The best way to reduce maternal and newborn mortality worldwide

* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.

Following the 2015 World Innovation Summit recently held in Doha, Qatar, and in conjunction with World Health Day taking place Tuesday, April 7th, I interviewed Mariam Claeson of the Bill and Melinda Gates Foundation. Claeson serves as director, Maternal Newborn and Child Health, and leads the foundation’s work to ensure that mothers and babies survive pregnancy, childbirth, and the newborn period. In our interview, we discussed new research produced in partnership with the Qatar Foundation, progress made on these issues to date and which interventions were most successful, challenges and opportunities to continued impact, and much more. 

Tell me a little bit about the origins of the partnership between the Gates Foundation and WISH, and why you decided to focus this piece of research on reproductive, maternal and newborn health.

The partnership between the Gates Foundation and Qatar Foundation was initiated after a meeting between HH Sheikha Moza and Bill Gates in 2013.  Both agreed to finds ways to use their respective strengths towards a collaboration that would benefit communities with the greatest need, especially women and children.  Given the convening power and importance of WISH as a policy and advocacy initiative (created by the Qatar Foundation), we were excited for the opportunity to present and discuss one of our priority issues with health leaders from around the world.  WISH offered the Gates Foundation an opportunity to have a conversation with a diverse global audience with experience and influence in private sector and NGO communities, resource mobilization, policymaking, health delivery, research and development as well as students and future leaders. 

Given the range of topics being presented at WISH each year and the variety of global health and development programs of the Gates Foundation, both partners agreed that RMNCH was a critical issue that had not been previously addressed.  Our objective was to share simple but critical policy recommendations with a group of healthcare stakeholders that had the ability to affect change in their respective countries.

Our maternal and newborn health program strives to reduce maternal and newborn mortality through expanded coverage of high-impact interventions to ensure that women and newborns survive and thrive.  We invest in efforts to adapt and develop innovative tools, technologies, and treatments; improve the quality of healthcare services and practices and the interactions between health workers and families; support healthy practices at home by families and communities: and advocate for national and global policies that benefit maternal, newborn and child survival and health. We also invest in operations research to better understand and remove barriers to scaling up of high impact interventions. WISH offered a forum to share these developments with key partners.

How much progress have we made on these issues in recent past, and what do you attribute that progress to? 

While we’ve seen great success in reducing under-five childhood mortality (we’ve halved childhood deaths in the past two decades), the reduction in newborn deaths have been slower and the proportion of newborn deaths has grown. Newborn deaths now account for 44% of all under-five deaths, despite the fact that we have existing, proven interventions.  We’ve nearly halved maternal mortality, and yet roughly 800 women die unnecessarily each day from complications related to pregnancy and childbirth. 

Those countries that have made progress in reducing maternal and newborn mortality have successfully implemented high-impact maternal and newborn health interventions. For example, Nepal, Bangladesh and Malawi have driven down their NMR and MMR by ensuring that:

• More women are having their family planning needs met (access to contraceptive services and information)
• More newborns are breastfed immediately and exclusively
• More women are delivering in health facilities with trained skill workers 

What these countries have in common that help explain the increase in family planning, exclusive breastfeeding, facility delivery and other key factors in reducing MMR and NMR are that they created demand for maternal and newborn care; expanded services and provided financial resources for mothers and newborns; used efficacious tools and practices, including Kangaroo Mother Care; implemented effective national policies focused on maternal and newborn health; and, compiled data and evidence to inform policy decisions.

Looking ahead, what are some examples of new, lifesaving innovations that you put a spotlight on in this report? 

We have the opportunity to dramatically reduce newborn and maternal deaths with existing tools.  We have the health interventions that can save lives – we need to scale up those proven interventions and do implementation research to address the barriers to scale. 2/3 of newborn deaths can be prevented by existing proven interventions.  If we could take these to scale, hundreds of thousands more lives could be saved each year.

For newborn the high impact interventions are:

1. Breastfeeding immediately and exclusively for the first six months gives newborns a 14 times greater chance of survival, providing necessary nutrition and immune protection.
2. Simplified antibiotics: Newborns can die very quickly of infection. By empowering healthcare workers to deliver simplified antibiotics immediately when a baby appears ill we can save 300,000 newborn lives per year. 
3. A hand-pumped oxygen mask and basic training can be critical to saving the life of a newborn struggling to breathe and could prevent one third of newborn deaths around the time of delivery.
4. Promoting thermal care through skin to skin contact can avert 20% of newborn deaths caused by preterm birth complications and is as easy as immediately drying and warming the newborn after delivery.
5. Keeping the umbilical cord clean is essential to prevent deadly infection. Chlorhexidine has been proven to reduce newborn deaths in high mortality settings.

For pregnant women the highest impact interventions are:

1. The timely administration of oral antibiotics for pregnant women can significantly reduce maternal infections (sepsis).
2. Preventing and treating pre-eclampsia (high blood pressure) through the effective use of the lifesaving drug MgS04 can greatly impact maternal mortality
3. Uterotonics to reduce death from hemorrhage (bleeding)
4. Having a skilled health worker present during birth providing quality care improves the chance of survival for both mother and newborn.
5. Providing women access to contraceptives yields lower maternal and newborn death rates. 

Looking ahead, we need to find solutions to reduce complications due to prematurity and prevent preterm death – now the leading cause of under-five childhood deaths.  Among the transformational research priorities are a better understanding of gestational age and biomarkers for preterm birth so we can better determine prematurity.

There are also innovative tools and processes that we are testing to improve the performance of health workers, like the Better Birth checklist and mentoring, which we are testing in UP Bihar (you can read my blog post here on the Better Birth checklist). 

In lower-resourced countries, women and newborns encounter numerous obstacles when trying to access health services. And, for those who do access services, quality of care remains one of the biggest barriers to reduction in maternal and newborn deaths globally. 

In thinking about the upcoming Sustainable Development Goals being drafted by the United Nations, where do you see these issues in the broader context of poverty and development work?

Women and children surviving and thriving are central to poverty reduction and sustainable development. It is incumbent on the global community to address the breadth of needs and to prioritize women, children and newborns. Together with partners, we support the goals of the Every Newborn Action Plan and Ending Preventable Maternal Deaths by reducing NMR to 12 per 1000 and MMR to 70 per 100.000 (or 140/100,000 in high MMR countries) by 2030, and to achieve the child mortality goal of 25 per 1000 by 2030.