The Lancet has published a new series on health transitions in Pakistan with a focus on four priority issues for Pakistan’s health system:

First, the country’s performance and future after the 18th amendment to the Constitution in which the federal Ministry of Health was abolished. Second, reproductive, maternal, newborn, and child health. Third, non-communicable diseases and injuries. And fourth, recommendations for future health reforms.

In the second paper in the series, “Reproductive, maternal, newborn, and child health in Pakistan: challenges and opportunities is a systematic review,” a research team led by our colleague, Professor Zulfiqar Bhutta, analyzes Pakistan’s progress toward Millennium Development Goals 4 and 5, and focuses on scaling up interventions using delivery platforms to reach poor and rural populations through community-based strategies. The authors conclude that a successful scale-up of a package of seven RMNCH interventions would have a major effect on health in Pakistan, reducing maternal and child deaths by nearly 60 percent and reducing stillbirths by 40 percent.

In addition to the research that makes up the series, The Lancet podcast features a discussion with Professor Bhutta on the health situation in Pakistan, including the critical need to expand access and reduce inequalities in coverage of key health interventions throughout the country.

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The 66th World Health Assembly convened today, May 20 with addresses and discussions focused on the post-2015 global development agenda. The Assembly runs through May 28, and will feature numerous discussions and consideration of resolutions on issues that are critical to advancing maternal health.

The Partnership for Maternal, Newborn and Child Health (PMNCH) has prepared an overview of side events on reproductive, maternal, newborn and child health. Among the highlights is “Securing the future: Saving the lives of women and children,” which will focus on success stories, as well as key challenges for the United Nations Secretary-General’s Global Strategy for Women’s and Children’s Health and Every Woman Every Child movement. It will provide an opportunity for discussion of a proposed resolution on the ‘Implementation of the recommendations of the Commission on Life-Saving Commodities for Women and Children.’ Other key events include a session on promoting accountability for maternal and child health, which will provide health ministers an opportunity to share perspectives on progress and challenges for MDGs 4 and 5, and to reflect on the “unfinished business” that will require attention past the 2015 MDG deadline; and a session on the importance of human resources for health.

For more on the proceedings of the World Health Assembly, including the provisional agenda and highlights of each day’s proceedings, visit the World Health Organization media center

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The Lancet has published a special issue, focused on maternal health, that comes just before the third Women Deliver conference to be held in Kuala Lumpur, Malaysia. This exciting issue includes several studies and comments that examine the critical factors influencing the reproductive health of women around the world.

The publications include discussions of the role of participatory women’s groups, the unmet need for family planning, the relationship between HIV/AIDS and maternal mortality, the health and human rights tragedy of obstetric fistula, the recent progress and challenges with aid for reproductive health, and more.

The special issue also includes a video interview with Ana Langer, Director of the Women and Health Initiative at Harvard School of Public Health. Dr. Langer discusses progress and persistent challenges to improving global maternal health.

From the executive summary of the special issue:

In recent years, two important changes in maternal health have taken place worldwide: a reduction in global maternal mortality, and an increase in the proportion of childbirths occurring in health facilities. Although substantial progress has been made, the fifth Millennium Development Goal to reduce the maternal mortality ratio by three quarters before 2015 will be missed.

Against this backdrop, The Lancet publishes a special themed issue to coincide with the third Women Deliver conference in Kuala Lumpur, Malaysia on May 28–30, 2013. Women Deliver brings together voices from around the world to generate political commitment and resource investments to improve the health and well-being of girls and women and achieve universal access to reproductive health. The studies published in The Lancet’s themed issue use different methods to show the multidimensional nature of reproductive health and the influence of social determinants and health systems.

Explore the Women Deliver special issue!

