What will we study?

In this project we aimed to study key factors at individual, household, community, and national levels that were key to reducing neonatal and maternal mortality in seven Exemplar countries from 2000 to 2017. We will examine the dyad of maternal and newborn health, and the interventions and implementation strategies that each country took to improve health outcomes for mothers and children.

Where are we working?

We are analyzing data from seven Exemplar countries (Bangladesh, Ethiopia, India, Morocco, Nepal, Niger, and Senegal), grouped into four regional clusters as outlined below.

Partners from Countdown to 2030, Gates Ventures, and the Bill & Melinda Gates Foundation selected the seven Exemplar countries based on their above-average reduction of both neonatal and maternal mortality from 2000 to 2017, normalized by annual growth in gross national income during this period. The performance of the selected Exemplar countries can be seen in Figures 1 and 2, showing each health outcome compared with the compound annual growth rate.

Figure 1: Neonatality mortality reduction predicted by gross national income compound annual growth rate, 2000–2017
Figure 2: Levels of country performance in reducing maternal and neonatal mortality

Country Selection

In addition, we are conducting research at the subnational level on six Indian states selected for study: Uttar Pradesh, Rajasthan, Madhya Pradesh, Odisha, Maharashtra, and Tamil Nadu. The first four are from a cluster of higher-mortality states, and the latter two are from lower-mortality states (Figure 5). State selection was also based on progress in reducing both neonatal and maternal mortality, relative to economic improvement (in this case, per-capita income).

Figure 3: Maternal and neonatal mortality rates by per-capita income in India, 2000–2015

Comparison of state-specific MMR levels in 2000 and 2018 by state per capita income

How is this research being conducted?

The research team is conducting mixed-methods research using the conceptual framework below, which summarizes the range of factors associated with reductions in maternal, late fetal, and neonatal mortality.

Qualitative research includes a literature review; analysis of health systems, policies, and programs related to maternal and newborn health; and interviews with key informants in each Exemplar country. Quantitative research includes analyses of coverage and equity (including quality-adjusted coverage analysis), mortality trends, and decomposition of the relative contribution of different drivers of reductions in neonatal mortality.

Who is leading the research?

Countdown to 2030 is leading the research, with three institutions as cross-country research partners: University of Manitoba, London School of Hygiene and Tropical Medicine, and Johns Hopkins University. In each Exemplar country, the research team is partnering with a local partner. In addition, a technical advisory group of experts is guiding the country selection and research process for this project.

Principal investigators:

  • Ties Boerma, University of Manitoba
  • Oona Campbell, London School of Hygiene and Tropical Medicine
  • Agbessi Amouzou, Johns Hopkins University

In-country partners:

  • Bangladesh: International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B)
  • Ethiopia: Ethiopian Public Health Institute
  • India: National Health System Resource Centre, Department of International Institute for Population Sciences
  • Morocco: Centre de Santé Reproductrice
  • Nepal: South Asian Institute for Policy Analysis
  • Niger: Niger National Institute of Statistics
  • Senegal: Medical Research Council Unit, The Gambia

Technical advisory group:

  • Dr. Allisyn Moran (Scientist at World Health Organization, Department of Maternal, Newborn, Child and Adolescent Health, Epidemiology, Monitoring and Evaluation team)
  • Dr. Amy Pollack (Director of Maternal, Newborn, and Child Health, Bill & Melinda Gates Foundation)
  • Dr. Ana Langer (Professor, Practice of Public Health, Coordinator of the Dean’s Special Initiative on Women and Health, Harvard University)
  • Dr. Jeremy Shiffman (Bloomberg Distinguished Professor of Global Health Policy, Johns Hopkins University)
  • Dr. Lisa Hirschhorn (Professor of Medical Social Sciences and Psychiatry and Behavioral Sciences, Northwestern University)
  • Dr. Lucy Gilson (Professor of Health Policy and Systems, University of Cape Town)
  • Dr. Peter Waiswa (Associate Professor of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences)
  • Dr. Rajesh Kumar (Professor, Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh)
  • Dr. Steve Lim (Professor of Health Metrics Sciences and Senior Director of Science and Engineering, Institute for Health Metrics and Evaluation)
  • Dr. Zulfiqar Bhutta (Co-director of the Center for Global Child Health, The Hospital for Sick Children, Toronto)