Continuum of Care for Maternal and Child: The Success Story of a Special Handbook

The Maternal and Child Health Handbook (MCHHB) is an effective tool for delivering proper maternal and child health care, which can be useful for both mother and child, and healthcare providers as well1. A recent randomized controlled study in rural Java, Indonesia determined the effectiveness of the MCHHB as a maternal education tool2.

According to WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division, maternal deaths approximated 295,000 in 2017 globally; of which Southeast Asia accounted for 16,000 (5%) of the global maternal deaths. The 2017 global maternal mortality ratio is estimated at 211 deaths per 100,000 live births; whereas in Southeast Asia it is estimated at 157 per 100,000 live births3,4. While the under-5 mortality rate was estimated at 39 per 1000 live births in 2018, of which neonatal mortality was estimated at 18 deaths per 1000 live births5.

Since the introduction of MCHHB in Japan, the infant mortality rate has strikingly improved from approximately 76 to 2.6 per 1000 live births through 1947 to 2007 and continues to improve1.
The study by Osaki and colleagues2 also depicted the effectiveness of MCHHB post-2-year follow-up of 454 respondents (183-intervention, 271-control). It promoted uptake of consecutive care in the intervention group, such as two doses of tetanus immunization, antenatal care four times or more, professional childbirth care and vitamin A supplementation for the child (OR= 2.03, 95% CI: 1.19-3.47). The intervention also promoted breastfeeding practice (exclusive breastfeeding during 6 months and complementary feeding after 6 months), home care for cough, greater husband support and resorting to professional care during pregnancy, postpartum and newborn complications. Furthermore, stunted growth and underweight rate in children in the intervention group was also reduced.

The United Nations has set a 2030 target to achieve a global maternal mortality ratio of <70 per 100,000 live births, with no country having a maternal mortality rate of more than twice the global average3,4. Also, the 2030 target of the United Nations aims to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortalities to at least as low as 25 per 1000 live births6.

Therefore, access to skilled healthcare professionals and proper maternal and child care is critical to achieving the United Nations Sustainable Development Goals. The access to healthcare services and proper maternal and child care during pregnancy, child delivery, and early child-rearing stage can be encouraged through sensitizing expecting mothers to MCHHB.

The MCHHB is an important home referencing guide for pregnant mothers that could educate them and their family members by providing essential information, such as maternal nutrition, the important of breastfeeding and gestational diabetes, to comply with during pregnancy and early child-rearing stages. It also helps parents in the identification of an early abnormality or disease in their child so that they could seek prior medical assistance1.

The MCHHB also acts as an indispensable medical record and a maternal and child health monitoring tool, which could facilitate clinical decision-making for the healthcare professional to provide appropriate and efficient individualized advice and care and to have better dialogues with the parents1.

However, there is still a lack of global outreach of the MCHHB. Many countries, such as Indonesia, Cambodia and Bangladesh have successfully adopted the MCHHB and there is also the international success of other MCHHB-like programs in Utah State of the US and other countries in reducing the infant mortality rates1. Thus, the continuum of care for maternal and child can be achieved with the MCHHB that promotes the overall health of mother and child. In the future, if adopted globally, it may play a pivotal role in reducing global maternal and neonatal mortality rates.


1. Takeuchi J, Sakagami Y, Perez RC. The Mother and Child Health Handbook in Japan as a Health Promotion Tool: An Overview of Its History, Contents, Use, Benefits, and Global Influence. Global Pediatric Health. 2016;3:2333794X16649884.
2. Osaki K, Hattori T, Toda A, Mulati E, Hermawan L, Pritasari K, Bardosono S, Kosen S. Maternal and Child Health Handbook use for maternal and child care: a cluster randomized controlled study in rural Java, Indonesia. Journal of Public Health. 2019;41(1):170-182.
3. Maternal deaths decline slowly with vast inequalities worldwide [Internet]. World Health Organization. 2019 [cited 26 November 2019]. Available from:
4. UNFPA, World Health Organization, UNICEF, World Bank Group, the United Nations Population Division. Trends in maternal mortality: 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2019.
5. UNICEF, WHO, World Bank, UN-DESA Population Division. Levels and trends in Child Mortality Report 2019: Estimates developed by the UN Inter-agency Group for Child Mortality Estimation. New York: United Nations Children’s Fund; 2019.
6. Child survival and the SDGs – UNICEF DATA [Internet]. UNICEF DATA. 2019 [cited 26 November 2019]. Available from: