Each day, more than 800 mothers and 15,000 babies continue to die, mostly from preventable causes. The phrase “mostly from preventable causes” is restated in so many global health articles that it almost seems like an afterthought, but it may hold the key to saving thousands of lives.
Despite the unprecedented decline in maternal and newborn mortality between 1990 and 2015, with rates dropping by 44 percent and 52 percent, respectively, the global health community is still struggling with uneven success. Unleashing the untapped power of prevention strategies, while continuing to focus on emergency interventions at or around the time of birth, may be the key to achieving the maternal and newborn health targets within the Sustainable Development Goals.
There are many reasons why organizations don’t do a better job of prioritizing and investing in prevention programs vis-a-vis emergency care interventions. Harvey Fineberg cited many of these in his provocative 2013 publication “The paradox of disease prevention: celebrated in principle, resisted in practice:”
• Success is often invisible and lacks excitement.
• Preventive health services can be difficult and expensive to access.
• Prevention often conflicts with personal, religious and cultural beliefs.
• The evidence base is often lacking.
While the above constraints are real, they are surmountable and should not obscure the potential of prevention to save maternal and newborn lives.
1. Prevention can reach a broad population and be highly cost-effective.
Prevention efforts not only save lives; they are proven to save money. For example, in 2010, a United States public investment in family planning demonstrated successful prevention of unintended pregnancies and reduced the incidence and impact of preterm and low birth weight, sexually transmitted diseases, infertility, and cervical cancer. This investment saved the government $13.6 billion, equivalent to an estimated taxpayer savings of $7.09 for every public dollar spent. The economic benefits of prevention are just as powerful in middle- and low-income countries as evidenced by studies, for example, of the cost-effectiveness of folic acid fortification in Chile, malaria intermittent preventive treatment in infants in Mozambique and Tanzania and rubella immunization worldwide.
2. Preventive interventions can reduce the toll from a range of adverse maternal and birth outcomes with shared risk factors.
Many factors influence the health of mothers and babies. Effective prevention focuses on reducing those risk factors and helping identify interventions that have the greatest impact on target populations. For example, studies demonstrate that during adolescence, a balanced diet with adequate caloric intake leading to a healthy weight and nutritional status at conception can reduce the incidence of congenital disorders, preterm birth, stillbirth and low birthweight.
3. Preventive interventions early in life can have a cascade of beneficial effects later on.
For newborns who are born premature or with a serious congenital disorders, prevention can reduce rates of associated severe lifelong impairment, which impart devastating emotional and economic costs on families and the communities in which they live. The potential savings are intergenerational as well. For example, the detection and management of diabetes before or early in pregnancy can reduce the risk of having a low birthweight baby preterm birth and a baby with low birthweight. Early intervention improves not only the health of a particular mother and her baby but also that of her grandchildren, should her baby be female and become pregnant one day.
4. Prevention encourages communication between sectors.
Effective prevention of maternal and newborn death needs to begin in adolescence and continue through preconception and the entirety of pregnancy in order to address the constellation of factors that increase risk. To do this, communication is key across medical specialties including adolescent, maternal and newborn health, as well as across public health categories such as reproductive health, nutrition, infectious disease and noncommunicable diseases.
How can we best harness the power of prevention for maternal and newborn survival?
As a first step, we need to increase our attention to risk reduction earlier in life. Born On Time, is a new, five-year initiative aimed at lowering the incidence of preterm birth in high burden countries by improving health service delivery, increasing uptake of health services and strengthening data collection.
We must also encourage new ways of thinking about how to partner on prevention to integrate and maximize interventions across medical disciplines. The Born On Time initiative harnesses unique expertise, resources and relationships across public and private sectors, and includes diverse partners such as World Vision, Plan International Canada, Save the Children, the government of Canada and Johnson & Johnson.
If we are to reach the 2030 targets set by the SDGs, it is imperative that international policymakers, donor organizations, researchers and NGOs view the elimination of preventable causes of maternal and newborn mortality as a priority. Every mother, no matter what her circumstances or where she lives, should have an equal opportunity to have a safe pregnancy and a baby who begins life healthy and strong. These mothers and babies deserve our help, not our excuses.
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