Regional collaborations as a way forward for maternal, newborn and child health:the South Asian healthcare professional workshop

This article reviews the importance of regional initiatives in the context of global efforts to achieve the Millennium Development Goal 4 and 5 and describes the action-oriented multi-country healthcare professional association (HCPA) workshops organized by the Partnership for Maternal, Newborn and Child Health. The South Asian HCPA workshop served as a catalyst for strengthening the ability of HCPAs in South Asian countries to organize and coordinate their activities effectively, play a larger role in national planning, and collaborate with other key stakeholders in maternal, newborn and child health

"Lives in the balance": The politics of integration in the Partnership for Maternal, Newborn and Child Health.

A decade ago, the Partnership for Maternal, Newborn and Child Health (PMNCH) was established to combat the growing fragmentation of global health action into uncoordinated, issue-specific efforts. Inspired by dominant global public-private partnerships for health, the PMNCH brought together previously competing advocacy coalitions for safe motherhood and child survival and attracted support from major donors, foundations and professional bodies. Today, its founders highlight its achievements in generating priority for 'MNCH', encouraging integrated health systems thinking and demonstrating the value of collaboration in global health endeavours. Against this dominant discourse on the success of the PMNCH, this article shows that rhetoric in support of partnership and integration often masks continued structural drivers and political dynamics that bias the global health field towards vertical goals. Drawing on ethnographic research, this article examines the Safe Motherhood Initiative's evolution into the PMNCH as a response to the competitive forces shaping the current global health field. Despite many successes, the PMNCH has struggled to resolve historically entrenched programmatic and ideological divisions between the maternal and child health advocacy coalitions. For the Safe Motherhood Initiative, the cost of operating within an extremely competitive policy arena has involved a partial renouncement of ambitions to broader social transformations in favour of narrower, but feasible and 'sellable' interventions. A widespread perception that maternal health remains subordinated to child health even within the Partnership has elicited self-protective responses from the safe motherhood contingent. Ironically, however, such responses may accentuate the kind of fragmentation to global health governance, financing and policy solutions that the Partnership was intended to challenge. The article contributes to the emerging critical ethnographic literature on global health initiatives by highlighting how integration may only be possible with a more radical conceptualization of global health governance

The pregnancy cycle approach to safe motherhood

The Population Council\u27s Reproductive Health program partnered with the Maternal Health Task Force (MHTF), the Partnership for Maternal, Newborn and Child Health (PMNCH), and the PAC Consortium, to address the UN Millenium Development Goal of improving maternal health, and reducing child mortality. Specifically this brief examines the pregnancy cycle approach whereby women’s needs from facilitating a desired pregnancy to successful parturition are addressed in a range of settings—home, community and health facility. This brief covers the different stages including abortion and postabortion care, antenatal care, delivery, and postpartum and beyond

Caesarean Section among Referred and Self-Referred Birthing Women: A Cohort Study from a Tertiary Hospital, Northeastern Tanzania.

The inequity in emergency obstetric care access in Tanzania is unsatisfactory. Despite an existing national obstetric referral system, many birthing women bypass referring facilities and go directly to higher-level care centres. We wanted to compare Caesarean section (CS) rates among women formally referred to a tertiary care centre versus self-referred women, and to assess the effect of referral status on adverse outcomes after CS. We used data from 21,011 deliveries, drawn from the birth registry of a tertiary hospital in northeastern Tanzania, during 2000-07. Referral status was categorized as self-referred if the woman had bypassed or not accessed referral, or formally-referred if referred by a health worker. Because CS indications were insufficiently registered, we applied the Ten-Group Classification System to determine the CS rate by obstetric group and referral status. Associations between referral status and adverse outcomes after CS delivery were analysed using multiple regression models. Outcome measures were CS, maternal death, obstetric haemorrhage ≥ 750 mL, postpartum stay > 9 days, neonatal death, Apgar score < 7 at 5 min and neonatal ward transfer. Referral status contributed substantially to the CS rate, which was 55.0% in formally-referred and 26.9% in self-referred birthing women. In both groups, term nulliparous singleton cephalic pregnancies and women with previous scar(s) constituted two thirds of CS deliveries. Low Apgar score (adjusted OR 1.42, 95% CI 1.09-1.86) and neonatal ward transfer (adjusted OR 1.18, 95% CI 1.04-1.35) were significantly associated with formal referral. Early neonatal death rates after CS were 1.6% in babies of formally-referred versus 1.2% in babies of self-referred birthing women, a non-significant difference after adjusting for confounding factors (adjusted OR 1.37, 95% CI 0.87-2.16). Absolute neonatal death rates were > 2% after CS in breech, multiple gestation and preterm deliveries in both referral groups. Women referred for delivery had higher CS rates and poorer neonatal outcomes, suggesting that the formal referral system successfully identifies high-risk birth, although low volume suggests underutilization. High absolute rates of post-CS adverse outcomes among breech, multiple gestation and preterm deliveries suggest the need to target self-referred birthing women for earlier professional intrapartum care

The Use of Antenatal Care Services Among Women Living in Cote d’Ivoire: Focus on Prevention of Mother-To-Child Transmission of HIV

