Addressing Critical Knowledge Gaps in Newborn Health

Blog

By Leith Greenslade on May 20, 2015
Africa, Asia

The news that a handful of corporations comprised 40 percent of the new commitments made at the launch of the Every Newborn Action Plan in 2014 caught the attention of many in the global maternal and child health community. As a neglected area of global health - why was newborn survival attracting such corporate interest?

Less than one year later, on May 14th 2015, the first report to attempt to capture the full scale of corporate investments in newborn survival was released, revealing 48 companies and associations with substantial investments in newborn heath and development across 70 countries.

The Ultimate Investment in the Future: Profiles of Corporate Engagement in the Health and Development of Newborns, a joint-venture of GBCHealth and the MDG Health Alliance in support of the UN Secretary-General’s Every Woman, Every Child movement, profiles 48 corporate newborn investments in an easy-to-read digital format, describing each commitment, its geographic impact and its relation to one or more of the five strategic objectives of the Every Newborn Action Plan.

Companies profiled range from the largest multinationals to start-up social businesses from the pharmaceutical, healthcare, banking, consumer goods, energy, food and beverage, communications, tourism, materials, retail and technology sectors. All of them are investing time, money and talent in preventing, diagnosing and treating the major causes of newborn death and disability.

The report finds that the majority of corporate commitments profiled are well aligned with the first three strategic objectives of the Every Newborn Action Plan to target investments in childbirth and the first week of life (1), to improve the quality of care (2), and to improve access to care for the most vulnerable women (3). In contrast, corporate investments to harness the power of parents, families and community (4), and to improve vital registration of births and deaths and general data quality (5) are lacking.


Photo: © ayzh

Newborn deaths and stillbirths now comprise the single largest reservoir of mortality in the world, responsible for an estimated annual 2.8 million newborn deaths and 2.6 million stillbirths. Seven out of every ten deaths now occur in just 15 “hotspot” countries - India, Nigeria, Pakistan, China, the Democratic Republic of Congo, Ethiopia, Bangladesh, Indonesia, Angola, Kenya, Tanzania, Afghanistan, Sudan, Uganda and the Philippines.

Company investments profiled in the report are generally well-targeted to several of the hotspot countries but more investment is needed in other high burden centuries, especially Pakistan, the Democratic Republic of Congo, Indonesia, Angola, Afghanistan and Sudan.

During the launch of the report, hosted by the UN Foundation, 10 companies whose work is profiled were invited to share details of their flagship newborn investments, including ayzh, Chevron, GlaxoSmithKline, Johnson & Johnson, McCann Health, Masimo, Medela, Novo Nordisk, and Philips.

Newborn investments by these companies range from reducing the risks of diabetes in pregnancy (Novo Nordisk), infection at the time of birth (ayzh), and mother-to child-transmission of AIDS (Chevron), to developing better medicines and devices to prevent, diagnose and treat the leading threats to newborn health including pulse oximetry (Masimo), fetal monitoring (Philips), breastfeeding supportive technologies (Medela), and chlorhexidine for umbilical cord care (GSK).


Photo: © designthatmatters

Other companies are investing to strengthen health systems by training birth attendants and midwives (Sandoz), and community health workers (J&J), and transforming the quality of communications to educate and empower women and their families to make better health decisions and health workers to provide better care (McCann Health). Several companies are active across all of these areas simultaneously.

Many of these companies are members of the Every Woman, Every Child movement - a growing and desperately needed multi-stakeholder movement to advance the health of the world’s most vulnerable women, newborns, children and adolescents and achieve global development goals. Newborns are a particular priority as only seven countries have managed to reduce newborn deaths to the levels required by the Millennium Development Goals and in 25 countries newborn deaths have actually risen since 1990, 22 of them in Africa.

As a result of the slower progress, newborn deaths and stillbirths now comprise 60 percent of all child deaths and are the major barrier to achievement of the new Sustainable Development Goal to end preventable child deaths by 2030, which will be officially launched in September 2015.

