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Maternal Health

Over the last two decades, the global community has witnessed a remarkable reduction in the annual number of maternal deaths worldwide. Yet, too many women continue to die in pregnancy and childbirth from preventable and treatable causes, and national maternal mortality averages often conceal large inequities within countries.

MCSP’s strategy for maternal health emphasized a health systems and quality improvement approach to reduce direct and indirect causes of maternal morbidity and mortality. We addressed the major direct causes of maternal mortality, including postpartum hemorrhage (PPH), pre-eclampsia and eclampsia, peripartum maternal infection, and prolonged labor. We also addressed the indirect causes that constitute an increasing burden of maternal mortality including prevention and treatment of anemia, HIV, malaria, tuberculosis, hypertension and other chronic diseases.

We applied a health systems lens to work with national, regional and district managers and frontline health workers to strengthen essential health system functions and to continuously improve utilization and quality of maternal and newborn care across the system (community, primary, referral) and life cycle (antenatal care, birth, postnatal care) continuums of care.

We supported work at three primary levels to advance coverage and quality of high-impact integrated maternal and newborn and postpartum family planning services in low-resource settings:

  • Sub-national health systems and service delivery
  • National policy and strategy
  • Global policy and initiatives

At the sub-national level, we worked closely with regional and district government and partner stakeholders and frontline health care workers to strengthen integrated maternal and newborn routine and complications services with a strong focus on health systems strengthening and quality improvement. At the national level, MCSP worked with national ministries of health and maternal and newborn stakeholders to advance favorable national policy and strategy. We regularly supported national ministries of health to update national maternal health policy and strategies. At the global level, MCSP worked closely with the World Health Organization (WHO), UNFPA, the Maternal Health Task Force, the Ending Preventable Maternal Mortality Working Group and other stakeholders to advance favorable maternal and newborn health policy and initiatives.

The Program coordinated efforts with routine monitoring and periodic evaluation to support global, regional, national and local learning and decision-making needs, and to advance reproductive, maternal, newborn and child health priorities. MCSP’s maternal health vision linked closely with the Program’s strategies to engage communities and increase demand for health services, working toward equity in access to and quality of respectful care at both the community and facility levels.

Key Results

  • In close collaboration with country counterparts at national and sub-national levels, MCSP supported improved coverage and quality of maternal health services for leading causes of maternal mortality and morbidity in 16 countries: Burma, DR Congo, Ethiopia, Ghana, Guinea, Guatemala, Haiti, Kenya, Laos, Liberia, Madagascar, Mozambique, Nigeria, Rwanda, Tanzania and Zambia.
  • MCSP supported national governments in multiple countries to update national maternal and newborn policies, strategies, guidelines and training curricula in line with WHO and other global evidence-based guidance. For example, in Nigeria, the Program supported the Ministry of Health and partners to develop a national maternal, newborn and child health quality improvement policy statement and strategy.
  • The Program collaborated with the WHO to update the Managing Complications in Pregnancy and Childbirth (MCPC) manual (first published in 2000). The updated 2nd edition MCPC manual was published in June 2017 along with a joint WHO/MCSP summary briefer, which is available in English, Spanish, French and Portuguese. A technical PowerPoint summarizing key areas of revision is also available in English.
  • MCSP contributed to global and country-level efforts to strengthen the quality and coverage of antenatal care (ANC) services. The Program participated in the WHO expert review group that developed the 2016 WHO Recommendations on ANC for a Positive Pregnancy Experience. MCSP, in close collaboration with the WHO and other stakeholders, also developed a series of briefs to summarize the new WHO ANC recommendations and to explore policy and program considerations for adopting and implementing the recommendations in an individual country context. MCSP’s ANC resources and technical briefs (including on malaria in pregnancy, postpartum family planning, and Zika) are available here.
  • As a member of the Ending Preventable Maternal Mortality (EPMM) working group, MCSP supported metrics efforts and country implementation of EPMM strategic priorities, including incorporation of EPMM maternal mortality ratio targets and phase-one and phase-two indicators into country national strategies. With WHO, USAID, and the Maternal Health Task Force, MCSP co-convened a technical consultation on recommended EPMM phase-one indicators summarized in a 2016 publication.
  • As a member of the WHO-led global Maternal and Perinatal Death Surveillance and Response (MPDSR) technical working group (TWG), MCSP supported implementation of MPDSR in Haiti, Kenya, Liberia, Mozambique, Nigeria, Rwanda, Tanzania and Zambia. The Program supported ministries of health to strengthen MPDSR systems and implementation, and integrate MPDSR with ongoing quality improvement efforts to ensure proper identification, notification and review of actions following maternal and neonatal deaths. In 2016-2017, MCSP conducted a regional facility-level assessment of MPDSR implementation in Nigeria, Rwanda, Tanzania and Zimbabwe to assess implementation of MPDSR processes at sub-national and facility levels, and to describe facilitators and barriers to sustainable sub-national MPDSR practices. A summary brief and poster of preliminary results of the regional MPDSR assessment is available and a complete report will be available by June 2018. With the MPDSR TWG, MCSP developed capacity building materials to help countries improve implementation of their MPDSR systems, including correct classification and surveillance of maternal deaths and formulation and systematic follow up of death audit recommendations.
  • With the WHO and partners, MCSP supported the WHO Quality, Equity and Dignity (QED) Network for maternal, newborn and child health. MCSP helped develop the network monitoring framework and country implementation guidance, was a member of the network monitoring working group, and co-chaired the network monitoring working group with WHO and UNICEF. The Program provided close technical support in two of the nine first-phase QED network countries (Nigeria, Bangladesh/MCHIP Associate Award) and helped to introduce the WHO quality of care framework and implementation guidance in Madagascar, Nigeria, Tanzania and Rwanda, promoting shared learning across MCSP-supported country maternal, newborn and child health quality improvement efforts. (Information on the WHO Quality of Care Network is available here.)
  • MCSP promoted respectful maternity care (RMC) as a central element of high-quality, safe, and person-centered maternal and newborn health care, and developed RMC operational guidance to provide country stakeholders and program implementers with a flexible process to guide design, implementation and monitoring of efforts to strengthen RMC and eliminate mistreatment as part of comprehensive maternal and newborn health programs. Using tools developed with the RMC operational guidance, MCSP programs in Guatemala and Nigeria conducted formative assessments to inform the local prioritization of interventions to strengthen RMC and eliminate mistreatment in facility-based childbirth.
  • The Program established and led a Postpartum Hemorrhage (PPH) Implementation Community of Practice (CoP) as a forum for sharing implementation experience and learning related to comprehensive PPH prevention and management best practices in low-resource settings. The CoP, which included policy makers, program implementers, researchers, donors, and other stakeholders, functioned as an online forum for information sharing and exchange. As part of PPH CoP activities, MCSP convened three virtual webinars and one in-person meeting each year.
  • MCSP developed a pre-discharge postnatal care job aid and poster to help frontline providers provide high-quality integrated postnatal care for mothers and newborns, including postpartum family planning. The materials remind providers of key postnatal health promotion and prevention interventions for mothers and newborns (such as exclusive breastfeeding and danger sign counseling), and guide providers through a systematic checklist to identify potential complications that should delay discharge. The poster may also serve as a prompt for women and their families to ask questions about postnatal care while still in the health facility. These materials were also adapted for use in areas with Zika virus.

Our Focus

Sources:
Maternal and Child Survival Program