Integrating Health Care to Meet the Needs of the Mother–Infant Pair: A Call for Papers for Year 3 of the Maternal Health Task Force–PLOS Collection

The Maternal Health Task Force (MHTF) and PLOS Medicine issue the call for papers for Year 3 of the MHTF-PLOS Collection: Integrating Health Care to Meet the Needs of the Mother–Infant Pair. Please see later in the article for the Editors' Summar

Maternal Health Is Women's Health: A Call for Papers for Year 2 of the Maternal Health Task Force–PLOS Collection

The PLOS Medicine editors and the Maternal Health Task Force announce a new call for papers on the theme of “maternal health is women's health.

The prevalence of disrespect and abuse during facility-based childbirth in urban Tanzania

Background: In many countries, rates of facility-based childbirth have increased substantially in recent years. However, insufficient attention has been paid to the acceptability and quality of maternal health services provided at facilities and, consequently, maternal health outcomes have not improved as expected. Disrespect and abuse during childbirth is increasingly being recognized as an indicator of overall poor quality of care and as a key barrier to achieving improved maternal health outcomes, but little evidence exists to describe the scope and magnitude of this problem, particularly in urban areas in low-income countries. Methods: This paper presents findings from an assessment of the prevalence of disrespectful and abusive behaviors during facility-based childbirth in one large referral hospital in Dar es Salaam, Tanzania. Client reports of disrespect and abuse (D&A) were obtained through postpartum interviews immediately before discharge from the facility with 1914 systematically sampled women and from community follow-up interviews with 64 women four to six weeks post-delivery. Additionally, 197 direct observations of the labor, delivery, and postpartum period were conducted to document specific incidences of disrespect and abuse during labor and delivery, which we compared with women’s reports. Results: During postpartum interviews, 15 % of women reported experiencing at least one instance of D&A. This number was dramatically higher during community follow-up interviews, in which 70 % of women reported any experience of D&A. During postpartum interviews, the most common forms of D&A reported were abandonment (8 %), non-dignified care (6 %), and physical abuse (5 %), while reporting for all categories of D&A, excluding detention and non consented care, was above 50 % during community follow-up interviews. Evidence from direct observations of client-provider interactions during labor and delivery confirmed high rates of some disrespectful and abusive behaviors. Conclusions: This study is one of the first to quantify the prevalence of disrespect and abuse during facility-based childbirth in a large public hospital in an urban setting. The difference in respondent reports between the two time periods is striking, and more research is needed to determine the most appropriate methodologies for measuring this phenomenon. The levels and types of disrespect and abuse reported here represent fundamental violations of women’s human rights and are symptomatic of failing health systems. Action is urgently needed to ensure acceptable, quality, and dignified care for all women

Eliminating Preventable HIV-Related Maternal Mortality in Sub-Saharan Africa: What Do We Need to Know?

Introduction: HIV makes a significant contribution to maternal mortality, and women living in sub-Saharan Africa are most affected. International commitments to eliminate preventable maternal mortality and reduce HIV-related deaths among pregnant and postpartum women by 50% will not be achieved without a better understanding of the links between HIV and poor maternal health outcomes and improved health services for the care of women living with HIV (WLWH) during pregnancy, childbirth, and postpartum. Methods: This article summarizes priorities for research and evaluation identified through consultation with 30 international researchers and policymakers with experience in maternal health and HIV in sub-Saharan Africa and a review of the published literature. Results: Priorities for improving the evidence about effective interventions to reduce maternal mortality and improve maternal health among WLWH include better quality data about causes of maternal death among WLWH, enhanced and harmonized program monitoring, and research and evaluation that contributes to improving: (1) clinical management of pregnant and postpartum WLWH, including assessment of the impact of expanded antiretroviral therapy on maternal mortality and morbidity, (2) integrated service delivery models, and (3) interventions to create an enabling social environment for women to begin and remain in care. Conclusions: As the global community evaluates progress and prepares for new maternal mortality and HIV targets, addressing the needs of WLWH must be a priority now and after 2015. Research and evaluation on maternal health and HIV can increase collaboration on these 2 global priorities, strengthen political constituencies and communities of practice, and accelerate progress toward achievement of goals in both areas

Business not as usual: how multisectoral collaboration can promote transformative change for health and sustainable development.

• We present a model of enabling fac-tors for effective multisectoral collabo-ration for improvements in health and sustainable development. • Drive change: assess whether desired change is better off achieved by mul-tisectoral collaboration; drive forward collaboration by mobilising a critical mass of policy and public attention. • Define: frame the problem strategi-cally and holistically so that all sec-tors and stakeholders can see the benefits of collaboration and contri-bution to the public good• Design: create solutions relevant to context, building on existing mecha-nisms, and leverage the strengths of diverse sectors for collective impact. • Relate: ensure resources for multi-sectoral collaboration mechanisms, including for open communication and deliberation on evidence, norms, and innovation across all components of collaboration. • Realise: learn by doing, and adapt with regular feedback. Remain open to redefining and redesigning the collaboration to ensure relevance, effectiveness, and responsiveness to change. • Capture success: agree on success markers, using qualitative and quan-titative methods to monitor results regularly and comprehensively, and learn from both failures and successes to inform action and sustain gains

Improving vasectomy services in Kenya : lessons from a mystery client study

Much has been done to improve quality of care for women seeking family planning services,1 but less is known about quality of care for men in those services. With this in mind, researchers in Kenya designed a 'mystery client' study, in which men posed as potential vasectomy clients at clinics in different parts of the country. There was wide variation in how men were treated. Positive experiences included a courteous reception, full information on vasectomy, and private, sympathetic counselling that included discussion of other contraceptive methods. Negative experiences included ridicule, inadequate information, discomfort in describing the male body and bias against vasectomy. Real-life stories by men were found to have a positive effect on service providers and male clients; many improvements in the quality of service delivery for men are recommended.7 page(s

Exploring perceptions of group antenatal Care in Urban India: results of a feasibility study

Background: Making high-quality health care available to all women during pregnancy is a critical strategy for improving perinatal outcomes for mothers and babies everywhere. Research from high-income countries suggests that antenatal care delivered in a group may be an effective way to improve the provision, experiences, and outcomes of care for pregnant women and newborns. A number of researchers and programmers are adapting group antenatal care (ANC) models for use in low- and middle-income countries (LMIC), but the evidence base from these settings is limited and no studies to date have assessed the feasibility and acceptability of group ANC in India. Methods: We adapted a “generic” model of group antenatal care developed through a systematic scoping review of the existing evidence on group ANC in LMICs for use in an urban setting in India, after looking at local, national and global guidelines to tailor the model content. We demonstrated one session of the model to physicians, auxiliary nurse midwives, administrators, pregnant women, and support persons from three different types of health facilities in Vadodara, India and used qualitative methods to gather and analyze feedback from participants on the perceived feasibility and acceptability of the model. Results: Providers and recipients of care expressed support and enthusiasm for the model and offered specific feedback on its components: physical assessment, active learning, and social support. In general, after witnessing a demonstration of the model, both groups of participants—providers and beneficiaries—saw group ANC as a vehicle for delivering more comprehensive ANC services, improving experiences of care, empowering women to become more active partners and participants in their care, and potentially addressing some current health system challenges. Conclusion: This study suggests that introducing group ANC would be feasible and acceptable to stakeholders from various care delivery settings, including an urban primary health clinic, a community-based mother and child health center, and a private hospital, in urban India