The World Health Organization has also set a 90/90/80/80 goal, which aims at ensuring that 90% of pregnant women receive at least 4 ANC visits; skilled health workers attend 90% of births; 80% of new mothers and babies receive post-natal care within two days of birth; and 80% of districts across countries have access to obstetric services and small and sick newborn care.
We heard about the maternal and newborn care gains eroded by the COVID-19 pandemic, reflected on the quality of maternal and newborn health, and discussed access, provision of care in stable and fragile/conflict settings, and the impacts of climate change. There was a push towards adopting a life course approach which emphasizes handling maternal, newborn, and child health (MNCH) across a continuum of the ante-natal, intra-partum and post-natal care for mature women and adolescents. Challenges highlighted included referrals and patient transportation; management of anaemia, folic acid deficiencies, and post-partum haemorrhage; availability of blood for transfusion; and providing ceasarian birth at the right time and for the right patients. The need to improve sexual and reproductive health care/family planning services, promote breastfeeding and access to human milk for newborns, and to end the silence on still births, were underscored.
Patient experiences were raised as an important quality of care element. We considered how respectful maternal and newborn care can be promoted in LMIC settings and how to incorporate mothers’ voices into discussions on respectful care. We heard about mothers’ fears concerning childbirth and stigma associated with still births and health care providers’ fears of litigation over births gone wrong. The importance of paying attention to the emotional well-being of health care workers and mothers in the perinatal period also stood out. From these discussions, there were calls to: 1) strengthen community support across pregnancy, birth, and the post-natal period; 2) improve bereavement counselling; and 3) address health worker burnout and compassion fatigue.
It is clear that to impact on these areas and achieve the desired quality of MNCH care, we will need to consider structural drivers and redesign services so that health care workers’ environments nurture positive interactions with patients, parents and wider communities. We found a session where presenters discussed organizational theory for the persistence of mistreatment in childbirth particularly useful for our work. Such sessions highlighted the importance of bridging the gap between clinical guidelines and realities, and of recognizing the complexity of health systems interventions. Other sessions underscored the importance of data in clinical decision making, and the need to consider maternal and child health from gender, justice, and human rights lenses. All of these initiatives are needed to have a hope of reducing the 4.5 million annual deaths of women and babies occurring during pregnancy, childbirth, or the first weeks after birth which equate to 1 death every 7 seconds.
It was not all about the conference! We were delighted to have a chance to visit and discuss research interests with health systems colleagues based at the University of Cape Town, and even had time to squeeze in a trip up the magnificent Table Mountains, one of the new seven wonders of the world.
As we start the journey to the next MNCH conference, the rallying call for all working towards better maternal, newborn, and child health outcomes remains, let’s aligning together, accelerate together and save lives together!