Worldwide, maternal mortality remains unacceptably high, especially in poor countries. While the total number of maternal deaths decreased from 543,000 in 1990 to 287,000 in 2010, and the maternal mortality ratio (MMR) decreased from 400 maternal deaths per 100,000 live births to 210 in 2010, wide variations persist between rich and poor countries.
Nearly 800 women die every day during pregnancy and childbirth – most of them (99%) in developing countries, with the highest rates of maternal mortality in sub-Saharan Africa and South Asia. The major direct causes of maternal death are postpartum hemorrhage (PPH) and pre-eclampsia/eclampsia (PE/E), which together account for more than 40% of maternal mortality. Maternal anemia, malaria and HIV are also large contributors to maternal morbidity and mortality.
The MCHIP Maternal Health Program focuses on three main areas to improve maternal health: prevention of PPH; prevention and treatment of PE/E; and expanding access to and improving the capacity of skilled birth attendants (SBAs) through global leadership, advocacy and integration. As a lead implementing and technical assistance organization for global standards, MCHIP has helped develop and disseminate essential WHO guidelines on prevention of PPH, prevention and treatment of PE/E, and task-shifting. The Program has also been a global leader in supporting activities that increase coverage and use of services to prevent PPH, such as the active management of third stage of labor (AMTSL) at the health facility, and community-based distribution of misoprostol. Evidence from these programs has helped MCHIP to inform and be a key contributor to soon-to-be-revised WHO recommendations that approve advanced distribution of misoprostol for self-administration to prevent PPH.
MCHIP also works to improve the quality of care (QoC) through competency-based training, supportive supervision, QoC surveys, an ongoing goal-oriented performance improvement approach, and development of user-friendly resources (such as the PE/E toolkit). The MCHIP Maternal Health Program works with other MCHIP programs to ensure an integrative approach to improve maternal and newborn health, such as through:
- Nutrition – to improve maternal anemia;
- Malaria and HIV – to prevent/treat in pregnancy;
- Newborn Health – to delay cord clamping to prevent infant anemia, prevent/manage prematurity (including the administration of antenatal corticosteroids); and
- Family Planning – for healthy spacing and timing of pregnancy.
Key Contributions to Maternal Health
- Multi-Country Analysis Survey: MCHIP undertook its second annual survey of national programs for the management of PPH and PE/E from January to March 2012. This country-level program analysis included countries from Africa, Asia and Latin America, focusing on those USAID priority countries that face the highest burden of maternal morbidity. Through this widely used survey and advocacy tool, which has been presented and disseminated at numerous venues, MCHIP has been able to raise critical quality of care issues related to maternal health commodities and achieved several programmatic results at the country level, especially in the areas of PE/E and PPH prevention and treatment. At the global level, the survey results have been used widely and helped provide much needed information to inform the global recommendations of the UN Commission on Life-Saving Commodities. At the country level, it has aided governments and implementing agencies to identify and address gaps, enabling them to work toward scaling up interventions related to reducing PPH and PE/E.
- MCHIP is a key contributor to WHO recommendations on PPH, which are likely to be revised in the coming months to include a recommendation in support of advanced distribution of misoprostol for self-administration to prevent postpartum hemorrhage at home birth. This has come through our extensive advocacy and programmatic work in the field, including the implementation of operations research on introduction of PPH prevention programs in four countries under MCHIP funding. These programs promote the use of AMTSL at the health facility as well as advanced distribution of misoprostol for home birth, demonstrating a comprehensive approach to the issue of PPH. The resulting peer-reviewed publications, along with an integrative review article on community-based distribution, will contribute to the growing body of evidence which will feed into the new guidelines, thus ensuring that all women are reached with this life-saving intervention.
- MCHIP has shown leadership by adopting an integrated approach that targets key interventions for mothers that address prematurity and improve outcomes for countless newborns. In close collaboration with other key stakeholders such as Born too Soon, Survive and Thrive, and the Gates Foundation, MCHIP has spearheaded the development of a prematurity toolkit that will be finalized in July 2013, along with advocacy and technical briefers, and a job aid promoting the use of Antenatal Corticosteroids (ACS) for fetal lung maturation.