Presenter: Shanon McNab, Averting Maternal Death and Disability, Columbia University
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Background: By 2050, two-thirds of the world’s population will live in urban areas and nearly 90% of this growth will be in Africa and Asia. In LMICs, over 860 million people are living in slums: 62% of urban residents in sub-Saharan Africa and 35% in south Asia are slum-dwellers. In many cities, MMR and NMR are much higher in slums than the urban average. Despite this massive urbanization, evidence on strategies for effective coverage of MNH interventions for the urban poor is extremely limited. Further analysis of strategic approaches, delivery structures, implementation frameworks, financial mechanisms, and roles of private and public partners is urgently needed. Saving Newborn Lives, in collaboration with Columbia University, conducted a global scoping of the status of MNH in urban settings focusing on south Asia and sub-Saharan Africa.
Methodology: A multi-tiered approach was used to understand the complexity of the ‘urban’ situation. A literature review was conducted to identify existing urban MNH programs, health policies and relevant stakeholders. A critical interpretive synthesis was conducted to better understand the context of the urban slum and its impact on program design and implementation. The findings were analyzed with the goal of identifying potential policy, program and implementation approaches to achieve impact at scale.
Results: Rapidly growing urban poor populations challenge the future of MNH. Innovative strategies around home-based care, care-seeking and access to facility-based services are necessary to address the complex needs of urban populations. Emerging from the MNH evidence-base as well as other sectors working in urban settings, recommendations were formulated for future programming.
Conclusion: Individual aspirations, community structures and health service delivery infrastructure vary widely within cities and across countries. Addressing the urban maternal and newborn health needs will require a shift from the traditional service delivery mode to innovative and comprehensive multipronged approaches.