Child and Maternal Mortality

in Islamic Countries

settings with high neonatal and maternal mortality. Both supply related health system factors –

such as access to and availability of services, quality of care, emergency transportation – and

demand related factors – such as income, education, social norm factors – affect the utilization

of obstetrical and child health care services. Care-seeking behaviors are influenced by a variety

of individual and contextual factors. According to Anderson, these factors can be categorized

into predisposing, enabling, factors related to perceived needs for seeking care, and factors

associated with health services.

Several Lancet series in the last decade have focused on maternal and neonatal health (MNH)

and have identified a range of interventions across the continuum of care that have

demonstrated effectiveness in reducing maternal and neonatal mortality (Neonatal Survival

Series 2005, Maternal Survival Series 2006, Maternal and Child Undernutrition 2008, Every

Newborn 2014, Maternal Health 2016). Figure 1.1, adopted from Bhutta’s 2012 review,

summarizes several of these interventions across the Reproductive, Maternal, Newborn, and

Child Health (RMNCH) Continuum and specifies the key intervention’s distribution across the

pre-pregnancy, pregnancy, delivery and post-partumperiods through community, outreach and

clinical channels.

However, achieving high coverage of effective interventions remains a

challenge in resource poor settings.

Majority of the women in many countries deliver at home. Simple community-based

interventions and strategies to improve antenatal, safe delivery and newborn care practices at

home settings have been shown to reduce neonatal deaths substantially. These simple health

practices and strategies include clean delivery practices (clean hands), clean umbilical cord care

(use sterile blade for cutting the cord, sterile thread for tying, and applying chlorhexidine to the

cord, and discouraging to apply harmful things to the cord) , thermal care (immediate drying

and wrapping of the baby after delivery, delaying bath/wash more than six hours, and skin-to-

skin contact with baby, especially for low-birth weight and preterm birth), immediate and

exclusive breastfeeding. While many of these high-impact interventions are often considered

“low hanging fruits,“ their utilization is low. Baqui and colleagues’ study has shown that simple

community level intervention at home can reduce neonatal mortality by 34%.

Study by Ahmed

and colleagues

and Khanam and colleague

have shown that education, wealth and women

empowerment are critical for improving maternal care utilization during pregnancy, delivery

and post-partum period. The odds of having a skilled attendant at delivery for women in the

poorest wealth quintile are 94% lower than that for women in the highest wealth quintile and

almost 5 times higher for women with complete primary education relative to those less

educated. The likelihood of using modern contraception and attending four or more antenatal

care visits are almost 2.0 and 3.0 times higher, respectively, for women with complete primary

education than for those less educated. Women with the highest empowerment score are

between 1.3 and 1.8 times more likely than those with a null empowerment score to use modern

contraception, attend four or more antenatal care visits and have a skilled attendant at birth.

The key challenges are to increase access, coverage, improve quality and to reduce inequity in

the utilization of evidence-based interventions in health care.

1.1.2. Significance of maternal and child mortality reduction: human rights perspectives and

intergenerational impacts

Maternal and child deaths are not just personal tragedies for families but indicators of egregious

failure of health systems and deficiencies in societal development. The United Nations Human

Rights Council recognizes maternal mortality not just an issue of development but an issue of