A new study led by the International Center for Equity in Health at the Federal University of Pelotas (ICEH/UFPel) introduces the MNHci (Maternal and Newborn Health Composite Indicator), a novel composite measure designed to assess the co-coverage of essential maternal and newborn health interventions in low- and middle-income countries (LMICs). Published in the journal Public Health, the study builds on technical discussions with experts from the international Countdown to 2030 initiative.

Adequate antenatal care, skilled childbirth care, and timely postnatal care are critical interventions for reducing maternal and newborn morbidity and mortality. Although these interventions are intrinsically connected across the continuum of care, they have typically been monitored as isolated indicators in public health frameworks.

"We identified a clear need for an indicator that combines these three key stages to better assess maternal and newborn healthcare as a continuous, integrated process," explains Luisa Arroyave, ICEH researcher and lead author of the study.

How the MNHci works

The innovative indicator operates as a straightforward, unweighted count of three core, SDG-aligned interventions:

 

• Antenatal Care: At least four antenatal care visits (ANC4+);
• Delivery Care: Institutional delivery (giving birth in a medical facility);
• Postnatal Care: Postnatal care (PNC) for either the mother or the newborn within two days of delivery.

 

Each mother–newborn pair receives a score ranging from zero (no interventions received) to three (all three interventions received). Using nationally representative household survey data from 97 countries, the research team — comprised of scientists Luisa Arroyave, Paulo Neves, Fernando C. Wehrmeister, Ties Boerma, and Aluisio J. D. Barros — analyzed the global distribution of the indicator, its direct association with infant mortality, and underlying socioeconomic inequalities.

Direct correlation with survival

The validation process yielded robust evidence: MNHci scores demonstrated a strong inverse association with both neonatal and post-neonatal mortality rates across countries. Simply put, countries achieving higher MNHci scores consistently showed lower infant mortality rates.

Most notably, statistical models revealed that receiving all three essential interventions was associated with a 43% lower risk of neonatal mortality compared with receiving none, even after rigorously adjusting for the sociodemographic characteristics of the households.

Unmasking structural inequalities

The study also cast a stark light on persistent disparities in healthcare access. Co-coverage of all three interventions was systematically and substantially higher among wealthier households (83% in the richest decile compared to just 44% in the poorest) and among women living in urban areas.

"We live in a profoundly unequal world, where access to and quality of healthcare services vary considerably because of socioeconomic and demographic barriers. We developed the MNHci not only to measure coverage but also to quantify inequalities within and between countries, providing solid evidence to inform programmes and policies aimed at reducing these disparities," Arroyave points out.

As a simple, reliable, and highly policy-relevant instrument, the MNHci provides global stakeholders with a valuable tool for monitoring health system performance and identifying gaps in continuity of care. Its baseline implementation can support LMICs in tracking progress toward the Sustainable Development Goals while actively promoting equity in maternal and newborn survival.

The MNHci has already gained significant traction within international global health circles. It has been featured in core Countdown reports and presented at major scientific forums, including the AlignMNH Conference (2023), the World Congress of Epidemiology (2024), and the International Maternal Newborn Health Conference (2026), as well as being highlighted in the Countdown Lancet Global Report.

• Read the full article in Public Health
• Read more in the Countdown Lancet Global Report

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