The great value of The Ultimate Investment in the Future: Profiles of Corporate Engagement in the Health and Development of Newborns is that it demonstrates the impact that corporations are having on newborn health and development and the vital role the private sector will continue to play in the implementation of the Sustainable Development Goals. The report identifies the areas where additional investments are needed - both the focus areas and the countries - so that companies can deepen their impact on newborn lives saved.

But perhaps most importantly the report will facilitate greater collaboration for newborn health and development by inspiring corporate actors to join forces with other stakeholders for greater impact. Increasingly, the United Nations, governments, non-government organizations and civil society can learn from these corporate investments and discover new and more cost-effective ways to support their expansion.


Photo: © BHP Billiton

 

Special thanks to Nisa Patel from GBCHealth and Natalie Africa from the UN Foundation for their thought leadership and partnership in the conceptualization, execution and dissemination of The Ultimate Investment in the Future: Profiles of Corporate Engagement in the Health and Development of Newborns and to Zubaida Bai from ayzh, Carol McCauley from Chevron, Pauline Williams from GSK, Joy Marini from Johnson & Johnson, Joe Kiani from Masimo, Andrew Schemer from McCann Health, Jan-Willem Scheijgrond from Philips, Fiona Cook from Sandoz, Paul Bolla from Medela, and Charlotte Ersbøl from from Novo Nordisk for their participation in the launch.

Leith Greenslade is a Vice-Chair at the MDG Health Alliance, a special initiative of the Office of the United Nations Special Envoy for Financing the Health Millennium Development Goals to accelerate achievement of the health-related MDGs by mobilizing governments, non-government organizations, academic institutions and corporations to accelerate global progress in support of Every Woman, Every Child, an unprecedented movement spearheaded by the United Nations Secretary-General to advance the health of women and children.

By Rima Jolivet on May 18, 2015

This blog was originally published by the Maternal Health Task Force. Written by Rima Jolivet.

In an important development for the global maternal health community, the long-awaited Strategies toward Ending Preventable Maternal Mortality (EPMM) will be launched at the 68th World Health Assembly, at an event hosted by Cameroon and Malawi and co-sponsored by the contributors to the Every Newborn Action Plan.

This event marks the culmination of over two years of consensus work and collaboration with multiple stakeholders that began in January 2013. The EPMM Working Group—led by the WHO in partnership with MHTF, UNICEF, UNFPA, USAID, Family Care International, Maternal Child Survival Program (MCSP), and White Ribbon Alliance—has stewarded the process to gather key inputs and consult widely with a broad range of stakeholders to develop the ambitious yet feasible targets for ending preventable maternal deaths within a generation, and to identify the strategic priorities and actions necessary for achieving this vision. The strategies are presented in full in the EPMM report that has been recently published by the World Health Organization. The EPMM targets were included as part of the Every Newborn Action Plan resolution at last year’s World Health Assembly.

The EPMM targets and strategies are grounded in a human rights approach to maternal and newborn health, and focus attention on eliminating significant inequities that persist, resulting in disparities in access, quality, and outcomes of care within and between countries. The strategy emphasizes effective planning for high-functioning maternal health systems that are equipped to identify the immediate and underlying causes of maternal deaths and to develop evidence-informed, context-specific programme interventions to avert future deaths.

Both the EPMM and ENAP strategies informed the technical working paper on “Effective Interventions and Strategies for Ending Preventable Maternal and Newborn Mortality and Stillbirths”, which fed into the updated United Nations Secretary-General’s Global Strategy for Every Women’s, Children’s and Adolescent’s Health. This technical paper is slated to be published in the British Medical Journal as part of a series of papers that support the Secretary-General’s updated strategy. The “zero draft” of the full “Global Strategy 2.0” is currently open for public comment, through June 5, 2015.

