Abstract

Maternal and neonatal mortality rates remain unacceptably high across low- and middle-income countries 
(LMICs), despite the availability of effective, evidence-based interventions. This narrative review synthesizes 
findings from studies published between January 2000 and March 2022, examining health system and policy 
interventions that enhance access to skilled maternal and newborn care. The review identifies four primary 
implementation domains: health system and policy factors; equity, access, and contextual determinants; 
knowledge-seeking, demand, and supply influences; and service-design measures. Key antenatal interventions 
include risk screening and management, nutritional supplementation, infectious disease screening, and vaccination. 
Intrapartum and delivery-related interventions encompass skilled birth attendance, emergency obstetric and 
newborn care (EmONC), cesarean section, uterotonic drug administration, and intrapartum fetal monitoring. 
Postpartum and neonatal interventions such as newborn resuscitation, thermal protection, infection control, and 
early breastfeeding support significantly reduce mortality risk. Effective implementation of these interventions 
depends on a strong health workforce, well-equipped facilities, reliable supply chains, and community-based 
outreach. Persistent inequities rooted in poverty, gender norms, and urban–rural disparities continue to limit 
access to quality care. Evidence underscores the need for integrated, context-sensitive strategies and policies that 
strengthen health systems, enhance community engagement, and ensure equitable access to skilled services. 
Strengthening maternal and newborn care delivery within resilient health systems offers a clear pathway toward 
achieving global maternal and neonatal mortality reduction targets.