Maternal, newborn, child and adolescent health

WHO launches new tools to help countries address stillbirths, maternal and neonatal deaths

Counting and reviewing every birth and death is key to preventing future tragedies

Every day, women die during childbirth and babies are born stillborn. With quality health care throughout pregnancy and childbirth, many of these deaths could be prevented, but countries often lack the knowledge and capacity needed to take actions to stop other women and babies dying in the same way. To address this issue WHO is today launching two new tools to help countries improve their data on stillbirths and neonatal deaths as well as a report on the global status of implementation of maternal death surveillance and response (MDSR), a key strategy for reducing preventable maternal mortality:

It is estimated that every year, worldwide, 303 000 women die during pregnancy and childbirth, 2.7 million babies die during the first 28 days of life and 2.6 million babies are stillborn.

“Every time a death is reviewed it has the potential to tell a story about what could have been done to save a mother and her baby.”

Dr Anthony Costello, Director of Maternal, Children’s and Adolescents’ Health

Nearly all babies who are stillborn and half of all newborn deaths who die do not receive a birth or death certificate, and thus have never been registered, reported or investigated by the health system. As a result, countries often do not know the true numbers of deaths or the causes of these deaths and thus are unable to take the right actions to prevent others babies and mothers from dying.

“We need to ensure all births and deaths are counted, and that we can understand what to do to prevent future deaths, no matter where they occur,” says Ian Askew, Director of Reproductive Health and Research at WHO. “By reviewing the causes of maternal and infant deaths countries can improve quality of health care, take corrective actions, and prevent millions of families from enduring the pain of losing their infant or mother.”

WHO Application of the International Classification of Disease-10 todeaths during the perinatal period (ICD-PM)

This standardized system for classifying stillbirths and neonatal deaths, aims to help countries link stillbirths and neonatal deaths to contributing conditions in pregnant women, such as diabetes or hypertension to identify the required interventions to prevent future deaths and enable comparisons within and between diverse settings. Previously there was no classification system that could be used across all low-, middle- , and high-income countries in a consistent way.

Related journal articles (BJOG)

Making Every Baby Count: Audit and Review of Stillbirths and Neonatal Deaths

This guide aims to help countries review and investigate individual deaths so that they can recommend and implement solutions to prevent deaths from similar causes in future. It incorporates the ICD-PM classification system in order to help health systems complete at least a basic death review, which is an in-depth investigation into causes and circumstances surrounding the death.

Time to respond: a report on the global implementation of maternal death surveillance and review

This publication describes the global status of implementation of maternal death surveillance and response (MDSR) which is a process that helps countries strengthen their maternal mortality review process in hospitals and clinics. It also provides guidance for establishing a safe environment for health workers to improve quality of care within clinics and an approach to recording deaths occurring outside the health system, such as when mothers deliver at home. The report summarizes the findings from the global MDSR baseline survey of global implementation status of MDSR in 2015 and high policy commitment among countries.

“Every time a death is reviewed it has the potential to tell a story about what could have been done to save a mother and her baby,” says Dr Anthony Costello, Director of Maternal, Children’s and Adolescents’ Health at WHO.

Underreported magnitude

Official reports underestimate the true magnitude of maternal mortality by up to 30% worldwide and 70% in some countries. Maternal death surveillance and response (MDSR) is a relatively new approach to investigating maternal deaths in real-time by a maternal death review committee (a group of experts) so that health facilities can then take corrective actions. By WHO standards, committees should meet at least twice a year, however, currently only 46% of countries are meeting this standard.

Conducting mortality audits and reviews is a key strategy for reducing preventable deaths among mothers and babies. It helps health system managers understand the causes of death, and the contributing factors, so they are able to take corrective actions to improve the quality of care. It is an important mechanism for holding countries accountable for meeting targets to reduce maternal and neonatal deaths laid out in the Sustainable Development Goals and Global Strategy for Women’s, Children’s and Adolescents’ Health.