Building Health Systems that Work for Mothers, Newborns and Midwives

By Catharine Taylor

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

A midwife leads a pregnancy club in eastern Uganda. (Photo: Kate Ramsey/MSH)

For many people living in poor and underserved regions – whether rural communities or growing cities – midwives are the health system. Continue reading “Building Health Systems that Work for Mothers, Newborns and Midwives”

Person-centered group antenatal care in Eastern Uganda: Reaching women through pregnancy clubs

By Shafia Rashid and Kate Ramsey

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.

Women examine cards depicting health information during a pregnancy club session in eastern Uganda. (Photo: Kate Ramsey/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”

Global Leaders in Maternal and Newborn Health: Dr. Hemant Shah (India)

By Kayla McGowan, Project Coordinator, Women and Health Initiative, Harvard T.H. Chan School of Public Health 

This article originally appeared on the Maternal Health Task Force (MHTF) blog.

In July 2016, global leaders gathered for the second annual Safe Mothers and Newborns Leadership Workshop (SMNLW) hosted by the Maternal Health Task Force (MHTF) in partnership with the Barcelona Institute for Global Health (ISGlobal) and The Aga Kahn University and sponsored by the Bill & Melinda Gates Foundation. The participants represented 26 countries from five continents.

Hemant Shah is Chief of Party, Technical Support Unit for CARE SMNLW participant Hemant Shah is Chief of Party, Technical Support Unit for CARE. He previously worked as the Director of the State reproductive, maternal, newborn, child, adolescent (RMNCH+A) unit in Bihar as well as a maternal health expert in the Integrated Family Health Initiative project and led quality improvement activities in health facilities in Bihar. Continue reading “Global Leaders in Maternal and Newborn Health: Dr. Hemant Shah (India)”

Maternal and newborn health in the hands of midwives

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.

Burkinabé midwives gather to discuss advocacy for supportive midwifery policies using data from the State of the World’s Midwifery Report 2014.
Burkinabé midwives gather to discuss advocacy for supportive midwifery policies using data from the State of the World’s Midwifery Report 2014.

Continue reading “Maternal and newborn health in the hands of midwives”

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”

Midwives and misoprostol: Saving lives from PPH

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.

A midwife meets with a client during an antenatal care visit.
A midwife meets with a client during an antenatal care visit.

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.[1]

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.

 

[1] Beverly Winikoff, Why misoprostol in the hands of non-physician providers matters, Presentation at the ICM Trienniel Congress, Prague, June 3, 2014.