Introduction: The use of antenatal care (ANC) services with programs for prevention of mother-to-child transmission (PMTCT) of HIV is vital in reducing maternal and infant mortality as well as reducing the rate of neonatal HIV infections. The objectives of this study were 1) to determine the knowledge that women have about HIV/AIDS as well as mother-to-child transmission (MTCT) of HIV, and 2) to identify factors that were associated with ANC attendance, timing of first ANC visit, HIV testing as part of an ANC visit, and place of delivery among women living in Cote D’Ivoire, a high HIV prevalent country in West Africa. Methods: The 2011-2012 Demographic Health Surveys (DHS) for Cote D’Ivoire was used, with a focus on women who had a parity of at least 1 and/or are currently pregnant. The outcomes of interest were ANC attendance, timing of first ANC visit, being tested for HIV as part of ANC visit, and the place of delivery. The independent variables included age, education, marital status, wealth, type of residency, general knowledge of HIV/AIDS (transmission and prevention), attitudes towards people living with HIV/AIDS, general knowledge of mother-to-child transmission (MTCT) routes, and HIV pre-counseling during ANC visits. Chi-Square tests, univariate and multivariate logistic regression were conducted. Results: There were a total of 7729 women who met the inclusion criteria, in which 4902 (90.9%) of them had at least one ANC visit, and 2340 (43.4%) had more than three ANC visits. More than half of the respondents went for their first ANC visit in their second trimester compared to 31.2% who went in their first trimester. Type of residence, wealth, attitudes towards people living with HIV/AIDS were associated with at least three of the outcomes. Women who did not receive counselling about testing for HIV during an ANC visit were more likely to not be tested for HIV (OR=24.65, 20.60 – 29.48; AOR= 22.21, 95% CI=16.82 – 29.31) compared to women who did receive counselling. Women less than 18 years were less likely to delivery in a health facility (OR= 1.76, 95% CI= 1.15 – 2.70) compared to women between the age of 25-29. Conclusion: Even though approximately 91.0 % of the women in the study had at least one ANC visit, less than half of them met the World Health Organization (WHO) guidelines to have at least four ANC visits. The study shows that HIV pre-counseling is an effective intervention in engaging pregnant women in PMTCT programs. However, interventions need to take in consideration people living in rural areas as well as people with low income

Why Do Mothers Die? The Silent Tragedy of Maternal Mortality

More than two decades after the launch of the Safe Motherhood Initiative, maternal health in many developing countries has shown little or no improvement. Year after year, more than half a million mothers continue to die in silence. The specificities of the complex cross-cutting issue only partly explain why tireless efforts have led to insufficient progress so far. While some success stories prove that results can be obtained quickly, the dissensions and deficiencies the Initiative has encountered have strongly weakened its impact. However, recent developments over the past 3 years allow us to foresee the silence will soon be broken. While advocacy begins to subsequently raise awareness, more financial means are mobilized. As a consensus on the priority interventions has finally been reached (Women Deliver conference, London, October 2007), more coordinated actions and initiatives are being developed. The strive for the achievement of the Millennium Development Goals helps to create the political momentum the cause strongly needs to generate new leadership, develop and implement the adequate strategies. Sensible focus on resources and structure as well as innovative management will be crucial in that process

11 years of tracking aid to reproductive, maternal, newborn, and child health: estimates and analysis for 2003–13 from the Countdown to 2015

Background Tracking aid fl ows helps to hold donors accountable and to compare the allocation of resources in relation to health need. With the use of data reported by donors in 2015, we provided estimates of offi cial development assistance and grants from the Bill & Melinda Gates Foundation (collectively termed ODA+) to reproductive, maternal, newborn, and child health for 2013 and complete trends in reproductive, maternal, newborn, and child health support for the period 2003–13. Methods We coded and analysed fi nancial disbursements to reproductive, maternal, newborn, and child health to all recipient countries from all donors reporting to the creditor reporting system database for the year 2013. We also revisited disbursement records for the years 2003–08 and coded disbursements relating to reproductive and sexual health activities resulting in the Countdown dataset for 2003–13. We matched this dataset to the 2015 creditor reporting system dataset and coded any unmatched creditor reporting system records. We analysed trends in ODA+ to reproductive, maternal, newborn, and child health for the period 2003–13, trends in donor contributions, disbursements to recipient countries, and targeting to need. Findings Total ODA+ to reproductive, maternal, newborn, and child health reached nearly US$14 billion in 2013, of which 48$6·8 billion), 34% supported reproductive and sexual health ($4·7 billion), and 18$2·5 billion). ODA+ to reproductive, maternal, newborn, and child health increased by 225% in real terms over the period 2003–13. Child health received the most substantial increase in funding since 2003 (286%), followed by reproductive and sexual health (194%), and maternal and newborn health (164%). In 2013, bilateral donors disbursed 59% of all ODA+ to reproductive, maternal, newborn, and child health, followed by global health initiatives (23%), and multilateral agencies (13%). Targeting of ODA+ to reproductive, maternal, newborn, and child health to countries with the greatest health need seems to have improved over time. Interpretation The increase in reproductive, maternal, newborn, and child health funding over the period 2003–13 is encouraging. Further increases in funding will be needed to accelerate maternal mortality reduction while keeping a high level of investment in sexual and reproductive health and in child health

Reducing Maternal Mortality

Outlines MacArthur's efforts to reduce maternal mortality mainly in Mexico, Nigeria, and India by funding projects to develop scalable models, enhance health workers' skills, promote informed advocacy, and advance research. Lists representative grants

Case 8 : Mentor Mothers: Preventing Mother-To-Child Transmission of HIV/AIDS in Jinja

Jinja district is working hard to prevent mother-to-child transmission (PMTCT) of HIV/AIDS and is using the WHO’S 4-prong approach. Uganda, as a country, has a goal of elimination of mother-to-child transmission (EMTCT) of HIV/AIDS. Jinja district needs to have a rate of mother-to-child transmission below 5% by 2015; the rate in 2014 was 15.7%. The district is facing numerous challenges including infants being lost to follow up, causing Dr. Nantamu (the District Health Officer) to examine alternate approaches such as the Mentor Mothers (m2m) program, to increase participation in the PMTCT services