At-home births are usually administered by poorly trained and poorly equipped traditional birth attendants. There is a widespread lack of skilled birth attendants.
Maternal and neonatal mortality are caused by multiple independent medical conditions, which result in 287,000 and 3.1 million deaths, respectively, every year. The vast majority of these deaths, 99% in the case of maternal deaths, occur in developing countries.
Three main conditions—preterm birth complications, infections, and birth asphyxia, which represent 35%, 24%, and 23% of mortality respectively, are together responsible for 82% of all neonatal mortality. Maternal mortality is caused by six major conditions—hemorrhage, hypertensive disorders, unsafe abortion, sepsis, indirect causes and other direct causes. Hemorrhage and hypertensive disorders are the largest causes of mortality, accounting for 35% and 18% of mortality respectively. Underlying all of these conditions are three broad challenges—most births take place at home without skilled birth attendants, most mothers do not receive sufficient antenatal care, and many mothers are malnourished.
[Here’s a video summary of Maternal and Neonatal Health in developing regions, including an analysis of how a hospital and a clinic in Kenya are improving healthcare for women and children.]
Most births in developing countries take place at home, administered by untrained health workers
More than half the childbirths in developing countries take place at home, with the assistance of traditional birth attendants who have limited or no formal training. This frequency of home
Most births in developing countries take place at home, administered by untrained health workers
More than half the childbirths in developing countries take place at home, with the assistance of traditional birth attendants, who have limited or no formal training. This frequency of home birth is particularly high for the poor in Sub-Saharan Africa and South Asia. However, there is an increasing trend towards more facility births. Some countries, like India, have seen dramatic changes within a few years after the government started providing cash incentives to women opting for facility births.
Expectant mothers do not receive antenatal care and are often malnourished
Across the largest countries in Sub-Saharan Africa and South Asia, 71% of women receive at least one antenatal care visit, but only 37% receive the WHO recommended 4+ antenatal visits. This indicates critical missed
Expectant mothers do not receive antenatal care and are often malnourished
Across the largest countries in Sub-Saharan Africa and South Asia, 71% of women receive at least one antenatal care visit, but only 37% receive the WHO recommended 4+ antenatal visits. This indicates critical missed opportunities to identify risk factors, provide treatment for basic conditions, provide nutritional supplements, and educate mothers on what they can do to improve their own health and the health of their children. Rates of malnutrition amongst women in developing countries are high. It is estimated that nearly half of pregnant women in developing countries have anemia, and a significant number are stunted or undernourished, which can lead to delivery complications and preterm births.
Maternal mortality is driven by multiple conditions
Maternal mortality and morbidity is driven by fewer than 10 medical conditions. While maternal mortality has many underlying causes, approximately half of the 287,000 maternal deaths are caused by post-partum
Maternal mortality is driven by multiple conditions
Maternal mortality and morbidity is driven by fewer than 10 medical conditions. While maternal mortality has many underlying causes, approximately half of the 287,000 maternal deaths are caused by post-partum hemorrhage (PPH) and hypertensive disorders of pregnancy. Other conditions that cause maternal mortality in developing countries are unsafe abortion (9%), sepsis (8%), and indirect causes such as HIV and malaria. Each of these causes of maternal mortality have different clinical needs. Post-Partum Hemorrhage, characterized by excessive blood loss following childbirth, is the largest cause of maternal mortality, accounting for 35% of all maternal deaths. The primary cause of PPH is uterine atony, which occurs when the uterus does not contract and help stop post-partum bleeding. PPH can also be caused by abruption, retained placental tissue, coagulation abnormalities, and other factors. Hypertensive disorders of pregnancy constitute the second leading cause of maternal mortality—18% of deaths—and are a range of complications linked to high blood pressure. The major hypertensive conditions are preeclampsia, when a pregnant woman develops high blood pressure and protein in the urine after the 20th week of pregnancy, and eclampsia, which is characterized by seizures.
