A Decade of Tracking Progress for Maternal, Newborn and Child Survival: Lessons from Countdown to 2015 for monitoring and accountability in the SDG era

By Zulfiqar A. Bhutta and Mickey Chopra

Zulfiqar Bhutta, of the Centre for Global Child Health, Hospital for Sick Children (Canada) and Aga Khan University (Pakistan), and Mickey Chopra, of The World Bank, are co-chairs of Countdown to 2015. This article originally appeared on the Maternal Health Task Force blog as part of a series for the Global Maternal and Newborn Health Conference, October 2015 in Mexico City.

‘Ten years from now, in 2015,’ said the opening line of the first Countdown to 2015 report, published in 2005, ‘the governments of the world will meet to assess if we have achieved the Millennium Development Goals (MDGs), the most widely ratified set of development goals ever, signed onto by every country in the world.’

Continue reading “A Decade of Tracking Progress for Maternal, Newborn and Child Survival: Lessons from Countdown to 2015 for monitoring and accountability in the SDG era”

Supporting midwives for a better tomorrow

Martha Murdock is Vice President for Regional Programs at Family Care International.

Midwives save lives. It’s as simple as that. But the obstacles and barriers midwives face are anything but simple.

We all know that midwives have crucial clinical skills that help them care for women and their newborns everyday all over the world. If these lifesaving services were available and accessible to all the women and babies who need them, midwives could help avert two-thirds of the nearly 300,000 maternal deaths and half of the 3 million newborn deaths that occur every year. Midwives play an absolutely critical role in making progress on Millennium Development Goals 4 (reducing child mortality) and 5 (improving maternal health and achieving universal access to reproductive health). And without a well-supported, trained, and supplied midwifery cadre, we won’t be able to meet the maternal and child health targets that will be part of the post-2015 agenda. We’re delighted to join our colleagues at the International Confederation of Midwives (ICM) in celebrating the International Day of the Midwife today, 5 May. Continue reading “Supporting midwives for a better tomorrow”

To reduce death and ensure health, The Lancet launches Midwifery Series

By Katie Millar

Katie Millar is a technical writer for the Maternal Health Task Force (MHTF), where this article originally appeared. 

Today, at the London School of Hygiene and Tropical Medicine, The Lancet launched its newest series Midwifery. This series provides concrete actions for stopping preventable maternal and newborn death and ensuring perinatal health. The knowledge that midwives are key to preventing perinatal death is not new. However, scaling up the utilization of midwives on a systems level is lacking, which has prevented this solution from becoming a reality.

The Midwifery Series was created to provide concrete guidance and frameworks on how to utilize midwives and a new standard of care for Quality Maternal and Newborn Care (QMNC). At the center of this model of care are the needs of women and their newborn infants. Even though the needs of women across the world seem to differ greatly, this series clarifies that no matter where a woman lives, care led by a midwife is the answer to ensuring health. The series comprises four separate papers which were created by a multidisciplinary group, including academics, researchers, advocates for women and children, clinicians, and policy-makers. This multidisciplinary approach is necessary for addressing current gaps in perinatal care.

The current maternal and newborn health landscape often offers fragmented solutions and interventions to address the needs of women and their newborns. This fragmentation is a barrier to adequate perinatal care. These gaps in care lead to 98% of the annual 289,000 maternal deaths, 2.6 million stillbirths, and 2.9 million neonatal deaths. In order to mitigate these preventable deaths, improvements in the quality throughout the continuum of care and emergency services are imperative. The series supports a whole-system approach to improving perinatal care by ensuring skilled care for all.#2 FOR EVERY WOMAN AND EVERY NEWBORN CHILD

The Lives Saved Tool (LiST) was used in the series to model different levels of scale-up of essential interventions for reproductive, maternal, and newborn health (RMNH) which are within the scope of practice of a midwife. In low-resource settings even a 10% increase in the interventions covered by midwifery would decrease maternal mortality by 27%. Therefore, more rigorous scale-up could have an incredible impact on reducing maternal mortality.

