Reproductive, Maternal, Newborn, and Child Health: Key Messages from Disease Control Priorities, 3rd Edition

Authors: Robert Black, Carol Levin, Neff Walker, Doris Chou, Li Liu, Marleen Temmerman, DCP3 RMNCH Authors Group

Summary:

As part of the Disease Control Priorities 3rd edition, the World Bank has published a volume on Reproductive, Maternal, Newborn and Child Health that identifies essential cost-effective health interventions that can be scaled-up now to reduce maternal, newborn and child deaths and stillbirths. This article summarizes the volume’s key findings and estimates the impact and cost of expanded implementation of these interventions. Recognizing that a continuum of care from the adolescent girl, woman, mother to child is needed, the volume considers the preventive and therapeutic health interventions in integrated packages: Maternal and Newborn Health and Child Health (along with folic acid supplementation – a key reproductive health intervention). Scaling up all interventions in these packages from current coverage levels in 2015 to hypothetically immediately achieve 90% coverage would avert 149,000 maternal deaths, 849,000 stillbirths, 1,497,000 newborn deaths and 1,514,000 additional child deaths. In alternative calculations that consider only the effects of reducing the number of pregnancies by provision of contraceptive services as part of the Reproductive Health package,  meeting 90% of the  unmet need for contraception would reduce global births by almost 28 million and consequently avert deaths that could have occurred at current rates of fertility and mortality.

Thus 67,000 maternal deaths, 440,000 neonatal deaths, 473,000 child deaths and 564,000 stillbirths could be averted from avoided pregnancies. Particularly impactful interventions in the Maternal and Newborn and Child Health packages would be management of labor and delivery, care of preterm births, and treatment of serious infectious diseases and acute malnutrition. Nearly all of these essential interventions can be delivered by health workers in the community or in primary health centers, which can increase population access to needed services. The annual incremental cost of immediately scaling up these essential interventions would be $6·2 billion in low income countries, $12·4 billion in lower middle income countries and $7·9 billion in upper middle income countries. With the additional funding, greater focus on high-impact integrated interventions and innovations in service delivery, such as task shifting to other cadres of health workers and supply and demand incentives can help rectify major gaps in accessibility and quality of care.  In recent decades it has been a global priority to reduce the avoidable maternal and child deaths. With continued priority and expansion of essential reproductive, maternal, newborn and child health interventions to high coverage, equity and quality, as well as interventions to address underlying problems like women’s low status and violence, these deaths and substantial morbidity can be largely eliminated in another generation.  Read more