POLICY BRIEF

Improve Maternal and

Newborn Health and Nutrition
Facts, Solutions, Case Studies, and Calls to Action

OVERVIEW Improving maternal and

Providing quality healthcare and nutritional support for all women and babies is vital for a healthy newborn health and nutrition
generation. In spite of substantial advances in maternal and newborn health over recent decades, is linked to the achievement
roughly 300,000 women still die due to pregnancy-related complications every year.1,2 There is of multiple SDGs and targets,
widespread evidence and agreement within the global community on what needs to be done to including:
prevent these deaths and improve the health, nutrition, and wellbeing of women and babies.
Clinical interventions and health services need to be delivered across a continuum of care — before, SDG 1: End poverty in all its
during, and after pregnancy.3 There must also be an enhanced focus on the role that nutrition plays in forms everywhere
saving lives and safeguarding the health of women, men, girls and boys — including newborns.4 Good
nutrition is essential for physical growth, mental development, performance, productivity, health, and 1.1 By 2030, eradicate
• 
wellbeing across the entire life-span, making nutrition a sound investment for any country.5 extreme poverty for all
The interventions discussed in this policy brief not only address the leading causes of maternal and people everywhere, currently
newborn death and disabilities, but they also explore solutions and overall health and wellbeing, measured as people living on
encompassing good nutrition and the prevention and treatment of maternal injuries. less than $1.25 a day

SECTION 1: FRAMING THE ISSUE 1.2 By 2030, reduce at least

• 
Over the past 25 years, great strides have been made in maternal and newborn health — the number by half the proportion of
of maternal deaths has dropped by nearly half since 1990,6 and the number of newborn deaths fell men, women and children of
47% between 1990 and 2015.7 However, of the nearly 127 million women who give birth every year in all ages living in poverty in all
developing regions, 28% (35 million women) do not deliver their babies in a healthcare facility and 37% its dimensions according to
(47 million women) do not receive the recommended minimum of four antenatal care visits, jeopardizing national definitions
their health and the health of their newborns. 8,9
For every woman who dies of pregnancy- and childbirth-related complications, another 20 women SDG 2: End hunger, achieve
experience a form of morbidity — such as an obstetric fistula or uterine prolapse — that carries long- food security and improved
term consequences, which can encumber health, wellbeing, and even social and economic status.10 nutrition, and promote
Therefore, efforts to improve maternal health need to look beyond maternal death. While a decrease in sustainable agriculture
maternal mortality is a useful indicator, simply surviving pregnancy and childbirth does not necessarily
mean improved maternal health.11 The burden of maternal morbidity can have severe impacts on the 2 .1 By 2030, end hunger
• 
health and wellbeing of women throughout their life. Embracing a human rights framework for universal and ensure access by all
health requires the provision of high-quality care, not only during pregnancy and labor, but also before
people, in particular the poor
pregnancy and during the postpartum period.12 To attain health for all, it is important to expand the
and people in vulnerable
focus on mortality to include morbidity.
situations, including infants,
Every year, an estimated 2.6 million stillbirths occur13 with more than 7000 deaths a day.14 Every day, to safe, nutritious and
some 830 women die from pregnancy- or childbirth-related complications, which equates to about one
sufficient food all year round.
woman every two minutes.15 In some countries, a woman’s lifetime risk of dying in pregnancy is as high
as 1 in 17, while in high-income countries, on average, it is 1 in 3300.16
2 .2 By 2030, end all forms
• 
The major causes of maternal death include severe bleeding, infection, pre-eclampsia and eclampsia of malnutrition, including
(hypertensive disorders during pregnancy), complications from delivery, and unsafe abortion. achieving, by 2025, the
Combined, these causes account for roughly 73% of all maternal deaths.17 However, causes of
internationally agreed targets
maternal mortality and morbidity are becoming increasingly diverse. Taking into account the effect of
on stunting and wasting in
non-communicable diseases, as well as environmental and demographic shifts — these diverse needs
require responsive policy and care.18 Weak health systems also contribute to maternal mortality rates,
children under 5 years of age,
particularly when facilities lack essential medical supplies and equipment, basic services such as reliable, and address the nutritional
accessible water and sanitation, and healthcare workers, including skilled birth attendants.19,20,21 needs of adolescent girls,
pregnant and lactating
A number of issues further contribute to increased vulnerability to maternal death and disability:
women, and older persons
•L
 ow-income, rural, and marginalized women have less access to quality care: Due to limited
access to comprehensive maternal healthcare, low-income, rural, and other marginalized women SDG 3: Ensure healthy lives
are most likely to experience pregnancy- and childbirth-related complications. 22 Fifty-three million and promote well-being for all
women worldwide, primarily from poor countries or at the lowest income levels in their countries,
at all ages
give birth each year without a skilled birth attendant present, which jeopardizes their health
and the health of their newborns. 23 Studies show a clear link between low income and births in
inadequate environments that lack the basic services for infection prevention, which is critical for a
3.1 By 2030, reduce the
• 
safe delivery. A World Health Organization (WHO) report looking at assessments from more than global maternal mortality
66,000 healthcare facilities in low- and middle-income countries found that 38% did not have access ratio to less than 70 per
to clean water. 24 This finding reinforces the need to ensure adequate support to women and their 100,000 live births

