Maternal and newborn health (UNICEF)

© UNICEF/NYHQ2009-2274/Holt

A pregnant woman is examined in Ethiopia. Across ESAR, progress in reducing maternal and newborn deaths is insufficient due to factors such as poor health infrastructure, low service delivery, and a lack of qualified health workers.

Maternal health

Across Eastern and Southern Africa, women are still dying unnecessarily in the most basic and natural act of giving life. In 2010, close to 58,000 women [1] lost their lives during pregnancy and childbirth, accounting for more than one fifth of all such deaths in the world.

Of the region’s 21 countries, 16 have high maternal mortality rates (300 or more maternal deaths per 100,000 live births). In Somalia, a woman’s lifetime risk of dying from maternal causes is 1 in 16, a close second to Chad’s 1 in 15 – the highest in the world. 

Thanks to national and international efforts, the past two decades have witnessed a worldwide downward trend in maternal deaths. In ESA, between 1990 and 2010 maternal mortality has fallen from 740 to 410 deaths per 100,000 births. However, the pace of progress is far too slow. 

Only Eritrea is on track to reach MDG 5, reducing maternal deaths by three-quarters by 2015. Angola, Comoros, Ethiopia, Madagascar, Malawi, Mozambique, Rwanda, Tanzania and Uganda are making progress (annual average decline of 2-5.5 per cent), while the other countries are making insufficient (less than 2 per cent) or no progress at all.

Hemorrhage is by far the leading cause of maternal deaths. Together with hypertension, it accounts for more than half of all maternal deaths. HIV-related illnesses also play a major role in maternal deaths, especially in Southern Africa where HIV prevalence is high. Despite impressive progress in HIV prevention and treatment for women and children, the “indirect”, AIDS-related maternal mortality is over 50 per cent in countries such as Swaziland (67 per cent), South African (60 per cent), Namibia (59 per cent), and Botswana (56 per cent).

Newborn health

The health and survival of newborns is closely linked and interdependent with that of their mothers. In most of sub-Saharan Africa, including ESA, neonatal mortality has seen no significant change in over a decade. Over 4 in 10 under-five deaths are among newborns up to 28 days of age, making neonatal mortality reduction increasingly the “unfinished business” of under-five mortality reduction. Ethiopia, Angola, Kenya, Tanzania, Uganda, Mozambique and Somalia account for close to 70 per cent of all neonatal deaths in the region.

Maternal and newborn deaths are heavily concentrated around the period of delivery, the day of birth, and the first week following birth, as evident in 50 per cent of all maternal and newborn deaths occurring in the first 24 hours of birth. Yet, more than half of all births in the region take place at home, without the support of a skilled birth attendant. Moreover, less than 1 in 4 postpartum mothers and newborns receive a postnatal visit within 48 hours of birth. 

This means that the majority of mothers receive no care to prevent or manage complications, initiate and sustain exclusive breastfeeding, and adopt practices, such as cord care, to stave off infection. It also means that should newborns become sick they would not receive adequate treatment or timely referral to clinics.

© UNICEF/UGDA2010-00153/Noorani

Kashifa Nanjala, 18, lies with her one-day old baby in a district hospital in western Uganda. Nine countries in ESAR, including Uganda are with the worst indicators on maternal health, and they are UNICEF's priority countries in this area.

UNICEF in action

There is now a clear understanding of when, where and why mothers and newborns are dying. Many, up to two thirds, maternal deaths and newborn deaths could be avoided if mothers and newborns were attended at birth by skilled health professionals; received postnatal care, especially the first day and first week; and if essential supplies, equipment and facilities were available. 

The reasons why mother and newborns are not receiving adequate maternal and antenatal care are largely due to poor health and social infrastructure, weak service delivery, and a shortage of qualified health workers. Compared to their well-off peers, the poor populations are more acutely affected by these challenges. UNICEF’s analyses consistently show that the indicators in maternal and neonatal mortality reflect the greatest and most persistent health inequity worldwide.

Supporting national governments, UNICEF, together with the partners under the United Nations Health 4+ (UNH4+) mechanism - WHO, UNFPA, the World Bank, UNAIDS and UN Women, as well as other development partners, civil society organizations and communities, works towards averting these unnecessary deaths. 

Results for children

• As part of the renewed push to end preventable deaths, UNICEF supported countries with analyses to better respond to and avert maternal and newborn deaths. Ethiopia, Zambia, Uganda and Malawi have completed such analyses, highlighting major bottlenecks that hinder the reach and quality of maternal and newborn care services. 


• Four of the eight “pathfinder” countries under the UN Commission on Lifesaving Commodities (UNCoLSC) - Ethiopia, Malawi, Tanzania, and Uganda – committed themselves at the highest level to ensure access to quality, yet long neglected lifesaving drugs for women, newborns and children. 


• High HIV burden countries in ESA have achieved good progress in the elimination of mother-to-child transmission (eMTCT) of HIV. Seven countries – Botswana, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe - have attained PMTCT coverage of over 80 per cent, and are on track to meet the eMTCT goals by 2015. The success factors in these countries are being increasingly applied to increase quality coverage for other lifesaving and maternal newborn services.


• As a region, ESA is increasingly embracing the adoption of an institutionalized community health workforce with clear roles and responsibilities for service delivery at the community level, as exemplified by Ethiopia’s Health Extension Programme. Community health workers in four countries - Ethiopia, Rwanda, Malawi, Uganda and Zambia - now have explicit responsibility for maternal and newborn health promotional and preventive care, as well as providing referral services for sick newborns.


• Ten out of the 21 countries - Botswana, Ethiopia, Kenya, Lesotho, Madagascar, Malawi, Rwanda, South Africa, Uganda and Zambia - have a policy on postnatal home visits for mothers and newborns during the first week of life although implementation is still limited in scale and scope.

Source: UNICEF