Prioritising maternal, newborn health programmes in Primary Health Care

Several studies published last week, during the just concluded International Maternal Newborn Health Conference 2023 in Cape Town, South Africa, provided insight on how to reduce maternal and newborn deaths by prioritising, financing maternal and newborn health programmes in Primary Health Care (PHC) centres.

Indeed, more than 1,000 stakeholders from around the world gathered, from May 8 – 11, 2023, in Cape Town, South Africa, to accelerate solutions to improve maternal and newborn survival and prevent stillbirths in a coordinated and inclusive manner.

The conference aimed to accelerate recovery and progress in maternal and newborn health, promoting targeted investments in primary healthcare as well as innovation and bolder partnerships across programmes that help countries improve survival.

To achieve the 2030 Sustainable Development Goals (SDG)-era targets, the discussions led with evidence, shared effective implementation strategies, reviewed joint progress, and nurtured collaboration and innovation within the maternal and newborn health community.

Based on current trends, more than 60 countries are not set to meet the maternal, newborn and stillborn mortality reduction targets in the UN Sustainable Development Goals by 2030.

Finance Maternal and Newborn Health (MNH) Programmes in Primary Health Care, focused on the importance of keeping maternal newborn health at the centre of primary health care.

The questions on the lips of stakeholders are: As the world moves out of the crisis stage of COVID-19 response, how can we ensure that women and newborns’ needs are at the centre of health programming? As important, how can we ensure those programmes are funded?

According to one of the reports, published, by the United Nations (UN), during the meeting in Cape Town, funding shortfalls and underinvestment in primary healthcare can devastate survival prospects. For instance, while prematurity is now the leading cause of all under-five deaths globally, less than a third of countries report having sufficient newborn care units to treat small and sick babies. Meanwhile, around two thirds of emergency childbirth facilities in sub-Saharan Africa are not considered fully functional – meaning they lack essential resources like medicines and supplies, water, electricity or staffing for 24-hour care.

The report titled, ‘Improving maternal and newborn health and survival and reducing stillbirth’, showed in the worst affected countries in Sub-Saharan Africa and Central and Southern Asia – the regions with the greatest burden of newborn and maternal deaths – fewer than 60 per cent of women receive even four, of World Health Organisations (WHO’s) recommended eight, antenatal checks.

According to the study, more than 4.5 million women and babies die every year during pregnancy, childbirth or the first weeks after birth – equivalent to one death happening every seven seconds – mostly from preventable or treatable causes if proper care was available.

The report showed global progress in reducing deaths of pregnant women, mothers and babies has flattened for eight years due to decreasing investments in maternal and newborn health.

The report assessed the latest data on these deaths – which have similar risk factors and causes – and tracks the provision of critical health services. Overall, the report shows that progress in improving survival has stagnated since 2015, with around 290,000 maternal deaths each year, 1.9 million stillbirths – babies who die after 28 weeks of pregnancy – and a staggering 2.3 million newborn deaths, which are deaths in the first month of life.

Director of Maternal, Newborn, Child and Adolescent Health and Ageing at the World Health Organisation (WHO), Dr. Anshu Banerjee, said: “Pregnant women and newborns continue to die at unacceptably high rates worldwide, and the COVID-19 pandemic has created further setbacks to providing them with the healthcare they need.

“If we wish to see different results, we must do things differently. More and smarter investments in primary healthcare are needed now so that every woman and baby – no matter where they live – has the best chance of health and survival.”

According to the report, the COVID-19 pandemic, rising poverty, and worsening humanitarian crises have intensified pressures on stretched health systems. Since 2018, more than three-quarters of all conflict-affected and Sub-Saharan African countries report declining funding for maternal and newborn health. Just one in 10 countries, of more than 100 surveyed, report having sufficient funds to implement their current plans. Moreover, according to the latest WHO survey on the pandemic’s impacts on essential health services, around a quarter of countries still report ongoing disruptions to vital pregnancy and postnatal care and services for sick children.

United Nations Children Fund (UNICEF) Director of Health (a.i.), Steven Lauwerier, said: “As is too often the case, vulnerability, fear, and loss are not spread equally around the world.

“Since the COVID-19 pandemic, babies, children and women who were already exposed to threats to their well-being, especially those living in fragile countries and emergencies, are facing the heaviest consequences of decreased spending and efforts on providing quality and accessible healthcare.”

Director of the Technical Division at the United Nations Population Fund (UNFPA), Dr. Julitta Onabanjo, said: “The death of any woman or young girl during pregnancy or childbirth is a serious violation of their human rights.

“It also reflects the urgent need to scale-up access to quality sexual and reproductive health services as part of universal health coverage and primary health care, especially in communities where maternal mortality rates have stagnated or even risen during recent years.