Disclaimer: The views and opinions expressed in this technical paper are those of the authors and do not
necessarily reflect the official policy or position of all partnering organizations.
 newborns, who are particularly susceptible to diseases associated with poor water, sanitation, and
hygiene that sicken and kill millions each year. These needs can be especially acute in emergency,
fragile, and conflict-affected contexts, where the specific hygiene needs of girls and women are often
overlooked.25

•Y
 oung women and adolescents are at increased risk: Early pregnancy and childbearing increases
the risks of complications for adolescent girls and their newborns. Pregnancy- and childbirth-related
complications is one of the leading causes of death for women aged 15-19 globally and results in
17,000 deaths per year. 26,27 Babies born to girls and women younger than 20 have a 1.5 times higher
risk of death compared to babies born to mothers in their 20s or 30s28 — these newborns are also
more likely to be pre-term and have low birthweight. 29,30,31 Studies show that if all women in low-
income countries had a secondary education, 26% fewer children would be stunted, or too short for
their age, making the need for investments into girls’ education more critical. 32 3.2 By 2030, end preventable
• 
deaths of newborns and
•N
 utritional status: Boosting girls’ and women’s nutritional status is critical to improving maternal
and newborn health. Malnutrition is both a cause and effect of gender inequality, making nutrition
children under 5 years of age,
investments one of the soundest investments to make today. Undernutrition among pregnant women with all countries aiming to
leads to increased risks of infection, anemia, lethargy and weakness, lower productivity, poor birth reduce neonatal mortality
outcomes, maternal complications, and even death. 33,34 to at least as low as 12 per
1,000 live births and under-5
Poor nutrition is also a significant risk to women and their newborns. Anemia — or iron deficiency —
mortality to at least as low as
affects about 500 million women of reproductive age (15-49), with as many as half of all pregnant
women in low-income and middle-income countries diagnosed with the condition. 35 The odds of
25 per 1,000 live births
maternal death are doubled in mothers with anemia. 36 Poor maternal nutrition also increases risk
of premature delivery, low birthweight, and birth defects. 37 Because of inadequate nutrition during 3.7 By 2030, ensure
• 
pregnancy, in 2017, more than 50 million children were wasted — or had body mass indexes that were universal access to sexual
too low — and approximately 150 million children around the world were stunted, which hampers and reproductive health-
the possibility of children being able to grow into healthy, active, and productive members of their care services, including for
families, communities, and countries.38 family planning, information
Overnutrition and obesity are also growing risks in most regions, for children and adults. 39 An and education, and the
estimated 6%, or 41 million, children under 5 around the world were overweight in 2016.40 integration of reproductive
Undernutrition and overnutrition can result in obesity and Gestational Diabetes Mellitus (GDM), or health into national strategies
the onset of diabetes during pregnancy, which is associated with higher incidences of maternal and and programmes
newborn health complications.41,42 Maternal obesity is also associated with a higher risk of pre-
eclampsia (hypertensive disorders during pregnancy),43 the second leading cause of maternal death,44 3.8 Achieve universal health
• 
which can also lead to newborn and infant death.45 coverage, including financial
•U
 nsafe abortion: One of the leading causes of maternal mortality, unsafe abortion results in at least
