Geneva, 1 April 2015. Governments could substantially reduce the tragic death toll of infants and mothers by making postnatal care services more accessible - especially to impoverished and poorly educated women in rural areas, according to a study published in the Bulletin of the World Health Organization today.
Postnatal care for mothers and babies includes, for example, keeping them in the facility for 24 hours before discharge or visiting them as soon as possible after a home delivery; repeated assessments of mother and newborn babies allows to identify problems early and manage them promptly.
The authors of the article, based in Canada and Switzerland, analysed data from 15 low and middle-income countries and territories and found that many mothers are not using postnatal services because they are not easily accessible, too expensive, or because mothers do not know when they and their babies need them.
In Kenya, for example, fewer than 20% of women receive postnatal care services, while this proportion is 35% in the Democratic Republic of the Congo.
"A large burden of maternal and infant deaths take place during the 42 days following delivery, yet access to postnatal care services is unacceptably low," said lead author Dr Etienne V. Langlois from the Alliance for Health Policy and Systems Research, a partnership hosted by the World Health Organization (WHO) in Geneva.
The study is the first systematic review - one that analyses all the available evidence on the topic - to look at why postnatal services are under-utilized.
"Another problem, our study identified, is that postnatal care services are not equitably distributed in low- and middle-income countries - where the vast majority (99%) of maternal and neonatal deaths occur," Langlois said, adding: "So women of low socioeconomic status with little education living in rural or remote areas have little or no access to these life-saving services".
The consequences can be devastating.
Many of the estimated annual 289 000 deaths of mothers and 2.9 million deaths of their newborns could be prevented by increasing access to postnatal care services.
Government and other health policy-makers should acknowledge the importance of providing postnatal care check-ups for mothers and babies, invest more and seek to increase access to postnatal care services, for example, by reducing user fees at point of care, Langlois said.
The study highlights - as one of the solutions - community-based outreach programmes for poor young women, educating them about reproductive health and explaining to them when to seek postnatal care.
"A good way for many governments to start would be to adapt WHO's recommendations on postnatal care to their specific local circumstances," said Dr Severin von Xylander from the team that developed WHO guidelines on postnatal visits and postnatal care during the six weeks after birth.
"Decision-makers should develop health promotion programmes to educate families and communities about the importance of using postnatal care services, for instance upon noticing dangers signs in newborns, such as convulsions or problems with feeding," von Xylander said.
Millennium Development Goals 4 and 5 are devoted to improving child and maternal health, but progress has been uneven and not all countries are on target to achieve them.
Last year, WHO's 194 Member States endorsed the Every Newborn Action Plan that includes objectives to reach every woman and every newborn and reduce inequities, as well as improve the quality of maternal and newborn care. This plan calls for particular attention to the care around the time of birth, for the mother and the child, including the first week of postnatal care to end preventable maternal and newborn deaths and stillbirths.
The 15 countries and territories analysed in the study are: Bangladesh, Belize, Brazil, China, the Democratic Republic of the Congo, India, Indonesia, Jordan, Lebanon, Myanmar, Namibia, Nepal, Nigeria, Pakistan and Palestine.
The main mission of the Alliance for Health Policy and Systems Research is to promote the generation and use of policy-relevant knowledge as a means to improve the health systems of low- and middle-income countries.
"Evidence on the coverage of postnatal care services and other maternal and child health services is crucial to inform policies and health systems decisions addressing unmet needs in low- and middle-income countries," Langlois explained.