Research Article: Measures matter: A scoping review of maternal and newborn indicators

Date Published: October 9, 2018

Publisher: Public Library of Science

Author(s): Ann-Beth Moller, Holly Newby, Claudia Hanson, Alison Morgan, Shams El Arifeen, Doris Chou, Theresa Diaz, Lale Say, Ian Askew, Allisyn C. Moran, Abraham Salinas-Miranda.


A variety of global-level monitoring initiatives have recommended indicators for tracking progress in maternal and newborn health. As a first step supporting the work of WHO’s Mother and Newborn Information for Tracking Outcomes and Results (MoNITOR) Technical Advisory Group, we aimed to compile and synthesize recommended indicators in order to document the landscape of maternal and newborn measurement and monitoring.

We conducted a scoping review of indicators proposed by global multi-stakeholder groups to suggest next steps to further support maternal and newborn measurement and monitoring.

We identified 140 indicators linked to maternal and newborn health topics across the continuum of service provision. Fifty-five indicators relate to inputs and processes, 30 indicators relate to outputs, outcomes comprise 37 indicators in the database, and 18 impact indicators. A quarter of indicators proposed by global groups is either under development/discussion or is considered “aspirational”, highlighting the currently evolving monitoring landscape. Although considerable efforts have been made to harmonize indicator recommendations, there are still relatively few indicators shared across key monitoring initiatives and some of those that are shared may have definitional variation.

Rapid, wide-ranging work by a number of multi-stakeholder groups has resulted in a substantial number of indicators, many of which partially overlap and many are not supported with adequate documentation or guidance. The volume of indicators, coupled with the number of initiatives promoting different indicator lists, highlight the need for strengthened coordination and technical leadership to harmonize recommendations for improved measurement and monitoring of data related to maternal and newborn heath.

Partial Text

With the adoption of the Sustainable Development Goals (SDG) [1] in 2015, countries have renewed their commitment to reduce preventable maternal and newborn deaths significantly by 2030. The SDG agenda is supported by several global initiatives and strategies such as the Global Strategy for Women’s, Children’s, and Adolescents’ Health (Global Strategy) [2], Every Newborn Action Plan (ENAP) [3], Ending Preventable Maternal Mortality (EPMM) [4], and the Global Financing Facility in Support of Every Woman Every Child [5]. These initiatives have set out goals and targets for ending preventable maternal and newborn deaths, as well as stillbirths by 2030.

The database comprises 140 indicators linked to a variety of maternal and newborn health topics across a continuum of service provision. (S2 Table maternal and newborn indicator database) Fifty-five indicators (39%) relate to inputs and processes, such as governance and financing, the health work force, the supply chain, and health information. Thirty (21%) indicators relate to outputs, such as service access and availability, as well as service quality and safety. Outcomes, encompassing both coverage of services and health related behaviors, comprise 37 (26%) indicators in the database. A total of 18 (13%) impact indicators are included. (Table 1 and Fig 1) This breadth of indicators underscores the complexity of tracking high-quality maternal and newborn health care, and highlights the variety of data sources, from routine administrative records to household surveys, needed for monitoring from the facility level up to the national and global levels.

Political engagement, financial investments, and technical innovation have resulted in the substantial advancement of the maternal-newborn health evidence base in recent years. There has been increasing consensus around sets of standard indicators, support for data collection and data use, and efforts to address topical gaps, develop innovative methods to further analyze existing data, and to review and validate existing indicators. These advancements not only feed back into higher-level advocacy at the global level, but also serve countries by providing national health planners with a range of options from which to select indicators addressing their specific context.

This scoping review forms a ‘stock take’ of current maternal and newborn indicators. The next steps include documenting the validation gaps and measurement challenges inherent in many of the existing indicators, harmonizing the indicator definition and proposing a set of core indicators and developing indicator specific guidance sheets.




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