Maternal Newborn Health Exemplars Study Published

Seven positive outlier countries reduced maternal and newborn mortality during 2000-2020 through:

  • Increasing contact with maternity services;
  • Improving quality of those services;
  • Reducing fertility and increasing access to safe abortion; and
  • Strengthening government commitment, resources, financing, and progressive implementation and learning.

These findings from the maternal newborn health (MNH) exemplars study have been published in BMJ Global Health.  Separate papers analyze specific factors from Bangladesh, Ethiopia, Nepal, Niger and Morocco, as well as both national and subnational analysis from India. Senegal was also an MNH exemplar country, and results are available online.

The MNH studies were part of the Exemplars in Global Health project; in addition to the peer-reviewed journal articles, interactive web pages are available with results from Bangladesh, India, Senegal and Ethiopia  and will be available for the other three countries in the future.

Synthesis: Learning from success: the main drivers of the maternal and newborn health transition in seven positive-outlier countries and implications for future policies and programmes

“We found evidence that most countries made concerted efforts to address many of the issues highlighted in global strategy setting, and tried to ensure improvements in many of the health-system building blocks. A distinctive feature was that many of these countries exhibited learning health systems which enabled them to collect relevant data, reflect on them, and make adaptive improvements over time,” the study’s authors wrote.

o   The findings from this paper were presented at the International Maternal Newborn Health Conference in 2023.

Bangladesh: Effective multi-sectoral approach for rapid reduction in maternal and neonatal mortality: the exceptional case of Bangladesh

“Bangladesh’s multi-sectorial and persistent focus on maternal and newborn health, along with economic and infrastructural improvements allowed for rapid gains,” the study’s authors wrote.

Ethiopia: Learning from Ethiopia’s success in reducing maternal and neonatal mortality through a health systems lens

Ethiopia has achieved one of the fastest declines in mortality in sub-Saharan Africa, with major intervention coverage increases. “Ethiopia’s progress in coverage for MNH indicators was characterized by its major expansion in health infrastructure and health workforce, supported by multiple initiatives such as task shifting to increase surgical capacity, increasing availability of ambulances, maternity waiting homes and generating demand through community volunteers, accompanied by prorural development approaches” the study’s authors wrote.


National level: Making the health system work for over 25 million births annually: drivers of the notable decline in maternal and newborn mortality in India

India’s progress in reducing maternal and neonatal mortality since the 1990s was faster than the regional average. “Government programmes strengthened public sector services, thereby expanding the reach of these [maternal and newborn health] interventions. Simultaneously, socioeconomic and demographic shifts led to fewer high-risk births” the study’s authors wrote.

Subnational level: A tale of two exemplars: the maternal and newborn mortality transitions of two state clusters in India

This study examined progress in two state clusters: higher mortality states (HMS) with lower per capita income and lower mortality states (LMS) with higher per capita income. “India’s National (Rural) Health Mission’s financial and administrative flexibility allowed states to tailor health system reforms. HMS expanded public health resources and financial schemes, while LMS further improved care at hospitals and among the poorest.” the study’s authors wrote.

The mortality transition model used in this study is highly valuable in characterizing where states have come from and guiding further advancements in maternal and newborn survival.

Nepal: Increased utilisation and quality: a focus on inequality and a learning health system approach—explaining Nepal’s success in reducing maternal and newborn mortality 2000–2020

Nepal’s success in mortality reduction was due to adaptive, evidence-informed, and inclusive policy-making, effective implementation, and a focus on reducing inequalities. Evidence from Nepal can guide countries with similar policies to effectively implement and scale-up successful programmes and achieve results.

Niger: Challenges in reducing maternal and neonatal mortality in Niger: an in-depth case study

Niger’s progress in reducing maternal and neonatal mortality during 2000–2012 has since stalled. The initial decline in mortality was driven by “a broad strategy of expansion of access to healthcare for women and children through the construction of primary integrated health centers and community health posts, the 2006 fee exemptions policy for mothers and children and access to basic emergency obstetric and newborn care, resulting in increased coverage of maternal and newborn health services.” The author’s suggest that further reductions require strategies targeting comprehensive care, referrals, quality of care, fertility reduction, social determinants and improved security nationwide.

Morocco: Approaching the SDG targets with sustained political commitment: drivers of the notable decline in maternal and neonatal mortality in Morocco

Authors found that women’s health improved, as well as their social status, during 2000-2020 and that strong political leadership led to investments in better quality of and access to maternity care.


In addition to the papers above which were published in May 2024, the MNH exemplars study previously published a conceptual framework that was used to select factors to analyze and a mortality transitions framework that explains how countries move from higher to lower mortality burden through five phases.