Three conditions are responsible for 82% of neonatal mortality
Neonatal conditions are the single largest cause of disease burden in developing countries, responsible for 202 million DALYs and 3.1 million global deaths each year. The following three conditions are responsible for
Three conditions are responsible for 82% of neonatal mortality
Neonatal conditions are the single largest cause of disease burden in developing countries, responsible for 202 million DALYs and 3.1 million global deaths each year. The following three conditions are responsible for 82% of neonatal mortality.
Preterm birth complications: Births are considered preterm when the infant has completed fewer than 37 weeks of gestation. Preterm infants are vulnerable to conditions like respiratory distress, difficulty feeding orally, hypothermia, and infection (most commonly sepsis and pneumonia). The causes of premature birth are not well understood, even in developed countries.
Infection: Major infections including pneumonia, sepsis and meningitis, are the second leading cause of neonatal mortality. The leading cause of neonatal infection is exposure to bacteria immediately before or during delivery. This occurs primarily when bacteria ascend from the birth canal during prolonged rupture of membranes and are aspirated by the infant. Infants can also be exposed to pathogens during birth due to unhygienic delivery practices.
Birth asphyxia: It is defined as the inability to establish breathing at birth and is referred to in some studies as intrapartum-related events or complications or neonatal encephalopathy. During birth, blood flow to the placenta is disrupted by contractions, which does not present a problem when the mother and fetus are healthy and labor progresses normally. Various conditions such as severe anemia and prolonged labor can exacerbate this disruption of blood and oxygen flow, leading to insufficient oxygen reaching the fetus and causing brain damage and death.
The challenges in maternal and neonatal health are systemic: there are too few adequately equipped clinics, too few adequately trained clinicians, and little regulation. This broad lack of access to basic care leads to a number of essential issues. It is also important to note that cultural barriers in many communities compel women to rely exclusively on informal, at-home care. As a result, even when adequate clinics exist, the demand for them isn’t guaranteed.
At-home births are usually administered by poorly trained and poorly equipped traditional birth attendants. There is a widespread lack of skilled birth attendants.
In low resource settings, even where facilities are available, they tend to be overburdened and poorly equipped, lacking reliable electricity, lighting, necessary equipment, and access to clean water and sanitation.
Proper care during pregnancy is essential to protect the mother and child from a spate of deadly diseases and conditions. Only 55% of mothers in developing countries receive the WHO recommended 4+ antenatal care visits, and this number is even lower in large countries in Sub-Saharan Africa and South Asia.
Poor nutrition prior to the pregnancy itself can also affect maternal and neonatal health. Stunting in girls, occurring as early as the first two years of life, for example, increases the risk of preterm delivery and PPH later in life.
Maternal and neonatal mortality, and morbidity is driven by fewer than ten conditions, the majority of which are treatable. Medical equipment in particular needs significant technological innovation and cost reduction to reach low-income populations, especially in rural areas. Interventions need to be targeted at bringing adequate care and treatment in an integrated, rather than condition specific manner.
While a number of reduced cost devices have been released over the past several years, and new devices continue to enter the market, broad deployment has not been achieved. These newer cheaper devices are still unaffordable for developing countries. Every device has its own power consumption needs and low resource facilities have limited power. Additionally, the market for procuring low cost devices is limited and fragmented forcing facilities and governments to source necessary devices and their services from multiple vendors, adding to cost and complexity. Standardization of medical devices to a single, off-grid energy platform will help promote the introduction of new devices. Even more beneficial would be the integration of devices, which utilize the same energy platform, information communication technology (ICT) infrastructure, and could be procured and serviced by single suppliers. The ideal low cost and off-grid devices required to fully equip facilities to provide basic antenatal care, basic emergency obstetric care, and intensive care for neonates, are: Even if the devices are successfully developed for at-scale distribution, broad deployment will depend on other important factors like financing, training, infrastructure, and service models for maintenance. The projected time to market readiness is 2-6 years, and the difficulty of deployment is CHALLENGING.
