Reflecting on the “mHealth for maternal health: bridging the gaps” technical meeting

Written by Alison Chatfield, on behalf of the Organizing Committee

Last week, 50 implementers, experts and donors from the mHealth and maternal health communities gathered in Boston for a meeting titled “mHealth for maternal health: bridging the gaps.” Throughout the two day meeting, the participants of this technical meeting grappled with the constraints to delivering high-quality, accessible and affordable maternal healthcare, discussed the opportunities for information and communication technologies to help alleviate those constraints, and outlined a shared “mHealth for maternal health” research agenda.

mh4mh_kwall_17inchesA prominent theme of the meeting was the need to improve the communication around the role of mobile technology in health as a pre-requisite for increased collaboration between mHealth and maternal health actors. Participants agreed that mobile technology should not be conveyed as a stand-alone health intervention, but rather a strategic tool for delivering maternal healthcare more effectively. The research questions posed by the group did not focus on whether mHealth works, but whether mHealth can deliver what we know works better than we are currently able to.

The meeting began with an illustrative case study that emphasized the need to position mHealth within a health systems approach to quality improvement before reflecting on results of a pre-meeting survey on the participants’ reflections on barriers and opportunities to achieving Universal Health Coverage (UHC). Expanding on the need to position mobile technology tools and strategies within a systematic approach to addressing barriers and opportunities, a logic model on the linkages between mHealth and health outcomes was presented.

A working mHealth vocabulary that is being developed by the WHO mobile Technical Evidence Review Group (mTERG) was shared, and participants suggested ways to refine this language to increase its acceptability within the maternal health community. In particular, finding explicit linkages between maternal health frameworks, redefining “quality” and positioning health, not technology, as the driver of innovation were all considered important.

A particularly exciting session featured a cross-section of 15 different projects where mHealth is being used to improve maternal health by working to increase client knowledge, provider competence and health system strength. All of the presentations are available here, and videos of these sessions are available here.

Day 2 of the meeting focused on evidence, specifically, understanding what kinds of evidence were important to donors, managers and implementers. The need for reporting standards so that every project using mobile technology is able to communicate its theory of change and results in a harmonized way was considered a top priority amongst participants.  Participants outlined ways they can contribute to building the evidence base and creating a shared research agenda, including increasing collaborations between academics and implementers. Participants emphasized that while additional research may not be needed about the benefits of digital data collection systems to improve data-based decision-making, more evidence around areas where it was considered “riskier” to use technology, such as during emergency obstetric situations, may be.

Participants of the meeting agreed that it is important that mHealth not be considered a panacea, while acknowledging that increasing access to information and communication technologies in settings where maternal death and disability are highest constitutes new opportunities for improving outcomes.

Further reflections from the mHealth for maternal health: bridging the gaps technical meeting will be featured in our mHealth for maternal health blog series. A meeting report will be made available shortly.

Do you have an opinion about using mHealth to improve maternal health? Contribute a post to our blog series! Get in touch with Yogeeta Manglani, ymm108@mail.harvard.edu.

Post-2015: Saving women’s lives with post-abortion care

A guest post from MHTF colleagues at Venture Strategies Innovations

Postabortion care provider-Rwanda

Post-abortion care provider in Rwanda

As new post-2015 targets and strategies to end preventable maternal deaths are being discussed and debated, we have the opportunity to leverage the progress made over the past decade by scaling up proven interventions that save the lives of women and girls. Deploying these interventions through an integrated delivery strategy that addresses all aspects of maternal and reproductive health will be crucial to saving the lives of more girls and women going forward. Related to this, the integration of family planning and maternal health services has received much needed attention, with efforts underway to better link family planning with antenatal care, postpartum care and HIV services. One key service that deserves more attention for its unique ability to expand access to family planning and other services, particularly for marginalized women and girls in rural communities, is post-abortion care (PAC).