The standard for QMNC presented in the series is globally applicable as it not only focuses on the scale-up of essential interventions, but also the harmful effects and necessary mitigation of over-medicalization of birth and perinatal care. Professor Petra ten Hoope-Bender, of the Instituto do Cooperación Social Integrare, Barcelona, Spain, said, “Although the level and type of risks related to pregnancy, birth, postpartum and the early weeks of life differ between countries and settings, the need to implement effective, sustainable, and affordable improvements in the quality of care is common to all, and midwifery is pivotal to this approach. However, it is important to understand that to be most effective, a midwife must have access to a functioning health-care service, and for her work to be respected, and integrated with other health-care professionals; the provision of health care and midwifery services must be effectively connected across communities and health—care facilities.”

In order to assist the development of health systems and their integration of midwives, the series provides three new tools:

  1. The Framework for Quality Maternal and Newborn Care is applicable to all countries on not only what needs to be implemented, but how to implement strategies to reduce maternal, neonatal, and infant mortality and morbidity, improve quality of care, and increase efficiency of health systems.
  2. Country diagrams can be used to identify the most important elements required to strengthen a country’s health systems to provide quality midwifery services.
  3. Pragmatic steps provide a guide to initiate or further develop their midwifery services.

Midwives not only provide care at the time of birth, but work with women from before their pregnancy through their newborns infancy to prevent death and ensure health. This life course approach is essential for having a large impact on the needless numbers of deaths and morbidities. Check out The Lancet’s Midwifery Series for more details on how midwives will make a large difference in the lives of women and their children in the coming years as the post-2015 agenda is implemented.

To learn more visit the official website of the Midwifery Series and follow the conversation on twitter by following @midwiferyaction and #LancetMidwifery.

A Price Too High to Bear: Showing Kenya the devastating costs of maternal death

Martha Murdock is FCI’s vice president for regional programs.

Last week in Nairobi, a range of partners — from the Kenyan government, UN agencies, donor countries, and many NGOs and research organizations from the national and county levels — came together for a presentation of new research that has the potential to increase the momentum of efforts to save the lives of nearly 300,000 women who die each year (5,500 of them in Kenya) from causes related to pregnancy and childbirth.

Each of these avoidable, premature deaths is a tragedy in its own right, and a terrible injustice. Each of these women — some of them barely more than girls — has a right to life and health, and to a standard of health care that protects her from preventable illness, injury, and death.

But we who work to improve maternal health have argued for years that each of these deaths also brings countless additional layers of loss, pain, and destruction. The tragic, sudden death of a woman in the prime of life — in many cases already a mother and often the most economically productive member of the family — begins a cascade of loss and pain that upends the lives of those around her: her newborn baby (if it survives) and her older children, husband, parents, and other members of her family and community.

Up until now, however, we haven’t had the hard data to support our case, to help us persuade governments, donors, and policy makers that investments in maternal health are also investments in children, in stable families, in education and community development, and ultimately in stronger national economies. Now, thanks to a study conducted in Kenya by FCI, the International Center for Research on Women (ICRW), and the KEMRI-CDC Research and Public Health Collaboration, we know that the data behind that argument is very powerful indeed.

Based on interviews and focus group discussions with every family, across a poor rural area in Siaya County in western Kenya, that had lost a family member to maternal death over a two-year period, we found that:

  • When a mother dies in or around childbirth, her newborn baby is unlikely to survive.
    • Of 59 maternal deaths in the study, only 15 babies survived their first two months of life.
  • A mother’s death harms the educational and life opportunities of her surviving children.
    • Many children had to leave school because the loss of a mother’s income meant that they couldn’t pay tuition fees, needed to work for a living, or had to take up essential household chores.
  • The cost of emergency care (even when unsuccessful), combined with high funeral costs, puts families under a crushing economic burden.
    • Families spent more on funerals than their total annual expenditure on food, housing, and other household costs, after having already spent 1/3 of their annual consumption expenditure on medical costs.
  • Loss of income and high, unexpected costs send many families into a spiral of debt, poverty, and instability.
    • Many families, under desperate financial pressure, had to sell household property, borrow from moneylenders, or move children out of the family home.

When this moving and compelling report was launched in Nairobi last Friday, I was proud to stand at the dais and introduce eminent leaders of efforts to improve women’s and children’s health in Kenya, including the U.K. High Commissioner for Kenya, Dr. Christian Turner (representing the U.K. Government, which funded this important research together with the John D. and Catherine T. MacArthur Foundation and the Partnership for Maternal, Newborn & Child Health). Dr. Turner, in turn, introduced Kenya’s Cabinet Secretary for Health, Hon. James Macharia. With us in the room were important policy makers from the Ministry of Health, national parliamentarians, and high-level representatives from UNICEF, WHO, UNFPA, USAID, and a range of other agencies and organizations.

