According to a new study published in PLoS One by researchers from Harvard School of Public Health (HSPH) and the World Health Organization (WHO), a simple and low-cost checklist has the potential to dramatically improve practices of health workers during childbirth.

From our colleagues at Harvard School of Public Health:

The researchers conducted the study at a hospital in Karnataka, India. As part of the checklist-based program, local staff reviewed deficiencies in their current practices and undertook training on using the WHO Safe Childbirth Checklist. The 29 items on the checklist address the major causes of maternal deaths (e.g. hemorrhage, infection, obstructed labor, and hypertensive disease), intrapartum-related stillbirths, and neonatal deaths (e.g. complications of premature birth, infection, and birth asphyxia).

 

Researchers observed the childbirth practices of health care workers during 499 birth events—the period from admission to discharge—prior to introducing the checklist to establish a baseline, and then compared the results with 795 birth events after implementing the checklist.

 

The results reveal that the number of essential practices performed by the hospital workers increased from an average of 10 of 29 at baseline to 25 of 29 after implementing the checklist. “The checklist program actively prompted health care workers to remember to complete proven practices such as handwashing, infection management, postpartum bleeding assessment, and breastfeeding within an hour after birth,” said Dr. Bhala Kodkany, professor of obstetrics and gynecology and director of JNMC Women’s and Children’s Health Research Unit in Karnataka, India, and a co-investigator.

Read the full press release here.

Read the full study here.

This study examined the impact of the checklist on health worker practices during childbirth–but did not measure the impact of the checklist on health outcomes of women and newborns. The  researchers are now working on a large-scale trial in more than 100 hospitals in northern India to take a closer look at the link between using the checklist and improved health outcomes among women and newborns.

Follow the conversation on Twitter! Stay tuned to Dr. Priya Agrawal (one of the authors of the study) at @priya__agrawal, Harvard School of Public Health at @HarvardHSPH, and the World Health Organization at @WHO.

New global maternal mortality estimates were released today in a report by the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA) and the World Bank. The report,“Trends in maternal mortality: 1990 to 2010”, shows that the number of women dying of pregnancy and childbirth related complications has almost halved in 20 years.  The estimates show that from 1990 to 2010, the annual number of maternal deaths has dropped from more than 543 000 to 287,000–and that a number of countries have already reached the MDG target of 75 per cent reduction in maternal death.

Major highlights from the report:

• In 2010, the global maternal mortality ratio was 210 maternal deaths per 100 000 live births. Sub-Saharan Africa had the highest maternal mortality ratio at 500 maternal deaths per 100 000 live births.

 

• In sub-Saharan Africa, a woman faces a 1 in 39 lifetime risk of dying due to pregnancy or childbirth-related complications. In South-eastern Asia the risk is 1 in 290 and in developed countries, it is 1 in 3 800.

 

• Ten countries have 60 per cent of the global maternal deaths: India (56 000), Nigeria (40 000), Democratic Republic of the Congo (15 000), Pakistan (12 000), Sudan (10 000), Indonesia (9 600), Ethiopia (9 000), United Republic of Tanzania (8 500), Bangladesh (7 200) and Afghanistan (6 400).

 

• Ten countries have already reached the MDG target of a 75 per cent reduction in maternal death: Belarus, Bhutan, Equatorial Guinea, Estonia, Iran, Lithuania, Maldives, Nepal, Romania and Viet Nam.

Read the full press release here.

Read the full report here.

Join the conversation on Twitter at hashtag: #motherhood #MMR2012

Over the past few years, the global health community has witnessed and contributed to the publication of more frequent and more technically advanced estimates for maternal mortality than ever before. This report adds to the growing body of evidence that is helping the maternal health community to measure and better understand the scope and trends of the problem. It is an exciting time in the field–and we encourage you to read the new report.

Harvard School of Public Health is looking for a Senior Grants Manager to provide grants management support to the Women and Health Initiative (W&HI)–including the Maternal Health Task Force.

Please see below for the job description:

Reporting to the Assistant Director of Finance and Grants Administration (ADF), this position will provide financial and grant management expertise and leadership within the Department of Global Health and Population (GHP) at the Harvard School of Public Health (HSPH). As a member of the GHP finance team, the Senior Grants Manager (SGM) will oversee a diverse and challenging portfolio of non-federal and federal grants, subawards and contracts, and will be responsible for managing related non-sponsored funds as well.

