Background
Delivery of essential newborn care is key to reducing neonatal mortality rates, yet coverage
of protective birth practices remains incomplete and variable, with or without skilled
attendance. Evidence of changes over time in newborn care provision, disaggregated by care
practice and delivery type, can be used by policymakers to review efforts to reduce mortality.
We examine such trends in four areas using control arm trial data.
Methods and findings
We analysed data from the control arms of cluster randomised controlled trials in Bangladesh
(27 553 births), eastern India (8 939), Dhanusha, Nepal (15 344) and Makwanpur, Nepal (6
765) over the period 2001-2011. For each trial, we calculated the observed proportion of
attended births and the coverage of WHO essential newborn care practices by year, adjusted
for clustering and stratification. To explore factors contributing to the observed trends, we
then analysed expected trends due only to observed shifts in birth attendance, accounted for
stratification, delivery type and statistically significant interaction terms, and examined
disaggregated trends in care practice coverage by delivery type. Attended births increased
over the study periods in all areas from very low rates, reaching a maximum of only 30% of
deliveries. Newborn care practice trends showed marked heterogeneity within and between
areas. Adjustment for stratification, birth attendance and interaction revealed that care
practices could change in opposite directions over time and/or between delivery types – e.g.
in Bangladesh hygienic cord-cutting and skin-to-skin contact fell in attended deliveries but
not home deliveries, whereas in India birth attendant hand-washing rose for institutional
deliveries but fell for home deliveries.
Conclusions
Coverage of many essential newborn care practices is improving, albeit slowly and unevenly
across sites and delivery type. Time trend analyses of birth patterns and essential newborn
care practices can inform policy-makers about effective intervention strategies.