Neonatal and Maternal Mortality
Maternal mortality is typically defined as the number of maternal deaths, defined as the annual number of deaths from any cause related to pregnancy, during pregnancy and childbirth, or within 42 days of termination of pregnancy, for every 100,000 live births.5 As of 2020, the global maternal mortality ratio was 152 deaths per 100,000 live births6 (the ratio is over 1,000 deaths per 100,000 live births in some nations).1
Most maternal and neonatal deaths occur during the intrapartum period (i.e., from the onset of labor to delivery of the placenta) or within 24 hours after delivery (see Figure 1). Given that the highest concentration of risk occurs around that time, a “dyad approach”—a course of care that consciously accounts for the integrated well-being of mother and child—is critical to reduce maternal and neonatal mortality, as well as the incidence of stillbirth.
Although good data on causes of death are still lacking in many countries, the big picture is clear: the main causes of maternal mortality in the most heavily afflicted countries include postpartum hemorrhage, hypertensive disorders, sepsis, abortion, and indirect causes such as embolisms.2 The leading causes of newborn death are prematurity, birth asphyxia, and neonatal infections.11 The primary causes of death in the first week of a newborn’s life are due to preterm birth and issues—notably asphyxia—arising during labor and delivery. Infectious diseases account for more infant deaths between 7 and 28 days of age.
In countries with higher rates of stillbirth (above 25 per 1,000 births), about half of stillbirths are due to antepartum causes and half due to intra-partum causes. As stillbirth rates decrease, a larger proportion of the remaining stillbirths are due to antepartum causes.
While substantial progress has been made toward reducing maternal mortality, neonatal mortality, and stillbirths, significant work is still required to reach the 2030 Sustainable Development Goals (SDGs). The SDG target for maternal mortality is 70 deaths per 100,000 live births globally, while at the country level, the 2030 goal for neonatal mortality is 12 deaths per 1,000 live births. The 2030 country target of the UN Every Newborn Action plan for stillbirths is 12 per 1,000 births.
Global progress has been made toward reducing maternal and neonatal mortality in the past few decades. Indeed, between 1990 and 2020 the maternal mortality ratio decreased from 244 to 152 deaths per 100,000 live births.6 Neonatal mortality decreased by over 50 percent between 1990 and 2017, declining from 37 to 18 deaths per 1,000 live births.10 And from 2000 to 2019, stillbirths declined from 21 to 13.9 per 1,000 live births.12
However, significant geographical disparities remain, with drastically higher rates of maternal mortality in low-income countries (462 per 100,000 live births) than in high-income countries (11 per 100,000 live births).2 The differences are equally stark for neonatal mortality, with rates of 48 deaths per 1,000 live births in low-income countries and just 4 deaths per 1,000 live births in high-income countries.13
To reduce maternal mortality, neonatal mortality, and stillbirths, emergent findings suggest that we focus on three specific objectives: reducing the fertility rate, improving service delivery, and broadening access to care.
Family planning efforts are essential to reducing neonatal and maternal mortality. Efforts to reduce fertility rates can have a significant impact on reducing maternal and neonatal mortality, primarily by decreasing the number of high-risk births, increasing birth spacing, and delaying the mother’s age at first birth.
Secondly, there are many approaches to improve service delivery, including expanding the health infrastructure which enables more women to give birth safely in well-equipped health facilities. Other approaches include expanding the number of skilled birth attendants (doctors, nurses, and midwives) and bolster the training and availability of community health workers who can provide basic care and build awareness of maternal health and neonatal health issues, especially in underserved rural areas.
Lastly, it is critical to remove barriers to women seeking care, while also creating demand for this care in the first place. Health insurance programs and vouchers covering the cost of transportation to facilities can help reduce these barriers to accessing care, while monetary incentives for in-facility births provide a positive incentive for care-seeking.
In addition, governments can invest in referral systems, both in terms of transportation infrastructure (such as ambulances) and communications networks. This will prevent primary points of care from being overwhelmed and ensure that there is timely access to specialized care when needed.
The conceptual framework below shows more detail on the distal, intermediate, and proximate factors that drive reductions in neonatal and maternal mortality. Given that most maternal deaths occur during or shortly after delivery, this framework focuses on the dyad of the mother and newborn, and the factors that contribute to improved health outcomes for both.
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United Nations Children’s Fund. Maternal and newborn health. Accessed April 19, 2022. https://www.unicef.org/health/maternal-and-newborn-health
World Health Organization. Maternal mortality. Accessed April 19, 2022. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
World Health Organization. Newborn mortality. Accessed April 19, 2022. https://www.who.int/news-room/fact-sheets/detail/levels-and-trends-in-child-mortality-report-2021
World Health Organization, United Nations Children’s Fund, United Nations Population Fund (UNFPA), World Bank Group, and the United Nations Population Division. Trends in Maternal Mortality: 1990 to 2015. UNFPA; 2015. Accessed April 19, 2022. https://www.unfpa.org/publications/trends-maternal-mortality-1990-2015
World Health Organization. Maternal mortality ratio. Accessed April 19, 2022. https://www.who.int/data/gho/indicator-metadata-registry/imr-details/26
Bill & Melinda Gates Foundation. Maternal mortality – 2021 Goalkeepers Report. Accessed April 19, 2022. https://www.gatesfoundation.org/goalkeepers/report/2021-report/progress-indicators/maternal-mortality/
World Health Organization. Neonatal mortality rate. Accessed April 19, 2022. https://www.who.int/data/gho/indicator-metadata-registry/imr-details/67
United Nations Children’s FundUNICEF. Neonatal mMortality . Accessed April 19, 2022source page. https://data.unicef.org/topic/child-survival/neonatal-mortality/
World Health Organization. Stillbirth. Accessed April 19, 2022. https://www.who.int/health-topics/stillbirth#tab=tab_1
Hug L, You D, Blencowe H, et al. Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment. The Lancet. 2021; 398(10302):P772-785. https://doi.org/10.1016/s0140-6736(21)01112-0
United Nations Children’s Fund. Ending Preventable Newborn Deaths and Stillbirths by 2030. New York: UNICEF; 2020. https://www.unicef.org/reports/ending-preventable-newborn-deaths-stillbirths-quality-health-coverage-2020-2025
United Nations Children’s Fund. Stillbirths. Accessed April 19, 2022. https://data.unicef.org/topic/child-survival/stillbirths/
United Nations Children’s Fund (UNICEF). Levels and Trends in Child Mortality: Report 2019. New York: UNICEF; 2019. Accessed April 19, 2022. https://www.unicef.org/media/60561/file/UN-IGME-child-mortality-report-2019.pdf