When a mother dies in a village in Malawi, one of the world's poorest countries, community members sit down with the health workers to analyse the events leading up to her death, said Tesfaye Shiferaw, UNICEF's regional advisor on child survival and development. "Then they try to fix it."
Performing "maternal death audits" and other non-medical postnatal care activities, such as home visits by community health workers, during the first seven days after the birth of an infant is saving the lives of newborns and mothers in developing countries, he told IRIN at the release of the annual report of UNICEF, the UN Children's Agency.
Saving mothers is critical. Babies whose mothers die in the first six weeks of their lives are far more likely to die in the first two years of life than those whose mothers survive, the report said. A study in Afghanistan found that about three-quarters of infants born to mothers who died, also subsequently died.
Other developing countries have begun to adopt these measures and best practices to bring down the number of newborn and maternal deaths. Postnatal care is a major gap in almost all such countries and is the time of most newborn and maternal deaths, said Joy Lawn, senior research and policy advisor with Save the Children-US, who contributed to the UNICEF report.
She said data from Bangladesh showed that a home visit on the first and or second day after birth could reduce neonatal deaths by two-thirds. The first seven days of life was also "the critical period for initiating high-impact life-saving behaviours, including exclusive breastfeeding."
Merely getting babies on to exclusive breastfeeding immediately could save the lives of 30 percent of newborns Shiferaw said.
Nearly four million newborns die every year – three quarters of these deaths take place within one week of birth, and one to two million babies die during the first day after birth, according Lawn. Simple measures like exclusive breastfeeding and keeping the baby warm could save almost half those lives.
At least half a million women die every year as a result of pregnancy or childbirth complications. "More than 99 percent of these deaths occurred in developing countries – the vast majority in Africa and Asia," said Ann Veneman, executive director of UNICEF. "On average, each day around 1,500 women die from complications related to pregnancy and childbirth."
|Highest neonatal mortality rates|
(deaths per 1,000 live births)
|Cote d'Ivoire 64|
|iSierra Leone 56|
The average lifetime risk of a woman in a least-developed country dying from complications related to pregnancy or childbirth is more than 300 times greater than for a woman living in an industrialised country, according to UNICEF. No other mortality rate is so unequal.
Around 70,000 of these deaths are among girls and young women aged 15 to 19. Around 99 percent of maternal deaths take place in the developing world, where having a child is still among the most serious health risks to women.
At least 21 percent of maternal deaths take place in just three countries: Democratic Republic of Congo, Ethiopia and Nigeria. In Niger, West Africa, which has the highest lifetime risk of maternal mortality worldwide, 1 in 7 women die from complications related to pregnancy or giving birth.
A significant portion of the deaths result from bleeding after delivery, and these lives could also be saved simply by a community member checking up on the mother, said experts. "In most cases, women are discharged after delivery - no one follows up the woman to her home to see if she is okay," said Lawn.
"For babies and mothers facing such complications as neonatal sepsis or postpartum haemorrhage, delay of even a few hours before appropriate care is delivered can be fatal, or result in long-term injuries or disability."
The community health worker in Malawi follows up on the mother before and after a delivery, and is in constant touch with the clinic should complications develop. "It's just a matter of good management of scarce resources and innovation," said Lawn.
Ethiopia, a drought-stricken country in the Horn of Africa with one of the highest maternal death rates in the world, now also trains community health workers. It still has a long way to go, as only six percent of births are attended by skilled healthcare workers, according to Veneman.
Kenya and India offer cash incentives to mothers to attend antenatal clinics, while UNICEF assisted in training community workers in Malawi, who are now on the government's payroll.
Lawn said investment in midwife training was required, especially in countries with low health coverage and facility care at birth.
|Highest lifetime risk of maternal death|
|Niger 1 in 7|
|Afghanistan 1 in 8|
|Sierra Leone 1 in 8|
|Chad 1 in 11|
|Angola 1 in 12|
|Liberia 1 in 12|
|Somalia 1 in 12|
But Shiferaw argued that if countries could not afford health workers, they could provide basic training to family or ordinary community members. "Just simple tips like wrapping the baby up as soon as it is born, and clearing the nostril to ensure it's breathing, does not require a great amount of investment."
Another health expert attending the launch of UNICEF's report commented that it was just a matter of political will.
Developing countries do not have far to look. Prioritising investment in postnatal care has achieved dramatic results in Sri Lanka, where an ongoing civil war is being fought, said Shiferaw.
The country scaled up health services for mothers and infants and has managed to halve its maternal mortality rate every six to 11 years by adopting sound strategies, allocating sufficient resources, and making a political commitment to improving the health of mothers and children.
More than 98 percent of births in Sri Lanka take place in hospitals with a skilled nurse, midwife or doctor in attendance, and 99 percent of pregnant women make use of antenatal care services.
The successes are not the result of medical interventions alone; efforts to empower women through education and employment have also played a significant role in lowering maternal and newborn death rates, according to UNICEF.
Other countries have begun to take notice. Between 1995 and 2005, skilled birth attendant coverage increased from 54 percent to 62 percent in the developing world, while antenatal care rose from 60 percent to 75 percent, said Veneman.
"Yet, around 50 million births in the developing world, or about 40 percent of all births, remain without skilled health personnel."