Continuum of Maternal Healthcare and Neonatal Mortality in Sub-Saharan Africa
Analysis of pooled data from 35 Sub-Saharan African countries reveals that while only 13.47% of mothers receive the full continuum of maternal care, adherence to this integrated pathway is independently associated with a significant reduction in neonatal mortality, highlighting the urgent need for equity-focused policies to improve service delivery for marginalized populations.
Original paper dedicated to the public domain under CC0 1.0 (https://creativecommons.org/publicdomain/zero/1.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
In the first month of life, a newborn's survival often depends on a chain of care that begins before birth and continues well after. This chain, known as the continuum of care, links three critical moments: regular checkups during pregnancy, the presence of a skilled professional during delivery, and a health check for the mother and baby within two days of birth. While each step alone offers protection, health experts have long suspected that connecting all three without a break provides the strongest shield against death. In Sub-Saharan Africa, where the risk of a newborn dying is still unacceptably high, understanding whether this full chain of care works as a unified system is a matter of urgent public health.
A team of researchers set out to test this idea on a massive scale, analyzing data from nearly 868,000 births across 35 countries in the region. They looked at records from national surveys conducted between 2010 and 2026 to see how many mothers actually completed every link in the chain. The results revealed a stark reality: only about 13.5 percent of mothers received the full package of care. The likelihood of completing the chain was heavily tied to a family's circumstances. Mothers who were wealthier, lived in cities, had more education, or were having their first child were far more likely to receive all three services. In contrast, those who were poorer, lived in rural areas, had less schooling, or had many children often received only parts of the care or none at all.
When the researchers compared the outcomes, the benefit of completing the full chain became clear. Babies born to mothers who received the complete continuum of care were significantly less likely to die within their first 28 days. The data showed that completing the chain reduced the odds of neonatal death by roughly 36 percent, even after accounting for factors like wealth, education, and the mother's age. To understand the real-world impact, the team ran a counterfactual analysis, essentially asking what would happen if every mother in the study had received the full care. They found that the probability of a newborn dying would drop from about 3.15 percent to 2.04 percent. While this difference might seem small in percentage points, applied to the entire population, it translates to preventing nearly 10,000 deaths in this sample alone.
The study also examined whether this protective effect varied from one country to another. Despite wide differences in how many women received care in different nations, the benefit of receiving that care remained consistent across the board. The only exception was Namibia, where the data suggested the benefit might be even stronger, though the overall pattern held true everywhere else. The researchers noted that while the study cannot prove that the care directly caused the survival in every single case, the strength of the association is robust. They also highlighted that the biggest barriers were not just a lack of clinics, but deep inequalities. The women who needed the care the most—the poorest, the least educated, and those living in remote villages—were the least likely to get it.
The findings point toward a clear path forward for health systems in the region. Rather than treating pregnancy, birth, and post-birth care as separate events, health services need to be integrated so that a mother is guided seamlessly through all three stages. The data suggests that simply building more clinics is not enough; policies must specifically target the most vulnerable groups to ensure they can access the full chain of care. By focusing on equity and ensuring that the poorest and most marginalized women receive the complete package of services, Sub-Saharan Africa could make a substantial dent in the number of newborn deaths, moving closer to global health goals.
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