After Mexico City and Before Copenhagen: Keeping Our Promise to Mothers and Newborns
Six months after the Global Maternal Newborn Health Conference (GMNHC) held in Mexico City last October and just weeks before the Women Deliver Conference in Copenhagen, leaders in maternal and newborn health gathered for a policy dialogue to review priorities, evaluate progress, and reignite efforts in the maternal newborn health field. The April 13 event, “After Mexico City and Before Copenhagen: Keeping Our Promise to Mothers and Newborns,” was part of the Maternal Health Task Force’s Advancing Policy Dialogue on Maternal Health Series, in partnership with UNFPA and the Wilson Center. It served as a reflection of the lessons learned at GMNHC as well as preparation for achieving the maternal newborn health agenda through an advocacy lens at Women Deliver. As Katja Iversen, Chief Executive Officer of Women Deliver, projected, “The Women Deliver Conference will focus on solutions: what works, what can be scaled up, and what can we go home and do?”
With the recent launch of the Sustainable Development Goals (SDGs), which target a reduction in the global maternal mortality ratio to less than 70 per 100,000 live births, universal access to sexual and reproductive health care services, and the end of preventable deaths of newborns and children under 5 years of age by 2030, now is the time to decide which steps we need to take to achieve these objectives. Despite strides in maternal mortality reduction, the maternal and newborn health community must remain ardent in its commitment to mothers and newborns. As Mariam Claeson, Director of Maternal and Newborn Child Health at the Bill & Melinda Gates Foundation, articulated:
“[Targets like the SDGs] hold all of us accountable for making progress. That’s why we need numbers and rates, and we need to ask the questions, ‘Are we making a difference in poor communities? Are we actually making any changes in quality improvement?’”
While we set the agenda for improving maternal and newborn health, we must consider where our efforts will be most efficient and effective. During the dialogue, Claeson cited a recent review of key findings on cost-effective health interventions for reducing maternal, newborn and child deaths, and stillbirths. According to Claeson, “One of the most important investments that financers can make is in the quality of labor and delivery.” Claeson explained that better labor and delivery offers a quadruple return on investment, including reduced rates of maternal mortality, newborn mortality, stillbirth, and disability.
Ariel Pablos-Méndez, Assistant Administrator of Global Health at the United States Agency for International Development, continued the conversation on the importance of investing in maternal and newborn health. He praised the innovative global financing facility, launched to increase private-sector resources in maternal, adolescent, and child health, as the “missing piece in the maternal child health space.” Pablos-Méndez described the platform as “country-powered partnerships, public and private, in which the World Bank … is set up with trust funds to bring the countries themselves, the Ministers of Finance, to put skin in the game.” He emphasized that the maternal newborn health community must support other countries in becoming autonomous in their maternal child health initiatives. According to Pablos-Méndez,
“As we project growth in many of these countries, we want to borrow from the future to save lives now, have countries own their own programs, and instead of sending proposals, develop joint investment cases at the country-level that are fully aligned with the national health plans and priorities of those countries.”
Peter Waiswa, Lecturer in the Department of Health Policy, Planning and Management at Uganda’s Makerere University School of Public Health, echoed the importance of retaining efforts at the country-level: “If we are to achieve the [SDG] targets, countries have to lead… Measurement alone is not enough, the data must be able to be used; first at the local level, and then at the national level.”
While Pablos-Méndez commended GMNHC for catalyzing efforts among country partners to end preventable maternal and child deaths, other presenters illustrated the conference’s immediate impact by providing examples of post-GMNHC policy changes and program implementation. For example, as a direct result of lessons learned at the conference, policy makers in India were able to introduce a new approach to training providers on reducing preterm birth risks. According to Jyoti Benawri, State Program Manager of Jhpiego, “We have been able to push the government to introduce one entire chapter in our curriculum on how to prevent neonatal mortality and how to introduce antenatal corticosteroids.”
Speakers also offered renewed insight on the GMNHC themes of equity, quality and integration of maternal newborn health care. A central theme of the dialogue was the importance of data in planning and implementing effective programs and strategies. However, while crucial, data can conceal inequities. As such, Waiswa called for disaggregation and context-specific indices within health measures. He stressed the importance of reviewing data by geography, age groups, and socioeconomic status while acknowledging the inherent challenges in this more nuanced approach, such as income levels that fluctuate with harvest seasons.
The dialogue centered on the importance of delivering quality care to mothers and newborns. As presenters agreed, one way to expedite quality care is to ensure policymakers, leaders, the media, and women themselves can understand and act on technical evidence. Unfortunately, this type of information is often understood by an exclusive few. According to Catherine Mwesigwa Kizza, Deputy Director of New Vision in Uganda, “Many times, evidence is gathered and it remains with the technocrats… it’s never interpreted.” When research is broken down and translated into language that policymakers and local leaders can understand, they can spur action themselves. Furthermore, this can spark change at the individual level: when women are aware of certain danger signs in pregnancy or know what to expect at a health facility, they can demand quality services.
Data has a strong influence on delivering quality care. Waiswa explained, “Using data to drive quality improvement, to drive audits, and to drive lobbying for staff… has been able to reduce maternal death in hospitals in Uganda by about 18% and neonatal deaths by about 20%.” But we must steer away from relying solely on data; we must maintain an approach that balances both data and quality measures. For example, according to Claeson, “It’s not about counting how many times a mother interacts with antenatal services or comes to the facility, but it’s what happens in these encounters that matters.”
Finally, the dialogue highlighted the importance of collaboration and integration. Ana Langer, Director of the Women and Health Initiative and Maternal Health Task Force at Harvard T.H. Chan School of Public Health, urged the community to unite in reaching the SDGs:
“We advocate for better integration: integration of strategies, integration of services, integration of funding streams. We cannot afford working in silos any longer; it’s detrimental for mothers, babies, families, and communities in general.”
To focus the community’s efforts to achieve the SDGs, Langer presented the Momentum for Maternal Newborn Health poster, a roadmap of ten critical actions stemming from GMNHC. The next steps serve as key reminders and responsibilities for the maternal and newborn health community, including maintaining focus on vulnerable populations, sharing both successes and failures, and ensuring access to respectful care. With the SDGs, the maternal newborn health community’s attention must go beyond mortality; we must also focus on morbidities, stillbirths, and child development. As Langer said, “We don’t just want people to survive, but we also want them to thrive.”
Photo Credit: After Mexico City, courtesy of the Wilson Center Maternal Health Initiative