The EPMM Strategy will be launched in conjunction with the one-year anniversary of the passage of the Every Newborn Action Plan resolution and with it the launch of the ENAP Progress Report. To mark the occasion of these significant achievements, an event at the 68th World Health Assembly will showcase a combined strategic approach using the EPMM and ENAP frameworks to accelerate progress and feature examples from country champions of successful models of integration at national policy and point-of-service levels.

By Melinda Cruz on May 15, 2015
Australia, Colombia, Sweden

Kangaroo Care with my middle son Dillon at 10 days old. Photo: Miracle Babies Foundation

This blog was originally published in LinkedIn. Written by Melinda Cruz and co-written by Naomi Rohr.

International Kangaroo Care Awareness Day - click here for photos and activity across the day.

Kangaroo Care - yes it has a cute name and yes, it provides some of the most beautiful pictures you’ll ever see but Kangaroo Care for premature and sick babies has immeasurable health benefits for both baby, mum and dad and everyone needs to get on the bandwagon.

So what is it? Kangaroo Care is the act of holding a preterm baby skin to skin.

A premature baby’s body is simply not yet ready for the physical world. Everything our body automatically does and we take for granted is an almost impossible struggle for a baby born weeks before it is due and they need all the help they can get. Their tiny fragile bodies need help to breathe, regulate body temperature and accept feeds, and their tiny bodies need to rest as much as possible.

Mother Nature already provides the perfect method to tackle all these needs and more. A method that completely compliments modern medicine and best of all, it’s free. So, why are we not seeing more of this?

The concept is not new. Kangaroo Care was encouraged in the late 1970's in an effort to reduce the high death rate (70%) of preterm babies being seen in Bogota, Columbia. Babies were dying from respiratory problems, complications due to infection and a lack of human contact. Studies found that babies who were held skin to skin with their mothers for long periods during the day, not only survived, but thrived.

And this is echoed by many other studies right around the world that have demonstrated the many benefits of Kangaroo Care. Here are just some.

Kangaroo Care:

  • regulates baby’s heart and breathing rates
  • maintains baby’s body temperature
  • earlier hospital discharge
  • improves oxygen saturation levels (which indicates how well oxygen is being delivered to the baby’s organs and tissues)
  • decreases incidence of infections
  • has positive effects on brain development
  • encourages baby to spend more time in a deep sleep
  • increases baby’s weight gain
  • babies are alert for longer periods
  • improves breast milk production, promotes frequent breast feeding, and increases the chance of successful breastfeeding
  • builds parental confidence
  • increases parental bonding and closeness with their baby and can ease feelings of separation and depression.

And did we mention that it’s not just for mums … dads can (and should) do it too. Having a baby born early or sick is one of the most heartbreaking and traumatic times a parent can go through. There are so many aspects of the entire experience that are removed from the fairy tale you imagine, so when parents are provided with the knowledge that they have the power to positively contribute to their baby’s outcome, the whole experience can change. A win for everyone.

In the recently published Every Newborn Action Plan coordinated by UNICEF and the World Health Organisation, Kangaroo Care was listed alongside breastfeeding as one of the top methods of helping to reduce the global death toll of babies born premature and while there are differing opinions on whether we do it well for a developed country like Australia, we still have a long way to go to meet the gold standard of Kangaroo Care in action at a neonatal unit in Uppsala, Sweden. The unit at The University Children’s Hospital, Uppsala oversees the provision of continuous Kangaroo Care throughout the baby’s entire hospital stay where the parents continuously hold their baby 24/7. The hospital supports their philosophy to keep parents and their babies together at all times in many ways including offering specially designed clothing to allow baby’s to receive Kangaroo Care and parents be mobile at the same time, to providing procedures such as blood tests and inserting naso-gastric tubes whilst being held in safety and comfort against their chests of their parents.

