Despite global commitments, low- and middle-income countries (LMICs) continue to experience significant gaps in the availability, affordability, and accessibility of quality life-saving maternal and newborn health (MNH) products. Although initiatives like the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) and Every Woman Every Newborn Everywhere aim to ensure essential products for evidence-based reproductive, maternal, newborn, child, and adolescent health (RMNCAH) interventions, critical medicines such as oxytocin, misoprostol, magnesium sulfate, and antibiotics often remain out of reach for vulnerable populations. Inaccessible, unaffordable, or poor-quality essential care is a major contributor to high maternal and neonatal mortality in LMICs. Being listed as “essential” does not guarantee availability or quality at the point of care.
Historically, MNH product supply chains have received less prioritization compared to vertical health programs like HIV and family planning. While those programs have benefited from dedicated funding and robust procurement mechanisms, maternal and newborn health has lacked comparable global investment, leading to weak and fragmented supply chains. LMICs frequently face inadequate regulatory oversight, poor product quality, and insufficient guidance for providers on storage and use, further undermining access to these life-saving products.
This landscape aims to map systemic, structural, and operational enablers and barriers affecting MNH product availability, affordability, and accessibility in LMICs. It examines the essential supply chain functions that determine product security, identifying common challenges and promising innovations. Cross-cutting considerations such as country financing and governance, supply chain organizational models, and regulatory capacity shape how these barriers manifest in different contexts. Factors such as innovation, availability, quality assurance, financing, warehousing, distribution, forecasting, provider access, and community engagement all interact across the supply chain to influence the successful delivery and use of MNH products.
A systems approach is critical to improving access, addressing upstream factors such as global and regional market shaping and national policy, as well as downstream aspects including facility practices and community use. The landscape also highlights tracer MNH products, including uterotonics, antihypertensives, and antibiotics, to illustrate product-specific challenges. While focused on MNH products, the barriers and solutions are relevant to the broader ecosystem of essential medicines, where uneven financing, regulatory, procurement, and policy implementation can deprioritize life-saving MNH drugs relative to other health interventions.
The document emphasizes the importance of country-specific context when planning solutions. Supply chain structures can vary widely: centralized systems allow tighter control but may cause delays, whereas decentralized systems can respond more flexibly to local needs but risk inconsistencies in quality, pricing, or stock management. The relative involvement of public and private sectors, as well as the maturity and effectiveness of a country’s regulatory system, also affect the suitability and impact of supply chain solutions. Overall, the landscape underscores that interventions must be tailored to local priorities, governance structures, and regulatory realities to be effective in strengthening access to quality maternal and newborn health products.
