Child and Maternal Mortality
in Islamic Countries
9
We have conducted a landscape analysis and explored the determinants of maternal and child
mortality and MCNH care utilization based on an analytical conceptual framework.
Our conceptual framework specifically examines the impact of availability and access to MNH
and Emergency Obstetrical and Neonatal care (EmONC), quality of care, utilization of
MNH/EmONC services and inequity in care, and accountability and governance on maternal and
child mortality.
Evidence has shown that utilization of facility-based care alone is not sufficient for reducing
maternal and perinatal mortality. Many studies in recent years point to poor quality of services
as one of the major contributors of elevated rates of morbidity and mortality in women,
newborns and children. In addition to technical quality of care, perceived poor quality of facility-
based care may hinder the utilization of facility-based services during pregnancy, delivery and
postpartum periods. Poor quality of care is now considered as a bigger barrier than access to
care. A recent estimate suggests that half of all maternal deaths and 1 million neonatal deaths
could be prevented by ensuring high quality of health care delivery system.25
Since emergency and life-saving interventions are delivered at health facilities, improving the
quality of facility-based care is essential for reducing excess mortality and in achieving the
health-related SDG targets. For mothers and newborns, the period around childbirth is the most
critical and access to affordable and quality health services is essential for saving the maximum
number of lives and preventing stillbirths. Therefore, understanding the underlying factors that
affect the quality of facility-based services and scaling up interventions to improve the quality
of care represent critical inputs for the reduction of maternal, newborn and child mortality.
The WHO has initiated a global vision in which ‘every pregnant woman and newborn receives
quality care throughout pregnancy, childbirth and the postnatal period’ under the umbrella of
Universal Health Coverage and Quality. This vision is in alignment with two complementary
global action agendas conceptualized by WHO and partners, namely Strategies toward Ending
Preventable Maternal Mortality (EPMM)' and the ‘Every Newborn Action Plan (ENAP)’.
However, only a limited number of studies have examined the quality of care in LIMCs.
There are also concerns about measurements, accountability and governance. We examine the
challenges of measurements, data paucity, and the role and relevance of accountability at the
following four levels: governmental accountability, institutional/health facility accountability,
community/societal accountability and individual accountability.