Burden of maternal and newborn mortality
The setting that drives the quality initiative in Maternal and Newborn Health (MNH) is the global burden of maternal and newborn mortality. Although overall there has been a halving of maternal mortality globally over the last two decades, a recent assessment states that only 16 countries were on track to reach the Millennium Development Goal (MDG) target by 2015 (Kassebaum et al 2014). The result of this failure of many countries to reach the MDG targets for women and children was widely referred to as “unfinished business” to be carried forward for inclusion in the Sustainable Development Goals (SDG) which came into force on 1st January 2016.
With the successes in reducing under-one and under-five child mortality, the increasing proportion and significance of neonatal mortality is now recognised. It is estimated that annually there are 2.9 million new born deaths, accounting for 44% of deaths of children under five years of age. There are an estimated 2.6 million babies stillborn each year, but there is a huge gap in our information about the numbers of stillbirths, making them an invisible loss (Lawn et al 2014).
Still births are now recognised as part of the post 2015 sustainable development agenda via the new Global Strategy for Women’s, Children’s and Adolescent’s Health (2016-2030) and the Every Newborn Action Plan (ENAP) to end preventable deaths (2014) (Richard Horton,and Udani Samarasekera, 2016). However, there is still no global target for stillbirths in the SDGs (UN, 2015). This failure to consistently include targets and to promote effective data collection and registration systems for stillbirth is seen by key observers as indicating that stillbirths remain hidden in the worldwide agenda (De Bernis et al, 2016), (Frøen et al, 2016).
Global commitments, resources and evidence
These were the words of the UN Secretary-General Ban Ki-moon when the Global Strategy for Women’s and Children’s Health was launched in September 2010. The initiative, which was subsequently updated in 2015, aims to accelerate the reduction of maternal and newborn deaths by pooling the resources of the global community. From a financial viewpoint, the most recent estimates suggest that essential quality improvement interventions for women and newborn babies across the continuum of care will amount to US$1928 for each life saved (Bhutta et al 2014).
From an evidence perspective, knowing what works is a crucial baseline from which to start. Although the evidence base is as yet imperfect, especially for strategic approaches in quality improvement, there has been unprecedented progress in the last 20 years in generating sound knowledge about safe clinical care interventions that have superior effects over alternatives.
The mother-baby dyad
Good quality care provided during pregnancy will affect the wellbeing not only of the mother, but of the unborn fetus and the newborn baby. After birth, the quality of care received by the mother will still have effects on the newborn (such as care for breastfeeding), although there will be other quality aspects which are directed solely to the newborn. Such distinctions are not always clearly laid out. Quality MNH services therefore affect both mother and child in a continuum, particularly in the period before and after birth to six weeks postpartum.
- Kassebaum, N. J. et al, (2014) Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
- Lawn, J. E., (2014) Progress, priorities, and potential beyond survival
- Bhutta, Z. A. et al, (2014) Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?
- Horton, R. and Samarasekera, U., (2016) Stillbirths: ending an epidemic of grief
- de Bernis, Luc et al., (2016) Stillbirths: ending preventable deaths by 2030
- Frøen, J Frederik et al., (2016) Stillbirths: progress and unfinished business
- United Nations, (2015) Transforming our world: the 2030 Agenda for Sustainable Development