A continuum of care across life stages, from home to health facility, and from prevention through treatment, is crucial to ensure a person’s health. Maternal and newborn care (MNC) is a key component of that continuum. MNC benefits the health and well-being of not only the woman and her baby, whose health is closely linked to the mother’s from conception through birth and beyond, but also to families and communities. Many women, however, do not have access to quality MNC information or services, and sometimes services are lacking all together.
Worldwide, maternal mortality remains unacceptably high, especially in poor countries. While the total number of maternal deaths decreased from 543,000 in 1990 to 287,000 in 2010, and the maternal mortality ratio decreased from 400 maternal deaths per 100,000 live births to 210 in 2010, wide variations persist between rich and poor countries. Every two minutes, a woman dies from complications related to pregnancy and childbirth—that means almost 800 deaths every day—more than a quarter of a million deaths every year worldwide, with the vast majority (99 percent) of these deaths occurring in the developing world.[i] The majority of maternal deaths can be prevented if women have access to and use skilled care during pregnancy, childbirth, and the first month after delivery; quality family planning (FP) services; post-abortion care (PAC) services; and, where permissible, safe abortion services. Reducing the number of women dying in childbirth by three-quarters by 2015 is one of the Millennium Development Goals.
1 in 36: The risk of an African woman dying from a complication related to pregnancy or childbirth.[i]
1 in 4,300: The risk of a woman from an industrialized country dying from a complication related to pregnancy or childbirth.[ii]
More than 80 percent of maternal deaths worldwide have five main causes: hemorrhage (excessive bleeding), unsafe abortion, pregnancy-induced hypertension disorders (eclampsia), sepsis (infections), and obstructed labor. The major direct causes of maternal death are postpartum hemorrhage (PPH) and pre-eclampsia or eclampsia (PE-E), which together account for more than 40% of maternal mortality. Maternal anemia, malaria, and HIV are also large contributors to maternal morbidity and mortality. For every death that occurs, an estimated 20 additional women suffer major complications of pregnancy.[i]
Poor maternal health and nutrition and inadequate maternal care directly affect perinatal, neonatal, and infant mortality rates. An estimated 3.1 million neonatal deaths occur annually; three-quarters of those deaths occur in the first week of life, with one-quarter to one-half dying within the first 24 hours.[ii] Preterm birth complications are the most common causes of newborn death and the second cause of deaths of children under 5 years of age in developing countries. Newborn infections and birth asphyxia are other common causes, and together with preterm birth complications they account for 80% of newborn mortality.[iii] Preterm and low-birth weight (LBW) babies need special care, including attention to feeding and keeping them warm. In endemic areas, malaria can contribute significantly to both LBW and maternal anemia.
Governments have a responsibility to ensure that every woman has access to quality maternal care, a skilled birth attendant to assist her and her baby at childbirth, and special care and referral services if serious problems arise for either of them. It is, however, difficult for many women and babies to access quality care because of poverty, distance, insufficient information, inadequate services, or cultural practices. Governments and local authorities also have a responsibility to address these barriers to ensure that women receive the quality health care they need and that they and their newborns have a right to receive it.
Community-oriented programs with an MNC component implemented by nongovernmental and community-based organizations (CBOs) can play a substantial role. Community health workers (CHWs) and CBOs can provide women and their families with the education and counseling, and in some cases services that they need; CBOs and CHWs also can link community members to the health system.
USAID is committed to Ending Preventable Child and Maternal Deaths (EPCMD) and aims to save the lives of 15 million children and nearly 600,000 women by 2020. Please refer to the report Acting on the Call: Ending Preventable Child and Maternal Deaths for details. Specifics on USAID’s strategy for working with global partners to End Preventable Maternal Mortality (EPMM) are further described in USAID’s Maternal Health Vision for Action, published in June 2014. For newborn health, USAID endorses the global action plan led by WHO and UNICEF, called Every Newborn: an action plan to end preventable deaths (ENAP).
[ii] WHO, 2010. Newborn Care at Birth. http://www.who.int/maternal_child_adolescent/topics/newborn/care_at_birth/en/
[iii] WHO , 2013. Management of newborn illness and complications. http://www.who.int/maternal_child_adolescent/topics/newborn/management_illness_complications/en/
[i] UNICEF, 2014. UN Data. http://data.un.org/Data.aspx?d=SOWC&f=inID%3A132#SOWC
[i] UNFPA, UNICEF, WHO, World Bank, 2012. Trends in Maternal Mortality: 1990-2010 https://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Trends_in_maternal_mortality_A4-1.pdf