New mother Rong Mala and her six-day-old baby Rakhal receive a postnatal check up at the new government clinic in Badulpur, Habijganj, Bangladesh. Photo: CJ Clarke/Save the Children
This blog is part of the Maternal and Newborn Health Integration Blog Series, “Integration of Maternal and Newborn Health: In Pursuit of Quality” technical meeting.
The continuum of care has become a rallying call to reduce the maternal deaths, stillbirths, neonatal deaths, and child deaths. Continuity of care is necessary throughout the lifecycle (adolescence, pregnancy, childbirth, the postnatal period, and childhood) and also between places of caregiving (including households and communities, outpatient and outreach services, and clinical-care settings). Within the continuum, all women should have access to care during pregnancy and childbirth, and all babies should be able to grow into children who survive and thrive.
Unfortunately in the modern era of medical science the program efforts addressing the health of mothers and newborns are often planned, managed, and delivered separately though from a biological perspective, maternal and newborn health are intimately linked.
Integration of maternal and newborn health is an important approach to avoid separation- between mothers and her newborn baby; places of service delivery; or at any event of health services. A persistent divide between training, programs, service delivery, monitoring, and quality improvement systems on maternal and newborn health limits effectiveness to improve outcomes. But it is evident that at the public-health level, even with scarce human and financial resources, integrated service packages can maximize the efficiency for health services.
In last two decades Bangladesh has demonstrated extraordinary progress in reducing maternal and child deaths, but unfortunately newborn mortality declined in a much slower pace and reduction of stillbirths was not even on the agenda. Fortunately, the country recently prioritized newborn survival and incorporated some priority interventions to reduce neonatal death. Improved delivery care services became one of the key strategies for improving child survival in addition to overall development of the health service delivery system.
The following newborn-specific interventions are prioritized to achieve the commitment of ending preventable child deaths by 2035.
- Ensure essential newborn care, including neonatal resuscitation and application of Chlorhexidine in the umbilical cord.
- Introduce and promote Kangaroo Mother Care (KMC) for premature and low birth weight infants.
- Ensure proper management of newborn infection with antibiotics at the primary care levels.
- Establish specialized newborn care unit at the sub-district and district level.
At the same time ensuring delivery by skilled birth attendants at the community levels, and establish round the clock emergency obstetric and newborn care at all sub-district, district and higher level health facilities along with establishing effective referral linkage to ensure continuum of care from community clinics to the union, sub-district, district and higher level hospitals are incorporated in the declaration. These give a clear indication of the government vision on integrated approaches to improve maternal and newborn health.
Intra-partum complication, prematurity-related complications and newborn sepsis are the major causes of newborn death is Bangladesh. Without integration of maternal and newborn health we cannot reduce mortality especially due to intra-partum complications and prematurity-related complications and these two together causes 67% of all newborn deaths in the country. Bangladesh recently scaled up Helping Babies Breathe initiative and that is a unique example of integration of maternal and newborn health.
Every year in the first day of life, 28,100 newborns of Bangladesh dies indicating the importance of integration of maternal and newborn services in pursuit of quality of care.