risk protection, access to
22,800 deaths annually.46,47,48 Unsafe abortions are more likely to occur where abortion is illegal.49 quality essential health-
In these contexts, women risk unsafe methods, such as obtaining an abortion from an unqualified care services and access to
provider, self-medicating to induce abortion, drinking toxic fluids, and self-injury.50,51 Women who safe, effective, quality and
survive these procedures often suffer serious — if not permanent — injuries.52 affordable essential medicines
and vaccines for all
•H
 IV: HIV is a significant factor in maternal deaths, particularly across the developing world. In 2015,
of the roughly 4,700 AIDS-related maternal deaths worldwide, sub-Saharan Africa accounted for
3.c Substantially increase
• 
85%, or 4,000 deaths.53 When compared with HIV-negative women, HIV-positive women are eight
times more likely to die during pregnancy, childbirth, or in the period immediately after childbirth.54
health financing and the
Early infant diagnosis is crucial to reducing the persistently high AIDS-related mortalities among recruitment, development,
children. Without treatment, newborns with HIV progress rapidly to AIDS because their immune training and retention
systems are underdeveloped.55 Half of newborns with HIV die before reaching the age of two, and of the health workforce
the highest number of deaths occur between six and eight weeks of life. The majority of these in developing countries,
deaths are preventable by treating opportunistic infections with antibiotics or through antiretroviral especially in least developed
therapy.56 countries and small island
•H
 umanitarian Emergencies and Displacement: Girls and women make up at least 50% of any
developing States
displaced or stateless population and face increased maternal health risks during emergencies and
displacement.57 During humanitarian emergencies, health workforce shortages, weak health systems, SDG 5: Achieve gender
and deteriorating access to water and sanitation facilities are particularly acute. These challenges equality and empower all
are often compounded by additional barriers to accessing quality reproductive and maternal health women and girls
services, such as violence against healthcare workers,58 collapsed infrastructure, and heightened
mobility constraints.59 Studies have found that countries with recent armed conflicts experience 5.1 End all forms of
• 
higher maternal mortality ratios than countries without recent armed conflicts.60,61 discrimination against all
When girls and women are displaced from their homes, risks to maternal health are also exacerbated. women and girls everywhere
When forced to flee and resettle, women may be forced to give birth in temporary shelters, roads,
or other places with hazardous conditions.62 In camp settings, the lack of qualified health workers 5.2 Eliminate all forms of
• 
who speak the same languages of displaced populations also makes providing quality maternal and violence against all women
newborn care challenging.63 Even in urban settings, most refugees and internally displaced persons and girls in the public and
live in areas that lack adequate access to public services, including inadequate water and sanitation private spheres, including
facilities and overcrowding. An absence of identification papers or unrecognized legal refugee status trafficking and sexual and
can also bar pregnant women from accessing publicly available maternal health services.64 other types of exploitation
 Women are also more likely to be food insecure than men in every region of the world. For the first
time in decades, more and more humanitarian settings and emergencies — caused by conflict and/
or natural disasters and climate shocks — have led to an increase in the number of women, men, and
their families who go hungry each day.65

