Maternal and newborn health: service delivery models that save lives

Maternal and newborn deaths are among the clearest signs of how well a health system works. The causes are well understood, and most deaths are preventable with timely, quality care. The challenge is delivery: getting the right services to the right women and babies at the right time.

A continuum of care

Outcomes depend on linked services across the course of pregnancy, birth and the early weeks of life:

• Antenatal care that detects and manages risks, including anaemia, hypertension and infection
• Skilled attendance at birth by a trained provider with the supplies to do the job
• Emergency obstetric and newborn care (EmONC) available around the clock for complications
• Postnatal care for mother and baby, including early newborn care and support for breastfeeding
• Family planning, which reduces risk by helping women space and time pregnancies

A weakness at any link, such as no transport to a referral facility, can undo strengths elsewhere.

What tends to make the difference

Emergency readiness. A facility offering EmONC needs trained staff on duty, working equipment, blood and essential medicines, and clear protocols. Readiness assessments identify gaps quickly.

Functional referral. Early recognition of danger signs, communication with the receiving facility and reliable transport save critical time.

Quality of care, not only access. Increasing facility births without improving quality can raise coverage while leaving outcomes unchanged. Clinical audits, mentoring and supervision help.

Reducing demand-side barriers. Cost, distance and cultural factors keep many women from care. Approaches such as vouchers, transport support and community engagement can help, provided they are well designed and monitored.

Community links. Community health workers and midwives who know local families can encourage early care-seeking and follow up after birth.

Making it measurable

Track a short set of indicators: antenatal and postnatal coverage, skilled birth attendance, facility readiness for emergency care, caesarean rates in an appropriate range, and where possible, maternal and newborn mortality and their causes.

Designing programmes that last

Programme design should reflect local realities: staffing, geography, and how women actually seek care. It should also plan for the day external support ends, by embedding services in routine budgets and supervision systems.

The knowledge exists. What decides outcomes is whether health systems can deliver it consistently, to everyone.