Challenges in reducing maternal and neonatal mortality in Niger: an in-depth case study

Area of Science:

• Global Health
• Maternal and Newborn Health
• Demography

Background:

• Modelled estimates indicated progress in maternal mortality in Niger since 2000.
• However, neonatal mortality stagnated since 2012, with maternal mortality data being limited.
• Research was conducted to identify drivers of progress and persistent challenges.

Purpose of the Study:

• To analyze trends and determinants of maternal and neonatal mortality in Niger.
• To assess the impact of health policies and interventions on mortality rates.
• To identify challenges hindering further reductions in maternal and neonatal mortality.

Main Methods:

• Reviewed two decades of health policies and analyzed mortality data from UN and national surveys (1998-2021).
• Assessed coverage and inequalities of maternal and newborn health indicators.
• Evaluated quality of care through facility surveys and emergency obstetric assessments; interviewed key informants.

Main Results:

• Maternal mortality ratio declined from 709 to 520/100,000 live births (2000-2011); neonatal mortality rate fell from 46 to 23/1000 live births (2000-2012) but rose to 43 in 2018.
• Key maternal and newborn health indicators improved until 2012, with interventions during childbirth saving the most lives.
• Progress drivers included health center expansion and fee exemption policies; challenges included high fertility, security, and workforce issues.

Conclusions:

• Niger achieved maternal and neonatal mortality reductions between 2000-2012, but progress has stalled in the last decade.
• Further reductions necessitate strategies addressing comprehensive care, quality of care, fertility, social determinants, and security.
• Addressing these multifaceted issues is crucial for renewed progress in maternal and newborn health outcomes.