SECTION 2: SOLUTIONS AND INTERVENTIONS

A health system that is ready to deliver for women, when women are ready to deliver, is a strong
health system. There is global consensus on the health and nutrition interventions that should be
made available to women and newborns along a continuum of care.66 These holistic, women-centered
interventions are not only aimed at preventing the leading causes of maternal and newborn deaths, 5.3 Eliminate all harmful
• 
but also look to improve the overall health of women and infants by facilitating proper nutrition,
practices, such as child, early
and preventing and treating maternal challenges, such as gestational diabetes, childbirth injuries,
and managing blood pressure.67 Improved care for women during pregnancy plays a decisive role in
and forced marriage and
reducing maternal and newborn mortality rates, as well as tackling low birthweight and stillbirths.68 female genital mutilation
An effective continuum of care includes quality care before, during, and after pregnancy, and 5.6 Ensure universal
• 
envisions care for normal pregnancy and childbirth, as well as emergency obstetric care delivered by
access to sexual and
skilled healthcare providers within a functioning health system.69 For the continuum of care to have
a significant impact on maternal and newborn health, it must also include access to the necessary
reproductive health and
facilities, medicines, supplies, equipment, and skilled health providers.70 In low-income settings, reproductive rights as agreed
improvements in water and sanitation are essential to improving the health of women and babies and in accordance with the
saving lives.71 Finally, health services must be available, accessible, acceptable, and of quality (AAAQ),72 Programme of Action of the
and must be provided in a dignified and respectful manner, free from discrimination and abuse.73 International Conference on
While the global community agrees on the clinical interventions needed to improve maternal and
Population and Development
newborn health and nutrition, there are still gaps in service. This brief highlights four strategies that and the Beijing Platform for
have the potential to address these gaps: Action and the outcome
documents of their review
•E
 nsure access to quality maternal and newborn care, including midwifery care
conferences
•E
 xpand community-level strategies to reach the most vulnerable girls and women
•A
 ddress unintended pregnancy through modern contraception and increase access to safe abortion SDG 9: Build resilient
infrastructure, promote
•P
 rovide maternal and newborn nutrition education, counseling, and support —
and promote exclusive breastfeeding
inclusive and sustainable
industrialization and foster
Ensure Access to Quality Maternal and Newborn Care, Including Midwifery Care innovation
Access to skilled, knowledgeable, and compassionate midwifery care is one of the strongest ways to
promote affordable and quality maternal and newborn healthcare services throughout pre-pregnancy,
9.1 Develop quality, reliable,
• 
pregnancy, birth, the postnatal period, and the first months of infancy. This is one of the most sustainable and resilient
important investments a country can make to improve maternal and newborn health.74 The provision of infrastructure, including
full care for all pregnant women and newborns — as recommended by the World Health Organization regional and transborder
(WHO) — combined with modern contraception for women who want to avoid pregnancy, would a infrastructure, to support
yield a drop in maternal deaths from an estimated 308,000 to 84,000 per year, and a drop in newborn economic development and
deaths from 2.7 million to 538,000 per year.75 In humanitarian and displacement settings, ensuring the human well-being, with a
availability of skilled midwives that speak the languages of displaced populations is critical to breaking focus on affordable and
barriers of communication and access, and addressing the needs of vulnerable populations. equitable access for all
Many countries — including Burkina Faso, Cambodia, Indonesia, Morocco, and Sri Lanka — have
significantly reduced maternal and newborn deaths by training and deploying midwives.76,77 Midwives, SDG 11: Make cities and
or skilled birth attendants with midwifery skills, can counsel women on sound nutrition practices — human settlement inclusive,
such as the importance of folic acid through food fortification — that strengthen their ability to carry safe, resilient and sustainable.
pregnancies to term, prevent birth defects, and save newborn lives.78 Midwives are crucial in the early
initiation and ongoing support of breastfeeding in the first moments and weeks of life, a key newborn
11.2 By 2030, provide access
• 
health and nutrition intervention.79 Continued exclusive breastfeeding for the first six months of life
to safe, affordable, accessible
has the potential to save the lives of hundreds of thousands of infants and reduce healthcare costs. 80,81
Newborns need the nutrients found in breastmilk to protect them from conditions such as diarrhea, 82,83
and sustainable transport
and adolescents and adults who were breastfed as babies are less likely to become overweight or systems for all, improving
obese.84 For women with the ability to breastfeed, breastfeeding can also help reduce risks of breast road safety, notably by
and ovarian cancer, type II diabetes, and postpartum depression. 85,86 expanding public transport,
Many low- and middle-income countries still have a long way to go before quality midwifery coverage
with special attention to the
is available for the most underserved populations. Only 42% of the world’s medical, midwifery, and needs of those in vulnerable
nursing professionals are available in the 73 low- and middle-income countries where 92% of maternal situations, women, children,
and newborn deaths and 98%87 of stillbirths occur.88,89 Not only is there a need to increase the number persons with disabilities, and
of midwives in these countries, but continued commitment by governments and their development older persons
partners must guarantee that midwifery services are available, accessible, acceptable, and of high
quality. One way of doing this is highlighted in the case study below.
Humanitarian emergencies also present additional challenges for promoting breastfeeding practices.
The disruption of social networks to promote breastfeeding, poor access to clean water, and absence
of private spaces for women to breastfeed in displacement settings all deter healthy breastfeeding
