During 2020-2022, Countdown employed a positive public health approach to understand why some countries’ maternal and newborn health improved faster that would be expected based solely on economic indicators. The selected countries were Bangladesh, Nepal, India, Ethiopia, Morocco, Niger, and Senegal.

From 2000 to 2017, the global maternal mortality ratio (MMR) declined by 38% and the global neonatal mortality rate (NMR) declined by 41%, with large variability in the pace of decline at the country level. Countries that surpassed average progress relative to their socio-economic progress were selected as exemplar countries.

Results were published on the exemplars website, in a supplement of BMJ Global Health, and in individual papers in Health Policy and Planning and The Lancet.

Cross-country 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

Zooming in and out: a holistic framework for research on maternal, late foetal and newborn survival and health

Maternal mortality, stillbirths, and neonatal mortality: a transition model based on analyses of 151 countries

Country Case Studies

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

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

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

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

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

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

Senegal: Exemplars in Global Health Senegal webpage