Catharine Taylor, a former practicing midwife, is the Vice President of the Health Programs Group at Management Sciences for Health (MSH). This post originally appeared on MSH’s Global Health Impact Blog.
Shafia Rashid is a Principal Technical Advisor for the FCI Program of Management Sciences for Health (MSH). Kate Ramsey is Senior Principal Technical Advisor for maternal and newborn health at MSH.
Improving the quality of care that women experience during pregnancy, childbirth, and the postpartum period has become a major global priority. Achieving good quality care requires not only clinical improvements, but also a person-centered approach that takes into account women’s and health workers’ needs and perspectives.
In 2016, the World Health Organization (WHO) updated its antenatal care guidelines, calling for a positive pregnancy experience through holistic, person-centered antenatal services that provide pregnant women with emotional support and advice in addition to the standard clinical assessments.
Group antenatal care, initially developed in the U.S. several decades ago, is a promising model that responds to women’s health and information concerns during pregnancy. Facilitated by a health provider, usually a nurse or midwife, group antenatal care offers a forum for pregnant women to learn more about their pregnancies, share their experiences, receive essential health and self-care information, and provide social and emotional support to each other within the group. Health care providers meet individually with group participants after the group sessions for routine physical and clinical care and to discuss any confidential issues. Group antenatal care can also benefit health care providers through increased job satisfaction without substantially increasing the amount of time required. Continue reading “Person-centered group antenatal care in Eastern Uganda: Reaching women through pregnancy clubs”
Amy Boldosser-Boesch is the Interim President and CEO at Family Care International. 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.
The year 2015 has been one of dramatic movement for global maternal and newborn health—from the end of the Millennium Development Goals to the beginning of a universal and even more ambitious global agenda. The Global Maternal and Newborn Health Conference is a key moment to examine how the Sustainable Development Goals will help ensure and improve quality of care, integration and equity. I’m pleased to see on the conference program a focus on midwives, a key partner in turning the conference themes and focus into a reality for women and their families everywhere.
At this crossroads moment in global development, it’s a travesty that the countries burdened with 92% of the world’s maternal and newborn deaths have only 42% of the world’s midwives, nurses and doctors. Even though we have the medicines and the technology to make sure no woman or newborn dies from preventable causes, a person’s place of residence often still determines whether–and how–she will live or die. This is simply unacceptable. Fortunately, skilled midwives can prevent up to two-thirds of maternal and newborn deaths, and in doing so can turn around health care in their communities, according to UNFPA’s State of the World’s Midwifery Report 2014.
Shafia Rashid is a senior program officer for Global Advocacy at Family Care International.
For women around the world, compassionate and competent care from a midwife can mean the difference between life and death. We know that midwives provide life-saving care during pregnancy, childbirth, and in the postnatal period. Midwives, and other mid-level and community health providers, can administer essential medicines, such as oxytocin and misoprostol, which are safe and effective for preventing and treating life-threatening postpartum bleeding or hemorrhage (PPH), the leading cause of maternal death in most developing countries. Access to misoprostol is particularly important in developing countries, and especially in rural areas, because (unlike oxytocin) it requires neither refrigeration nor injection: it can be used in poorly equipped health facilities and even home births.
In order for midwives to provide life-saving maternal health care, they need the support of policies that enable them to provide a full range of medical interventions. In some countries, however, midwives are not legally authorized to administer oxytocin and/or misoprostol —despite evidence that administration by low and mid-level health providers is feasible and effective. But physicians sometimes resist or oppose expansion of midwives’ scope of practice, based on notions of “professional territoriality” and concerns about their capacity to correctly and safely administer these medications.
Most women in low-resource settings give birth in lower-level health facilities or at home, attended by a midwife or other mid-level health provider. So restrictive policies requiring that administration of medications be carried out only by physicians limits women’s access to essential medicines they need for safe pregnancy and childbirth. Placing misoprostol in the hands of non‐physician providers, for example, can expand access to timely PPH treatment. In remote and rural areas, where transfer for emergency obstetric treatment at a higher-level facility may be delayed, difficult, or impossible, misoprostol could be administered by a low-level provider as a “first aid” treatment to stop bleeding.
The global health community can play an important role in addressing and removing policy and regulatory barriers, and ultimately in improving women’s access to essential medicines. Making this happen will require that governments, in many countries, revise policies that allow administration of medications only by physicians. In 2012, WHO issued guidelines on task-shifting for maternal and newborn health. They called for a “more rational distribution of tasks and responsibilities among cadres of health workers …[to] significantly improve both access and cost-effectiveness – for example by training and enabling ‘mid-level’ and ‘lay’ health workers to perform specific interventions otherwise provided only by cadres with longer (and sometimes more specialized) training.” This makes excellent sense.
The leading global health professional associations focused on pregnancy and childbirth, the International Confederation of Midwives (ICM) and the International Federation of Gynecology and Obstetrics (FIGO), can work together to ensure that these international recommendations translate into changes in national norms and in clinical practice. Earlier this year, ICM and FIGO issued a joint statement, Misoprostol for the treatment of postpartum hemorrhage in low resource settings, which called on partners to:
Promote task-sharing approach
Ensure that skilled health providers (and not just doctors) can administer uterotonic drugs like misoprostol and oxytocin
Challenge regulatory and policy barriers that limit access to high quality maternal health care
Advocate for increasing the midwifery workforce
Implement innovative strategies to strengthen the role of midwives and non-physician providers in providing high-quality maternal health services
Health professionals, policy makers, and other partners must work together to ensure that every woman has access to the uterotonic medicines that can protect her from the suffering and potential death that can be caused by postpartum hemorrhage.
 Beverly Winikoff, Why misoprostol in the hands of non-physician providers matters, Presentation at the ICM Trienniel Congress, Prague, June 3, 2014.