practices.90 In some emergencies, increased access to breastmilk substitute donations also
disincentivize critical breastfeeding practices.91 Female-friendly spaces and breastfeeding programs for
displaced women can help protect and support breastfeeding practices in emergencies.
Case Study: Improving Midwifery Care in Cambodia
Maternal and newborn mortality has been falling significantly in Cambodia since 2005.92 Key to this
decline was a notable investment in midwifery education and a marked increase in the number of midwives
providing antenatal care and deliveries within an expanding primary healthcare network. Ensuring
increased access to quality maternity care was led by the government, with the support of a range of
partners, including NGOs and UN organizations.93,94 Access to improved primary healthcare, with a focus
on midwifery, was also seen across the health system, including the public and private health sector. In
2010, skilled birth attendance in a facility accounted for 55% of all births, and home deliveries with a
midwife for 16%. Pre-service education and in-service training for midwives have been prioritized and all
health centers have at least one primary midwife.95,96
Relevant International
Case Study: Infant and Young Child Feeding Program in Refugee Camps in Jordan Agreements:
Save the Children established mother- and baby-friendly spaces in Syrian refugee camps in Jordan that
provided privacy and support for breastfeeding women with children under the age of five. The spaces • Programme of Action of the
also offered health education sessions that emphasized the health benefits of breastfeeding and proper International Conference on
nutrition for young children. The program engaged more than 15,000 mothers in the Za’atari camp Population and Development
between December 2012 and May 2014.97 (1994)
Expand Community-Level Strategies to Reach the Most Vulnerable Girls and Women
• Beijing Platform for Action,
In order to improve maternal and newborn health and nutrition, essential health services need to be Fourth World Conference on
provided through functioning health systems that integrate a continuum of community- and facility- Women (1995)
based care. Grassroots-level interventions include community mobilization, health and behavior change
education, community support groups, and home visits during pregnancy and after childbirth.98 These
• Millennium Development
may be provided by a healthcare provider or a community health worker at the home, village, school,
or local clinic. Growing evidence suggests that community-based strategies improve maternal and
Goals (2000 - 2015)
newborn health outcomes, and positively affect health and nutrition practices — such as the uptake of
exclusive breastfeeding.99 Finally, strengthening community participation and engagement — involving • Global Strategy for Women's
both women and men — in the design and delivery of health services has led to improvements in their and Children's Health (2010)
quality, availability, and utilization.100 Invoking the power of community participation and engagement
in emergency settings is particularly key to ensuring that the specific needs of girls and women are not • Scaling Up Nutrition (SUN)
overlooked.101,102 Movement Strategy
Effective community-level interventions include: (2012 - 2015)
•T
 raining and deploying community health workers (CHWs): Community health workers can play an
• Scaling Up Nutrition (SUN)
important role in increasing access to essential health information services and can be instrumental
Strategy and Roadmap
in providing care to underserved populations, including youth and adolescents, in rural areas, and
in humanitarian settings. Community health workers receive a limited amount of training to deliver
(2016 - 2020)
a wide range of health and nutrition services to the members of their communities and to promote
sound practices, such as breastfeeding. They typically remain in their home village or neighborhood, • Sustainable Development
serving as a link between their neighbors and the health facility or formal health providers. In this Goals (2015-2030)
capacity, they can ensure that women at risk and infants are referred to the appropriate health
facility, or skilled provider, for needed care and treatment.103,104 A number of countries have • WHO’s Global Strategy
embarked on national community health worker programs with positive results. Ethiopia’s Health for Women’s, Children’s, and
Extension Program (HEP), Pakistan’s Lady Health Worker (LHW) Program, and Uganda’s Village Adolescents’ Health
Health Teams, among others, improve the promotion of essential health information and services.105 (2016-2030)
•M
 obilizing communities through women’s or community groups: Evidence from countries in Africa
and Asia points to the role of women’s groups in improving maternal and newborn care practices • Report of the High-Level
and reducing maternal and newborn deaths. These groups bring women together before, during, Working Group on the
and after pregnancy to share common experiences, identify problems, exchange information, Health and Human Rights
discuss ways to access quality maternal and newborn healthcare, identify gaps in the system, and of Women, Children and
find potential solutions. A meta-analysis conducted in 2013 shows that women’s groups can reduce Adolescents (2017)
maternal deaths by 49% and newborn deaths by one-third.106
• UN Decade of Action on
Case Study: Pakistan’s Lady Health Worker Program
Nutrition (2016-2025)
With many urban-rural disparities and a drastic imbalance in the health workforce, including insufficient
numbers of health workers, nurses, and skilled birth attendants, through the Prime Minister’s Programme
for Family Planning and Primary Care, Pakistan created the Lady Health Worker cadre in 1994.107 Lady
Health Workers must be recommended by the community, have at least eight years of schooling, and
undergo extensive training. The goal of this program is to equip female health workers with the skills to
provide essential primary health services in rural and urban slum communities.108 External evaluation has
shown substantially better health indicators in the population served by Lady Health Workers. In the Punjab
province, for example, Lady Health Workers have played a critical role in reducing maternal mortality rates.
A 2006 study of the region revealed a drop in maternal mortality from 350 to 250 per 100,000 live births.
Infant mortality also declined from 250 to 79 per 100,000 live births.109

