rates and improvements in health indicators such as immunization rates were achieved during the 1990s (United Nations Children’s Fund, 2002), neonatal mortality rates, which currently account for half or more of infant mortality, have declined far less quickly (The Child Health Research Project, 1999; Rutstein, 2000).

Over the past 15 years, agencies and researchers working in the field have acquired considerable knowledge about pregnancy and childbirth in low-resource settings. There is increasing agreement on which interventions are most likely to reduce maternal, late fetal, and neonatal mortality. This report reviews the individual—and to a large extent, interdependent—health risks and needs of mothers, fetuses, and neonates and identifies a limited number of interventions to significantly improve birth outcomes1 in developing countries.


The Centers for Disease Control and Prevention requested that the Institute of Medicine’s Board on Global Health undertake a study to examine the steps needed to improve birth outcomes in the developing world. The National Institute for Child Health and Human Development of the National Institutes of Health and the U.S. Agency for International Development joined the sponsorship of the project. The specific charge to the committee is:

Birth outcomes worldwide have improved dramatically in the past 40 years. Yet there is still a large gap between the outcomes in developing and developed countries. This study will address the steps needed to reduce that gap. It will review the statistics of low birth weight and premature infants and birth defects; review current knowledge and practices, identify cost-effective opportunities for improving birth outcomes and supporting families with an infant handicapped by birth problems, and recommend priority research, capacity building, and institutional and global efforts to reduce adverse birth outcomes in developing countries. The committee will base its study on data and information from several developing countries, and provide recommendations that can assist the Centers for Disease Control and Prevention, the National Institute for Child Health and Human Development, and the U.S. Agency for International Development in tailoring their international programs and forging new partnerships to reduce the mortality and morbidity associated with adverse birth outcomes.


In this report, a successful birth outcome is defined as the birth of a healthy baby to a healthy mother.

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