42 Days: Reimagining the postpartum and postnatal period

Why 42 days? What is special about 42 days? 

The first 42 days following childbirth is considered to be a critical phase in the lives of women and their newborn infants. From the moment of placental separation, until the 6-week postpartum check-up, the first 42 days have historically been marked by practices and rituals that aimed to bring meaning as well as care to this tentative time.[1] Supporting the health and the survival of the newborn infant and postpartum woman remain vitally important. It is estimated that 80% of all maternal deaths occur in the first 14 days following birth[2] and 47% of all deaths in children under 5 take place in the first 28 days of life. Most are preventable; nearly all take place in low- and middle-income countries, or where access to care is poor.[3]  

With the shift to higher numbers of facility deliveries globally, there is a huge opportunity to rethink the role of health systems in creating equitable and meaningful practices that continuously aim to prevent mortality, and support women and infants in their transition back to their home and community settings. This global health conference will re-examine the first 42 days by asking two key questions: 

  1. How do we improve the quality of care in the first 42 days while continuing to advance gains in access and equity; and
  2. How do we move beyond a focus on mortality prevention to build health systems that aim to reduce inequities and promote inclusion beyond the first 42 days?

A wide-ranging panel of speakers from public health, epidemiology, pediatrics, family medicine, obstetrics and gynecology, will present from their fields of experience from Canada, the US, Uganda, Kenya, Rwanda, Pakistan and Guatemala. Conference participation will be richly integrated in the program to enable a global conversation on this topic. 

Panel 1: Building caring health systems

Universal health coverage (UHC), with its emphasis on access, is an essential starting point for improving health systems and care in the postnatal and postpartum period.[4] However, poor-quality care has become a more significant barrier to reducing mortality than insufficient access. An increased focus on quality improvement, therefore, needs to become a core component of UHC, alongside other essential elements, such as expanding coverage, financial protection, and community health worker engagement.

Panel 2: Moving beyond mortality to equity and justice

Our second panel will aim to shift away from the 42-day time constraint and the clinical focus on mortality prevention, to broaden the conversation to social justice and equity. Recognizing the limitations of the existing paradigm, it will feature care models around the world, as well as from the Downtown East Side and rural Canada that are committed to restoring, and building back better, practices and rituals that reduce inequities, promote inclusion, and attend to those at the margins. 

At the same time, by singularly focusing on reducing mortality, we risk developing a false sense of complacency about progress in maternal and newborn health. We would like to challenge the notion that reducing mortality and a focus on biomedical care is sufficient. Our focus should be on helping mothers and children thrive by providing culturally appropriate, equitable and integrated care that gives newborns a healthy start in life and helps build the foundation for a sound childhood and a productive life. In addition to being an important end in itself, this is also an essential component of health-care quality and will also support efforts to improve access and equity. 
 
This conference will help us to re-examine the notion of 42 days being a critical phase, with a continued commitment to reducing mortality, while also re-focusing on health and wellbeing, as we move towards ensuring all women and newborn babies receive the optimal care they need and deserve.

 

[1]Eberhard-Gran M, Garthus-Niegel S, Garthus-Niegel K, Eskild A. Postnatal care: a cross-cultural and historical perspective. Arch Womens Ment Health. 2010 Dec;13(6):459-66. doi: 10.1007/s00737-010-0175-1. Epub 2010 Aug 3. PMID: 20680363.
[2] Li XF, Fortney JA, Kotelchuck M, Glover LH. The postpartum period: the key to maternal mortality. International Journal of Gynecology & Obstetrics. 1996 Jul 1;54(1):1–0.
[3] Sankar MJ, Natarajan CK, Das RR, Agarwal R, Chandrasekaran A, Paul VK. When do newborns die? A systematic review of timing of overall and cause-specific neonatal deaths in developing countries. J Perinatol. 2016 May;36 Suppl 1(Suppl 1):S1-S11. doi: 10.1038/jp.2016.27. PMID: 27109087; PMCID: PMC4848744.
[4]Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, Adeyi O, Barker P, Daelmans B, Doubova SV, English M, García-Elorrio E, Guanais F, Gureje O, Hirschhorn LR, Jiang L, Kelley E, Lemango ET, Liljestrand J, Malata A, Marchant T, Matsoso MP, Meara JG, Mohanan M, Ndiaye Y, Norheim OF, Reddy KS, Rowe AK, Salomon JA, Thapa G, Twum-Danso NAY, Pate M. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health. 2018 Nov;6(11):e1196-e1252. doi: 10.1016/S2214-109X(18)30386-3. Epub 2018 Sep 5. Erratum in: Lancet Glob Health. 2018 Sep 18;: Erratum in: Lancet Glob Health. 2018 Nov;6(11):e1162. Erratum in: Lancet Glob Health. 2021 Aug;9(8):e1067. PMID: 30196093; PMCID: PMC7734391.