Reducing maternal and neonatal mortality in the poorest communities

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Abstract
Introduction Every year 530 000 women die from maternal causes, four million infants die in the neonatal period, and a similar number are stillborn.w1 w2 Despite a plethora of newly validated interventions, the millennium development goals to reduce maternal mortality by three quarters and child mortality by two thirds are unlikely to be achieved.1 One of the reasons for this is that current safer motherhood and newborn care programmes emphasise interventions that do not reach the poorest households. Community based interventions have been neglected and undervalued. In this article, we argue that large scale community effectiveness trials are both necessary and feasible if we are to make further progress with reducing maternal and child mortality. Peer education is the best method of changing behaviour Footnotes References w1-w13 are on bmj.com Contributors and sources For six years AC, DO, and DM have worked together on a community effectiveness trial to improve maternal and newborn care in rural Nepal. DM has been a national adviser to the government of Nepal on safer motherhood and newborn health policy. AC and DO are collaborating with local partners on perinatal community effectiveness trials in Bangladesh, India, and Malawi. AC will act as guarantor. Competing interest None declared.