We came together that morning, I said, “because we are all resolved, together with so many colleagues and partners here in Kenya and around the world, to work together to finally put an end to a tragic toll of maternal and newborn death that goes back to the beginnings of human history.” We have long known that far too many women were dying.  What we lacked, until now, was hard data to help us fully understand the financial and social impact of a mother’s death — the costs to the health and well-being of thousands of surviving children, families, and communities. We and our partners undertook this study because we saw that filling this critical knowledge gap will offer advocates and policy makers a powerful tool for bringing further attention and investment to maternal health.

The messages that emerge from this research were expressed clearly and succinctly by Hon. James Macharia as he presided over the official launch of the report:

A mother’s death ignites a chain of disruption, economic loss, and emotional pain that often leads to the death of her baby, diminished educational and life opportunities for her surviving children, and a deepening cycle of poverty for her family.

The cost of a maternal death is, quite literally, a price too high to bear.

 

(An excellent in-depth news report on the study and its launch, by a leading Kenyan television network, can be viewed here:

Ann Starrs on the power of community advocacy

In the midst of a long and busy week of discussions and events around the annual meeting of the United Nations General Assembly, FCI president Ann Starrs sat down for an interview on the critical role of communities in demanding accessible, high-quality health services.

“Women and their families,” she says, “have to be active, they have to understand what their rights are in terms of access to health care, in terms of access to information, and they have to demand that their political leaders, locally and nationally, make these services available and make these services high quality. If you don’t have that kind of demand and that kind of momentum in place, then any changes that get implemented are not going to be sustainable.”

Watch the video:

Action on the global stage: Life-saving reproductive health commodities getting much-needed attention

Ann Starrs is FCI’s president and co-founder.

During the third week of May, I was in Geneva — together with an impressive collection of global health leaders from governments, UN agencies, and civil society — for the 66th session of the World Health Assembly (WHA). I am in Geneva fairly often, for meetings with WHO, the Partnership for Maternal, Newborn & Child Health (PMNCH) and other partners, but the annual World Health Assembly meeting is unique. The WHA is the governing body of the World Health Organization, and so it is attended by high-level delegations – usually led by the Minister of Health – from WHO’s member states. That makes WHA a great opportunity for networking and strategizing: finding an available seat, much less a table, in the famous (but oddly named) Serpent Bar at the Palais de Nations is always a challenge, as many conference participants spend virtually all of their time huddled there in intense discussion.

WHA delegates at work in the Serpent Bar (WHO/Pierre Albouy)

Issues around reproductive, maternal, newborn, and child health featured strongly in this year’s agenda, which is why I was there. The MDGs, and development goals beyond 2015universal health coverage; life-saving commodities; and frameworks for holding countries and donors accountable for fulfilling their health commitments were all on the agenda, for formal discussion, side events, and hours of conversation at the Serpent Bar.

Perhaps most importantly, this year’s WHA considered, and ultimately passed, a resolution to implement the recommendations of the UN Commission on Life-Saving Commodities for Women and Children. The resolution commits countries to improving the quality, supply, and delivery of underutilized and essential commodities for RMNCH, and tasks WHO with reporting back to WHA each year through 2015 on progress in implementing the Commodity Commission recommendations as well as those of Commission on Information and Accountability for Women’s and Children’s Health. The WHA resolution is a clear, global endorsement of the Commodity Commission recommendations, and represents a commitment by the world’s nations to ensure that life-saving medicines and technologies get to the women and children who need them. It is a significant achievement for our community, and it provides an important mechanism for ongoing advocacy, and for holding governments and development partners accountable for keeping their promises.

