Interconnections Between Maternal, Newborn and Child Health

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

There is surprising little synthesis of evidence across this continuum of care that specifically examines the interconnected benefits of interventions for the mother, fetus, infant, and young child. This realization prompted us to take a fresh approach to quantifying and assessing the quality of the evidence for joint benefit of interventions for averting maternal, neonatal and child deaths and stillbirths.

Despite the tremendous progress being made, every year, approximately 8.5 million women and children under 5 die from preventable causes and a further 2.6 million babies are stillborn.

More than a tenth (11 percent) of all newborns in developing countries are born with low birth weight, largely related to poor health and nutrition of their mother. Low birth weight increases the risk of infections and health problems later in life.

In continuation with the theme of the current series of papers in Seminars in Perinatology on Global Perinatal Health, it is important to underscore the importance of linkages between maternal, fetal, and newborn health.

Continuum of care for maternal, newborn and child health (MNCH) is based on the concept that the health and well-being of women, newborns, and children are closely linked and can be managed in an integrated way, and that interventions at one stage of the life cycle profoundly affect the rest.

Our review of the evidence of a range of interventions addressing maternal, newborn, and child outcomes indicate that in addition to the well recognized interventions that save lives such as basic and comprehensive emergency obstetric care, a range of interventions addressing fertility, maternal, nutrition, and maternal illness (such as diabetes, hypertensive disease of pregnancy, etc.) can have huge benefits for mothers and their young children.

Click on image to download a high-resolution pdf of this chart

We learned that when defining intervention packages for implementation in programs, we need to pay more attention to selecting a range of interventions on the basis of their interconnectivity (or benefits for mothers, newborns, and young children), impact across a range MNCH outcomes and potential for integration in health system settings.

Click on image to download a high-resolution pdf of this chart.

Such potential integration of strategies is cost-effective and would also allow for greater efficiency in training, monitoring and supervision of health care workers. It would also help families and communities to access and use services.

One comment
  1. Intecconnection between maternal newborn and child health is an excellent step for saving lives of mothers and neonates. But I wonder its implementation for infant health.While the statistiics of survival may show a bit decline, thanks to improved neonatal , perinatal care in India through efforts at government, private sector and ngo,s and increased utility of better obstetric and neonatal services (available not to all). Dr Bhutta in his statement from continum of care has listed in framwork of linkages in reproductive and maternal health with
    perinatal and neonatal outcome.
    What beyond survival of neonates ?.There are hardly any data about neonatal morbidity in field studies, and so also what happens to neonates after hospital discharge, most data are hospital based only .
    My concern comes for few problems which are not being a cocern of pediatricians and public health personnel so far?, or received scant attention .
    1;early hospital discharge , has led to problem of neonatal hyperbilirubinemia,which i fear may lead to increased morbidity ,both neonatal and later due to high bilirubin levels. The problems are three fold;1) lack of imparting knowledge to mothers about danger signs in neonates .2) poor follow up of dischared home babies within few days (parent,s ignorance, travel distance,or home deliveries with poor postnatal care).3) and of course if lactation is not well established, incidence of hbil is more in breast fed babies. 4)neonatal sepsis rate is high if deliveries are not conductedproperly and that adds to hbil.
    WE do not see kernicterus or very high serum bilirubin in hospital births,but in outborn babies in referal hospitals, it is not infrequent. In a referal neonatal unit with all outborn babies, the number of babies I have seen with bilirubin encephalopathy, outnumber such babies in my 4 decades of neonatal practice. hence I feel this is one area that needs attention of all health personnel and is an avidable problem. NNPNd DATA 2002-2003 In India reveaed incidence of hyperbilirubinemia in 3.3% of inborn babies, while it was 22.1% in extra mural births, highlighting the problem in a total of nearly 1.5 lac births from several centers in India.

    THE other concern is increasing survival of high risk neonates from neonatal units all over the country, but what after this?. Increasing survival of babies with birth asphyxia (incidence is 4-12% in hospital births ; IN NNPND INDIA , birth asphyxia was noted in 8.7% of intramural births and 16% of exra mural births. High incidence of perinatal asphyxia, increasing survival of very low birth weight babies and intensive care nursery survivals , so far inadequate antenatal care,intact survival is the need of hour. IT has been established in several studies and in my own experince that neurological examination at discharge of nicu survivors is significantly associated with neurodevelopmental problems later. Once dischared , these high risk babies though at risk of neurodevelopmental problems are receiving follow up services for develomental assessment and early intervention programmes. A provision hence should be made to assess all babies for develomental problems iin infancy in these babies( this service is so far scanty despite easy methods developed in India-TDSC) ,which can be easily carried out in 5-10 min at immunisation sessions and also with use of WHO growth charts and milestones of development.
    The third concern is about creating family planning awareness in posnatal period,it should not be left to only obstetricians, should be an impotant health issue with all health personnel
    Lastly, empowering young girls about basic issues like importance of breast feeding, newborn danger signs, pregnancy complication and immunisations etc at school and college level, and rural areas at community fairs ,and tthrogh primary health care providers. All programmes turn to be futile if health education fails.

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