Address Unintended Pregnancy Through Modern Contraception and Increase Access to

Safe Abortion
Roughly 43% of the 206 million pregnancies that occurred in developing regions in 2017 were
unplanned.110 If the unmet need for modern contraception was satisfied, 36 million induced abortions
could be prevented,111 half of which are typically unsafe.112 To eliminate the risks posed by unintended
pregnancy and unsafe abortion, girls and women need access to contraceptive information, counseling,
products, and services, as well as to be able to plan their pregnancies.113 Girls and women also need access to quality postabortion care
to treat complications arising from an incomplete or unsafe abortion.114
In humanitarian settings, the need for reproductive health services is more acute, because girls and women affected by armed conflict
and natural disasters are at increased risk of multiple forms of gender-based violence, unintended pregnancy, maternal morbidity and
mortality, and unsafe abortion.115,116 As a result, meeting the demand for family planning in humanitarian settings is critical. For example,
nearly three quarters of pregnant Syrian refugee women surveyed in Lebanon wished to prevent future pregnancy, and more than
one-half did not desire their current pregnancy.117 Demand for the full range of contraceptive options, including long-acting methods, is
present in humanitarian settings, and evidence shows that women will use them if available and of reasonable quality.118
Increasing access to and use of modern contraception is the best way to reduce unintended pregnancies and unsafe abortions.119 The
use of modern contraception also allows for birth spacing, which in turn reduces birth complications, thus increasing the health of both
the woman and baby.120,121 However, when contraceptive methods fail, or when pregnancies pose a health risk to the mother, access
to safe and legal abortion is crucial to reducing maternal mortality and morbidity.122 Therefore, liberalizing abortion laws and increasing
access to safe abortion services needs to be a priority in places where it is currently highly restricted or illegal.123 In countries such as
Nepal, South Africa,124 and Tunisia, legalizing abortion has been linked to a drop in maternal mortality.125
Where safe abortion services do exist, communities must know how to access them, and available services must be affordable.
In countries where abortion remains highly restricted, and therefore often unsafe, postabortion care (PAC) services should be
strengthened and efforts must be made to increase awareness of them. Fear of stigma may prevent women, and especially adolescents,
from seeking care for abortion-related complications. PAC providers should not only be trained on appropriate techniques and
procedures, but should also know how to provide non-judgmental, confidential, and adolescent/youth-friendly services, which should
include counseling on contraception. Evidence shows that providing contraceptive services and counseling alongside PAC services
increases contraceptive use, thereby reducing unintended pregnancies and repeat abortions.126
In countries where abortion is legal, the following actions promote access to safe abortion:127
•R
 egistering essential medicines and making supplies available for safe abortion services;
•T
 raining providers on WHO-endorsed safe abortion methods, including vacuum aspiration for surgical abortion and misoprostol for
medical abortion; and
•E
 nsuring abortion is affordable, legal, and confidential for all, without age or marriage restriction.

Case Study: The Impact of Legal Reform on Availability of Abortion in South Africa
In 1996, abortion was legalized in South Africa, after which there was a significant decrease in infections and hospitalizations of women who
had undergone unsafe abortion, especially younger women.128 A review of national data indicates that abortion mortality dropped by more than
90% between 1994 and 2001.129

Provide Maternal and Newborn Nutrition Education, Counseling, and Support — and Promote
Exclusive Breastfeeding
Given the intergenerational nature of malnutrition, it is important to recognize the value of nutritional education, counseling, and
support services as effective tools to improve maternal and newborn health and enhance overall health and wellbeing for all. When
girls and women who are malnourished become pregnant, the impacts can be detrimental — for themselves and their babies.130 Lack of
proper nutrition can lead to the birth of underweight babies who face an increased risk of poor health throughout their lives — a risk
that can have long-term impacts on health.131 It is estimated that one quarter of children under five worldwide experienced chronic
malnutrition in 2017.132 This figure is even higher in regions such as South Asia, Eastern and Southern Africa, and West and Central
Africa, where more than one-third of all girls and boys are stunted.133 Proper nutrition during the first 1,000 days of a baby’s life,
starting from the beginning of a woman’s pregnancy, is critical.134 This 1,000-day critical window of opportunity can have a strong
impact on a child’s physical and cognitive growth and ability to learn,135 as early childhood nutrition and early stimulation and learning
programs extend school completion, improve learning outcomes, and increase adult wages and access to decent work opportunities.136
An increased risk of malnutrition, death, and illness during the postnatal period has been linked to poor and inadequate feeding
practices. Evidence clearly indicates the benefits of early initiation and exclusive breastfeeding for the first six months of life, which
has been on the increase over the past decade.137 Globally, 43% of infants younger than six months were exclusively breastfed in 2015,
up from 35% in 2005.138 The prevalence of exclusive breastfeeding is highest in Southern Asia (59%) and Eastern Africa (57%), but
much lower in Latin America and the Caribbean (33%), Eastern Asia (28%), Western Africa (25%), and Western Asia (21%).139 A lack of
awareness of optimal feeding practices and a lack of support and encouragement from skilled counselors, family members, healthcare
providers, employers, and policymakers still exists throughout Africa,140 although this is changing.141 Babies who are not breastfed within
the first hour have a higher risk of death.142 Therefore, it is vital that healthcare providers, family, and community members advising new
mothers have accurate information about the merits of breastfeeding and are equipped to promote and support maternal nutrition and
recommended breastfeeding practices.143 Special attention and support around breastfeeding must also be given to low-birthweight
babies and their mothers, HIV-positive mothers, and babies born in fragile and emergency settings.144 Due to lacking maternity
protection provisions, many women who return to work stop breastfeeding partially or completely because they do not have sufficient
time or a place to breastfeed, express, and store their milk.145 Enabling conditions at work, such as paid parental leave; part-time work
arrangements; on-site childcare; clean, safe, and private facilities for expressing and storing breast milk; and breastfeeding breaks, can
help.146
A Lancet study estimated that the costs required for breastfeeding promotion are relatively low. For the 34 countries with 90% of the
world’s stunted children, achieving vast coverage in promoting early, exclusive, and continued breastfeeding through education and
nutrition supplementation would cost roughly $175 per life-year saved.147

