Since 1990, efforts to reduce child mortality have made an impact across the globe. By 2015, the global under-five mortality rate was reduced by 53%, from 91 per 1000 live births to 43 per 1000. However, despite the overall progress in under-five child mortality, less progress was made with neonatal mortality, representing 45% of the 5.9 million under five deaths in 2015. Furthermore, the burden of death remains unequally distributed, as both sub-Saharan Africa and south Asia recorded a neonatal mortality rate of 29 per 1000 live births, combining for an estimated 2.1 million neonatal deaths recorded in 2015. The burden of stillbirths is similar to that of neonatal mortality and these regions account for a similar proportion of all stillbirths. Most of both neonatal deaths and stillbirths in these regions occur among term or near-term fetuses/neonates. These deaths have been substantially reduced in high-resource settings. To end preventable stillbirths and deaths of newborns and reach the United Nations Sustainable Development Goal (SDG) (3.2) by 2030 (with all countries reducing neonatal mortality to no more than 12 per 1000 live births), success must be achieved in reducing stillbirths and neonatal mortality. Most stillbirths occur during labor and most neonatal deaths occur shortly after delivery. Globally, intrapartum-related complications are estimated as the cause of as much as 60% of stillbirths and 23% of neonatal mortality. Skilled birth attendance and an institutional environment capable of providing effective obstetric and neonatal care are needed to significantly reduce stillbirths and neonatal deaths. While delivery in a health facility is assumed to improve birth outcomes, the existing evidence to date has shown contradicting results, particularly in areas where enabling environments are constrained. For example, one recent study from Ghana observed that facility delivery was not associated with decreased risk of maternal or neonatal mortality.
To date, few prospective studies have assessed the impact of the shift from home births to delivery in health facilities on stillbirths and neonatal mortality across low-resource settings. In a population-based pregnancy registry, we sought to evaluate the trends toward institutional delivery and associated stillbirth and neonatal mortality rates in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Global Network for Women’s and Children’s Health Research (GN) sites from January 2010 to December 2018.
By: Goudar SS, Goco N, Somannavar M, Kavi A, Patel A, Vernekar SS et al.