The evidence base for interventions to reduce maternal and neonatal mortality in Low and Middle-Income countries

The evidence base for interventions to reduce maternal and neonatal mortality in Low and Middle-Income countries

Review of neo-natal health, and options for interventions

Reviews the scale of maternal and neonatal mortality and serious morbidity in low and middle income countries, and the factors that account for the huge discrepancies in the rates of these poor outcomes compared with high income countries. The interventions that could prevent nearly all of these events, and conditions needed to use them, are reviewed, along with extant estimates of the costs of putting essential services in place. The reasons why essential and emergency obstetric services are not universally available are varied, and are discussed in a section on constraints to scaling up interventions.

Maternal mortality has declined fifty- fold in the developed world since 1900, but changed hardly at all in the poorest countries. The lifetime risk of maternal death is 1 in 1800 in developed countries, and 1 in 48 in developing countries. Ninety-nine percent of the estimated 515,000 annual deaths of women from pregnancy-related causes occur in developing countries. A much larger number suffering serious, long-term morbidity. About 4.3 million stillbirths and 3.4 million deaths occur each year in the first week week of life, 98% of them in developing countries.

These early deaths are inextricably linked to theirmother’s health and obstetric care. Pregnancy-related death in Europe and North America was largely eliminated before high-technology equipment and medicines. Similar gains could be achieved in developing countries if women had skilled attendance at birth—a person skilled in midwifery, and access to emergency obstetric services for serious complications. Perhaps half the women in developing have access to these services.

Other lifesaving measures for mothers and newborns include: a small set of specific antenatal interventions, family planning options to reduce unwanted pregnancies, access to safe abortion and post-abortion care, and early postnatal care. Obstetric care need not be costly. A number of countries with relatively low per capita incomes (e.g., Costa Rica, Sri Lanka, Malaysia, Kerala State in India) have reduced maternal mortality dramatically through nationwide initiatives supported by central governments. The cost of a normal delivery with a skilled attendant can be as low as $2 in poor countries, and complicated deliveries, as low as $50.

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