Closing the first 1,000 days gap: midwife-and nurse-led interventions for maternal, neonatal and child health-a narrative review

Abstract

The first 1,000 days, from conception to a child's second birthday, shape maternal survival, newborn health and the course of early child development. Nurses and midwives deliver most of the care received in this period, yet evidence on their contribution is usually reported one stage at a time. This narrative review brings that evidence together across the whole continuum. PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Embase, the Cochrane Library, WHO IRIS and UNICEF repositories were searched for English-language publications from January 2019 to June 2026, and current WHO guidance was consulted. Eighteen key studies were charted and synthesised thematically. Midwife continuity of care increased spontaneous vaginal birth and reduced caesarean and instrumental birth, although its effect on preterm birth was small or uncertain. Midwife-delivered bundles for postpartum haemorrhage, basic newborn resuscitation training, deferred cord clamping and immediate kangaroo mother care reduced severe morbidity or mortality in trials from low- and middle-income countries. Kangaroo mother care also lowered maternal depressive symptoms, and breastfeeding support reduced early cessation of exclusive breastfeeding. Parenting programmes improved early child development, whereas intensive nurse home visiting in one large trial did not change birth outcomes. Two-way mobile health communication increased antenatal attendance and skilled birth attendance. Three gaps remain: in coverage, in quality and in continuity between facility and community, with the second year of life the least studied. Closing them requires adequate nursing and midwifery staffing, competency-based education and services that follow the mother–child pair through all 1,000 days.