Celebrating mother and child on the fortieth day: The Sfax Tunisia postpartum program

This edition of Quality/Calidad/Qualité gives information about a postnatal family planning program in the Sfax Center of the Tunisia Maternity and Newborns Hospital. This program, developed jointly by the national family planning program and the Maternity staff, has had extraordinary success in getting more mothers to return after six weeks for their postnatal visit. During the visit, the period between births is discussed; and family planning services are offered as an important means for achieving both the recovery and good health of the mother, as well as the physical and mental development of the infant. The report describes a few of the plans that the Sfax Center is considering to increase the options that can be offered to clients in the postnatal state. These are, in effect, a part of the permanent evaluation of program services; and it is through this evaluation that they look for better ways to respond to the needs of the clients of the Center to protect their reproductive health

Expanding Use of Magnesium Sulfate for Treatment of Pre-eclampsia and Eclampsia

Pre-eclampsia/eclampsia is a serious condition that can develop during pregnancy, even in women with no risk factors. Although there is little understanding of what causes pre-eclampsia/eclampsia, there is an effective treatment for this condition which, if left untreated, can progress to coma and death. In 1994, the World Health Organization (WHO) recommended magnesium sulfate as the standard treatment for pre-eclampsia and eclampsia and within two years it was placed on WHO's Essential Medicines List. Despite its known efficacy, this inexpensive drug is often underutilized, in part because the diffusion of innovation takes time but also because of the service delivery challenges inherent to the use of magnesium sulfate—it requires a strong and effective referral system, often a challenge in under-resourced health systems. The underutilization of magnesium sulfate has been a recognized problem in Nigeria for some time; prior to 2007 there was almost no magnesium sulfate in the country.The significant contribution of pre-eclampsia/eclampsia to maternal mortality in Nigeria—along with the promise of magnesium sulfate as a solution—caught the attention of the John D. and Catherine T. MacArthur Foundation in 2005 when a program officer overheard a conversation between two Nigerian doctors who were lamenting the failure of a piece of equipment in their hospital laboratory that was used for manufacturing magnesium sulfate. Without it, one was saying to the other, they would have no supply of the drug to treat pre-eclampsia/eclampsia and no way to save women's lives. The Foundation decided to fund a series of grants to expand the use of magnesium sulfate for pre-eclampsia/eclampsia in Nigeria and, in 2014, commissioned an evaluation of that work. This case study describes the findings of the evaluation, including the challenges encountered while implementing the projects, the successes achieved, and existing opportunities for future scaling up of the services across the country

Scaling up Access to Misoprostol at the Community Level to Improve Maternal Health Outcomes in Ethiopia, Ghana, and Nigeria

Over the past decade (2004–2014), the Population and Reproductive Health area of the MacArthur Foundation has focused on supporting projects aimed at reducing maternal mortality. In particular, it has supported efforts to use misoprostol to prevent postpartum hemorrhage, the anti-shock garment to aid in the treatment of hemorrhage, and magnesium sulfate to decrease deaths from eclampsia. In recent years, the Foundation has invested in a range of research and evaluation efforts to better understand these interventions, their effectiveness, and the extent to which successful pilot projects have been scaled up.In 2014, the Foundation commissioned the Public Health Institute to evaluate the grants it had made to increase community-based access to misoprostol for postpartum hemorrhage prevention in Ethiopia, Ghana, and Nigeria. Specifically, the Foundation was interested in documenting the models and approaches used and the progress toward scaling up the respective models in the three countries. Between June and November 2014, the evaluation team reviewed grantee reports, proposals, and the literature; interviewed key informants and global, national, and local stakeholders; conducted focus group discussions with local stakeholders; and made observations during site-visits in each country. From this the team produced case study reports relating to misoprostol use in each country. This report is a synthesis of those three case studies, highlighting the common findings across the projects, identifying differences, and interpreting the lessons learned for broader use and scale up of misoprostol at the community level in Africa and globally

Festejando a la madre y al bebé en el cuarentavo día el programa post-parto de Sfax, Tunicia

En esta edición de Quality/Calidad/Qualité se da información sobre un programa de planificación familiar postnatal que se lleva a cabo en el Centro Sfax del Hospital de Tunisia para Maternidad y Recién Nacidos. Este programa, desarrollado conjuntamente por el programa nacional de planificación familiar y por el personal de Maternidad, ha tenido extraordinario éxito en lograr que un mayor número de madres regresen después de seis semanas a su visita postnatal. Durante la visita, el período entre nacimientos se discute; y se ofrecen servicios de planificación familiar como medio importante para lograr tanto la recuperación y la buena salud de la madre, como el desarrollo físico y mental del infante. El informe describe unos pocos de los planes que el Centro Sfax está considerando para aumentar las opciones que puedan ofrecerse a las clientes en estado postnatal. Son, en efecto, una parte de la permanente evaluación de los servicios del programa; y es a través de esta evaluación que se buscan formas mejores de responder a la necesidad que tienen las clientes del Centro de protección para su salud reproductiva. This edition of Quality/Calidad/Qualité gives information about a postnatal family planning program in the Sfax Center of the Tunisia Maternity and Newborns Hospital. This program, developed jointly by the national family planning program and the Maternity staff, has had extraordinary success in getting more mothers to return after six weeks for their postnatal visit. During the visit, the period between births is discussed; and family planning services are offered as an important means for achieving both the recovery and good health of the mother, as well as the physical and mental development of the infant. The report describes a few of the plans that the Sfax Center is considering to increase the options that can be offered to clients in the postnatal state. These are, in effect, a part of the permanent evaluation of program services; and it is through this evaluation that they look for better ways to respond to the needs of the clients of the Center to protect their reproductive health

ACCESS, DELIVERED: A Toolkit for Providers Offering Medication Abortion

This Provider Toolkit offers a step-by-step guide for initiating a modern medication abortion service within your primary care practice. It provides information on setting up the service, patient-centered standards of care, and resources for understanding federal and state regulations on abortion services. This resource is part of Access, Delivered: an initiative to create new channels of abortion access in the U.S. in partnership with Plan C (plancpills.org) and the University of Washington Department of Family Medicine. As part of the initiative and under the leadership of Dr. Emily Godfrey, the team uses implementation science methods to inform, improve, and share innovative models of medication abortion care for primary care practices. In addition to regular updates to the Provider Toolkit, we will evaluate the acceptability and feasibility of this model among providers and medication abortion users. The COVID-19 pandemic has dispelled the myth that physical clinics are needed to safely provide early abortion care. Primary care and other clinicians have a unique opportunity to shape the future of abortion access in the United States by using “no test” protocols and providing service via telemedicine with pills mailed directly to patients. The Provider Toolkit Second Edition includes key updates: • The most recent FDA guidance on Mifepristone dispensing • Additional information on regulatory compliance • Improved “Dispensing and Distributing the Medications” section, including information on dispensing from your clinic or partnering with a mail-order pharmacy along with visual aid for providers • Gender-inclusive abortion provision with resources on further education and trainin