Over the past decade, experts in newborn and child health have demonstrated conclusively the incredible impact of community-based health care, care that is provided through frontline workers in people’s homes and in first-level health clinics, on the health and survival of newborns and children in our poorest countries. Frontline health worker programs, which aim to improve the capabilities and performance of the workers who are the first point of contact for families with the health care system, have sprung up in a number of countries with an aim to reach children with these community-based services.
This is great news. However, when it comes to the impact of frontline health workers like community health workers on maternal health in these same regions of the world, we haven’t seen the same positive trend. A focus on training programs for traditional birth attendants, for example, hasn’t resulted in a decrease of maternal mortality.
Maternal health experts have shifted attention to ensuring the presence of skilled care at health facilities. This makes sense when it comes to ensuring all women have access to skilled care during childbirth and for life-threatening emergencies – care that all women deserve.
However, the pendulum may have swung too far away from community-based care as the role of care in the community for women has been relatively neglected in maternal health programming.
There is a conflict within maternal and child health programs, in part because of this difference in research and program priorities. This “gap” has also contributed to a lack of innovation in identifying shared solutions to common goals for maternal and child health.
Maternal health programs often fail to integrate with programs for delivering care to children and then to measure the impact on both newborn and child health outcomes as well as maternal health outcomes. Similarly, child health programs often fail to integrate maternal health care into their plans.
There is reason to be hopeful, however.
In the Shivgarh community of Uttar Pradesh, India, the Gates Foundation supported a community-based program centered on promoting preventive newborn care by empowering families and communities. Though the program did not focus on maternal health, what we found was fascinating and pushed us to delve deeper into the connections between maternal and newborn/child health care.
We know that key newborn care practices such as wiping the baby dry after delivery, immediate breastfeeding, and keeping the baby close to the skin play critical roles in saving newborn lives. In fact, as we’ve reported, these simple practices cut neonatal mortality in half over a 16-month period of time, in Shivgarh.
The program did not focus on maternal care, but we recognized that many of the risk factors for newborn death also posed a threat to mothers, and many interventions for newborns could also improve maternal health, such as being adequately prepared for childbirth, ensuring a clean delivery (e.g., hand-washing) and early home visitation by a community health worker.
What is perhaps most amazing about the program is that although it was focused on newborns, mothers utilized the information provided to them and the access afforded to frontline healthcare providers (e.g., nurse midwives) through household visits and community meetings for their own health benefits.
The newborn health program stirred a latent demand among mothers in Shivgarh for maternal health services, despite being in an environment with very few resources.
This study adds new evidence to suggest that community-based strategies in some of the poorest regions of the world, where health care services may be few and far between, focused on prevention and care-seeking have important, and under-appreciated potential to improve the health of women.
We need to learn more about the ways in which maternal health may be improved through community-based programs geared towards newborn health and how newborns may also benefit from care for mothers. If programs such as on the one in Shivgarh, India are any indication, the integration of maternal and child health programs may be even more beneficial than we could have imagined.