Resource Library

On March 30, 2022, the World Health Organization released guidance on maternal and newborn care for a positive postnatal experience. A total of 63 recommendations on maternal care, newborn care, health systems, and health promotion address individual patient care and service delivery.

The new guidelines respond to global trends in maternal-newborn morbidity and mortality. As death rates drop globally, the new guidelines place great emphasis on thinking beyond survival, and continue to provide guidance on essential interventions to continue reductions in maternal and newborn mortality.

Here is what’s new:

• The importance of family-centered care | The new guidelines address the importance of the home and whole family in the health of the mother-baby dyad, including specific guidelines for the inclusion of men in care plans, the use of home-based medical records, and assessment of the home environment prior to discharge.
• Increased focus on maternal well-being | Moving beyond survival for the mother, the new guidelines address maternal mental health and comfort, including specific guidelines for pain control following delivery, and universal screening and intervention for depression and anxiety.
• Thinking beyond survival for the newborn | Interventions during the hours, days, and weeks following birth can have long-lasting impact on the health and well-being of children. The new guidelines specifically address responsive care, early infant development, safe sleep, and screening for hearing and eye abnormalities.
• Tackling health system and workforce challenges | The new guidelines recommend several strategies for increasing the size and quality of the healthcare workforce needed for a positive postnatal experience, including specific recommendations about mobilizing a greater diversity of health workers, establishing midwife-led continuity of care models, and using digital tools to improve birth registration and health behaviors in the home. The new guidelines also recommend integration of complementary maternal-newborn services when possible (maternal mental health and early infant development) and routine screening and prevention of infectious diseases (de-worming, TB, HIV screening).

While major progress has been made over the past two decades to improve mortality outcomes in women and newborn— major disparities remain in survival rates around the time of birth for mothers and infants born in high-, middle- and low-income countries. A significant gap continues to exist between actual and achievable health care outcomes, primarily because effective interventions are not implemented for every patient, every time. While access to and use of services for childbirth care has increased globally, and in some countries beyond expectations, the quality of care remains an impediment to accelerating the pace of reductions in preventable maternal and newborn mortality and stillbirths worldwide. The evidence for what to do to close the disparities gap has been known for years but there has been limited success in understanding how to implement these interventions.

This International Joint Statement was reviewed and endorsed by the Council of International Neonatal Nurses (COINN), the International Confederation of Midwives (ICM), the International Council of Nurses (ICN), the International Federation of Gynecology and Obstetrics (FIGO), and the International Pediatric Association (IPA).

The statement was developed by the United States Agency for International Development’s Applying Science to Strengthen and Improve Systems (ASSIST) with support from the Every Preemie-SCALE project, the American Academy of Pediatrics (AAP), the American College of Nurse-Midwives (ACNM), the American College of Obstetricians and Gynecologists (ACOG), Global Alliance to Prevent Prematurity and Stillbirth (GAPPS) and Save the Children’s Saving Newborn Lives project.

Since the beginning of the COVID-19 pandemic, WHO has engaged with countries to ensure the continuity of essential health services. Through a special initiative, the Department of Maternal, Newborn, Child, and Adolescent Health and Ageing has supported 19 countries: Bangladesh, Bolivia, Brazil, Cameroon, Democratic Republic of the Congo (DRC), Ethiopia, India, Kazakhstan, Myanmar, Nepal, Nigeria, Pakistan, Romania, South Africa, Sudan, Tajikistan, Timor-Leste, Uganda and Yemen in their efforts to mitigate the impact of COVID-19 on essential MNCH services.

This global event shared and discussed countries’ experiences and lessons learned during the implementation, including establishing structures and systems to coordinate the response and ensure continuity of services,  proactive use of data to inform decision-making, adaptation of service delivery and innovation.

This event offered health policymakers, health systems, programme managers, emergency officers, MNCH programme implementers, health professionals, researchers, development and funding partners with an opportunity to interact with Ministries of Health and implementers from the 19 countries and discuss strategies to strengthen the health systems able to rapidly respond and build back better.

Background Accountability for mistreatment during facility-based childbirth requires valid tools to measure and compare birth experiences. We analyse the WHO ‘How women are treated during facility-based childbirth’ community survey to test whether items mapping the typology of mistreatment function as scales and to create brief item sets to capture mistreatment by domain.

Methods The cross-sectional community survey was conducted at up to 8 weeks post partum among women giving birth at hospitals in Ghana, Guinea, Myanmar and Nigeria. The survey contained items assessing physical abuse, verbal abuse, stigma, failure to meet professional standards, poor rapport with healthcare workers, and health system conditions and constraints. For all domains except stigma, we applied item-response theory to assess item fit and correlation within domain. We tested shortened sets of survey items for sensitivity in detecting mistreatment by domain. Where items show concordance and scale reliability ≥0.60, we assessed convergent validity with dissatisfaction with care and agreement of scale scores between brief and full versions.

Introduction Mistreatment of women during childbirth is increasingly recognised as a significant issue globally. Research and programmatic efforts targeting this phenomenon have been limited by a lack of validated measurement tools. This study aimed to develop a set of concise, valid and reliable multidimensional measures for mistreatment using labour observations applicable across multiple settings.

Methods Data from continuous labour observations of 1974 women in Nigeria (n=407), Ghana (n=912) and Guinea (n=655) were used from the cross-sectional WHO’s multicountry study ‘How women are treated during facility-based childbirth’ (2016–2018). Exploratory factor analysis was conducted to develop a scale measuring interpersonal abuse. Two indexes were developed through a modified Organisation for Economic Co-operation and Development approach for generating composite indexes. Measures were evaluated for performance, validity and internal reliability.

