Improving maternal and newborn health requires innovative approaches that maximise opportunities for impact throughout the continuum of care. In the past decade, maternal health services have largely focused on the management of intrapartum complications and on rationalising the package of antenatal services to include emergency obstetric care provided by skilled birth attendants. These interventions have sought to target what are widely considered to be the most common and immediate causes of maternal death.
Yet this approach fails to address many underlying morbidities that are instrumental in generating high rates of maternal mortality, such as anaemia and inadequate birth spacing. Also missing is a direct focus on the substantial proportion of maternal deaths in the postpartum. Indeed, as a component of maternal health, postpartum care has been neglected, along with the whole field of newborn health in Africa. The essential package and optimum structure of postpartum services for women and newborns in Africa remains poorly defined, with many missed opportunities for improved care.
We thus propose developing a package of interventions targeting newborn health and women in the early postpartum period and throughout the first year after childbirth. This package will be delivered through a combined facility- and community-based approach designed to integrate services and strengthen health systems. It will be implemented in four African countries (Burkina Faso, Kenya, Malawi and Mozambique) by a consortium of five African and three European partners.
Intervention design will be preceded and informed by a situational analysis of postpartum policies and practices in the four countries and a feasibility assessment. This will ensure that interventions are amenable to scaling up and appropriately tailored to local contexts. Implementation will be followed by health systems research to evaluate effectiveness and impact, and to identify determinants of sustainable and scalable health care improvements. The project will help to define the optimum package of postpartum interventions required to improve maternal and newborn health in Africa and – through its ongoing policy outcomes – impact on overall maternal and child mortality, thus contributing to Millennium Development Goals 4 and 5.
Every year, a large number of women worldwide die from pregnancy or childbirth related causes with the highest mortality rates in the first and second days after delivery. Postpartum haemorrhage and sepsis are the pre-eminent causes of maternal death at this time.
Furthermore, every year an estimated three and a half to four million babies die in the first four weeks of life, which constitutes more than one third of all child deaths. Among newborns, just three conditions – infections, asphyxia and preterm birth –account for nearly 80% of deaths.
Given the clustering of deaths before and soon after delivery, much policy attention has been focused on the antenatal and peri-partum period. By contrast, there has been a lack of attention to the postpartum period. Women remain at increased risk of death for a considerable period of time after delivery, and certainly beyond the traditional six-week postpartum period.
Although the pattern of postpartum mortality and morbidity is clear, the essential package of services to support women in the first year after childbirth is poorly defined, and the optimum service delivery configuration and number of routine visits for these services remains unclear In sub-Saharan Africa, there thus is an urgent need for expanding services after childbirth, a critical part of the lifecycle for both women and newborns.
The main objective of the MOMI project is to improve maternal and newborn health through a focus on the postpartum period, adopting context-specific strategies to strengthen health care delivery and services at both facility and community level in four sub-Saharan countries (Burkina Faso, Kenya, Malawi and Mozambique).
Progress (as of October 2013): The MOMI project is currently heading towards the end of its second period. The consortium partners have defined packages of postpartum interventions, building on results from a thorough assessment of current postpartum policies and national and district data on maternal and new-born health services and care. Those results were embedded in four country-specific reports that were finalized in January 2013. In parallel with the implementation of the intervention, monitoring tools are also put into place to facilitate the evaluation of the MOMI impact.
The MOMI consortium is currently organizing field visits in the four sites to support this implementation process and identify potential hindrances to the interventions process. Local stakeholders and Policy Advisory Boards are also used to ensure the intervention activities conducted within MOMI remain in line with the specific needs at each site. MOMI communicates on its progress and results via its website, which is regularly updated, and via a newsletter distributed bi-annually. Dissemination will continue throughout the project, following the MOMI dissemination strategy.