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Despite encouraging progress, coverage of malaria control efforts among pregnant women remains low. Malaria in pregnancy (MiP) continues to be a substantial contributor to maternal and infant mortality and morbidity in malaria-endemic regions. The interventions that comprise the World Health Organization’s (WHO) three-pronged approach to reducing the burden of MiP are implemented at rates far below global targets.  These interventions include:

  • Uptake of intermittent preventive treatment of malaria in pregnancy (IPTp) using Sulfadoxine-Pyrimethamine (SP);
  • Use of insecticide treated nets (ITNs); and
  • Appropriate, effective case management of malaria.

The Malaria in Pregnancy Working Group, one of several working groups within Roll Back Malaria, consists of partners dedicated to optimizing the delivery of the above key interventions “through the dissemination of successful technical guidance and programmatic approaches, fostering partnership between national reproductive health and malaria control programs and engaging key partners at both global and country level to help accelerate implementation and increase nation-wide coverage.”

This week, the MiP Working Group held its annual meeting in Geneva on 13-14 May 2013.  The meeting agenda included presentations and discussions on the dissemination and adoption of the WHO’s new IPTp policy, country MiP progress, new technical evidence and key programming updates, and the MiP working group work plan.

The MHTF has shared an abbreviated summary of participants’ presentations on Storify. Important takeaway messages from the presentations and discussions include the following:

  • Integrating malaria in pregnancy and extending partnerships to allied fields (e.g. reproductive health, newborn health, and HIV/AIDS) is key.
  • While the new WHO IPTp guidelines represent a step forward, the challenge will be to integrate these guidelines into country programs.
  • MiP is a model for integration through the harmonization of policies and commitment to national level coordination.
  • MiP is also a platform for optimizing the delivery of interventions and strengthening antenatal care.
  • IPTp-SP is highly cost-effective, a characteristic that will be important in the post-2015 agenda.
  • Case management is the neglected third prong.

Meeting presentations, publications, and minutes will be available shortly on the MiP Working Group website and the MHTF’s MiP topic page.

 If you have feedback on our MiP topics page or are interested in submitting a guest post or cross-post for our ongoing MiP blog series, please contact Samantha Lattof at slattof@hsph.harvard.edu or Kate Mitchell at kmitchel@hsph.harvard.edu

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Guest post by Fistula Care

With just 1 midwife for every 1000 live births, Sierra Leone needs a twelve-fold increase in its midwifery workforce to ensure full coverage of maternal and newborn health services.  It is tempting to focus exclusively on training new midwives, but existing midwives also require attention. They can only function effectively if their own professional needs are met. The Aberdeen Women’s Centre in Freetown, Sierra Leone, provides an example of what a midwife-led maternity unit can look like: where midwives have the support they need to do their jobs well, and where mothers and babies therefore receive respectful, high-quality services.

An important new article in the Midwifery’s forthcoming Millennium Development Goals special issue describes in detail a practical example of how we can “invest in midwives” and equip them to offer competent, compassionate, and respectful care to expecting and delivering mothers. “Striving for excellence: Nurturing midwives’ skills in Freetown, Sierra Leone” recounts how the Aberdeen Women’s Centre launched a maternity unit focused on supporting midwives to offer exemplary care.

The Aberdeen Women’s Centre is a private clinic that was founded in 2005 to provide surgical repair to women who suffer from obstetric fistula. The Centre’s focus on fistula treatment remained constant until one of its own staff died in childbirth. In the wake of this loss, the clinic’s leaders began to consider expanding their mandate. They saw an opportunity to offer quality maternity care to women who would be unable to pay, thereby preventing the occurrence of new fistula cases and reducing maternal mortality. With support from the Gloag Foundation and U.S. Agency for International Development (via EngenderHealth’s Fistula Care project), the Aberdeen Women’s Centre opened its midwife-led maternity unit in May 2010.

The Centre provided ongoing in-service education and supportive supervision for its staff midwives. Expert midwife volunteers served as mentors, modeling a commitment to quality, evidence-based care. Through training and routine review of near-misses, the Aberdeen Women’s Centre midwives have developed professionally and are poised to become future leaders for midwifery in Sierra Leone.

