Ending preventable maternal and newborn deaths: Five insights into how to make Maternal and Perinatal Death Surveillance and Response work

Every passing minute, across the globe, a family’s joy turns to sorrow and mourning in the wake of the tragic loss of a mother or baby due to complications during childbirth or in the immediate postpartum period. According to the World Health Organisation (WHO), every day in 2020, almost 800 women died from preventable causes related to pregnancy and childbirth, equating to a maternal death almost every two minutes[1]. Further, the statistics show there are approximately 6500 newborn deaths every day, with most of these (75%) occurring during the first week of life[2]. In the face of such profound tragedy, we must all come together to implement lasting solutions that end preventable deaths of mothers and babies.

One promising strategy to reduce maternal and perinatal deaths is Maternal and Perinatal Death Surveillance and Response (MPDSR). This approach involves the systematic identification, review and analysis of individual cases of maternal and perinatal deaths to identify the underlying causes and contributing factors, followed by actions to prevent future deaths. If implemented optimally, MPDSR has the potential to significantly enhance the quality of maternal healthcare services, contributing to reduction in maternal mortality by up to 35% [3] and perinatal mortality by 30% [4].

However, in many countries, the implementation of MPDSR in accordance with WHO guidelines faces many challenges including a lack of community involvement, fear of blame or litigation among healthcare providers, poor-quality data, and inadequate funding for implementation. In particular, many facilities and systems face challenges in implementing perinatal death reviews and implementing actions in response to review recommendations. [5].

To overcome these challenges, we are collaborating with governments and partners across multiple countries to champion and enhance the implementation of MPDSR and use of MPDSR data in decision-making. Our aim is to institutionalise this process as part of our continuous quality improvement efforts and embed it within governments’ planning and budgeting cycle, thus unlocking the required resources. We’ve worked closely with health providers and government in Bungoma to pioneer the development of an MPDSR Action Tracker and are supporting countries to institutionalise its use to analyse the problem that caused a maternal or perinatal death, monitor the implementation of recommendations, and target advocacy and accountability efforts.

We’re also a member of the WHO-led Global MPDSR Technical Working Group (TWG), which provides implementation guidance and tools, and facilitates coordination of various actors and initiatives. I recently represented Options in a meeting of the TWG that took place in Kampala, Uganda. The main agenda of the meeting was to take stock of the progress made and agree on the priorities over the coming year. Five key take-aways emerged from the discussion on what the remaining challenges and lessons are in making MPSDR work:

1. While more countries are engaging in maternal death reviews, there remains a significant gap in the implementation of neonatal and stillbirth reviews, indicating a disconnect that needs to be addressed.
2. The integration of standalone MPDSR systems within existing national monitoring mechanisms is essential for sustainability and effectiveness. This includes strengthening linkages between MPDSR and routine Health Management Information Systems (HMIS), Civil Registration and Vital Signs (CRVS) systems, and Integrated Disease Surveillance and Response (IDSR) systems.
3. Despite its potential benefits, fear of blame and punitive actions pose significant barriers to successful MPDSR implementation. Establishing a supportive regulatory framework can mitigate these concerns and foster a culture of learning and improvement.
4. Without adequate resources and support for implementation, MPDSR recommendations risk remaining merely aspirational, failing to drive meaningful change in clinical practice and healthcare delivery.
5. Lastly, committed leadership, supported by professional associations and community engagement, is crucial for sustaining momentum and driving positive change.

Stakeholders must unite and advocate for scaling and institutionalising MPDSR. Such efforts represent a crucial contribution to the global mission of eradicating preventable maternal and perinatal deaths, as well as stillbirths.

[1] https://www.who.int/news-room/fact-sheets/detail/maternal-mortality

[2] https://www.who.int/news-room/fact-sheets/detail/newborn-mortality

[3] Willcox ML, Price J, Scott S, et al. Death audits and reviews for reducing maternal, perinatal and child mortality. Cochrane Database Syst Rev. 2020;3(3):CD012982.

[4] Pattinson R, Kerber K, Waiswa P, et al. Perinatal mortality audit: counting, accountability, and overcoming challenges in scaling up in low- and middle- income countries. Int J Gynaecol Obstet. 2009;107(Suppl 1):S113-S121.

[5] https://iris.who.int/bitstream/handle/10665/348487/9789240036666-eng.pdf?sequence=1