How the context impacts newborns and mothers

The context in which one is born or pregnant has an immense impact on health outcomes, both directly and indirectly. The physical environment, especially when affected by climate change, can dramatically influence maternal and newborn health outcomes. Climate hazards, including air pollution, extreme heat, vector-borne diseases, and precipitation events, are linked to gestational diabetes, hypertensive disorders, prematurity, low birth weight, and stillbirth. These impacts can last a lifetime, especially during the vulnerable newborn period, and lead to complications later in life, such as respiratory and cardiac damage, as well as cognitive and other mental deficits.

Climate change leads to adverse health impacts which disproportionately affect the most underprivileged groups. Climate change increases gender, race, geography, and socioeconomic inequities. These inequities are exacerbated by climate related health risks. Climate events disproportionately affect women and girls in indirect ways, as they most often engage in outdoor activities, like cooking and collecting water, where they are exposed to the elements. Women and girls also are more likely to cook indoors, exposing themselves, their newborns, and their fetuses to indoor air pollution. Whether directly or indirectly, the impacts of climate change and the physical environment on pregnant women and newborns are profound. Learn more about climate change and mortality here.

Other contextual aspects have serious impacts on newborn and maternal health outcomes. Nearly 95% of all maternal deaths occur in a low- and middle-income country (LMIC). Strengthening health systems, improving quality of care, implementing proven interventions, and ensuring proper resourcing can help reduce the burden on LMICs. More than 50% of the world’s population live in an urban setting; in a rapidly urbanizing world, the urban poor are being left behind. New thinking is needed to address this increasing gap.

Conflict, natural disasters, and other humanitarian emergencies affect every aspect of life. Health systems and sources of food (agriculture, food stores, etc.) are disrupted or destroyed, and communities and families are displaced. Despite this, women still become pregnant, and babies are still born. Nearly 60% of maternal deaths and 45% of newborn deaths occur in countries affected by a humanitarian crisis; as such, access to essential services before, during, and after pregnancy in emergencies is critical. For contexts already burdened by poor newborn and maternal health outcomes, emergencies exacerbate these existing challenges. Building resilience and preparedness in countries, health systems, and communities before an emergency can help mitigate these challenges. Once an emergency strikes, the Newborn Health in Humanitarian Settings Field Guide and the Inter-Agency Field Manual and MISP refence sheet can provide guidance and reduce delays in access. Learn more about humanitarian response and health here.

Countries with an ongoing humanitarian crisis as of 2024

The above map displays countries that have an ongoing humanitarian crisis, including Afghanistan, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Colombia, Democratic Republic of the Congo, El Salvador, Ethiopia, Guatemala, Haiti, Honduras, Israel and Occupied Palestinian Territory, Mali, Mozambique, Myanmar, Niger, Nigeria, Somalia, South Sudan, Sudan, Syria, Ukraine, Venezuela, and Yemen.

There are profound inequities in newborn and maternal health worldwide; social and gender inequities are one of the social determinants that have the deepest impact on newborn and maternal health outcomes. Social inequities, like racism, violence, or religious or ethnic discrimination, can greatly reduce quality of and access to care during pregnancy and delivery. Improving rights-based and respectful care through values clarification training and other proven measures can break down harmful cultural norms and discriminatory practices.

Ultimately in global newborn health, without funding and commitment to action, nothing will progress. Luckily, there are multiple global initiatives and partnerships moving the needle forward. The Every Newborn Action Plan (ENAP), launched in 2014,  provides a road map of strategic actions for ending preventable newborn mortality and stillbirth, and contributing to reducing maternal mortality and morbidity. The ENAP presents evidence-based solutions, with clear recommendations for countries on how to close the gap in equity by 2030. With specific, actionable targets and five-year reviews, the ENAP is the gold standard for global newborn initiatives. ENAP and Ending Preventable Maternal Mortality (EPMM) are jointly supporting countries to develop and implement annual MNH acceleration plans.

The Sustainable Development Goals (SDGs) go beyond newborn and maternal health to address global challenges to sustainable development and poverty reduction. These 17 goals are interconnected and support each other to advance the health and wellbeing of all. There are several that specifically mention newborns and mothers (Goal 2, Goal 3, and Goal 5), but all are important to advancing global development.

Without funding, none of this can be achieved. Donors have a unique opportunity to set agendas and drive progress forward; however, this cannot be achieved without clear communication and commitment from implementing partners and governments. Additionally, donor-driven restrictions, such as short funding timelines, can be challenging for certain contexts or interventions, like humanitarian contexts. Donors should be open to innovation and integrated programming that goes beyond the traditional system.