Meanwhile, these midwives have offered an excellent level of care to delivering mothers and their newborns. In the first two years of the maternity unit’s services, its staff assisted 2,076 births, with better-than-expected health outcomes for mothers and babies.

For more, visit the Respectful Maternity Care blog series.

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On May 12th, NPR ran a story, C-Sections Deliver Cachet For Wealthy Brazilian Women, that explores the extraordinary numbers of Cesarean deliveries occurring in Brazil. The author discusses various factors that might be contributing to the issue: To what extent are women demanding Cesarean births? Are doctors pressuring women to opt for surgery? Are Cesarean births becoming a “status” symbol?

The author also examines the role of doulas, or birth coaches–and raises questions about how doulas, fairly uncommon in Brazil, might serve as a critical intervention in supporting women who would like to have a vaginal birth but are feeling pressured into a Cesarean delivery.

Excerpt from the piece:

There is a debate in Brazil as to why the rate here is so high. Doctors like Sasaoka say it’s due to the demand.

But new mother Mariana — who doesn’t want her last name used for fear of offending her doctor — says often women feel bullied into it.

She says she wanted to have a vaginal delivery.

“My doctor said to me he’d have more control in a C-section than in a natural birth,” she says.

He also told her he would also almost certainly have to do an episiotomy — a procedure where the vaginal opening gets cut to allow for delivery. She was terrified. She says her doctor kept telling her that C-sections were better, and that she felt pressure to have one.

Read the full story.

Listen to the audio version of the story.

Learn about the Maternal Health Task Force’s work to better understand the under- and over-use of Cesarean births in low-income countries. 

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PBS is in the midst of publishing a ten-part blog series exploring the connections between between mobile technology and health in Africa. In its latest post, the series highlights the Mobile Alliance for Maternal Action’s (MAMA) Ask MAMA Mobi, which uses a website, social networking, text messaging and a smartphone app to provide women in South Africa with information and education on healthy pregnancy, birth and newborn care. Recent posts have also featured stories about two efforts in Malawi to address issues relate to maternal health using mobile technology: a national effort supported by the Ministry of Health and John Snow International that uses a mobile tool known as “cstock” in its effort to better maintain stocks of essential health supplies;  Village Reach, which operates a hotline to respond to questions about health concerns, schedule appointments and generally improve communications and information-sharing as part of an effort to improve maternal health.

Throughout, the series highlights how various organizations are attempting to harness the recent, massive expansion of mobile phone ownership in sub-Saharan Africa in order to address persistent health challenges. In doing, blog posts underscore both the immense opportunities and promise for this sort of innovation and some of the challenges that they face in attempting to improve communication within health systems and engage the public.

To read more, visit PBS’s Rundown blog

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This year, as the family health team at the Bill & Melinda Gates Foundation undertakes its annual strategy review, its members are contributing to the Family Health Check Up blog series. In the post introducing the series, Gary Darmstadt, the Foundation’s Director of Family Health writes:

This year’s six-part Family Health Check Up 2013 blog series is intended to present the evolution of our thinking leading to adjustments to our strategy, highlight lessons learned from our investments last year, and give some insight into plans for the coming year in pursuing our vision collaboratively across Family Health.

The series is a great resource for simply learning more about the Gates Foundation’s work. It also provides an opportunity to reflect on some major developments in maternal, newborn and child health, such as last year’s London Summit on Family Planning, an event generated remarkable new commitments, as well as the upcoming launch of a new Family Planning program in June 2013. As a whole, the series provides an opportunity to consider connections across the spectrum of family health issues, as well as among research and evidence, health programming and policy.