Today on International Kangaroo Care Awareness Day, Miracle Babies Foundation launched Australia’s first Kangaroo-a-thon. Our goal, is to encourage all the Neonatal Intensive Care Units (NICUs) and Special Care Nurseries across the country to actively promote Kangaroo Care and log as many hours of Kangaroo Care holding (including modified holding) in a 2 week period. The Foundation would like to see as many hours of brain developing, neuro-protective, attachment building, and immunity boosting good times and are pleased that so far more than 10 units have taken up the challenge.

You can follow their progress in the coming weeks online at miraclebabies.org.au And, as for some of most beautiful photos you’ll ever see, jump onto social media using #kangarooathon #miraclebabies and #kangaroocare. You’ll be blown away.

It is not a magic bullet, we know that, but we should be allowing Mother Nature to help increase a premature or sick baby’s chance for a survival and better outcomes. The perfect complement to the amazing care our babies are already receiving.

Kangaroo Care – cute name, beautiful photos, life-saving.

By Summer Aronson on May 13, 2015
Haiti

Photo: Midwives For Haiti

This blog was originally published by Midwives For Haiti. Written by Summer Aronson.

Each day, 800 mothers in the world die from mostly preventable causes during pregnancy or childbirth and 99% of these deaths occur in developing countries. In other words, it is mostly the poorest women in the world who die from causes that we know how to prevent.

In Haiti, where the maternal and infant mortality rates are highest in the Western Hemisphere, mothers face three critical barriers to maternal care: lack of prenatal care, lack of transportation, and lack of skilled birth attendants. These barriers are acutely critical for rural women. Midwives For Haiti’s Mobile Prenatal Clinic address all three.


Photo: Midwives For Haiti

The Mobile Prenatal Clinic visits twenty remote villages in the Central Plateau of Haiti. The midwives carry their supplies and medications in old suitcases, which are strapped atop an all-terrain vehicle, and travel up to two hours over rutted roads, rivers, and streams to reach the women who would otherwise not have access to care. The team sets up in churches, schools, community buildings, or sometimes under a tree, and gets to work while expecting and newly delivered mothers wait patiently for the health care they know will make a difference for themselves and their babies surviving childbirth, or not.

Every Haitian mother knows a woman who has died from pregnancy or birth complications. Magdala Jean, a graduate of Midwives For Haiti who now works on the mobile clinic, says “Too many women are dying in birth. My cousin died because of eclampsia [a treatable complication]. I want women to have loving care and support.” In Haiti, the focus is on survival and hope that mother and baby will live through the many complications that are brought on by poor nutrition, malaria, worms, early hypertension, lack of prenatal care, lack of transportation and a lack of skilled birth attendants.

Photo: Cheryl Hanna-Truscott

By bringing comprehensive prenatal and postnatal care to rural women by skilled, compassionate providers (all graduates of Midwives For Haiti’s training program), the Mobile Prenatal Clinic closes a critical gap in care for very poor women. This care includes providing vitamins and iron supplements, maternal and fetal health assessment, lab testing and treatment for anemia, worms, malaria, sexually transmitted infections and referrals for HIV. Mothers also receive extensive education on the importance of nutrition, breastfeeding, danger signs of pregnancy and when to seek help. Every woman receives a chart and her health is followed throughout her pregnancy. Very ill mothers receive emergency transport to a medical facility.

The project is working. The Mobile Prenatal Clinic provides over 6,000 patient visits annually. Last year alone, the midwives transported 25 mothers for life saving emergency medical care. For the rural women of these 20 remote villages, the care these traveling midwives provide can literally mean the difference between life and death.


Photo: B.D. Cohen

We know how to end preventable deaths of rural mothers and babies. We know that it costs money to bring maternal care to these women. It costs $10 per patient visit to run these clinics in rural Haiti. With solutions like this, it is no longer a question of how, but why? When we hear the statistic that 800 mothers die each day while bringing life into the world, we must remember that it is mostly rural, poor women who are dying. And we need to ask ourselves, are the lives of these women worth saving? Midwives For Haiti has answered with a resounding “Yes.”