Case Study: Scaling Up Breastfeeding in Bangladesh

Breastfeeding has been widely lauded for enduring health benefits for infants and their mothers. Between 2007 and 2011, targeted education
and advocacy helped increase exclusive breastfeeding in Bangladesh from 43% to 64%.148 Bangladesh’s success has been attributed to
community mobilization and media outreach around the importance of breastfeeding, along with comprehensive health worker training. This
training helped create a support system at health facilities that provides a vital resource for positive nutritional education. Bangladesh
also utilized strategic technical experience of various stakeholders — including civil society, UNICEF, and the Alive and Thrive initiative149
— incorporated existing evidence and best practices, and worked across sectors to create uniform messaging and practice around
breastfeeding promotion.150 The Alive and Thrive initiative, for example, helped increase breastfeeding in targeted populations: In women
reached by the initiative, the proportion of women who reported practicing exclusive breastfeeding increased from 49% to 88%, and the
proportion of women engaging in early initiation of breastfeeding increased from 64% to 94%.151

SECTION 3: THE BENEFITS OF INVESTMENT

If all girls and women had access to modern contraception and the full range of maternal and newborn health services, maternal
death would drop roughly 73% and newborn deaths would be reduced by about 80%.152
Investments in maternal, newborn, and reproductive health are sound investments. They not only save lives, they increase both
social and economic benefits for developing nations.153 Every $1 spent globally on interventions promoting contraception and
high-quality maternal and newborn healthcare would reap $120 in benefits.154 Given the important role girls and women play
in contributing to national and global economies, ensuring they are healthy makes them more likely to save, invest, and deliver
better for themselves, their families, communities, and societies. Conversely, poor health outcomes, resulting from maternal death,
disability, and inadequate nutrition, adversely affects the economy and slashes family earnings.
Evidence suggests that in Africa and Asia, an 11% loss in gross national product is directly linked to malnutrition, and that scaling
up nutrition interventions targeting pregnant women and young children yields a return of at least $16 for every $1 spent.155,156
Children who are malnourished during their first 1,000 days of life are more susceptible to infectious diseases and have lower
cognitive abilities.157 As a result, early undernutrition or overnutrition can considerably hinder a country’s economic growth.158
During the first two years of a child’s life, optimal breastfeeding reduces a child’s risk of death and lowers the long-term negative
impact of poor nutrition.159 Breastfeeding and proper nutrition may also lower the risk of high blood pressure and cholesterol,
obesity, diabetes, cancers, and some childhood asthmas.160,161 Providing women with micronutrients can help ensure healthy
pregnancies, prevent anemia, enhance fetal growth, and support healthy birthweights.162 Micronutrients are important for the
health of the baby, but also for the overall health and wellbeing of girls and women.
Research has demonstrated that the impact of maternal death on families, and especially on children who are left behind, can be
devastating.163 Maternal mortality has implications for the surviving household’s financial stability and puts the future education of
children at risk.164 Research has shown that newborns whose mothers die in childbirth are far less likely to reach their first birthday
than those whose mothers survive.165 Among surviving daughters, school dropout and early marriage rates rise, repeating the
cycle of poverty for the next generation.166

