the need for, barriers to, and the way forward for maternal and newborn health integration — at Putting Mothers and Babies First: Benefits Across a Lifetime, an event at The Forum at Harvard T.H. Chan School of Public Health on February 26th, 2015.

Rong Mala and six-day-old, Rakhal, receive a postnatal check up at the government clinic built in Badulpur, Habijganj, Bangladesh. This clinic is already having a positive effect in transforming attitudes towards healthcare as, traditionally, the mother and child should not leave the house until one month after the birth. However, at just six-days-old Rong Mala is treading new ground in bringng Rakhal to the clinic. To mitigate this, her mother-in-law accompanied her to the clinic and she carriers a small bag of earth taken from the house, so that mother and child remain connected to the family home whilst they are away. Photo: CJ Clarke/Save the Children
Rong Mala and six-day-old, Rakhal, receive a postnatal check up at the government clinic built in Badulpur, Habijganj, Bangladesh. Photo: CJ Clarke/Save the Children

Poor integration of maternal and newborn services during pregnancy, childbirth and in the postpartum period can have adverse consequences for the quality of care that mothers and babies receive. It can also affect the equitable access to this care, especially among poor and marginalized populations. In many countries around the world, significant challenges exist at the national, sub-national and local levels for the increase of maternal and newborn health integration. A variety of health system, financial, human resource as well as societal factors must be recognized and addressed to find the right balance of integrated service delivery.

Some challenges are related to health system issues. For instance, when the responsibility for maternal and newborn health services does not sit within the same organizational unit of government health services, there is increased risk of poor coordination in the resourcing and delivery of services. The lack of medicine and supplies for mothers but not babies or vice versa can adversely affect the delivery of quality and timely care.

When discussing human resource issues, challenges include the availability of skilled professionals in many low and middle-income countries.  Rural midwives frequently find themselves alone having to care for both women and newborns during the delivery process. Under such difficult conditions, where referral services are not readily available, complications for either the mother or her newborn can result in serious disability or death. Furthermore, the lack of reliable data on maternal and newborn service coverage makes identifying implementation problems difficult and monitoring progress very challenging. Other constraints related to integration include national policies that inadvertently affect the affordability and access to care. For example, waiver of fee payments for needed care of either mother or babies (but not both) can create serious financial burdens for patients. Multiple visits to a clinic can add to that financial burden and discourage service utilization.

While we work to improve health systems, we should also remember that women and communities have the power to improve health outcomes of their families when armed with appropriate information and provided the needed support. Within our own work at Save the Children’s Saving Newborn Lives program,  we are placing increased emphasis on improving care seeking, behavior change and community mobilization to impact improvements along the continuum of care. Life-saving interventions such as immediate and exclusive breastfeeding, skin-to-skin care of the newborn, use of uterotonics help prevent postpartum hemorrhage and proper cleansing of the umbilical stump are all steps that can save lives and can be done at the household level.

The Bill & Melinda Gates Foundation has been supportive of this work and is encouraging us to investigate how we might operationalize integration at the country level. Overall, implementing agencies and funders need to do a better job of communicating the importance of strengthening health systems to create solutions for women and newborns that are sustainable. We also need much more investment in implementation research to explore how integration of services can improve outcomes and equity of care, and to help accelerate the expansion of services to reach all populations.

The path towards meaningful and beneficial integration for the mother-baby dyad is not without its challenges, but many partners, donors, public health managers and service providers are committed to its principles and want to make it happen. Challenges translate into opportunities for increased collaboration, and the maternal newborn communities must show our collective commitment to improving outcomes for both women and newborns by working together to find practical solutions.

I encourage you to read the new Putting Mothers and Newborn First: Integrating Policies, Programs and Services policy briefing and become involved in the upcoming Global Maternal Newborn Health Conference taking place this October in Mexico City. The planning has already begun and we look forward to your insights and contributions so that we can work to create practical ways of improving the quality, equity and integration of services for mothers and newborns everywhere.

This blog originally appeared on the blog of Healthy Newborn Network.