Global Perinatal Health

The following piece is part of a series highlighting Global Perinatal Health. Originally posted in the Bill & Melinda Gates Foundation, re-posted with permission. 

This year, 2010, has been an influential year in terms of advocacy and attention given to the health of women and children in low- and middle-income countries.

World leaders, policymakers, academics, the private sector, nongovernmental organizations, and others have gathered in multiple fora this year to discuss maternal, newborn, and child health. Together, we’re working to reduce deaths and illness for women, babies and children around the world, including stillbirths.

The December issue of Seminars in Perinatology capitalizes on this momentum and on the progress in reducing deaths achieved in recent years, while drawing a critical eye on the current state of the field, its knowledge gaps, coverage of effective interventions, recent advances, and promising new solutions.

In this series, the other authors and I outline recommendations for where to focus future policy and programming efforts, and identify critical areas where reductions in deaths can be significantly accelerated over the next few years.

We stress the importance of skilled care and assistance with childbirth, including emergency obstetric care, as critical opportunities to reduce maternal and newborn deaths and stillbirths. Insufficient implementation of interventions that have been proven to be effective is a theme throughout the issue. Innovations in technology, but equally important and perhaps more urgently, in the delivery of solutions, is fundamental to future progress.

Simple, cost-effective practices, such as newborn resuscitation, could reduce deaths during birth by 30 percent, yet findings show that only 15 percent of sub-Saharan maternity hospital staff has the training and equipment necessary.

Skin-to-skin care (or kangaroo mother care) and maternal corticosteroid treatment are effective interventions that reduce preterm birth complications, yet their implementation also remains much too low. Melinda French Gates blogged about the profound importance of skin-to-skin care last week.

Inclusion of the community is also critical to achieving impact; community and facility care must be more effectively connected. This can be accomplished in two fundamental ways: 1) bring care closer to the community, for example through equipping frontline workers with effective, affordable and acceptable interventions and with the communication skills to negotiate for their uptake by families, and 2) bring families closer to care, through innovations in transportation and communications systems and in incentive programs such as conditional cash transfers.

The issue’s key findings come at a critical time of increased attention and global support for maternal, newborn, and child health, and growing recognition of the importance of stillbirths. By examining progress and identifying promising opportunities to improve childbirth and early postnatal care, and thus address the most critical periods for advancing maternal and newborn survival, it is our sincere hope that this publication will help to further stimulate programming, policy and resolve to achieve Millennium Development Goals 4 and 5 to reduce deaths and improve health for women and children around the world, and especially among the poorest and most vulnerable segments of society.

Global Perinatal Health articles:

1. Darmstadt GL. Global Perinatal Health: “Accelerating progress through innovations, interactions, and interconnections.” Semin Perinatol 34:367-370, 2010.
2. Lawn JE, Kerber K, Enweronu-Laryea C, et al: “3.6 Million neonatal deaths—what is progressing and what is not?” Semin Perinatol 34:371-386, 2010
3. Yakoob MY, Lawn JE, Darmstadt GL, et al: “Stillbirths: epidemiology,evidence and priorities for action.” Semin Perinatol 34:387-394, 2010
4. Wall SN, Lee ACC, Carlo W, et al: “Reducing intrapartum-related neonatal deaths in low- and middle-income countries—what works?” Semin Perinatol 34:395-407, 2010
5. Simmons LE, Rubens CE, Darmstadt GL, et al: “Preventing preterm birth and neonatal mortality: exploring the epidemiology, causes and interventions.” Semin Perinatol 34:408-415, 2010
6. Ganatra HA, Zaidi AKM: Neonatal infections in the developing world. Semin Perinatol 34:416-425, 2010
7. Mullany LC: “Neonatal hypothermia in low-resource settings.” Semin Perinatol 34:426-433, 2010
8. LBhutta ZA, Lassi ZS, Blanc A, et al: “Linkages between reproductive health, maternal health and perinatal outcomes.” Semin Perinatol 34:434-445, 2010
9. Kumar V, Kumar A, Darmstadt GL: “Behavior change for newborn survival in resource-poor community settings: bridging the gap between evidence and impact.” Semin Perinatol 34:446-461, 2010
10. Schiffman J, Baqui AH, Agarwal S, et al: “Community-based intervention packages for improving perinatal health in developing countries: a review of the evidence.” Semin Perinatol 34:462-476, 2010
11. Martines J, Qazi S, Bahl R, et al: “Why is continuum of care from community to health facilities essential to improved perinatal survival?” Semin Perinatol 34:477-485, 2010.