I recall reading the Manifesto for Maternal Health with appreciation for the strategies delineated but regret that many of the actions identified had not received the deserved attention earlier. I felt optimistic that with increasing global focus on maternal health, the Manifesto would be taken seriously but also wondered if national commitment, international mobilization, adequate resourcing, and meaningful action would follow suit and worked with sister organizations on advocacy efforts.
Now, a year on, it is reassuring that my initial optimism was well-placed. Donors are mobilized and more prepared than ever to support capacity building of governments, enabling organizations like mine, Pathfinder International, to support governments to make a special push towards delivering on the actions in the Manifesto. Countries like Haiti are focused on the improvement of health systems which are the backbone of meaningful progress in not just maternal health, but health, overall. There is also greater attention dedicated to the barriers that prevent women from accessing maternal care, including gender-based violence and poverty.
In fact, several of the specific strategies noted are now being translated into programs and policies. Despite the focus on facility-based deliveries, there is attention to addressing birth wherever it happens, since women still give birth at home. Organizations dedicated to improving maternal health are making efforts to reach women where they live through community health workers and community distribution of medications like misoprostol to prevent postpartum hemorrhage. It is satisfying to see the leadership of governments in making this happen and their growing partnership with community based organizations and civil society to address maternal health.
I have also witnessed many governments and organizations taking concrete steps to establish maternal health systems which cover a continuum of care (point #4). Pathfinder’s own continuum of care model has been used in many countries over the past seven years, but recently we have found an increasing number of partners adapting and implementing similar strategies to great benefit.
One area called out by Manifesto point #11, which has seen marked progress, is leveraging mobile health to improve maternal health outcomes. I am particularly proud of Pathfinder’s own work in this arena which includes close partnership with the government of Nigeria, as well as other countries.
Unsafe abortion remains one of the leading causes of maternal mortality and morbidity. The challenges posed by social stigma, policy and donor restrictions make it difficult to mainstream comprehensive abortion care, in maternal health efforts.
I also wonder if we are paying enough attention to the unseen women to which the Manifesto alludes in point #6. I hope to see a growing focus on reaching isolated populations such as those Pathfinder works with in Northern Nigeria. Our integrated project on prevention of mother to child transmission (PMTCT) and maternal-newborn health enables women, who culturally face barriers in leaving their homes, to receive antenatal care as well as PMTCT services. This approach encourages male involvement, maintains confidentiality of the HIV status of the mothers, and increases antenatal care uptake significantly.
We must continue to focus our attention and investment on evidence-based approaches like emergency obstetric care that are highly effective in reducing maternal mortality. It is crucial that we bring attention to the special challenges young mothers face, approaching our work with adolescents and youth with a unique understanding of their needs and the barriers they face.
Let’s applaud our progress. But let us remember that more needs to be done especially for those segments of the populations that are vulnerable and marginalized.
The MHTF is currently celebrating the Manifesto for Maternal Health’s one year anniversary through a blog series. Would you like to contribute? Connect with us on Twitter and Facebook. Or send us an email.