Recommendation 6. To determine the true burden of disease associated with adverse birth outcomes and measure the effectiveness of interventions to address these problems, basic epidemiological and surveillance data must be collected, analyzed, interpreted, and acted upon. Each country should, as resources permit, incrementally develop complete national demographic data and ongoing surveillance of maternal, neonatal, and fetal mortality and morbidity (Chapter 5).

Health care services can be improved continuously over time by recognizing priorities that need to be addressed, identifying interventions that address them, implementing the interventions, assessing their effectiveness, and tuning them to be more effective.

Recommendation 7. Each country should strengthen its public health capacity for recognizing and implementing interventions that have proven effective in reducing maternal, neonatal and fetal mortality in similar populations. This also involves monitoring and tuning interventions for clinical- and cost-effectiveness in the local setting (Chapter 5).


Health care services to reduce maternal, neonatal, and fetal mortality—particularly during the period spanning late pregnancy through the first month of a child’s life—have shown inadequate improvement in most developing countries. After more than a decade of increased attention to maternal health care in the developing world, maternal mortality rates have not measurably declined. Meanwhile, although significant reductions in mortality rates in children under 5 years have been achieved during the 1990s, neonatal mortality rates, which now account for the majority of infant mortality, have declined far less quickly.

Over the past 15 years, however, researchers have built a significant body of knowledge on pregnancy outcomes in low-resource settings. There is increasing agreement on the interventions most likely to reduce maternal, neonatal, and fetal mortality and recognition that some interventions can benefit all three populations. Mortality rates could approach those in developed countries by effectively implementing strategies already established as effective: skilled attendance at all deliveries; referral of all deliveries with complications to good-quality essential obstetric and neonatal care; and effective antenatal and postpartum maternal and neonatal care. Continued and sustained improvement of birth outcomes, however, will require an investment in the development of effective health care systems. This will require strong health care policies supported by appropriate resources, good collection of basic surveillance data, and the public health capacity to recognize priority interventions and implement them effectively.

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