Notably, the Commodity Commission’s list of 13 priority commodities includes two that are advocacy priorities for FCI: misoprostol, a drug that is highly effective for preventing and treating postpartum hemorrhage (PPH), the leading cause of maternal death; and emergency contraceptives, which help women prevent unintended pregnancy after unprotected sex. (FCI is host organization for the International Consortium for Emergency Contraception—ICEC.)  At a very well-attended side event during the WHA, hosted by the delegations from Nigeria, Norway, and the U.S., along with World Vision International and PATH, speakers focused on the importance of innovation in overcoming barriers to access to essential health commodities. Presentations highlighted the substantial achievements that have already been made, and the important step forward represented by the Commodity Commission’s recommendations. Representatives from various countries also noted the significant challenges that remain, including those related to health commodity distribution systems, manufacturing, and supply. Several countries expressed a preference for purchasing and distributing locally-manufactured commodities, although this approach can sometimes raise concerns about quality assurance; further study, and advocacy, will be needed to address this challenge.

Only a few days later, and half a world away, I was one of a dozen FCI staff members who attended Women Deliver 2013, in Kuala Lumpur, Malaysia. This week was even busier – in fact, much crazier – than the previous week in Geneva; there were meetings and events starting at 7 in the morning, and organized social events went until 8 or 9 pm every night. The conference was amazing, bringing together 4,500 leaders, clinicians, program managers, and advocates representing over 2,200 organizations and 149 countries. I could not take full advantage (or anywhere near it) of everything the conference had to offer; there was an endless variety of stimulating plenary and concurrent sessions (including six sessions presenting the latest findings from Countdown to 2015, in which FCI is a leading advocacy partner), as well as Speaker’s Corner (where FCI and WHO presented new tools for strengthening countries’ policies on adolescent sexual and reproductive health). There was a youth corner and a cinema corner, a busy and bustling exhibition hall, and many, many other activities going on at all times. The cumulative value of all the connections made, facts and ideas conveyed, materials disseminated, and plans and strategies developed was immeasurable but immense.

FCI country directors (Fatimata Kane, Mali; Angela Mutunga, Kenya; Brahima Bassane, Burkina Faso) meet at the FCI booth at Women Deliver 2013

Here, too, essential health commodities were on the agenda. On the Monday morning just before the conference officially started, FCI co-sponsored a side event called “In Our Hands: Successful Strategies to Prioritize Essential Maternal Health Supplies,” at which the Maternal Health Supplies Working Group and the Maternal Health Supplies Caucus of the Reproductive Health Supplies Coalition brought together global and national advocates and program implementers in an interactive forum – including advocacy case studies from Africa, Asia and Latin America – to network, strategize, and exchange ideas for elevating maternal health supplies onto global and national health agendas. At the same time, ICEC co-sponsored a session on “Emergency Contraception: New Research Findings, Programmatic Updates, and Advocacy Strategies,” at which advocates, researchers, pharmaceutical representatives, and other leaders in the field discussed efforts to ensure access to EC globally, with a focus on developing countries.

That afternoon, FIGO and Gynuity Health Projects (our partners in misoprostol advocacy) co-hosted a discussion of misoprostol for PPH: “New Evidence and the Way Forward.” Presenters offered the latest information on ways that the current evidence can help inform and develop effective policies and service delivery programs across varying levels of the health system, and on lessons learned from innovative programs in Afghanistan and Nepal. I concluded the session with a presentation on advocacy opportunities and challenges for “Making Misoprostol an Operational Reality.”

At these and related sessions the level of discussion, the enthusiastic participation by advocates and health workers, and the clear attention that these issues are getting from policy makers, made for an inspiring and energizing two weeks. “Making sure that women and children have the medicines and other supplies they need is critical for our push to achieve the MDGs,” said Secretary-General Ban Ki-moon when he launched the Commodities Commission 15 months ago. Progress is being made, and we, together with our advocacy partners, are working hard to make sure that essential commodities are available to all who need them.

The Connection Between Healthy Mothers and Healthy Newborns

by Gary L. Darmstadt, France Donnay, and Ann Starrs

Gary Darmstadt and France Donnay are, respectively, Director of Family Health and Senior Program Officer, Maternal, Neonatal and Child Health, at the Bill & Melinda Gates Foundation. Ann Starrs is president of FCI. This post first appeared on Impatient Optimists, the blog of the Bill & Melinda Gates Foundation, on June 3, 2013.

This month, the Journal of Maternal-Fetal and Neonatal Medicine published a special issue that sheds new light on the indissoluble links between the health of a mother and that of her newborn baby. Its release comes just weeks after the Global Newborn Health Conference, and simultaneously with a State of the World’s Mothers 2013 report revealing that a baby’s first day is the most dangerous of its life.

