Although the global maternal and newborn health (MNH) burden has decreased significantly in the last 30 years, progress is now stalling, and the relevant Sustainable Development Goal (SDG) targets will not be reached by 2030. Every year there are 260,000 maternal deaths, 2.4 million newborn deaths, and 1.9 million stillbirths due to complications in pregnancy and childbirth, mostly in low- and middle-income countries (LMICs). Much of the progress in mortality reduction has come from expanding access to care. This is reflected in the recent Every Woman Every Newborn Everywhere (EWENE) targets which call for – 90% coverage of four antenatal care (ANC) visits, 90% coverage of skilled birth attendance, 80% coverage of postnatal and newborn care, and 80% coverage of emergency obstetric and newborn care. EWENE is now guiding country efforts to reach MNH targets under the SDGs, yet many countries are not on track[1].
Increasing service coverage alone, however, is not sufficient to achieve further reductions in MNH mortality. It is equally critical to ensure that the care provided is of high quality. High-quality care for MNH has four dimensions: Delivery by the right provider; in an adequately equipped facility; delivering the right package of services; using the right, quality-assured health products. Even where service access is high, limited availability and/or poor-quality essential health products can significantly undermine outcomes. Strengthening quality and availability of life-saving products, alongside coverage, is therefore critical to achieving sustainable reductions in MNH mortality.
While there have been interventions and commitments in increasing access to MNH products in LMICs, studies in different countries show that consistent availability at the point of care remains a significant challenge. An assessment by UNFPA in the West and Central African region found that availability of at least seven vital maternal health commodities was critically low in several countries, such as Senegal (12.8%), Congo (31.35%), Benin (36%) and Mali (45%)[2]. Some assessments suggest that stock outs are getting worse over time in LMICs[3]. This results in limited and uneven access to essential MNH products. For example, less than 20% of women who need antihypertensive drugs in pregnancy receive them. There are similar gaps for uterotonic drugs and iron and folic acid supplements, where less than 50% of pregnant women receive these essential interventions[4]. Over the past few years, Unitaid and other partners have invested in accelerating access to newer- and lesser-used MNH products. These efforts have contributed to important progress in supporting country adoption and early scale up. However, sustaining access requires continued action. Even as products gain policy endorsement and enter national programs, persistent and systemic barriers remain, putting progress in improving health outcomes and equitable access to essential MNH products at risk. These barriers, such as those related to national quantification, procurement, and financing systems, can be overcome with targeted efforts focused on improving coordination, data use and alignment. These country-driven activities also support optimized use of scarce resources, which is particularly critical given the funding constrained environment.
Health products that are supported by significant donor funding, such as those for HIV or malaria, sometimes have dedicated programmatic support, with direct or centralized financing and procurement. In contrast, most MNH products are procured and financed by governments with domestic funding. As a result, MNH products are subject to different financing and procurement arrangements and are often managed within the broader essential medicines supply chain systems. This can potentially facilitate long term sustainability; however, it also exposes them to the same systemic challenges that affect essential medicines overall. Often there are no dedicated budget lines for MNH products, and they are grouped under broader budgets for essential medicines, often inadequate to meet the overall needs. Greater fragmentation of financing and procurement limit the application of market-shaping initiatives. While global financing mechanisms for MNH products exist, they are often underutilized due to limited awareness or clarity on how country programs can access these funds. Furthermore, reduced donor funding in other areas has exacerbated budget constraints, increasing competition for limited resources. As a result, MNH products risk being further deprioritized in favor of other health products. Additionally, when government funds are released, they are often delayed and insufficient, creating significant challenges for procurement planning, price negotiations and timely payments to suppliers. These factors make access to these products especially vulnerable, both to systemic constraints and to challenges specific to MNH.
Delays in updating guidelines, policies, and essential medicines lists (EMLs) to include newer and more effective MNH products can hinder product selection and limit availability of key MNH products. For example, although low dose aspirin may be included in the EMLs, clinical guidelines in some countries do not yet recommend its use for pre-eclampsia prevention[5]. These delays may stem from gaps in coordinated and evidence-based mechanisms for product introduction and scale up. Limited methodologies for forecasting MNH products, coupled with unreliable consumption and service data, limit the accuracy of forecasts. There is often a disconnect between forecasting efforts and budgeting and procurement decisions, leading to gaps between the actual need and what is financed and procured. Procurement processes can be slow and cumbersome, which affects delivery time. Additionally, procurement policies which prioritize low price can compromise quality. Fragmented procurement systems, both within countries and across regions, hinder coordination with variable pricing across geographies pointing to gaps in market optimization. Furthermore, poor access to health products in hard-to-reach areas exacerbate the access and equity challenge as well.
High-quality suppliers are often discouraged from entering LMIC markets due to poor visibility on market demand and lengthy product registration processes. Moreover, since these products are typically low-cost and low margin, they offer limited commercial incentives for suppliers to make the necessary investments. Gaps in post-marketing surveillance can further contribute to the proliferation of poor-quality MNH products. As a result, lower quality MNH products often dominate LMIC markets.
Examples of challenges limiting access to MNH products
| Function | Challenges |
| Guidelines & Policies | Delays in updating guidelines and policies to align with new evidence and WHO recommendations |
| Suboptimal coordination mechanisms for new product introduction and scale up | |
| Low prioritization of MNH compared to other health areas | |
| Forecasting & Quantification | Limited methodologies for MNH product quantification |
| Unreliable consumption and services data | |
| Disconnected forecasting efforts, not informing budgeting and procurement decisions | |
| Financing and budget execution | Lack of dedicated budget lines for MNH products |
| Inadequate financing and delayed disbursements | |
| Limited awareness of and capacity to access global financing instruments for MNH products | |
| Procurement & contracting | Procurement timelines and processes limit ability to realize efficiencies or ensure use of quality product |
| Fragmented procurement within and across countries reinforcing quality and pricing variations | |
| Regulatory approval and quality assurance | Product registration processes and limited visibility on market demand can discourage investment in quality production |
| Gaps in post-marketing surveillance combined with high use of products with low or uncertain quality | |
| Last mile delivery | Challenges in last-mile delivery to remote areas hinders equity in access to care (exacerbated by climate-related challenges) |
Landscape report highlights innovative solutions to strengthen access to quality life-saving maternal and newborn health products: Solutions for improving access to quality maternal and newborn health products
[1] Improving maternal and newborn health and survival and reducing stillbirth. Progress report 2023
[2] West and Central Africa’s Regional trend analysis in the supply and availability of reproductive health products at service-delivery points(2017-2023)
[3] Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences
[4] Maternal Health Data Report | Landscape & Projection of RH Supply Needs Report
[5] Preeclampsia prevention: a survey study on knowledge and practice among prenatal care providers in Ethiopia