 

Within his/her portfolio, the SGM will provide financial and grants management support primarily to the Women and Health Initiative (W&HI), managing, coordinating, monitoring and evaluating multiple grants, subcontracts and service agreements (both foreign and domestic). S/he will assist the Director of the W&HI and the W&HI’s Project Management team with project budget development, financial management and compliance, and reporting.

 

The SGM will be responsible for both pre- and post-award management. Pre-award responsibilities include grant proposal preparation and review of application requirements. Post-award responsibilities include budget reconciliations, projections, and updates; final financial reporting to the sponsor in coordination with Harvard’s sponsored programs office; coordination of timely effort reporting; submission of timely payroll changes for project personnel; reviewing and approving accounts payable, and monitoring expenses to ensure appropriate expense allocation to sponsored awards.

 

The SGM will ensure compliance with federal, state, granting agency and university regulations and will serve as the principal source of information/guidance for faculty and program staff on complex administrative and fiscal policies and procedures. The SGM will maintain strong relationships with SPA and OSP to ensure compliance with HSPH, University, and sponsor regulations. The SGM will identify problems and initiate or recommend remedial action, advise project staff on established policies and procedures, interpret the terms and conditions of the sponsoring organization, and perform related job duties as required.

 

The W&HI, housed within the Department of Global Health and Population, advances a unique agenda simultaneously focused on women’s health needs and women’s critical roles as both formal and informal participants in healthcare systems. The W&HI’s portfolio includes several projects including the Maternal Health Task Force (MHTF), aimed at reducing maternal morbidity and mortality. With support from the Bill & Melinda Gates Foundation, the MHTF will improve global maternal health policies and programs by strengthening the maternal health community through expanding access to critical knowledge, evidence and information; providing a neutral space for scientific debate and consensus building; strengthening the capacity of developing country professionals; and expanding the knowledge base on how to improve and evaluate the content and quality of maternal health care.

Read the full job description and apply here.

Mother’s Day 2012 provides a good occasion to celebrate accomplishments in the field over the past year. The Maternal Health Task Force shares ten exciting developments.

1. The State of the World’s Midwives report provided the first comprehensive analysis of midwifery services in countries where the needs are greatest.
2. The MHTF & PLoS launched an open-access collection on quality of maternal health care.
3. UNICEF & UNFPA launched the UN Commission on Life-Saving Commodities, to increase access to maternal, child, and newborn health commodities.
4. Joyce Banda, an advocate for women’s health & rights, became Malawi’s first female president.
5. The White Ribbon Alliance, along with many partners, developed the Respectful Maternity Care Charter: The Universal Rights of Childbearing Women.
6. Direct Relief International, Fistula Foundation, & UNFPA partnered to develop the first-ever Global Fistula Map, outlining the global landscape of the issue.
7. The first-ever estimates of preterm birth rates by country were published in a new report, Born Too Soon: A Global Action Report on Preterm Birth.
8. Save the Children’s 13th State of the World’s Mothers report focused on nutrition during the period from pregnancy through the child’s 2nd birthday, the first 1 000 days
9. The World Health Organization added Misoprostol to the List of Essential Medicines, a critical step toward preventing post-partum hemorrhage.
10. Melinda Gates announced plans to help raise $4 billion to dramatically increase access to family planning around the world by 2020.

Please add to the list in the comments!

Save the Children’s thirteenth State of the World’s Mothers report was released yesterday–providing a ranking of the “best” and “worst” places to be a mother, based on various indicators such as lifetime risk of maternal death, number of years of formal schooling, maternity leave benefits, access to safe water, under 5 mortality rate, and many others. The report, titled Nutrition in the First 1 000 Days: The State of the World’s Mothers 2012, takes a close look at the role of nutrition during the period from the start of a mother’s pregnancy through her child’s second birthday, the first 1 000 days.

Save the Children’s thirteenth State of the World’s Mothers report shows Niger as the worst place to be a mother in the world — replacing Afghanistan for the first time in two years. Norway comes in at first place. The Best and Worst Places to Be a Mom ranking, which compares 165 countries around the globe, looks at factors such as a mother’s health, education and economic status, as well as critical child indicators such as health and nutrition. This year, the United States ranks 25th.

While the ranking is fascinating, it is worth digging deeper into this report–where you will uncover surprise success stories that don’t show up in the “best” and “worst” lists. For example:

Solomon Islands is one of the least developed countries in the world, yet it performs very well on early nutrition indicators, demonstrating that a strong policy environment and individual adoption of lifesaving nutrition practices can matter more than national wealth when it comes to saving children’s lives. Within an hour after birth, 75 percent of babies in Solomon Islands are put to the breast.