That interconnections exist between maternal and newborn health is well known. Most maternal deaths are caused by the woman’s poor health before or during pregnancy, or by inadequate care in the critical hours and days during and just after childbirth; the same is true for most newborn deaths. And when a woman dies after giving birth, her death is far too often followed by the death of her newborn baby. And we know, based on substantial evidence, which interventions are best for improving maternal health and saving women’s lives, and which are effective for improving newborn survival.

What we didn’t sufficiently understand, until now, was the range of interventions that bring health and survival benefits to both mother and newborn. In this new study, a research team from Aga Khan University in Pakistan, working in collaboration with Family Care International and with support from the Bill & Melinda Gates Foundation, looked at more than 150 interventions, assessing them for impact on both maternal and neonatal outcomes. They then grouped the interventions into “packages of care” that can be effectively delivered at each of the key levels of care: community, health center, and hospital.

This study advances our knowledge in important ways. It reinforces the widely-recognized benefits, for women and their babies, of high-quality antenatal care, skilled birth attendance, and postpartum care, which are still too often insufficiently, ineffectively, or inequitably delivered. It highlights the crucial role of family planning, which can be used to delay and space pregnancies. It identifies a number of areas — including management of preconception diabetes, treatment of maternal depression, and community-based approaches for improving birth preparedness and care-seeking — which are currently neglected but could significantly improve maternal and newborn outcomes.

Most importantly, the findings send a clear message: that greater integration of maternal and newborn care — and, more broadly, of services across the reproductive, maternal, newborn, and child health (RMNCH) continuum of care — is one of our most promising strategies for strengthening efforts to save women’s and children’s lives.

This kind of integration may sound like an obvious step, but it is not always easy. Integration of services is critical if countries are to make substantial progress towards national health goals. It forces policy makers, donors, program managers, and health workers to find common ground among their varying constituencies, goals, and agendas; to understand the needs of women and their babies in new and different ways; and to design services that respond to these needs. It requires that the physical, financial, and human architecture of the health system be designed and constructed to efficiently and equitably deliver high-quality services across the continuum of care.

And yet, Progress on reducing maternal and newborn deaths has been too slow, and far too many women and babies die every day. Recognizing and acting on the crucial interconnections between maternal and newborn health revealed by this study, and the broader linkages that tie together the RMNCH continuum, can help save the lives of millions of women and children. The time to take action is now.

Placing women at the center: Rethinking the RMNCH continuum of care

Ann Starrs is FCI’s president, and is a founding member and former co-chair of the board of the Partnership for Maternal, Newborn & Child Health (PMNCH), of which FCI is  a leading advocacy partner. In this post, cross-posted on the PMNCH website, Ann reports on the Global Maternal Health Conference 2013, which took place in Arusha, Tanzania on January 15th through 17th.

Last week’s Global Maternal Health Conference (GMHC), held in Arusha, Tanzania, was both inspiring and sobering. Twenty-five years after the Safe Motherhood Initiative was launched at an international conference held in neighboring Kenya, maternal mortality has finally begun to decline, and there are many and diverse examples of how countries are addressing the challenge of preventing deaths of women and newborns from complications of pregnancy, childbirth, and the postnatal period. But as the conference highlighted, huge challenges remain — in improving the quality of care, the conference’s core theme; in strengthening the functionality and capacity of health systems; in addressing major inequities in access to care, within and across countries; and in ensuring that maternal and newborn health receives the political support, increased funding, and public attention that it needs.

The majority of the conference’s breakout sessions featured informative and often fascinating presentations on research findings and promising programmatic and technical innovations. One session, however, took a different tack — a debate on “Has the ascendance of the RMNCH continuum of care framework helped or hindered the cause of maternal health?”  I proposed this session to the Maternal Health Task Force, which organized the GMHC, because for me and the organization I head, Family Care International, maternal health has been at the core of our institutional mission since we planned the first Safe Motherhood conference in 1987. For much of the past decade, however, I have been closely involved with the Partnership for Maternal, Newborn and Child Health (PMNCH) and Countdown to 2015, two coalitions that are dedicated to promoting an integrated, comprehensive approach to the reproductive, maternal, newborn and child health (RMNCH) continuum of care. Have our efforts to define and advance the continuum of care framework contributed to progress in improving maternal health? If so, how much? If not, what can be done about it?

