The following resources are a selection of useful tools and guidelines for improving delivery and care to ensure positive outcomes for mother and newborns. Selected resources focus on Health Systems Strengthening, Community Interventions, Advocacy and Evidence.
Improving maternal and newborn survival on the day of birth – how can facility-based delivery, respectful maternity care, midwives, healthy timing and spacing of pregnancy contribute?
Every year, 40 million mothers still give birth without any help from a midwife or another health worker, trained and equipped to save the life of the baby or mother. Approximately 800 women die from preventable causes related to pregnancy and childbirth every day according to the World Health Association (WHO). The situation for newborns is even more alarming, as one million die on their first day of life, many because of mothers not getting quality care during labor and delivery. Midwives, doctors, and nurses stand at the forefront of caring for the pregnant woman and newborn baby during the antenatal, delivery, and postnatal periods. Often the midwife is the sole health care professional responsible for both the mother and baby. The causes of stillbirths and newborn and maternal deaths are closely related, and we know the solutions. Ensuring essential care is provided around labor, delivery, and immediately afterwards is critical to ending both maternal and newborn deaths. Available, skilled, well-equipped birth attendants to assist women and newborn babies during labor and birth are vital to their survival.
Photo: Colin Crowley/Save the Children
Health Systems Strengthening
1. Saving Mothers, Giving Life Phase One: Emergency Obstetric and Newborn Care Services: Access and Availability. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2014. Saving Mothers, Giving Life (SMGL) is a public-private partnership building on existing newborn, maternal and public health platforms, launched in 2012 to accelerate the reduction of maternal and newborn morbidity and mortality in sub-Saharan Africa. Partners include USAID, the CDC, and Merck for Mothers, and the Norwegian Ministry of Foreign Affairs. Saving Mothers, Giving Life promotes “an integrated health systems approach that addresses the ‘three delays’ associated with maternal and newborn deaths: delays in, 1) seeking appropriate care, 2) reaching care in a timely manner and 3) receiving high-quality care at a health facility.” This initiative has achieved a 35% reduction of institutional facility maternal mortality in Uganda and Zambia.
2. Success factors for women and children’s health: Policy and program highlights from 10 fast-track countries, PMNCH, WHO, World Bank and AHPSR 2014. This 48-page stakeholder policy-review paper synthesizes best practices and lessons learned from 10 “fast-track” countries that have successfully reduced maternal and newborn mortality. The success factors studies highlight the importance of collaboration across a many actors, integration among sectors, and data driven decision making. Additionally, tailoring strategies according to political priorities, available resources, and local contexts is critical to delivering results.
Community Interventions
3. Evidence from community level inputs to improve quality of care for maternal and newborn health: interventions and findings. Journal of Reproductive Health 2014, 11 (Suppl 2):S. This 19-page journal article reviews existing evidence on the effectiveness of community-based inputs for improving maternal and newborn health outcomes. The interventions fell into the following categories: outreach services (including home visitation and referrals); task shifting; training; and formation of support groups for community mobilization. The findings indicate when community-based inputs are compared to district and facility level inputs “community level home visitation, community mobilization and training of community health workers and traditional birth attendants…[have] the maximum potential to improve a range of maternal and newborn health outcomes.”
4. WHO recommendation on community mobilization through facilitated participatory learning and participatory learning and action cycles with women’s groups for maternal and newborn health, 2014. This 32-page report provides a concise overview of the available evidence on the effectiveness of community mobilization through facilitated participatory learning and action cycles with women’s groups regarding the health outcomes of mothers and newborns. This WHO recommendation serves as a guideline for health program managers as well as governments, non-governmental organizations, and policy makers who play a role in the development of maternal, newborn, and child health programs in low-resource settings.
Advocacy
5. Since 2000, Save the Children annually produces the State of the World’s Mothers (SOWM) report. This report highlights where mothers and newborns fare best and where in the world they are most vulnerable, ranking more than 170 countries using the latest data on health, education, economics, and female political participation. In 2013, the SOWM report, “Surviving the First Day: State pf the World’s Mothers (SOWM) 2013, Save the Children,” focused on the day of delivery. This 88-page report the first issue to include the Birth Day Risk Index, which identifies the safest and most dangerous places in which to give birth and be born.
6. Improvement of maternal and newborn health through midwifery. The Lancet 23 June, 2014. The State of the World’s Midwifery Report 2014. This 10-page article is one of a special series of six articles on midwifery published in the Lancet. The report shows that midwives can provide 87% of the needed essential care for women and newborns when educated and trained to international standards. Based on these findings, the report recommends three areas for additional research and details the support required at a national level to improve quality of care provided by midwives.
7. In 2014, Save the Children’s Saving Newborn Lives (SNL) program and the Maternal Health Task Force (MHTF) at the Harvard School of Public Health held a technical consultation to address the integration of maternal and newborn health care. This two-day meeting convened 50 key stakeholders to promote collaboration between the maternal and newborn health communities with the objective of improving quality of care during the antenatal, intrapartum, and postnatal periods. The Integration of Maternal and Newborn Health Care: In Pursuit of Quality Meeting Report provides a 26-page summary of key themes, conclusions, and recommendations. Additional resources include a blog series highlighting participants’ perspectives, presentations, and videos of the presentations.
Evidence
8. Birth Spacing – Report from a WHO Technical Consultation, WHO, 2006. This 44-page WHO policy brief makes two recommendations with regard to the Healthy Timing and Spacing of Pregnancy (HTSP) approach based on a series of six studies commissioned by USAID to inform the growing body of research on pregnancy spacing and health outcomes. This technical consultation specifically addresses birth spacing after a live birth and spacing after an abortion.
9. Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis, Bohren et al.: Reproductive Health 2014 11:71. This 17-page article reflects evidence generated from 34 studies from 17 countries on care-seeking behaviors and perceived quality of care regarding delivery t health facilities in low- and middle-income countries. The findings explore various “facilitators” and “barriers” in a woman’s decision-making process.
10. Approaches to improve the quality of maternal and newborn health care: An overview of the evidence, Austin et al. Reproductive Health 2014, 11(Suppl 2):S1. This nine-page article is the first paper in a series of five papers synthesizing existing literature on high-impact, evidence-based interventions designed to improve the quality of care for women and newborns. This paper details the conceptual framework used in this study as well as the selection criteria for the systematic review. The quality of care framework clearly presents factors that influence the quality in facility-based maternal care.
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