Enhancing, and protecting, maternal and neonatal health care

Nearly 10 years ago, The Lancet published a landmark Series of papers on widespread mortality burden that had, until then, received virtually no recognition the global health agenda. six-part collection drew attention to 2 million fetal deaths after 28 weeks’ gestation—stillbirths—that take place globally every year, and fact third them occur in healthy pregnancies during labour, meaning they are almost certainly avoidable with skilled delivery care. Stillbirths were not included monitoring processes time—the Millennium Development Goals, Countdown 2015 initiative, or Global Burden Disease project—and country-level surveillance exercises for stillbirths variable non-existent. final paper set out “Vision 2020”. At end this strangest years, how is vision looking? had marked influence at international policy level. Intrapartum stillbirth prevention was integrated into WHO UNICEF's 2014 Every Newborn Action Plan UN's Strategy Women's, Children's Adolescents’ Health. Routine data national level improved, several countries—notably India—launched action plans their own. Yet latest data, released October 2020 first-of-its-kind report from UN Inter-Agency Group Child Mortality, showed annual rate reduction since 2000 half under-5 (to 2·3% vs 4·3%, respectively). A possible mechanism by which accelerate progress explored an Article month's issue. Andrea Nove colleagues modelled resource tremendous potential reduce some main causes risk factors (childbirth complications, antepartum haemorrhage, maternal infections disorders such as hypertension) well related neonatal mortality. used Lives Saved Tool model much different levels scale-up suite midwife-delivered interventions (eg, intermittent preventive treatment malaria; screening management diabetes, hypertension, pre-eclampsia) could prevent all three tragedies. authors estimate 25% increase coverage these 5 2035 88 high-burden countries would result 41% fewer deaths, 26% stillbirths, 39% deaths. After another Lancet's Series, Midwifery, 2014, impact midwife trained standards can have maternal, neonatal, child has been increasingly apparent. Yet, Mary Renfrew notes her linked Comment, “Research funding preferentially supports either technological solutions obstetric emergencies implementation less workers care mothers infants”. need high-quality education whomever attends women newborn babies often most dangerous moments lives without question. Another issue explores quality neonates first hours birth nine hospitals Ghana, Guinea, Nigeria. Women health-care observed throughout childbirth, immediate postpartum period, recommended practices skin-to-skin contact between baby mother, non-separation neonate breastfeeding within 30 min recorded. Alarmingly, more than separated birth, breasfeeding encouraged cases, instances mistreatment noted. Poor-quality disrespectful abusive discourages families attending facilities. Unfortunately, we found so does pandemic. Empirical India Nepal show devastating travel restrictions, health-worker displacement, fear contagion facility rates numbers perhaps very studies reported points shift mindset might apparent ago. So do continue rise, now time ensure COVID-19 response measures systems health, hinder safe, effective, respectful h birth: prevalence associated multicountry, facility-based, observational studyA high proportion did receive practices, constitute mistreatment. Further research needed understanding measuring improve care, including neonates. Full-Text PDF Open AccessEffect pandemic intrapartum stillbirth, outcomes Nepal: prospective studyInstitutional childbirth reduced lockdown, increases institutional mortality, decreases Some behaviours notably hand hygiene keeping mother. An urgent exists protect access excess vulnerable system users period. AccessCOVID-19 outbreak decreased hospitalisation pregnant labourAt tertiary India, mainly provided medical colleges advanced institutes, specialised consultative given patients who referred primary secondary along general local community.1 ratio 78%, 556 per 100 000 livebirths 1990 122 2015–17, because deliveries (from 18% 2005 79% 2016) effective referral emergency AccessPotential midwives preventing reducing stillbirths: modelling studyMidwives help substantially LMICs. However, realise potential, skills competencies line recommendations International Confederation Midwives, be part team sufficient size skill, work enabling environment. Our study highlights but there many challenges achievement potential. If increased achieved, will better able provide essential sexual, reproductive, newborn, adolescent interventions. AccessScaling up must priorityMidwives save children scale unmatched other In Health, colleagues1 estimated 67% 64% 65% low-income middle-income accounting vast majority averted. solution? Universal provision meet context multidisciplinary teams. Access