In The Gambia, a small country in West Africa, 1 in 10 newborns have a low birth weight — less than 5.5 pounds — and face daunting challenges. They are more likely to die within a month of birth or in their first year, and they experience higher rates of physical and cognitive impairment and higher risks of developing chronic health issues throughout their lives.

But there is a solution: More prenatal checkups support improved birth outcomes. That is a key finding of a new study co-authored by University of Notre Dame researchers, which provides new causal evidence from The Gambia that can help improve the health of newborns. The study was published in PLOS Global Public Health.

“Newborn health, measured by birth weight, is an important marker that not only reflects an infant's immediate well-being but also predicts future health and development,” said co-author Santosh Kumar Gautam, associate professor of development and global health economics and director of doctoral studies in sustainable development for the University of Notre Dame’s Keough School of Global Affairs. “Our study found that more prenatal checkups produce better birth outcomes, and these findings can inform policies that will prioritize the health of mothers and their newborn children.”

Previous studies in other contexts have shown a causal link between prenatal checkups and improved birth outcomes, Gautam said. Within The Gambia, previous studies had shown an association between checkups and outcomes, but there was limited empirical evidence estimating the causal effects these checkups have on low birth weight. However, in this latest study, Notre Dame researchers moved beyond correlation to demonstrate a causal link, Gautam said.

The study analyzed data on more than 4,400 births from the 2019-20 Gambian Demographic and Health Survey. Researchers found that each prenatal checkup was associated with a small increase in birth weight — about .77 ounces — and a 1.2 percent reduction in low birth weight, Gautam said.

But Gautam stressed that prenatal checkups had a cumulative effect: Mothers who had four or more prenatal checkups were 3.9 percent less likely to have a newborn with low birth weight than mothers who had fewer than four checkups. The average treatment effect for having four or more checkups was a 2.5-ounce increase in birth weight and a 4.7 percent reduction in the incidence of low birth weight. Gautam said these improvements would help to reduce deaths within the first month and the first year after birth.

Prenatal checkups play a vital role in detecting and managing conditions like intrauterine growth restriction, Gautam said, which occurs when a baby does not grow at the expected rate during pregnancy. The interventions delivered during these visits, including iron and folic acid supplementation and ongoing education about healthy behaviors, can target the causes of low fetal growth and ensure babies have a healthy weight at birth, he said.

Gautam co-authored the study with Alasana Suso, a 2024 graduate of the Keough School's Master of Global Affairs program, and Elizabeth Wood, associate professor of the practice and director of the Master of Science in Global Health program within the University's Eck Institute for Global Health.

The research is part of the larger work that the Eck Institute for Global Health does to address the critical healthcare needs of pregnant and postpartum women and their children. Through its Maternal, Newborn and Child Health Initiative, the institute fosters interdisciplinary collaborations and inspires advancements to improve health outcomes around the world. The research is also part of larger work by the Keough School to address issues relating to global poverty and inequality.

Gautam and Wood said future research should examine the comprehensiveness and quality of prenatal checkups to determine which components most effectively support fetal growth and neonatal survival in resource-constrained settings such as The Gambia.

Ultimately, researchers said, this study and new work that builds on it can provide additional evidence that will inform public health policy and improve birth outcomes.

“Our findings are especially valuable for guiding policy in sub-Saharan Africa, as they highlight both the quantity and quality of care as essential for meaningful gains in neonatal health,” Wood said. “These insights underscore the urgent need for sustained investments to ensure mothers have access to comprehensive prenatal checkups so that their children start life on a healthy path.”

Originally published by Josh Stowe at keough.nd.edu on June 19, 2025.