In the second series post, “The Health of Mother and Baby,” Mariam Claeson, the Family Health team’s Deputy Director of Maternal, Neonatal and Child Health and Gary Darmstadt reflect on progress and priorities specifically related to advancing maternal and child health. They highlight the ways that driven by evidence, the MNCH strategy has been adjusted in the past year, maintaining an integrated approach to maternal, newborn and child health, with new emphases on preterm births, as well as improving quality of care for the increasing numbers of women who are  delivering in facilities health facilities around the world. They write:

While we continue to support efforts to ensure that more women have access to a skilled attendant at birth and to life-saving commodities and emergency care if necessary, we need to place more emphasis on assuring that quality of care is provided at health facilities, to respond to the increasing demand for those services.  We need to identify effective strategies and define our role, to improve the quality of intrapartum care at facilities, with a better understanding of barriers and facilitators to effective intrapartum and immediate maternal and newborn care. The increased focus on intrapartum and postnatal care brings together maternal and neonatal health efforts and is an important adjustment to our MNCH strategy.

Throughout, the series presents questions that the team is considering as it seeks to refine its strategy, often underscoring the need to develop integrated approaches. For instance, in the most recent post, which focuses on maternal and child nutrition underscores the connections between these and  issues such as WASH, agriculture, education, and social protection.

To join the discussion on Twitter, follow @gatesfoundation and @gdarmsta. Visit Impatient Optimists for the latest posts in the Family Health Check Up series, or to stay up to date on the Gates Foundation’s work on maternal, newborn and child health, family planning or other major global health and development issues. 

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The Wilson Center Comparative Urban Studies Project is hosting an discussion on May 14 to mark the launch of Girls on the Move: Adolescent Girls and Migration in the Developing World, the latest edition of the Population Council’s Girls Count report series.

From our colleagues at the Wilson Center:

Girls on the Move illuminates the experiences of girls who relocate to urban areas to pursue work, education, and social opportunities unavailable to them in their natal homes. The report explores how migrant girls who successfully connect to urban resources and opportunities can be powerful agents of change, making them an important group for policy and programmatic attention. At this event, Population Council researchers will highlight findings from the report, and a panel of experts will examine how new evidence on migrant adolescent girls can be used to increase their visibility, reduce their vulnerability, and support them to reach their full potential.

The event will be held from 3:00-5:00pm on May 14 at the Wilson Center in Washington, DC.  To attend in person, RSVP to events@unfoundation.org and indicate “May 14″ in the subject line of your message. In addition, if you are not able to attend in person, video of the event will be webcast live on the Wilson Center website. For more information on how to attend in person or by video, visit the Wilson Center event page.

The Girls Count report series is part of the Girls Count initiative of the Coalition for Adolescent Girls sponsored by the Nike Foundation and the UN Foundation, and previous reports in the series are posted on the Coalition for Adolescent Girls website.

For more information on the Girls on the Move report, visit the report announcement, or contact girlsonthemove@popcouncil.org. The report will be available for download on May 14.

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As we noted last week, PLOS Medicine launched a new collection on May 7, Measuring Coverage in Maternal, Newborn and Child Health.The collection compiles evidence related to tools and indicators for collecting high quality evidence to expand coverage and improving the quality of care for key health interventions.

About the collection:

Measuring Coverage in Maternal, Newborn, and Child Health, a PLOS Collection, presents innovative assessments of the validity of measuring population coverage for interventions in this field. Coverage indicators are widely used to assess whether interventions are reaching women and children in low- and middle-income countries, particularly through population-based household surveys. This collection of original research articles and reviews shows that while some indicators can be measured accurately, others may not provide valid results and therefore need further investigation and development.

Highlights of the “Measuring Coverage” collection include two articles that address approaches for strengthening quality of maternal health services: “Validating Women’s Self-Report of Emergency Cesarean Sections in Ghana and the Dominican Republic,” and Testing the Validity of Women’s Self-Report of Key Maternal and Newborn Health Interventions during the Peripartum Period in Mozambique.”

The collection also includes reviews key determining and interpreting inequalities in coverage and discussing  new findings, strategies and recommendations for action.

For more, watch video of the May 7 launch event at the National Press Club, or visit Impatient Optimists to read a blog post by Miriam Claeson and Wendy Prosser of the Bill & Melinda Gates Foundation.

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