Maternal Newborn Health

During 2023-2024, Countdown collaborations in 21 sub-Saharan African countries conducted secondary data analyses related to maternal and newborn health (MNH). The research provided policymakers with up-to-date information and recommendations on:

Neonatal mortality and stillbirth rates by facility type and ownership, geographic area and socio-economic group since 2000
Birth place, attendance, and Caesarean section rates, by facility type, geographic area and socio-economic group since 2000
Total and median birth and Caesarean section volumes by facility type and ownership
Health policies and systems characteristics (e.g. financing, resources, organization of services) to support the provision of routine and emergency childbirth care
Comparison of the MNH care trends in relation to countries’ MNH-related policy and systems characteristics and stages of a maternal and newborn health transition model

Background and rationale

Good-quality obstetric and newborn care in health facilities is central to reducing maternal and neonatal deaths and stillbirths, as well as improving the future health of women and children. Institutional births have increased dramatically in sub-Saharan Africa, but maternal and neonatal mortality and stillbirth reduction has remained slower and inequitable. Solely increasing institutional delivery coverage is unlikely to reduce mortality if facilities lack basic requirements for emergency obstetric & neonatal care, have inadequate staffing, or cannot refer in emergencies. More evidence was needed to determine the best balance of childbirth care services to adequately provide life-saving, comprehensive childbirth care.

Data Sources

Analyses included national Demographic Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) between 2001-2022, as well as countries’ 2022 Health Management Information System (HMIS) data from DHIS2, maternal and newborn health related policy documents, and health systems data on financing and densities of facilities, beds and health workers.

Results:

In the 21 study countries in sub-Saharan Africa, the rise in institutional deliveries was primarily driven by lower-level facilities (such as health posts and health centrrs), especially in countries with lower coverage levels (with over 75% of the increase). Yet lower-level facilities usually had low birth volumes of less than four per week, and limited capacity to conduct Caesarean sections.
However, countries that reached higher institutional delivery coverage (over 85%) also greatly increased the proportion of hospital births, with a median of 30% to 50%. Hospitals each performed much higher volumes of births and Caesarean sections, making them more likely to ensure access to emergency care and maintain better quality.
Persistently low Caesarean section rates - below 10% - among the poorest in most countries still reflect inequitable, unmet need for comprehensive emergency care.
Most countries have established national childbirth care policies increasingly focused on equity and quality, but health system and implementation gaps remain. Contextually adapted strategies and resource allocations to optimize the density, distribution, quality and linkages to provide equitable, high quality childbirth care at subnational levels will be needed to improve women's and newborn's health in sub-Saharan Africa going forward.

Cross-country synthesis publication:

One-page briefs with study highlights:

Burkina Faso · Cameroon · Chad · Democratic Republic of Congo · Côte d’Ivoire · Ethiopia · Ghana · Guinea · Kenya · Liberia · Malawi · Mali · Mozambique · Niger · Nigeria · Rwanda · Senegal · Sierra Leone · Tanzania · Uganda · Zambia· Zimbabwe

Synthesis Reports:

Burkina Faso · Cameroon · Chad · Democratic Republic of Congo · Côte d’Ivoire Ethiopia · Ghana · Guinea · Kenya · Liberia · Malawi · Mali · Mozambique · Niger · Nigeria · Rwanda · Senegal · Sierra Leone · Tanzania · Uganda · Zambia · Zimbabwe