Assessing the global status of maternal and neonatal health in 2020 presents a varied, albeit alarming, view of the lives of mothers and newborns around the world. Malnutrition in children and pregnant women, and high mortality rates for newborns and mothers, continue to impact certain regions of the world disproportionately. The socioeconomic strain of the COVID-19 pandemic, moreover, has caused upticks in adult and child malnutrition, leading experts to predict a rise in maternal and neonatal mortality this year.
Newborn deaths this year, for instance, still make up the largest proportion of child deaths under the age of five. The WHO estimates that 7,000 newborns die every day, a sum equal to 47 percent of all child deaths under five years old-- an increase from 40 percent in 1990. This neonatal mortality burden continues to fall most heavily in Sub-Saharan Africa, followed by Central and South Asia. Indeed, a South Asian or Sub-Saharan African child is 10 times more likely to die in its first month of life than a child born in a high income country.
As for mothers, the most recent estimates indicate that on an average day, 810 women die due to preventable pregnancy-related causes. While this figure in fact reflects substantial progress on the global scale, the global maternal mortality ratio (MMR) having fallen by 38 percent between 2000 and 2017 (or 2.9 percent each year), it masks the high degree of regional variation in the data.
As with newborns, the majority of maternal deaths occur in Africa, which bore two-thirds of the share of global maternal deaths in 2017.A number of countries and regions by contrast, have made remarkable progress despite resource scarcity. Zambia for instance, experienced a decline in maternal mortality of over 50 percent in 25 years (1990-2015), largely through prioritizing dedicated national programmes for maternal health.South Asia as a whole, where almost one-fifth of maternal deaths take place, has had the greatest overall reduction in maternal deaths, with a decline of nearly 60 percent between 2000 and 2017. India and the Maldives in particular, have had groundbreaking success as a result of rapidly increasing the number of births attended by skilled health staff, and other effective government policies. India’s present MMR is in fact below the SDG target, after having managed to reduce its MMR by 77 percent between 1990 and 2015, while the Maldives reduced its MMR by 90 percent during the same time period.
The continuing threat posed by malnutrition is part of the reason for the persistence of high rates of maternal and neonatal mortality. For children under the age of five, around 45 percent of deaths are tied to malnutrition, and nearly one out of 4 children are stunted.An additional 49.5 million children (7.3 percent), mostly in Sub-Saharan Africa and South Asia, experience wasting - a form of severe weight loss. Even so, the prevalence of malnutrition is highly concentrated in relatively few regions, with more than half of the world’s stunted children residing in Asia. The Caribbean, and Eastern and Central Asia meanwhile, have had the largest rates of reduction in stunting prevalence, and are in fact on track to achieve 2025 and 2030 stunting targets.
For pregnant women, malnutrition may also be a particularly severe issue this year.According to the World Food Programme, the number of people facing food insecurity in low-to-middle income countries (LMICs) will almost double to 265 million by the end of 2020. This will undoubtedly impact the number of women dying in childbirth, as women with inadequate stores of iron and other micronutrients are more likely to face fatal infections and bleeding during delivery. Indeed, the World Health Organization (WHO) already estimates that 40 percent of pregnant women are anaemic.
This prevalence of malnutrition moreover, is highly correlated with income. High income regions, such as North America, Europe and Central Asia, have the lowest incidence of anaemia in pregnant women, while rates remain high in South Asia and Sub-Saharan Africa; reaching over 60% in certain countries. For low-resource countries, the Maldives could be used as an example of how to go about addressing maternal malnutrition. With only a minimal growth in national incomes (2%), the country managed to implement a program where all women receive pregnancy supplements at antenatal appointments -- leading to a 25 percent decrease in the share of reproductive-age women with anaemia over the span of twenty years.
As long as routine healthcare continues to be disrupted due to COVID-19, countries will have to double down on maternal and neonatal healthcare provision. According to a recent study, 118 low and middle income countries could experience an almost 5-time increase in under five deaths per month (9.8 percent to 44.8 percent), and an 8.3 to 38.6 percent rise in maternal deaths in only six months. As with the provision of COVID-19 related care, emulating the successes of different countries with regards to maternal and neonatal health will likely become a necessity.
Now as a next step, we ask what could be done to lower the costs of the implementation of the E-MOTIVE bundle? The most obvious answer is to consider displacing the tens of thousands of disposable plastic drapes with a purpose-built reusable device.
Fortunately one of the obstetricians involved in the E-MOTIVE study, Dr. Justus Hofmeyr, had been innovating around this very issue, designing a tray with wells that could fit under a woman’s buttocks, collect and accurately measure the. blood. This tray, theMaternaWellTraywas conceived as a device that could be sterilized and reused, and is manufactured in South Africa by Umoya.
The Pumani bubbleCPAP was designed to meet this need for Malawi and is now widely available through Maternova. We had a few questions about post-research phases of the Pumani bubbleCPAP which we posed to Jocelyn Brown, inventor of the Pumani bubbleCPAP, and Molly McCabe, Director of Product Management.