Midwives and nurses play a vital role in protecting, promoting and supporting breastfeeding worldwide.

Universal breastfeeding has the potential to prevent 823,000 child deaths and 20,000 maternal deaths each year. Breastfeeding helps prevent childhood infections and mortality; decrease rates of obesity, diabetes, and maternal and child cancers; increase cognitive development; and decrease childhood obesity.

Key Findings

• Midwives and nurses can serve as frontline advocates for breastfeeding support in the community and in health facilities
• All midwives and nurses can protect and support breastfeeding
• A collaborative multidisciplinary approach provides the most robust set of skills to support the mother-infant dyad
• Education and clinical training ensure that mothers receive the most accurate and up to date evidence-based information
• Supportive infrastructure is essential to allow nurses and midwives to provide needed care for the mother-baby dyad
• Implementation and monitoring of policies and programs should include evaluation of breastfeeding outcomes with measurable targets
• Midwives and nurses should adhere to the International Code of Marketing of breast-milk substitutes and World Health Assembly resolutions, including refusing samples, gifts, and sponsors of any kind or display of baby food, formula, or feeding bottles from companies

Background Evidence has shown the benefits of labour companions during childbirth. Few studies have documented the relationship between the absence of labour companions and mistreatment of women during childbirth in low-income and middle-income countries using a standardised tool.

Methods We conducted a secondary analysis of the WHO multi-country study on how women are treated during childbirth, where a cross-sectional community survey was conducted with women up to 8 weeks after childbirth in Ghana, Guinea, Nigeria and Myanmar. Descriptive analysis and multivariable logistic regression were used to examine whether labour companionship was associated with various types of mistreatment.

Peripartum deaths remain significantly high in low- and middle-income countries, including Kenya. The COVID-19 pandemic has disrupted essential services, which could lead to an increase in maternal and neonatal mortality and morbidity. Furthermore, the lockdowns, curfews, and increased risk for contracting COVID-19 may affect how women access health facilities. SARS-CoV-2 is a novel coronavirus that requires a community-centered response, not just hospital-based interventions. In this prolonged health crisis, pregnant women deserve a safe and humanized birth that prioritizes the physical and emotional safety of the mother and the baby. There is an urgent need for innovative strategies to prevent the deterioration of maternal and child outcomes in an already strained health system. 

This roadmap aims to provide a framework for countries to improve quality of care for newborns, including care for small and sick newborns, and support countries to achieve the SDG target to reduce neonatal mortality to less than 12 per 1,000 lives births by 2030. It consists of 10 strategies to guide countries in developing their policies to improve the number and competencies of the health care workforce to deliver high quality essential care for small and sick newborns.

Key Messages

• Critical for universal health coverage and to meet the SDGs by 2030: Countries must invest in the health care workforce to achieve universal health coverage, meet the SDG targets, and ensure the vision of the Every Newborn Action Plan that every newborn not only survives, but thrives.
• Rights-based and family-centered: All newborns have the right to quality, evidence-based, nurturing care from health workers with the appropriate knowledge, technical skills, and behavioral skills, working in partnership with families.
• Opportunity to save lives now: Facility-based births will provide links to maternal care, ending preventable stillbirths, and extending newborn services for improved outcomes.
• Preventing disability: The focus should be on high quality care, not just reducing neonatal death. This will also help optimize neurodevelopmental outcomes.
• Promoting equity: Addressing inequity in human resources will reduce neonatal mortality and morbidity.
• Promoting high quality care and well-being: Strengthening human resources for health policies will enable countries to manage, train, recruit, and retain health workers.

This module describes a core set of indicators for Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) that can be captured through routine health management information systems (HMIS). It includes possible analyses and visualizations of the indicators, references on how to assess the quality of the data, and considerations for using the data for decision-making. By the end of this module, participants will be able to:
1. Describe the core set of HMIS indicators for routine monitoring of RMNCAH programmes;
2. Conduct basic analyses and data visualizations of these indicators to help monitor RMNCAH programmes;
3. Interpret the indicator values and their implications for RMNCAH programme management.

Increasing global rates of caesarean section are debated because of evidence that medically unnecessary caesarean sections are associated with worse outcomes for mothers and their children. There is consensus that caesarean sections are overused in some countries and underused in others. As Ties Boerma and colleagues report in this Lancet Series on optimizing caesarean section use, there are unacceptable disparities: caesarean section rates of 44% in Latin America and the Caribbean compared with 4·1% in western and central Africa. Challenges have arisen as low-income and middle-income countries attempt to rectify insufficient access to caesarean sections. The investment in workforce training and facilities to increase access to caesarean sections can bring with it a culture of surgical intervention that leads to variation within countries between the urban wealthy giving birth in private facilities where there are high rates of caesarean section and the rural poor without access to the procedure. This situation calls for country and regional specific strategies to address these inequalities.

Inadequate health-care provider performance is a major challenge to the delivery of high-quality health care in low-income and middle-income countries (LMICs). The Health Care Provider Performance Review (HCPPR) is a comprehensive systematic review of strategies to improve health-care provider performance in LMICs.

This review by Rowe and colleagues found substantial variation in the impact of strategies to improve health-care provider practice although some approaches were more consistently effective than others.

Key findings

• Training or supervision alone typically had moderate effects (10·3–15·9 percentage points), whereas combining training and supervision had somewhat larger effects (18·0–18·8 percentage points).
• Group problem solving alone (e.g. quality improvement) showed larger improvements on provider performance (28·0–37·5 percentage points).