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Midwives For Haiti relies on private donations to keep the Mobile Prenatal Clinic on the road all year round. Make a tax-deductible donation by May 29 to help them earn a matching grant and cover the annual cost of this life saving project. Each dollar donated will be matched, please give now.

By Kathryn Millar on May 11, 2015
Africa, Asia

This post originally appeared in the American College of Nurse Midwives’ Quickening, Volume 46, Number 2 (Spring 2015) and by the Maternal Health Task Force. Written by Kathryn Millar. Slight changes were made from the original post.

Today, May 5, is the International Day of the Midwife. This is an opportunity for the global community to come together to recognize the incredible impact midwives have on maternal and newborn health and decreasing mortality. Want to know more about what global leaders are doing to strengthen midwifery?

On Monday, March 23rd, global leaders in midwifery and maternal, newborn and child health gathered in Washington, DC at the Wilson Center for Call the Midwife: A Conversation About the Rising Global Midwifery Movement. This symposium hosted four panels to discuss current data, country investments, important global initiatives and public private partnerships and innovation in midwifery. Each of the panels was presented in the context of exciting new strides in maternal health with the forthcoming Sustainable Development Goals, an updated strategy for the United Nations’ Every Woman, Every Child initiative and the World Bank’s Global Financing Facility that supports it.

While each speaker’s background and focus varied, the themes of the symposium were consistent:

  • Improve management and leaderships skills of midwives
  • Improve pre-service and in-service education
  • Innovate to keep midwives in rural areas
  • Fill the need for well-trained midwifery faculty
  • Integrate maternal and newborn healthcare
  • Provide respectful maternity care (RMC)
  • Build capacity

To kick-off the symposium, His Excellency Björn Lyrvall, Swedish Ambassador to the United States told the story of midwifery in Sweden: in 1751, it was reported to parliament that 400 of 651 maternal deaths could be averted with midwifery. Parliament took this seriously and by training midwives with safe delivery techniques decreased Sweden’s maternal mortality ratio (MMR) from 900 deaths per 100,000 live births (among the highest in Europe at the time) to 230. Sweden’s passion and investment in midwifery can act as an example to countries that are now facing a similar burden of maternal mortality.

The data on midwifery

The first panel on data summarized the State of the World’s Midwifery 2014 (SoWMy 2014), the Lancet Series on Midwifery and the International Confederation of Midwives’ (ICM) vision and programs. In his presentation on SoWMy 2014, Luc de Bernis, Technical Adviser at UNFPA, focused on projections of workforce availability and met need, or the ratio of workforce time available to time needed. Projections identify countries with a low-met need, medium-met need and high-met need in 2030. Interestingly, two countries that are doing well now, Ethiopia and Burkina Faso, will not be able to meet their health workforce needs by 2030 if investment does not accelerate now to keep up with an increasing need for services.

In her review of the Lancet Series on Midwifery, Holly Kennedy, Varney Professor of Midwifery at Yale University, announced two papers that will be added to the series: one on disrespect and abuse and RMC and another that summarizes the top 10 research priorities from the series to improve maternal and newborn health using the QMNC framework.

Frances Day-Stirk, President of the International Confederation of Midwives (ICM), then spoke on her organization’s vision and programs, including “A Promising Future,” a campaign to promote midwifery as the norm and not a novelty. The focus of ICM is to have midwives who are appropriate (well-educated and regulated), accessible (especially in poor geographic areas) and cost-effective. Day-Stirk also outlined the critical pillars of midwifery—education, regulation and association—which stand on a foundation of ICM core competencies. The focus and pillars of ICM were echoed throughout the remainder of the symposium.

At the end of this panel, countries were encouraged to look at long-term plans for strengthening and scaling-up professional midwifery, instead of quick fixes with training auxiliary midwives.