Post-abortion care is the clinical management of complications caused by an induced abortion or miscarriage. It entails immediate treatment of complications, as well as follow-up counseling on contraception use as a means of breaking the cycle of repeated unwanted pregnancies and improving the overall health status of the girl or woman. It is a service typically sought out in crisis, when the girl or woman is at risk of death or serious injury from excessive bleeding or infection.  For girls and women in developing countries, post-abortion care may be their first and only interaction with the healthcare system. This visit can therefore be an important opportunity for providers to assess health needs and offer other appropriate reproductive health services.

postabortion care poster

Post-abortion care poster

It is essential that PAC services be easily accessible, high quality and youth-friendly. Providers at varying levels of the health care system should be trained to treat girls and women correctly, without judgment. As a critical emergency service, PAC should be integrated into any menu of maternal and reproductive health services; given that it may also be the entry point for girls to access reproductive health services at all, it is important that providers take the opportunity to offer other relevant counseling and services at the point of care.  Ensuring that a young girl receives high-quality post-abortion care can introduce her to the health system, and help her to feel comfortable coming back for other services, thus allowing a one-time visit for emergency care to be the first step to her becoming a lifetime user of family planning services offered by her local clinic or hospital.

Research has demonstrated that postabortion care can be safely and effectively provided at the lowest levels of the health system by primary care providers. Consequently, it is a package of services that can be scaled up to reach a country’s most rural peripheries. Nurses in Rwanda, primary care nurses in Zimbabwe, and nurse assistants in Angola have been trained to effectively provide PAC services, treating women and girls with either misoprostol or manual vacuum aspiration, and providing contraceptive counseling and methods. Providing these critical services closer to women’s homes reduces the cost and time required to travel to higher-level facilities for care, which can ultimately save more women’s lives.

MH clinic-Rwanda

Maternal health clinic in Rwanda

In setting the maternal health agenda post-2015, post-abortion care should be prioritized as it furthers the goal of health equity. Post-abortion care offers a critical window to provide women and girls, many of whom have few other opportunities for entering the health system, with access to contraception, HIV prevention, and STI services. Given this, the maternal health community must seize the opportunity to expand this high-impact intervention, integrated with other services, to rural, hard to reach areas. As a key component of the post-2015 framework, post-abortion care can increase access to services for vulnerable populations and ultimately, help to decrease maternal death and disability.

As we approach the 2015 deadline for the Millennium Development Goals, what does the future hold for international maternal mortality targets? The MHTF is pleased to be hosting a blog series on post-2015 maternal mortality goal setting. Over the next several weeks, we will be featuring responses and reactions to proposed targets from around the world. Please share your thoughts with us!

International Day for Maternal Health and Rights: answering the call to action

Written by Kathleen McDonald, technical lead on respectful care at the Women and Health Initiative and Maternal Health Task Force (MHTF), and Natalie Ramm, MHTF

Today, April 11, 2014 is the inaugural International Day for Maternal Health and Rights. Spearheaded by CHANGE, and co-sponsored by a consortium* of leading maternal health organizations, the event was launched with a tweetchat to discuss rights-based women’s health care, including respectful maternity care. The discussion served as a call to action for government, international institutions, and the global community to recognize the day and take action to keep maternal health on the post-2015  agenda.

People and organizations responded in droves, and by midday east coast time, #IntlMHDay and #maternalhealth were trending worldwide on Twitter. Chat participants answered questions posed by CHANGE and shared their perspectives on the status of maternal health as a human rights issue.

The overwhelming response from the global maternal health community signals that rights-based maternal health is a key area of concern, and we have heard you.

Last year, the Maternal Health Task Force issued a call for your perspectives on respectful maternity care.  In celebration of the International Day for Maternal Health and Rights, we are re-launching our RMC blog series. This year, we want to hear from you on the full spectrum of women’s health services.  To quote CHANGE:

If you have a story you would like to share, or thoughts on keeping women-centered healthcare in the post-2015 agenda, please email Natalie Ramm.

*Elizabeth Glaser Pediatric AIDS Foundation, Ibis Reproductive Health, International Center for Research on Women, International Planned Parenthood Association, Pathfinder International, Population Council, Women Deliver

April 11: International Day for Maternal Health and Rights

Disrespect and abuse during childbirth happens all over the world and at an alarming rate. For example, about half of respondents in a 2012 survey identified lack of privacy, lack of informed consent, and verbal abuse, as examples of disrespect or abuse during childbirth in their countries.

To promote respectful maternity careCenter for Health and Gender Equity (CHANGE) is calling on governments, international institutions, and the global community of civil society organizations to celebrate and recognize April 11 as the International Day for Maternal Health and Rights.

Read Gender Health’s new respectful maternity care fact sheet (pdf) and follow the conversation on Twitter using hashtag #IntlMHDay tomorrow from 11:00 am – 12:00 pm (EST).

To sign-on to the Call to Action as an organization, please email Devan Shea at dshea@genderhealth.org. Individuals can add their names here: http://bit.ly/IntlMHDay.