Dying to give birth

Next week, the global maternal newborn health community will gather in Cape Town for the first biannual International Maternal Newborn Health Conference (IMNHC). This will see the launch of the first joint progress report from the Ending Preventable Maternal Mortality (EPMM) Initiative and Every Newborn Action Plan (ENAP), which will serve as a crucial accountability mechanism. With the number of global maternal deaths on the rise, or stagnating, and a death occurring every two minutes, it marks an important milestone over the next eight years as we progress to 2030.

Having delivered interventions across all health system building blocks, with a focus on reproductive, maternal, newborn, child and adolescent health (RMNCAH) and nutrition, over the last 30 years, this is a timely opportunity to look back at how our work has contributed to both EPMM and ENAP targets.

Addressing all causes of maternal mortality, reproductive and maternal morbidities, and related disabilities

In Nepal, one of the cornerstones of this work is our 25-year partnership with the government, which has focused on building a strong, accessible and resilient health system. Starting with our support to the Safe Motherhood Programme in 1997, which supported the development of foundational policies, we have contributed to improving access to facility-births and life-saving caesarean sections for women facing obstetric emergencies, and improved the quality of health services in the country. This has contributed to reducing Nepal’s maternal mortality ratio by 70% between 1997 and 2021 and increasing institutional delivery rates from 8% in 1996 to 80% in 2022.

In Kenya, we’ve worked with the government, health workers, community members, the media and partner organisations to test and scale up successful innovations that have demonstrated impact in reducing maternal and newborn mortality and improved maternal and newborn health outcomes through our Maternal and Newborn Improvement (MANI) project and County Innovation Challenge Fund (CICF). The former combined a novel quality of institutional care (QuIC) approach with maternal and perinatal death surveillance and response (MPDSR), which led to a 70% increase in health facility readiness to perform emergency obstetrics and newborn care (EmONC)  in just three years, as well as a review of over 80% of maternal and 50% of perinatal deaths across 20 Kenyan counties.

Strengthening health systems to respond to women and girls’ reproductive health needs

We provide embedded technical assistance – meaning, we are based within the Nepal government’s health ministry and its divisions, and sit alongside key decision-makers at each level of the federal and sub-national governments. This gives us the necessary insights to continue to adapt our support to the government’s changing needs in the context of its newly devolved governance system. Most recently, we facilitated the development of Nepal’s Nursing and Midwifery Strategy (2020-2030) to improve professional training and drafted the country’s Safe Motherhood and Newborn Health Roadmap 2030.

We provided similar support in Malawi through our Results-based Financing (RBF) for Maternal and Newborn Health Initiative – addressing factors contributing to high numbers of maternal and newborn deaths using innovative approaches to health financing. This helped to remove financial barriers for women to access facility-birth, and contributed to an increase in the number of women who gave birth without complications and remain in hospital for 48 hours post childbirth from 40% to 90%.

Ensuring accountability to improve quality of care and equity

We have improved accountability and promoted the rights and visibility of marginalised groups through our Evidence for Action (E4A) – MamaYe and Women’s Integrated Sexual Health (WISH) programmes. This has involved championing and supporting over 300 civil society organisations since 2017 to engage with government and health practitioners on maternal and newborn health, and gender and equality issues, and enabled organisations to participate in planning, budgeting and decision-making forums to hold governments accountable to their sexual and reproductive health and family planning commitments. This work led to an increase in budget allocation for family planning by USD$9 million in Nigeria, the Democratic Republic of Congo, Malawi, Uganda, Tanzania and Madagascar.

IMNHC marks an important moment as we get closer to 2030, the deadline of the globally agreed upon goals for maternal and newborn health and prevention of stillbirths. While we still have a long way to go on the road to ending avoidable deaths, our work shows that by working closely in partnerships with governments and local stakeholders on the ground to develop local solutions it is possible to make significant progress towards achieving EPMM and ENAP targets.

This piece was written by Shanti Mahendra, Options’ Nepal/Global Practice Specialist, Reproductive, Maternal, Newborn and Child Health.