Country investments and lessons learned

Representatives from Cameroon, Afghanistan, Liberia and Ethiopia presented data on current initiatives in their countries to support and scale up midwifery. Ethiopia and Cameroon have both seen improvements in midwifery and maternal health indicators through investing in midwifery education and establishing accreditation of schools and training sites. Although they have seen success in their efforts, challenges still remain with a shortage of midwifery faculty and clinical training sites.

In Afghanistan, the Community Midwifery Education (CME) program, supported by USAID, Jhpiego, WHO and UNFPA, provides quality, sustainable midwifery education. The 2-year program supports women with at least a 10th grade education, chosen by their communities to participate. After training is complete, women return to their communities where child care and transportation is provided to enable them to use their skills and also to incentivize them to stay in their community. Other initiatives include leadership training, accreditation and mobile programs.

Marion Subah, a senior nurse midwife and Jhpiego’s country representative in Liberia, reported that since Ebola, antenatal care (ANC) coverage, skilled birth attendance and institutional delivery have all had an absolute decrease of about 10%, reversing recent advances in maternal health in Liberia. She recounted the difficulties of delivering maternal health care in the context of Ebola: six midwives have died from Ebola and women who need post abortion care are especially at risk because of the fears associated with contracting Ebola through bodily fluids. Moving forward, the ministry of health (MOH) has created a 10-year plan that focuses on increasing the number and quality of midwives, faculty development and establishing well-working computer and science labs and clinical sites.

Global midwifery initiatives

All over the world, organizations of all types are banning together to improve maternal and newborn health by investing in midwifery. With initiatives by the World Bank, USAID, GE Foundation and global policy experts, there was a lot to be excited about.

These initiatives are focused on creating a sustainable midwifery workforce, strengthening professional associations, improving workplace conditions for midwives, promoting RMC, building leadership and management skills, implementing global policies for ending maternal and newborn deaths and a new ICM Midwifery Services Framework. Many of the initiatives presented have overlapping goals, all to the end of creating a healthy, well-educated, accessible midwifery workforce.

At the close of this panel, Laura Laski, Chief of the Sexual and Reproductive Health Branch at UNFPA, noted three upcoming critical turning points for midwifery:

  1. The Global Maternal Newborn Health Conference in Mexico City: timed right after the agreement of countries on the SDGs, this conference in October 2015, provides an opportunity to emphasize the need to invest in midwives to accomplish the SDGs
  2. The World Health Assembly: provides a forum in May to discuss the new version of Every Woman, Every Child
  3. The Women Deliver Conference in 2016

Innovation and Public-Private Partnerships for Midwifery

To end the day, we looked forward to the future with a focus on innovation and pioneering public-private partnerships (PPPs). Greeta Lal of UNFPA shared recently developed e-learning modules that were created in partnership with Jhpiego, UNFPA, Intel and WHO. With topics ranging from family planning to essential newborn care, these e-learning modules can be conducted almost anywhere with a battery-operated projector, solar powered charger and a cheap tablet, these modules can be used in almost any part of the world.

In addition, Survive & Thrive and Nurses Investing in Maternal Child Health both seek to strengthen young professionals to become leaders in the field to create sustainable change. Both programs work internationally, but with different strategies. Survive & Thrive, supported by ACNM and other partners, works to strengthen professional associations and host master training of trainer courses for the management of maternal and newborn complications, from Malawi to Afghanistan. Nurses Investing in Maternal Child Health is an 18-month program supported by Johnson & Johnson and Sigma Theta Tau for nurse fellows to work with a mentor in order to gain leadership and technical skills in order to improve maternal and child health through evidence-based practice, health systems improvements and program evaluation.

Lastly, the NGO Direct Relief, with technical support from ICM, creates midwife kits for facility-based deliveries. With essential commodities, these kits have the potential to decrease MMR and the neonatal mortality rate by 63%. Thus far, these kits have been distributed in the Philippines after Typhoon Haiyan and in Sierra Leone in the wake of Ebola.

The symposium was a full day of reviewing the incredible impact midwifery can have and what we need to do as a global community to realize that impact.

Resources discussed at this symposium: