An estimated 60% of maternal deaths in the developing world occur during the six-week period after childbirth (Middleberg 2003). Based on the most recent global estimates, that translates to 172,000 postnatal maternal deaths per year. The vast majority of these fatalities are preventable, caused by sepsis, hemorrhage, hypertensive disorders, anemia and other treatable conditions (UNFPA 2010). What is more, for every maternal death there are an estimated 20 women who suffer from serious injury or infection (PDF Geeta et al. 2005). While antenatal care is crucial for ensuring women’s health needs are met, risk factors for maternal morbidity and mortality are often difficult to identify before complications arise—emphasizing the importance of care during labor, delivery and postpartum, when problems are more likely to present themselves. Further, care during these periods can reduce the mortality risk for neonates as well.
In recent decades, the maternal health community has largely focused on access to high-quality maternity care during pregnancy, labor and delivery. Although the postpartum period, defined as the six weeks following birth, is equally important, it has not received the same level of attention. Many women, particularly those who deliver at home, may see a health care provider just once or twice during that time, while others never receive any care at all. Of the 60% of deaths occurring postpartum, 45% occur within 24 hours of birth and more than 65% occur within one week (PDF Li 1996), highlighting the importance of care particularly in the early postpartum period. Women who suffer morbidities during childbirth need follow-up care in order to ensure proper healing. Beyond the well-being of women themselves, saving the lives (and livelihoods) of more mothers would also improve their families’ economic well-being and their children’s likelihood of survival (Kirigia et al. 2006; Ronsmans et al. 2010).
The paucity of research on postnatal care has led to sparse evidence regarding best practices in the field. Our current knowledge about mothers’ needs postpartum, while limited, points to the importance of increased attention on postnatal care in order to develop a “gold standard” regarding the timing and content of postnatal visits which will best meet the needs of both mothers and newborns. To accomplish this goal, it will be important not only to develop the content of care, but also to confirm the best methods of delivering that care.
The Role of the MHTF
The Women & Health Initiative is leading Adding Content to Contact (ACC), a project which systematically assesses the obstacles that prevent and the factors that enable the adoption and implementation of cost-effective and innovative approaches for antenatal and postnatal care along the care continuum. ACC is a collaborative effort between the Women & Health Initiative at the Harvard School of Public Health, ICS Integrare, and the Human Reproduction Programme at the WHO. ACC explores how these innovative approaches can best be adopted and scaled up in resource poor settings to benefit women and children. In addition to conducting targeted literature reviews of current guidelines and practices related to antenatal and post-natal care, ACC has also conducted in-depth assessments in select countries to determine how guidelines are being translated into practice along the care continuum. At a technical meeting in spring 2014, the project team further identified gaps and opportunities for improvement in ANC and PNC delivery. The in-depth country assessments and systematic reviews were presented at a special workshop held in conjunction with the International Confederation of Midwives conference in Prague in early June. Papers based on the project findings are currently being prepared for publication.
For information on perinatal care for mothers and newborns, please visit our Perinatal Health topic page.
- (PDF) WHO Guidelines for the Management of Postpartum Hemorrhage and Retained Placenta. WHO, 2009.
- (PDF) Workshop on Comprehensive Postpartum Family Planning Care: Notebook for Trainers, Jhpiego, 2008.
- K4Health: Postpartum Family Planning (PPFP) Toolkit. USAID, 2006.
- (PDF) Pregnancy, childbirth, postpartum and newborn care: A guide for essential practice, WHO, 2006.
- Geneva Foundation’s database on guidelines for postpartum care. Geneva Foundation, 2014.