The numbers indicate a complexity of diseases that infants, in the developing world, face in their first months, or even first weeks of life. There is little debate as to what is the best approach in order to reduce infant mortality rates: a broad plan for effective maternal health services. According to the Fetal and Infant Mortality Review (a collaborative effort between the American College of Obstetricians and Gynecologists, the Maternal and Child Health Bureau and the Health Resources and Services Administration), "[i]nfant mortality is associated with a variety of factors including quality of and access to pregnancy and pediatric health care, socioeconomic conditions, family stressors, the strength of high risk safety nets, the quality of community resources and the cultural competence of local service systems."
Yet, in two studies in 2005, it was found that the most important factor to improve infant mortality rates was the availability of effective and accessible health care for mothers. One study published in the New England Journal of Medicine that initiated an intervention in Pakistan concluded that "[t]raining traditional birth attendants and integrating them into an improved healthcare system were achievable and effective in reducing perinatal mortality." In that same year, a study in the Lancet comparing improved neonatal mortality rates in Brazil from 1982 to 2004, found that "[m]ajor changes in health systems happened in these two decades, of which the most important was the creation of the Sistema Único de Saúde (Unified Health System)... ensuring free health care for every citizen. The expansion in health care in [the city of] Pelotas led to more than 98% of pregnant women receiving some antenatal care..."