Eight Treatments That Could Save the Lives of Mothers and Newborns

The model also incorporated country-level mortality data, local feedback, and information about the medical supplies and equipment needed to follow the 25 medical guidelines that the WHO recommends for prenatal and postnatal care and that it considers feasible for community health workers to implement.

The researchers evaluated this initial set of 25 interventions and then worked with a reduced set of 22 that they determined were feasible for the Somali program.

The model’s prediction for the optimal interventions strikes a balance between the cost of providing care and the cost of training workers. And it suggests that of the WHO-recommended treatments, eight could be prioritized at the Somali program to maximize the number of lives saved. The treatments include malaria prevention and iron supplementation in pregnancy, as well as basic sanitation, hand washing with soap, skin-to-skin contact between baby and mother, umbilical cord care, thermal regulation, and breastfeeding promotion.

These recommended guidelines were not necessarily the most cost-effective. In fact, that invervention—neonatal resuscitation—was left out because it requires volunteers to undergo a significant amount of classroom training, explain the researchers.

The clinic in Somalia primarily used nine of the WHO’s 25 methods because of cost, accessibility, and other limiting factors. Its selected nine included some but not all of the eight that the researchers recommend. The model predicted that changing and narrowing the type of care the program offered would have prevented 15 percent of the 4,132 maternal and neonatal deaths that were expected in 2023 in the Galmudug state of Somalia, where the program was located. Offering these eight care options would have allowed supervisors to spend less time training volunteers, which would have freed up both the supervisors and volunteers to treat more patients.

The researchers then calibrated the model to see whether findings might translate to other settings in the country outside a community-health-worker program, such as in urban health clinics that had slightly more resources than the one in Galmudug and might have been using more of the WHO-recommended guidelines. The recalibrated model predicted that the number of lives saved would increase to nearly 2,000—almost half the region’s maternal and neonatal deaths in 2023.

The team concludes that allocating more funds toward medicine, vaccines, and medical equipment wouldn’t help as much as retaining and recruiting more health workers, be they volunteers or professionals.

Globally, maternal mortality is most concentrated in areas with poverty and violence. In 2020, 70 percent of global maternal deaths occurred in sub-Saharan Africa alone, according to the 2023 report from the WHO and its research partners. But Montgomery, Ata, and their coauthors suggest their model could be helpful in regions with similar, specific contraints—such as those losing doctors who serve pregnant women or rely on community-level health programs, which tend to face high worker turnover and burnout, limited infrastructure, supply-chain disruptions, and funding cuts due to public health emergencies or disease outbreaks. These regions include some areas of the United States, where hospitals are providing fewer services or closing altogether.

“The model provides a framework into which local expertise and perspectives can be readily incorporated,” the researchers write.