We must take a human rights and gender transformative approach to address maternal and newborn mortality, and it is vital that we stamp out the underlying factors which give rise to poor maternal health outcomes like socio-economic inequalities, discrimination, poverty and injustice.”

To increase survival rates, women and babies must have quality, affordable healthcare before, during and after childbirth, the agencies say, as well as access to family planning services. More skilled and motivated health workers, especially midwives, are needed, alongside essential medicines and supplies, safe water, and reliable electricity.

The report stresses that interventions should especially target the poorest women and those in vulnerable situations who are most likely to miss out on lifesaving care – including through critical subnational planning and investments.

Improving maternal and newborn health further requires addressing harmful gender norms, biases and inequalities. Recent data show that only about 60 per cent of women aged 15-49 years make their own decisions regarding sexual and reproductive health and rights.

The report tracks progress against two key global strategies: Every newborn: an action plan to end preventable deaths and Strategies for ending preventable maternal mortality. Targets, among others, include: (1) 90 per cent pregnant women receiving at least four antenatal care contacts, (2) skilled health personnel attending 90 per cent births, (3) 80 per cent of new mothers and babies receiving postnatal care within two days of birth and (4) 80 per cent of districts across countries having access to emergency obstetric services and small and sick newborn care.

Also, another report showed an estimated 13.4 million babies were born premature in 2020, with nearly a million dying from pre-term complications.
According to Born too soon: Decade of action on preterm birth, the “silent emergency” that is claiming one million tiny lives born premature each year requires concerted action to swiftly improve children’s health and survival.

Produced by a range of agencies, including UNICEF and the WHO, with its Partnership for Maternal, Newborn and Child Health (PMNCH), the report outlines a strategy forward to address this phenomenon, which has been long under-recognised in its scale and severity. Southern Asia and sub-Saharan Africa have the highest rates of preterm birth, accounting for more than 65 per cent of global cases.

The report showed other factors are also making an impact, increasing risks for women and babies everywhere. For example, air pollution is estimated to contribute to six million preterm births each year.

PMNCH Executive Director, Helga Fogstad, said: “Progress is flatlining for maternal and newborn health, as well as the prevention of stillbirths.” Gains made are now being pushed back further through the devastating combination of COVID-19, climate change, expanding conflicts and rising living costs, she warned. She said: “By working together in partnership – governments, donors, the private sector, civil society, parents, and health professionals – we can sound the alarm about this silent emergency.

“This means bringing preterm prevention and care efforts to the forefront of national health and development efforts, building human capital by supporting families, societies, and economies everywhere.”

The report showed preterm birth rates have not changed in any region in the world in the past decade, with 152 million vulnerable babies born too soon from 2010 to 2020.

Preterm births occur earlier than 37 weeks of an expected 40-week full-term pregnancy. The report included updated estimates from WHO and UNICEF, prepared with the London School of Hygiene and Tropical Medicine, on the prevalence of preterm births.

Director of Health at UNICEF, Steven Lauwerier, noted that every preterm death, created “a trail of loss and heartbreak”.

“Despite the many advances the world has made in the past decade, we have made no progress in reducing the number of small babies born too soon or averting the risk of their death. The toll is devasting. It’s time we improve access to care for pregnant mothers and preterm infants and ensure every child gets a healthy start and thrives in life.”

The report said preterm birth is now the leading cause of child deaths, accounting for more than one in five of all deaths of children occurring before their fifth birthday. Preterm survivors can face lifelong health consequences, with an increased likelihood of disability and developmental delays.

Too often, where babies are born, determines if they survive, the report found, noting that only one in 10 extremely preterm babies survive in low-income countries, compared to more than nine in 10 in high-income nations.

The report showed gaping inequalities related to race, ethnicity, income, and access to quality care, determine the likelihood of preterm birth, death, and disability, even in high-income countries.

According to a new analysis in the report, at the same time, nearly one in 10 preterm babies are born in the 10 most fragile countries affected by humanitarian crises.

Across the world, groups for affected families of preterm birth have been at the forefront of advocating for access to better care and policy change and supporting other families, the report showed.

In addition, the past decade has also seen a growth of community activism on preterm birth and stillbirth prevention, driven by networks of parents, health professionals, academia, and civil society.

UN agencies, including the UN Population Fund (UNICEF), WHO, and UNICEF, are calling for a set of actions to save lives: boost investments in newborn health, accelerate implementation of national policies, integrate efforts across sectors, and support locally led innovation and research to support improvements in quality of care and equity in access.

Director for Maternal, Newborn, Child and Adolescent Health and Ageing at WHO, Anshu Banerjee, said: “Ensuring quality care for these tiniest, most vulnerable babies and their families is absolutely imperative for improving child health and survival.

“Progress must also advance in prevention, which means every woman must be able to access quality health services before and during pregnancy to identify and manage risks.”