The role of health systems on newborns and mothers

Most newborn and maternal care globally falls under a Primary Health Care (PHC) system. This system, first promoted in the 1970s, is designed to respond to individual care across the life cycle in an integrated, holistic approach. When done well, it empowers people and communities and leads to better health outcomes for all. PHC systems can be seen as stepping stones towards Universal Health Coverage (UHC), an equity and rights-based system for health care that is available to all, without financial or accessibility barriers. UHC is a target of the Sustainable Development Goals (SDGs), presenting an opportunity for countries to move towards UHC in their health policy reforms. UHC can also improve health outcomes for newborns and mothers, as it reduces barriers to access and can ensure quality of services; Countdown to 2030 monitors country-level progress on UHC indicators towards achieving the SDGs.

Health systems come in a variety of capacities and qualities, but every system could benefit from health systems strengthening (HSS). HSS comes in many forms, from provider capacity trainings and values clarification to supply chain strengthening and financing models. HSS can occur at any level of the system, from the individual to the international. Newborn specific HSS activities include provider capacity training in emergency newborn care, specifically the Helping Babies Survive program, and improving data collection and monitoring systems to drive newborn health prioritization. Learn more about HSS interventions here.

A health system is more than just the services it provides, it is also the quality and inclusivity of those services. In newborn and maternal health services, respectful care is as important as the quality of services. Across the world, many adolescent girls and women, newborns and their families experience disrespectful, abusive, or neglectful treatment during childbirth, and this extends to the postpartum period. Giving birth is a vulnerable and dangerous time for women and newborns, it is crucial that women feel supported and respected.

Studies have shown that women who receive disrespectful treatment are more distrustful of health systems overall and less likely to receive care from them in the future, leading to poorer health outcomes for them and their families.

Health systems also need to be inclusive of those who have historically been ostracized from maternal and newborn services, especially adolescents and people with disabilities. Adolescent-responsive health systems are those that meet adolescents where they are at and provide the full spectrum of appropriate health services, without judgement or biases. Adolescents who become pregnant are regularly stigmatized in the health system, judged for their pregnancies and treated poorly by providers. Responsive systems need to go beyond “youth-friendly” spaces and strengthen the entire system to meet the needs of adolescents and address the gendered-barriers to respectful care that they face.

Persons with disabilities are also frequently unable to access health services in an equitable way. Women with disabilities who seek maternal health services are often stigmatized or refused care, as providers tend to see them as difficult to treat or requiring complicated procedures. Disability needs to be included in health systems strengthening training programs, especially those that work on values clarification and quality of care.

Additionally, maternal mental health should also be a priority of inclusive, responsive health systems. Almost 20% of women globally will experience a mental disorder after giving birth, usually depression; in some cases this may include thoughts of suicide or violence. These disorders can affect the ability of a mother to care for their newborn and lead to adverse health outcomes for both. Mental health should be included in postnatal care and general women’s health care, and training for identifying and destigmatizing maternal health challenges prioritized.