Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health

A global review of the key interventions related to reproductive, maternal, newborn and child Health

Executive Summary

Why reproductive, maternal, newborn and child health?

Poor maternal, newborn and child health remains a significant problem in developing countries. Worldwide, 358 000 women die during pregnancy and childbirth every year and an estimated 7.6 million children die under the age of five. The majority of maternal deaths occur during or immediately after childbirth. The common medical causes for maternal death include bleeding, high blood pressure, prolonged and obstructed labour, infections and unsafe abortions. A child’s risk of dying is highest during the first 28 days of life when about 40% of under-five deaths take place, translating into three million deaths. Up to one half of all newborn deaths occur within the first 24 hours of life and 75% occur in the first week. Globally, the main causes of neonatal death are preterm birth, severe infections and asphyxia. Children in low-income countries are nearly 18 times more likely to die before the age of five than children in high-income countries.

Good maternal health and nutrition are important contributors to child survival. The lack of essential interventions to address these and other health conditions often contribute to indices of neonatal morbidity and mortality (including stillbirths, neonatal deaths and other adverse clinical outcomes).

The highest maternal, neonatal and under-five mortality rates are in sub-Saharan Africa and in Southern Asia. Although substantial progress has been made towards achieving the Millennium Development Goals (MDGs) 4 and 5, the rates of decline in maternal, newborn and under-five mortality remain insufficient to achieve these goals by 2015. Interventions and strategies for improving reproductive, maternal, newborn and child health and survival are closely related and must be provided through a continuum of care approach. When linked together and included as integrated programmes, these interventions can lower costs, promote greater efficiencies and reduce duplication of resources. However, few efforts have been made to identify synergies and integrate these interventions across the continuum of care. Despite the existing plethora of knowledge, there is a lack of consensus on how best to move forward in a coordinated manner so as to achieve progress towards the MDGs. Furthermore, consensus is also needed on the level of evidence.

The foremost aim of this global review is to compile existing evidence on the impact of different interventions on the main causes of maternal, newborn and child deaths. The specific objectives of this review were to serve as a first step towards:

• Developing consensus on the content of RMNCH packages of interventions at each level of the health system across the continuum of care.
• Facilitating the scaling-up of these interventions.
• Identifying research gaps in the content of core packages of interventions.

Policy and regulatory environment

Policy and regulations are crucial to the implementation of any interventions. The recommended list of interventions should be reviewed in light of the existing national policy and regulatory environment. All interventions provided should comply with the laws and policies of the country. When required, these laws and policies may be reviewed and updated to ensure that priority life saving interventions are delivered.