Maternal and Newborn Health for the Urban Poor: The Need for a New Mental Model and Implementation Strategies to Accelerate Progress

Abstract

Background: Urbanization challenges the assumptions that have traditionally influenced maternal and newborn health (MNH) programs. This landscaping outlines the ways in which current mental models for MNH programs have fallen short for urban slum populations, and identifies implications for the global community. We employed a three-pronged approach, including a literature review, key informant interviews with global- and national-level experts, and a case study in Bangladesh. Main Body: Our findings highlight that the current mental model for MNH is inadequate to address the needs of the urban poor. Implementation challenges have arisen from using traditional methods that are not well adapted to traits typically inherent of slum settings. A re-thinking of implementation strategies will also need to consider a paucity of available routine data, lack of formal coordination between stakeholders and providers, and challenging municipal government structures. Innovative approaches, including with communications, outreach, and technology, will be necessary to move beyond traditional rural-centric approaches to MNH. As populations continue to urbanize, common slum dynamics will challenge conventional strategies for health service delivery. In addition, the COVID-19 pandemic has exposed weaknesses in a system that requires intersectoral collaborations to deliver quality care. Conclusion: To meet the MNH needs of the urban poor, programs will need to be iterative and adaptive, reflective of sociodemographic features. Integrating the social determinants of health into evaluations, using participatory human-centered design processes, and innovative public-private partnerships may prove beneficial in slum settings. But a willingness to rethink the roles of all actors within the delivery system overall may be needed most.

Neonatal and perinatal mortality in the urban continuum: A geospatial analysis of the household survey, satellite imagery and travel time data in Tanzania

“…Further, literature shows that poor women, especially those living in informal settlements, might also receive poorer quality of care, encounter stigmatising attitudes and disrespectful care in health facilities. 43-45 Our additional analysis on the timing of deaths showed that a comparatively low percentage of neonatal deaths in core urban areas occurred on the day of birth compared to semi-urban and rural areas. Interpretation is difficult, but one explanation may be better access to emergency obstetric care including neonatal resuscitation in core urban compared to rural areas.…”

Household Vulnerability in the urban slums of Mumbai, India: Analysis of a large cross-sectional Survey

“…The primary healthcare systems in the developing world have been unable to adequately meet the essential health needs of the people living in the slums, especially related to their maternal and child health requirements (30). Moreover, during the Covid-19 pandemic, lack of primary health system preparedness and their suboptimal services, especially in the delivery of maternal and child health (MCH) and NCD treatment services, contributed to the further accentuation of the pre-existing health vulnerabilities amongst the people, especially living in slums (31).…”