Perinatal and Neonatal Palliative Care: Challenges and Contextual Solutions in Low- and Middle-Income Countries

The purpose of this review was to explore the primary obstacles to providing comprehensive, family-centered palliative care during the perinatal and neonatal period, using insights from existing literature and clinical practice.

Perinatal and neonatal palliative care (PNPC) represents a holistic, interdisciplinary, and family-centered approach aimed at improving the quality of life for newborns diagnosed with life-limiting or life-threatening conditions. Despite its clinical and ethical significance, the provision of such care in low- and middle-income countries, such as Iran, remains substantially underdeveloped and fraught with multifaceted barriers.

In this narrative review, the WHO's House Model was used to systematically examine perinatal and neonatal palliative care challenges and propose viable solutions for analyzing the current landscape in Iran and similar low-resource settings. This model comprises 6 foundational domains: (1) Empowerment of people and communities, (2) Health policy, (3) Research, (4) Use of essential medicines, (5) Education and training, and (6) Provision of palliative care.

The challenges are multifaceted and include deep-rooted cultural and religious norms, restrictive legal frameworks, and the absence of standardized national guidelines. Furthermore, there is limited access to essential medications, particularly opioids, and shortages in trained human resources. Finally, significant gaps exist in interdisciplinary education and communication skills among healthcare professionals.

The findings underscore the urgent need to develop culturally and legally informed care frameworks, invest in interdisciplinary capacity-building, expand access to essential medications, palliative care services and enhanced psychosocial and spiritual supports. Addressing these issues may not only improve end-of-life outcomes for neonates but also mitigate parental distress, promote ethical care practices, and enhance the overall responsiveness and equity of the health system.