Read more about the case of Solomon Islands on Page 29 in the report.

Be sure to also take a look at the section on the state of maternal malnutrition. (Page 16)

Many children are born undernourished because their mothers are undernourished. As much as half of all child stunting occurs in utero, underscoring the critical importance of better nutrition for women and girls. In most developing countries, the nutritional status of women and girls is compromised by the cumulative and synergistic effects of many risk factors. These include: limited access to food, lack of power at the household level, traditions and customs that limit women’s consumption of certain nutrient-rich foods, the energy demands of heavy physical labor, the nutritional demands of frequent pregnancies and breastfeeding, and the toll of frequent infections with limited access to health care.

Read the full report here.

In an exclusive interview with Newsweek, Melinda Gates explained that she has decided to make family planning her signature issue and primary public health priority. Written by Michelle Goldberg, the Newsweek piece describes Gates’ passion for increasing access to contraception, her commitment to building consensus (and breaking down the controversy) around family planning, and her plans to start raising $4 billion to dramatically increase global access to contraceptives.

Now the foundation, which is worth almost $34 billion, is putting her agenda into practice. In July it’s teaming up with the British government to cosponsor a summit of world leaders in London, to start raising the $4 billion the foundation says it will cost to get 120 million more women access to contraceptives by 2020. And in a move that could be hugely significant for American women, it is pouring money into the long-neglected field of contraceptive research, seeking entirely new methods of birth control. Ultimately Gates hopes to galvanize a global movement. “When I started to realize that that needed to get done in family planning, I finally said, OK, I’m the person that’s going to do that,” she says.

Read the full story here.

Learn more about the Gates Foundation’s No Controversy campaign here.

Join the conversation on Twitter at hashtag #nocontroversy.

Follow Melinda Gates on Twitter: @melindagates

Last month, the International Journal of Gynecology and Obstetrics published a paper, Awareness of danger signs and symptoms of pregnancy complication among women in Jordan, that explores the levels and determinants of awareness of danger signs of pregnancy complications among pregnant women in Jordan. The researchers found that awareness of danger signs was low and that a number of sociodemographic factors were associated with awareness–such as duration of education, current employment, husband’s duration of education, and others.

Take a look at the abstract:

Objective
To assess the level and determinants of awareness of the danger signs and symptoms of pregnancy complication among pregnant Jordanian women aged 15 years and older.

 

Methods
A descriptive cross-sectional study of 350 women attending prenatal care services was performed. Interviews were conducted at 4 public-health centers in Zarqa, Jordan, using a structured questionnaire. Awareness was defined as “knowing at least 4 danger signs and symptoms”.

 

Results
Overall, 84,8% of the women interviewed were not aware of danger signs and symptoms of pregnancy complication. Sociodemographic factors—including duration of education and current employment; husband’s duration of education; family size; and whether women were given information about danger signs and symptoms—were associated with awareness in a binary analysis. Multivariate logistic regression analysis revealed that education level of study participants, their husbands’ education level, and receiving information about danger signs and symptoms were all associated with awareness (P = 0,02 for all associations).

 

Conclusion
Awareness of danger signs and symptoms of pregnancy complication among women in Jordan is low. A need exists to provide prenatal care that includes sufficient information about pregnancy-related danger signs and symptoms to meet the need for safe motherhood, as pointed out by the Millennium Development Goals.

Access the article here.

In honor of International Day of the Midwife (tomorrow, May 5th), our colleagues at AMREF shared a blog post today that calls on governments and development partners to invest in training midwives. The post describes the critical role that midwives play in sub-Saharan Africa and outlines the various ways that AMREF is supporting midwives–including their efforts to train 15 000 midwives in sub-Saharan Africa by 2015 as well as their plans to nominate an African midwife for the 2015 Nobel Peace Prize.

From AMREF’s post:

Midwife literally translates to “With a Woman” from Latin, reflecting the practice that from time immemorial, women sought the assistance of other women close to them at the time of labour and childbirth. Midwives have therefore been part of the human experience since time immemorial.

 

Up until the advent of modern midwifery in approximately the 17th and 18th centuries when the first schools of midwifery training appeared in Europe, the whole world had approximately the same levels of maternal death during childbirth, roughly 20%, with the most feared causes being hemorrhage and puerperal fever, or infection after childbirth. Today, there is very low maternal mortality in the developed world, not least because of the professionalization of midwifery in those countries. However, approximately 35 000 women continue to suffer severe complications of childbirth daily, with about 900 deaths every day, most in the developing countries of Africa and Asia (The State of the World’s Midwifery 2011)…

Read the full story here.

