The health of mothers and newborns can give insights into the overall health of a population, revealing important clues about the quality and accessibility of healthcare services. United Nations Sustainable Development Goal 3 aims to reduce the global maternal mortality rate (MMR) to below 70 deaths per 100,000 live births by 2030 and strives to guarantee universal access to sexual and reproductive healthcare services (United Nations 2016). However, the World Health Organization (2023) presents a concerning outlook for achieving the goal, with estimates showing that approximately 287,000 women lost their lives during pregnancy and delivery in 2020. Worldwide, women in developing countries are generally at greater risk when giving birth. A global study classified 15 countries in sub-Saharan Africa and South Asia as having high and alarming levels of maternal and neonatal mortality, with one-fifth of total global maternal deaths occurring in South Asia (WHO 2023). Afghanistan has the highest MMR among Asian countries and is ranked within the top 10 globally, with a documented 620 deaths per 100,000 live births. Cambodia follows closely with an MMR of 218 per 100,000 live births. Furthermore, India contributes to 8% of all global maternal deaths (WHO 2023).
These statistics paint a grim picture of the state of maternal and child health in developing Asia. The region faces challenges related to limited affordable and high-quality public healthcare, restrictions on women’s movements due to gender norms, and sociodemographic factors that hinder the effective provision of maternal and child health services (Tey and Lai 2013; Asim et al. 2020; Raina et al. 2023). It is also greatly affected by high fertility rates, early marriage, and teenage pregnancy. A worrying statistic shows that one out of every four young women in South Asia who are married or in a union before turning 18 are at risk of maternal health complications (UNICEF 2023).
The leading causes of nearly 75% of maternal deaths and up to two-thirds of neonatal deaths are associated with complications at four distinct stages: complications during pregnancy, severe bleeding during childbirth, eclampsia, and postpartum infections (WHO 2023). Enforcing effective healthcare strategies from pregnancy through the first week after delivery can play a crucial role in improving maternal and child health outcomes in Asian countries. A “Continuum of Care” strategy can provide comprehensive care to mothers and their infants, covering prenatal care, delivery, the immediate post-natal period, and childhood. Another essential interconnected continuum is connecting households with hospitals by enhancing home-based practices and mobilizing families for essential healthcare-seeking behaviors, as well as improving access to quality care at health facilities (Tinker et al. 2005). This approach ensures that women and children receive a seamless continuum of care, with a focus on preventive, promotive, curative, and rehabilitative services that ensure their health and well-being at every stage.
The completion rate of a continuity of maternal health services can serve as a metric to gauge the well-being of women and newborns. A study carried out by Rahut et al. (2024) across 10 South and Southeast Asian countries found that close to 8% of women were not utilizing any maternal and child health services. Furthermore, only 46% of women received holistic care that continued after delivery, with roughly one-quarter of women depending on just one maternal and child health service. The low level of completion implies that most of the women, along with their toddlers, would miss proven benefits at various contact points of the continuum—after conception, during birth, and in the postpartum period.
Antenatal care (ANC) visits serve as a pivotal entry point for continuous care. During ANC visits, health personnel and pregnant women have the opportunity to engage in discussions about various pregnancy-related matters, including the well-being of the baby and mother, dietary considerations, potential complications, and available remedies. The frequent interactions between healthcare workers and expectant mothers may help explain the correlation between having four or more ANC visits (ANC4+) and the presence of skilled birth attendants during delivery, thereby ensuring efficient and comprehensive care (Guliani et al. 2012; Magoma et al. 2013). Rahut et al.’s (2024) study of 10 Asian countries revealed that 41% of women had not received four or more ANC visits. Highlighting the pivotal role of ANC4+ visits in the care continuum, Asian countries should promote policies and rigorous implementation to enhance the accessibility and affordability of these services. In the era of advancing technologies, leveraging smart connectivity solutions, such as utilizing mobile phones for sending messages and calendar alarms, and disseminating informative messages about ANC, can expand the reach of the continuum of care (Lund et al. 2014).
Numerous individual and community-level factors influence the ongoing use of maternal and child health services. In rural areas, women encounter significant barriers, such as limited transportation services, considerable distances to health facilities, and shortages of staff and equipment that hinder their access to healthcare services (Zelka et al. 2022, Rahut et al. 2024). This highlights a gap in the supply side of services. Efforts to emphasize the importance of making healthcare services available and accessible to the community are crucial for enhancing maternal and child health programs. Decision-making powers, including authority over health center visits and financial resources, influence the utilization of maternal and child health services. Gender sensitivity efforts should focus on educating men about the importance of maternal and newborn care, including attending antenatal care visits with their partners, gaining awareness about maternal and child health issues, and actively participating in decision-making processes related to healthcare. Additionally, men’s engagement can also encompass post-natal care, providing support for breastfeeding, and contributing to family planning initiatives.
The evaluation of maternal healthcare services should consider not only the frequency of contact but also the detailed content of each aspect (Tamang 2017). Emphasizing more frequent recommended contact within the healthcare program without underscoring the essential elements will be insufficient for reducing maternal and neonatal fatalities and illnesses. Therefore, policy makers and those designing programs need to consider both the frequency and substance of care in maternal health services across varying touch points and locations.
References
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Guliani, H., A. Sepehri, and J. Serieux. 2012. What Impact Does Contact with the Prenatal Care System Have on Women’s Use of Facility Delivery? Evidence from Low-Income Countries. Social Science & Medicine 74(12): 1882–1890.
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