These questions were debated by a stellar panel I moderated, which included Wendy Graham, Professor of Obstetric Epidemiology at the University of Aberdeen; Marleen Temmerman, the new head of the Department of Reproductive Health and Research at WHO; Friday Okonofua, Professor of Obstetrics and Gynaecology at the University of Benin, Nigeria; and Richard Horton, Editor in Chief of The Lancet, as well as a fantastic and diverse audience. (You can view a video of the entire discussion here.) To start the discussion I shared the definition of the continuum of care that PMNCH has articulated, based in part on the World Health Report 2005: a constellation of services and interventions for mothers and children from pre-pregnancy/adolescence, through pregnancy, childbirth and the postnatal/postpartum period, until children reach the age of five years. This continuum promotes the integration of services across two dimensions: across the lifespan, and across levels of the health system, from households to health facilities. Key packages of interventions within the continuum include sexuality education, family planning, antenatal care, delivery care, postnatal/postpartum care, and the prevention and management of newborn and childhood illnesses.

It is, of course, impossible to conduct a randomized control trial on the impact of the RMNCH continuum of care on maternal health, so the discussion was based more on perceptions than on hard evidence. Nevertheless, there are a few data points to consider in debating the question. From an advocacy perspective, panelists generally agreed, the adoption of the continuum of care framework has helped the cause by appealing to multiple constituencies related to women’s and children’s health. Attribution is always a challenge; there are many other developments over the past 5-7 years that have also had an impact, such as the two Women Deliver conferences held in 2007 and 2010 (with the third one taking place in May of this year). But participants generally agreed that linking women’s and children’s health, and defining their needs as an integrated whole, has appealed to policy-makers and politicians on an intuitive and practical level, as demonstrated by the engagement of heads of state, celebrities, private corporations, and other influential figures.

Let’s look at the money: during the period 2003-2010 overseas development assistance (ODA) has doubled for MNCH as a whole, according to Countdown to 2015 (Countdown’s analysis did not look at funding for reproductive health, but a new report later in 2013 will incorporate this important element). Maternal and newborn health, which are examined jointly in the analysis, have consistently accounted for one-third of total ODA, with two-thirds going to child health. Given the significant funding that GAVI has mobilized and allocated for immunization over this time period, the fact that maternal and newborn health has maintained its share of total MNCH ODA is noteworthy.

And let’s look at how maternal health has fared within the UN Secretary General’s Every Woman Every Child initiative, launched in September 2010: a recent report summarizes each of the commitments made to Every Woman Every Child in the two years since it was launched. Of the 275 commitments included, 147, or 53%, had specific maternal health content. If we look at the commitments according to constituency group, developing country governments had by far the largest percentage of commitments that had specific maternal health content — 84% — compared to 39% for non-governmental organizations, 24% for donors, and 52% for multilateral agencies and coalitions. Clearly, maternal health has not been marginalized within the continuum from a broad policy, program and funding perspective, despite the fear some had expressed that it would be pushed aside in favor of child health interventions that are perceived as easier and less costly to implement.

Another benefit of the continuum of care framework, as noted by Dr. Okonofua, has been increased collaboration among the communities that represent its different elements. While there were tensions and rivalries when PMNCH and Countdown were first established, especially between the maternal and child health communities, today groups working on advocacy, policy, program implementation, service delivery, and research within the continuum generally work together more frequently, cordially and effectively than they did before, especially at the global level. PMNCH and Countdown, as well as Every Woman Every Child, have brought together key players to define unified messages and strategies that have achieved widespread acceptance.

That was the good news; but panelists and participants at the session also saw a number of problems with the continuum of care concept. The concern articulated by Richard Horton, and echoed by many of the session participants, was that the continuum views women and adolescents primarily as mothers or future mothers. This narrow view contributes to a range of gaps and challenges; it means crucial cultural, social and economic determinants of health and survival, including female education and empowerment, are not given adequate weight. Gender-based violence deserves much more attention, both for its own sake and for its impact on maternal, newborn and child health. Politically sensitive or controversial elements of the continuum, especially abortion but also, in some cases, family planning and services for adolescents, may be neglected in policy, programming, and resource allocation.

