The impact of maternal health improvement on perinatal survival: Cost‐effective alternatives

Abstract

Each year, an estimated half million women die from complications related to child birth either during pregnancy, delivery or within 42 days afterwards. When pregnant women have complications, their infants are at greater risk of becoming ill, permanently disabled or dying. For every maternal death, there are at least 20 infant deaths: stillbirths, neonatal or postneonatal deaths. Altogether, an estimated 7 million infants each year die perinatally (stillborn or deaths within the first week of life). Low cost, feasible, and effective intervention strategies include: a) improved family planning and abortion services; b) obstetric care at delivery; and, c) prenatal services. Two hypothetical populations of one million (a low mortality and a high mortality country) are used to illustrate maternal and perinatal program strategies and priorities. In countries with high fertility, major reductions in maternal and infant deaths result both from reductions in the number of pregnancies through family planning and from improved obstetric care. Where fertility is already low, reductions result almost entirely from improved obstetric and prenatal care. The investments required are relatively low, while the potential gains are great. The cost to avert each death in a high mortality population is estimated between $800 and $1,500 or as low as $0.50 per capita per year. The priorities for programs targeting maternal and perinatal health depend on demographic, ecologic and economic factors, and should include the promotion of good health, not merely the avoidance of death. More operational research is required on various aspects of maternal and perinatal health; in particular, on the cost-effectiveness of different service components.

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

“…For some interventions or packages of care, promising results in efficacy trials have included, or subsequently led to, evaluations of their cost-effectiveness. 671,672 In general, however, attempts at costing interventions have included posthoc data collection or extrapolation, which are not optimal for this kind of analysis. 673 Studies in developed countries have shown that early initiation of antenatal care is among the most cost-effective strategies for reducing neonatal mortality.…”

Research Priorities for the Reduction of Perinatal and Neonatal Morbidity and Mortality in Developing Country Communities

“…13 Overall, pregnancy and delivery complications are implicated in more than half of newborn deaths.…”

Evaluation of maternal and child health services in El-Minia City, Egypt

“…The main causes of maternal mortality are postpartum hemorrhage, inappropriate timing and spacing of children, too many pregnancies, unsafe abortion, and insufficient prenatal care and care during delivery (WHO 1990). In countries with high fertility rates, major reductions in maternal and infant deaths result both from reductions in the number of pregnancies through family planning and from improved obstetric care (Walsh et al 1994).…”