Next generation maternal health: external shocks and health-system innovations

Abstract

In this Series we document the substantial progress in the reduction of maternal mortality and discuss the current state of science in reducing maternal mortality. However, maternal health is also powerfully influenced by the structures and resources of societies, communities, and health systems. We discuss the shocks from outside of the field of maternal health that will influence maternal survival including economic growth in low-income and middle-income countries, urbanisation, and health crises due to disease outbreaks, extreme weather, and conflict. Policy and technological innovations, such as universal health coverage, behavioural economics, mobile health, and the data revolution, are changing health systems and ushering in new approaches to affect the health of mothers. Research and policy will need to reflect the changing maternal health landscape.

Figure 1. Urban and rural birth projections

Proportion of births in urban areas by region, 1970–2050. We used urban and rural crude birth rate data from the UN Demographic Yearbooks from 1970–2013, population data from the UN World Urbanisation Prospects 2014, and total crude birth rate data from UN World Population Prospects 2012 to estimate the percentage of births occurring in urban areas from 1970–2050 by region. We used average values of available urban and rural crude birth rates per country within the region as a proxy for the entire region.

Figure 2. Coverage of maternal health interventions by urban or rural residence in low-income and middle-income countries

Each circle represents a country. Black horizontal lines represent median value for each subgroup. Available data, 2005–13: 85 countries had data available for the births attended by skilled health personnel and 72 countries had data available for the antenatal coverage indicator. Data taken from WHO.

Figure 3

Cities in Bangladesh where Manoshi operates