How the community shapes newborns and mothers

Newborn care goes beyond the family and home; whether a newborn is born in a facility or at home, community systems and support structures are crucial to ensuring healthy growth and development. One of the most common community-level care systems is the community health worker (CHW). While they come in many forms and with many names, they offer essentially a cadre of community-based health care providers who provide health information, help to recognize warning signs, encourage facility-based care, and serve as a link between the community and health facilities.

CHWs provide a variety of services depending on what is available in their facilities and the policies of their local and national governments, but there are some interventions that especially support newborns, their mothers, and their families. Kangaroo Mother Care (KMC) is one of these interventions. KMC is the practice of providing early, continuous, prolonged skin-to-skin contact between mother and baby, exclusive breastmilk feeding, and follow-up care with high-risk newborns; community-initiated KMC (ciKMC) is KMC initiated in the community for newborns born outside of the facility. As some CHWs provide antenatal care and pregnancy support services, they can promote ciKMC before birth and can ensure its use after delivery. While KMC is especially encouraged for low-birth weight newborns, evidence for KMC’s benefits for all newborns is growing. Learn more about KMC and ciKMC here.

Another intervention that can be supported by CHWs and other community-based systems is the prevention of rapid repeat pregnancies. This is especially important for adolescents, who are more likely to experience this. CHWs can reach and counsel on, and sometimes directly provide, a mix of contraception methods throughout the continuum of childbirth care. Postpartum contraception is when a woman begins a contraception method in the first twelve months after childbirth. Initiating contraception in the postpartum period leads to healthier spacing of pregnancies. This can include the promotion of exclusive breastfeeding as a means of family planning. When pregnancies are too close together (less than 24 months between the last live birth and the next pregnancy), the risk of low birth weight, preterm birth, and newborn death increases; when pregnancy begins within six months of the last live birth, these complications are even more likely. While facility-based care providers can and do offer contraception and counseling, community-based services can help drive demand for and provide the foundation for acceptance and use, including supporting adolescents and adults to understand and address social norms that may influence contraception uptake.

Childhood illnesses can be devastating if not properly diagnosed, managed, and treated. Integrated community case management (ICCM) of childhood illnesses allows community health workers to classify, diagnose, treat, and refer children for the illnesses that kill the most children; malaria, pneumonia, and diarrhea. ICCM can and should be part of every health system where community access to facilities is challenging or restricted. Learn more about ICCM here.

The local health facility is the heart of the community-level health system. It is where most newborns come into the world (80% of all newborns were born in a facility between 2015 and 2021), though these rates are context dependent (less than 65% of newborns in Sub-Saharan Africa were born in a facility in the same time period). Facility-based delivery helps ensure that girls and women and newborns receive timely care in an emergency and greatly reduces the risk of mortality and morbidity. However, while care can be timely, there is no guarantee of quality. Lack of supplies, capacities, and equipment, along with disrespectful practices, can severely impact health outcomes even with a facility-based delivery. Learn more about how health systems strengthening can support facility-based delivery here. Another challenge to quality care within facilities is infection prevention control (IPC). Access to clean, sanitary conditions is reliant upon correct hygiene and sanitation measures, including clean water and waste management services. There are large inequities in the quality of IPC measures globally – in Sub-Saharan Africa, just under half of health care facilities do not have basic water services, and 63% have limited or no hand hygiene services. IPC is critical to keeping newborns and mothers safe from preventable infection, including possible severe bacterial infection (PSBI).

In case of emergencies, basic obstetric and newborn care is critical.

Global standards and guidelines for basic and comprehensive emergency obstetric and newborn care (BEmONC and CEmONC, respectively) have been integrated into national and regional health policies worldwide. These standards reflect a series of seven key services, or signal functions, that comprise basic care, with two additional signal functions included in comprehensive care. These services, including a trained health care provider, need to be available 24 hours a day, seven days a week.

BEmONC and CEmONC are just part of the larger Primary Health Care model, a community-level health system that is designed to provide basic, comprehensive care across the life cycle. This integrated care model is the most inclusive, equitable, and cost-effective way to reach as many people as possible, working towards Universal Health Coverage (UHC).

The community is more than just the health system, it also provides the foundation of the social environment for newborns and mothers. Social norms and culture play a large role in determining care, including possible harmful care practices. Norms around breastfeeding, facility delivery vs home-based delivery, and traditional gender norms that reduce women and girls’ autonomy and agency all are shaped and enforced by the community. In many contexts, men culturally have more control over finances, leading to more control over financing health care and decisions around when and how women, girls, and children access that care. Where harmful norms are in place, women, girls, and newborns are more likely to have poor health outcomes. These norms can be enforced by cultural and faith leaders within the community. Engaging with these leaders to prioritize and promote recommended health behavior and practice can have a profound impact on maternal and newborn health outcomes.