The fragmentation inherent in the continuum of care also contributes to what Wendy Graham called the compartmentalization of women. As Countdown’s analysis of coverage has demonstrated, the continuum of care doesn’t guarantee continuity of care; coverage rates are much higher for interventions like antenatal care and child immunization than for delivery or postnatal/postpartum care. Women’s needs for a range of interventions and services, available in a single health facility on any day of the week, are not being met in many countries.

Other concerns that emerged during the discussion were that the RMNCH continuum of care framework does not explicitly or adequately reflect the importance of quality of care, which in turn depends on a range of factors: skilled, compassionate health care workers, functional facilities, adequate supplies and equipment, and an effective health information system that tracks not just whether interventions are being provided, but also whether individual women and their families are receiving the care they need throughout their lives.

Dr. Okonofua, in his comments, focused on how the continuum of care concept has been implemented, or hasn’t, in countries. The implications of the continuum of care for on-the-ground program implementation have not been fully articulated and communicated; more effort, he noted, needs to be invested in making the concept relevant and useful for policy-makers, program managers, and service providers.

Despite these gaps, however, participants in the session – and the panelists themselves – agreed that the continuum of care is a valid and valuable concept, and that the inadequacies identified should be addressed. “Don’t throw the baby out with the bathwater,” said one member of the audience. The continuum of care, as a concept, has already evolved; initially, for example, it did not fully integrate reproductive health elements. As Marleen Temmerman commented, the continuum of care concept is a tool; what is important is what is done with it.

As 2015 approaches, the global health community is struggling to articulate a health goal for the post-2015 development framework that will resonate widely and guide accelerated, strategic action to prevent avoidable deaths and improve health of people around the world. The RMNCH community — or communities — needs a framework that more fully reflects the realities and complexities of the lives of women and children, and that enables us to reach out to other health and non-health communities, including HIV/AIDS, NCDs, and women’s rights and empowerment, for a common cause. To do this, we need to revise the continuum of care framework to maximize its relevance and utility for countries, and to incorporate the following missing elements:

  • Recognition of the importance of quality of care
  • Responsiveness to the needs of girls and women throughout the life cycle, not just in relation to pregnancy and childbirth
  • Links to the cultural, social and economic determinants of women’s and children’s health

Richard Horton’s call for a manifesto to emerge from the GMHC included 10 key points; redefining the RMNCH continuum of care was one of them, inspired by the panel. The challenge has been issued; it is now up to us to meet that challenge.

Countdown to 2015 at FIGO Rome 2012

This item, featuring an interview with FCI president Ann Starrs, is cross-posted from the website of the Partnership for Maternal, Newborn & Child Health.

8 OCTOBER 2012 | ROME – Countdown to 2015 partners hosted a side event at the end of the first day of FIGO 2012 [the World Congress of Gynecology & Obstetrics]: “Reproductive, Maternal and Newborn Health: Are Countries Making Progress?” Participants heard about the newest Countdown to 2015 data on 75 highest-burden countries and received information on why and how countries should work with Countdown to amass data and tools to promote evidence-based policy change.

In her presentation on the Countdown initiative and its value, Dr Joy Lawn, Director of Global Evidence and Policy with Save the Children’s Saving Newborn Lives program, used recent child mortality findings to demonstrate how presenting clear and meaningful data is helpful for hammering home the need to address remaining challenges urgently even if progress is being made.

Among children under five years old, data shows deaths from diarrhea have come down and malaria as well, meanwhile there has been very little progress on neonatal causes of death. If countries were to continue making progress at their current rates (the global annual rate of reduction for neonatal death is 1.8 percent), it would take the following regions quite a long time to meet their Millennium Development Goal targets: the Americas would achieve their target in 2040, Southeast Asia not until 2085 and Africa not until 2165.

“It is so important to present data in a way that is understandable and has an impact,” said Ann Starrs, President of Family Care International, one of the partner organizations behind the Countdown Initiative who also spoke at the event. “Graphs are great, but they can be confusing. It’s helpful when you can look at indicators and they tell you a story — this can lead very directly to policy and funding changes.”

The Countdown country profile

Ms Starrs said it is crucial that health professionals are brought on board when advocating for change.

“If the medical community resists then it’s very, very hard to get a new policy adopted and implemented,” she said, which is why initiatives like Countdown are essential for helping RMNCH champions within government or civil society make the case for adopting or investing in proven solutions to reduce preventable deaths.