A new horizon of improving maternal and newborn health

© Andres Rodriguez / Fotolia

Improving the well-being of mothers and children is an important public health goal across the globe. Their well-being determines the health of the next generation and can help predict future public health challenges for families, communities, and the health care system.

This Reproductive Health Supplement derives from presentations at the ‘2nd International Conference on Maternal and Newborn Health – Translating Research Evidence to Practice’ celebrating the work of the Jawaharlal Nehru Medical College (JNMC) Women’s and Children’s Health Research Unit (WCHRU) of the Karnataka Lingayat Education (KLE) Academy of Higher Education and Research Deemed-to-be-University, Belagavi, India and its collaborators over the last 18 years.

The outcomes of the research carried out by the WCHRU have influenced public health policy, both nationally and globally, and have received international acclaim.

The outcomes of the research carried out by the WCHRU have influenced public health policy, both nationally and globally, and have received international acclaim.

The conference highlighted the efforts undertaken through quality research and advocacy related to improving maternal and child health, not only in India but in low resource settings worldwide. The primary focus was to engage various stakeholders to share completed and ongoing research and to develop a roadmap for programmatic implementation.

Ensuring that all pregnant women seek and receive timely and appropriate skilled attendance at the time of delivery at an institution equipped to deal with complications is a key element of safe motherhood. Improving maternal, perinatal and neonatal survival depends on an effective health system across all levels of care.

Evaluating the current research evidence for programmatic scale up and identifying newer and cost effective strategies for improving maternal and newborn health outcomes is the need of the hour. Here we share some of the strategies that were discussed.

Prevention of bleeding after childbirth

Nearly a third of pregnancy-related deaths in low resource settings are associated with obstetric hemorrhage. Most of these deaths occur because of failure of uterine contraction immediately after birth. The use of uterotonics administered immediately after birth is a recognized intervention for reducing bleeding after childbirth.

Oxytocin and Misoprostol have been advocated as uterotonics of choice in facility and community settings lacking refrigeration respectively. However, the search is on for an ideal uterotonic that has the same effectiveness as Oxytocin but that doesn’t require cold chain supply and storage. The conference discussed a recently completed WHO sponsored trial of Heat Stable Carbetocin for prevention of blood loss after childbirth.

Strategies for improving maternal and infant nutrition

Poor nutrition during pregnancy is a significant contributor to maternal morbidity and a leading cause of childhood illnesses and deaths worldwide. There is a need to address the issue of sub-optimal nutrition, from prior to conception, among mothers to improve newborn and infant outcomes. While current approaches advocate nutritional supplementation during pregnancy, deficiency pre-pregnancy still requires attention.

Reducing neonatal deaths and disability from preterm birth

The risk of preterm birth is highest in low resource settings where an estimated 12% of births are preterm compared to 5-7% in high resource settings.

Preterm delivery remains the major cause of neonatal deaths and illnesses throughout the world directly contributing to 28% of deaths within the first seven days of life. Moreover it is responsible for up to 50% of pediatric neurodevelopmental disorders.

The risk of preterm birth is highest in low resource settings where an estimated 12% of births are preterm compared to 5-7% in high resource settings. Because of the tremendous medical, financial and emotional burden of preterm birth in the developing world, interventions aimed at reducing the rate of preterm birth deserve consideration.

Reducing deaths and disability from hypertensive disorders of pregnancy

Hypertensive Disorders of Pregnancy (HDP) is a constellation of disorders which remain a major health issue for women and their infants. Appropriate prenatal care, with timely monitoring of the women and for signs of preeclampsia and then referral to the appropriate care, has reduced the number and extent of poor outcomes.

However, serious maternal-fetal morbidity and mortality still occur. Thus effective strategies and interventions for prevention and control of pre-eclampsia are the need of the hour.

About this Supplement

The supplement presents a summary of research performed by the KLE – JNMC WCHRU group and its collaborators. Together the manuscripts of this supplement represent a body of research informing interventions to reduce maternal, fetal and newborn mortality. It illustrates what a dedicated research group together with institutional support can accomplish.