SECTION 4: CALLS TO ACTION

The vast majority of maternal and newborn deaths and disabilities can be prevented by known interventions provided through
a continuum of care. Access to quality maternal and newborn care and nutrition not only benefits the woman and child, it has
far-reaching benefits for families, communities, and societies as a whole. In order to power progress for all, many different
constituencies must work together — governments, civil society, academia, media, affected populations, the United Nations, and
the private sector — to take the following actions for girls and women:
•G
 uarantee access to quality, affordable care before, during, and after pregnancy — inclusive of midwifery and obstetric care,
modern contraception, safe abortion, and post-abortion care. (Most relevant for: civil society, governments, the United Nations,
and the private sector)
•E
 nsure quality care is inclusive of midwifery and obstetric care, family planning, safe abortion and postabortion care, and repairs
of fistula. (Most relevant for: civil society, governments, the United Nations, and the private sector)
•M
 eet the unmet need for modern contraception for girls and women. (Most relevant for: civil society, governments, the United
Nations, and the private sector)
•S
 upport the prevention, screening, and treatment of common challenges during pregnancy such as obesity, gestational diabetes,
and high blood pressure. (Most relevant for: civil society, governments, the United Nations, and the private sector)
• I ncrease national budgets for maternal and newborn health and nutrition to meet global health and nutrition targets by 2030.
(Most relevant for: governments)
•S
 et measurable targets for improving maternal and newborn health and nutrition, monitor progress, and strengthen
accountability mechanisms, while ensuring the equal involvement of all stakeholders, including civil society. (Most relevant for:
civil society and governments)
•A
 ddress barriers to healthcare, including user fees, poor infrastructure — including inadequate access to clean water, sanitation,
and hygiene — and a lack of essential supplies, medicines, and micronutrients. (Most relevant for: governments, civil society and
the private sector)
• I nclude girls, young people, and women in the design and implementation of maternal and newborn health and nutrition
programs as context experts. (Most relevant for: civil society, governments, and the United Nations)
•H
 old governments accountable to commitments made in support of girls’ and women’s health, rights, and wellbeing. (Most
relevant for: affected populations, civil society, and the United Nations)
•P
 romote and provide young people and women access to nutritious food, counseling on proper nutritional practices such as
early initiation, exclusive and continued breastfeeding, and critical micronutrients. (Most relevant for: affected populations, civil
society, governments, the United Nations, and the private sector)
•E
 nsure that adequate parental protection measures are put in place so that women who return to work are aware of their rights
 and can continue breastfeeding until their baby is at least 6 months old. (Most relevant for: governments, the United Nations, the
private sector and civil society)
•E
 nsure that the full spectrum of maternal and newborn health, food security, and nutrition interventions are included in humanitarian
response guidelines and protocols, financed, and implemented, including the Minimum Initial Service Package (MISP) and the minimum
standards in food security and nutrition guidelines. (Most relevant for the United Nations, governments, and civil society)

Last Reviewed and Updated: June 2018

Brief Prepared in 2016 by: Kathleen Schaffer, Family Care International and Shafia Rashid, FCI Program of Management Sciences for
Health
Reviewed by: Genine Babakian, Consultant; Juliana Bennington, Women Deliver; Mary Crippen, Consultant; Iselin Danbolt, Scaling
Up Nutrition (SUN) Movement; Masha DeVoe, Women Deliver; Tatiana DiLanzo, Women Deliver; Louise Dunn, Women Deliver; Katja
Iversen, Women Deliver; Jessica Malter, Women Deliver; Susan Papp, Women Deliver; Savannah Russo, Women Deliver; Athena
Rayburn; Women Deliver; Dominic Schofield, Global Alliance for Improved Nutrition; Liuba Grechen Shirley, Consultant; Ann Starrs,
Guttmacher Institute; Petra ten Hoope-Bender, Women Deliver; Tamara Windau-Melmer, Women Deliver; Courtney Carson, Women
Deliver
Disclaimer: The views and opinions expressed in this technical paper are those of the authors and do not necessarily reflect the official policy or
position of all partnering organizations
These briefs are intended to be used by policymakers, decision-makers, advocates, and activists to advance issues effecting girls and women in
global development. These materials are designed to be open-sourced and available for your use.

â Learn more about the Deliver for Good campaign.

ENDNOTES
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163. Belizan, Jose and Suellen Miller. “True Costs of Maternal Death.”
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164. Ibid.

165. Moucheraud, Corrina, et al. “Consequences of maternal mortality on

infant and child survival: a 25-year longitudinal analysis in Butajira Ethiopia
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166. Belizan, Jose and Suellen Miller. “True Costs of Maternal Death.”
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