Learn more about AMREF’s work to train health workers here.

For more information about International Day of the Midwife, visit the International Confederation of Midwives website.

Join the conversation about midwives on Twitter: #InternationalDayoftheMidwife and #midwives.

The Asia Regional Meeting on Interventions for Impact in Essential Obstetric and Newborn Care begins tomorrow, May 4, 2012 in Dhaka, Bangladesh. The three-day meeting plans to focus on postpartum hemorrhage, pre-eclampsia and eclampsia as well as other issues relating to maternal and newborn health. The meeting will bring together maternal and newborn health leaders, clinicians, and program managers.

The event is sponsored by the Government of Bangladesh, USAID’s flagship Maternal, Newborn and Child Health Integrated Program (MCHIP), and the Bill & Melinda Gates Foundation-supported Oxytocin Initiative, in collaboration with Women Deliver, VSI, FIGO, and ICM.

The live webcast of the meeting will be accessible here: http://www.oneworldgroup.org/mchip

Tweeting? The conference hashtag is #MNHDhaka.

For more information about the meeting, visit: www.MCHIP.net/MNHDhaka

Questions? Send them to info@mchip.com.

A report released today, Born Too Soon: The Global Action Report on Preterm Birth, features the first-ever estimates of preterm birth rates by country. The report, coordinated by the March of Dimes, the Partnership for Maternal, Newborn & Child Health, Save the Children and the World Health Organization, shows that preterm birth is now the leading cause of newborn death around the world.

The report makes the case for why preterm birth matters–and how important it is that the global health community pay more focused attention to the issue.

Urgent action is needed to address the estimated 15 million babies born too soon, especially as preterm birth rates are increasing each year. This is essential in order to progress on the Millennium Development Goal (MDG) for child survival by 2015 and beyond, since 40% of under-five deaths are in newborns, and it will also give added value to maternal health (MDG 5) investments. For babies who survive, there is an increased risk of disability, which exacts a heavy load on families and health systems…

Learn more about why preterm birth matters.

The report goes on to detail the scope of the problem.

Over 60% of preterm births occur in Africa and South Asia. The 10 countries with the highest numbers include Brazil, the United States, India and Nigeria, demonstrating that preterm birth is truly a global problem. Of the 11 countries with preterm birth rates of over 15%, all but two are in sub-Saharan Africa. In the poorest countries, on average, 12% of babies are born too soon compared with 9% in higher-income countries. Within countries, poorer families are at higher risk…

Learn more about where and when preterm births are occurring.

The report also outlines how preterm birth can be addressed along the continuum of care–starting with interventions that meet the health needs of women before they even become pregnant,  the needs of women during pregnancy and childbirth, as well as the health needs of newborns.

Preconception care has, until recently, been a weak link in the continuum of care. Providing care to women and couples before and between pregnancies (interconception
care) improves the chances of mothers and babies being healthy, and awareness is growing. Preconception care may be defined as “any intervention provided to women and couples of childbearing age, regardless of pregnancy status or desire, before pregnancy, to improve health outcomes for women, newborns and children” (Bhutta et al., 2011a)…

Learn more about care before and between pregnancies, care during pregnancy and childbirth, and care of the preterm baby.

The report wraps up with a detailed call to action that outlines next steps for the global health community–calling on program implementers and researchers alike, health professionals working all along the continuum of care–to consider how their work might contribute to reducing the burden of babies who are born too soon.

All partners are invited to join this global effort for preterm birth, which is linked closely to the health and care of women and girls, as well as to child survival and global development. Much is being accomplished by individual partners, and each has a unique role to play. By pooling our efforts collaboratively and transparently, with each organization playing to its strengths, our shared goal, as epitomized in Every Woman Every Child, can be realized — a day when pregnancies are wanted and safe, women survive, babies everywhere get a healthy start in life, and children thrive…

Read the action plan.

For more information about the report, click here. Download the full report.

Join the Twitter chat on preterm birth tomorrow, Thursday, May 3rd from 9 am to 4pm EDT. The chat will be led by the Partnership for Maternal, Newborn & Child Health (PMNCH), Save the Children, the United Nations Foundation (UNF), March of Dimes, the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS) and the Healthy Newborn Network (HNN)– and will bring together experts, professionals, advocates, and parents in a conversation around preterm birth. Hashtag: #BornTooSoon