We have the technical knowledge and interventions to address most of the critical health problems that affect women and their babies. The strategies needed to implement these technical solutions are also becoming increasingly clear, although achieving impact at scale remains a major public health challenge. Integrating reproductive, maternal, newborn, and child health care – before and during pregnancy, through childbirth, and into early childhood – is an approach that holds promise for promoting greater efficiency and effectiveness for improving the health and survival of women and their children. In particular, the linkages between maternal and newborn health are especially strong, and are the focus of this special issue.
This special issue of the Journal of Maternal-Fetal and Neonatal Medicine presents research conducted by investigators at the Aga Khan University in Karachi, Pakistan on the interconnections between maternal and newborn health. Previous studies have established that the health of a mother and her newborn baby are inextricably linked; we know that most maternal and newborn deaths are caused by a mother’s poor health before or during pregnancy, or by inadequate care in the hours and days during and after childbirth. When a woman dies in childbirth, her newborn is much less likely to survive as well. Most studies, moreover, have examined the impact of technical interventions on the health and survival of either the mother or the newborn, but have failed to quantify their simultaneous impact on both the mother and newborn.
The review by the Aga Khan University advances our knowledge base by identifying which maternal and newborn health interventions have positive health benefits for both mother and newborn. Over 150 interventions were reviewed for their impact on composite maternal and neonatal outcomes. The review also grouped interventions into proposed packages of care for delivery at the community, health center, or hospital level. Packages of care found to have benefits for both maternal and newborn health included:
Family planning/birth spacing: Family planning, including counseling on and provision of contraceptive methods, prevents unintended pregnancies and abortions, and increases spacing between births. Adequate birth spacing (between 18–23 months) reduces the risk of maternal and newborn-related deaths. In spite of this evidence, there continues to be a large unmet need for investment in contraceptives, information and services, including counseling, to space pregnancies or prevent unintended pregnancies.
High-quality antenatal care (ANC): Antenatal care provides a critical window to address a range of health care needs, such as treating HIV and sexually transmitted diseases (STDs), and providing counseling and educational support to the woman and her family. Well-designed, good quality ANC reduces the risk of preterm birth, perinatal mortality, and low birth weight infants. The potential of ANC to provide integrated care that meets the needs of both women and their newborns is nevertheless insufficiently exploited.
Skilled attendance at birth: Ensuring a skilled attendant at the time of childbirth can avert nearly all of the fatal outcomes and serious disabilities associated with childbirth. A skilled health professional, adequately trained and supported, can address the largely unpredictable and life-threatening complications that can occur, such as postpartum hemorrhage, obstructed labor, and prematurity/low birth weight.
Postpartum care for mother and newborn: The hours, days, and weeks following childbirth can be the most dangerous period for mother and baby. Postnatal visits, conducted at home or at the health center, can have benefits for both, including promoting exclusive breastfeeding, care-seeking for illness, counseling on birth spacing and family planning, and general supportive care.
The review also identified a number of interventions that have been neglected or underemphasized in the past, but which have significant potential for improving both maternal and newborn health; these include:
Prevention and management of preconception diabetes: Screening, detecting and managing diabetes in women before pregnancy can reduce perinatal mortality, the risk of C-sections, and the occurrence of congenital malformations. Counseling of diabetic women should therefore begin before conception rather than during pregnancy.
Community-based approaches: Community-level strategies, including establishment of women’s support groups and empowering women on birth and newborn care preparedness, improve maternal health care-seeking behavior, and facilitate early recognition of complications. The review assessed the impact of community-based approaches as a whole on maternal and newborn health outcomes, and not as single interventions.
Recognition and treatment of maternal depression: Maternal mental health benefits both the mother and newborn baby. Its recognition and treatment has resulted in improved contraceptive use in mothers (at 12 months), reduced incidence of infant diarrhea, and an increased rate of completed immunization at 12 months.
This research is a critical step in better understanding the profound interconnections between the survival, health and well-being of a woman and that of her newborn baby. It also underscores how vital it is to integrate health care for women and their newborns. Integration is not easy - it forces programs and stakeholders with different agendas, goals, and constituencies to work together. And yet, integration of services across the continuum of care is critical if countries are to make progress towards national health goals and strategies for women, infants and children.
The research findings reported in this special issue have implications for the research, program, advocacy and clinical communities. Program, policy, donor communities, and clinical practitioners should prioritize interventions that benefit both mother and newborn. The advocacy community should include integrated approaches for improving maternal and newborn health in their messages. The research community must also analyze impact on both mothers and newborns and study outcomes for all outcomes for all groups.
Disclaimer
The Journal of Maternal-Fetal & Neonatal Medicine is pleased to collaborate with the article authors in the preparation of this supplement, which has been supported by a grant from the Bill & Melinda Gates Foundation. The manuscripts have undergone the Journal's standard peer review process.
Declaration of Interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.