On September 9th and 10th, the Maternal Health Task Force and Save the Children’s Saving Newborn Lives program convened experts in Boston to discuss maternal and newborn health integration. The meeting, “Integration of Maternal and Newborn Health Care: In Pursuit of Quality,” hosted about 50 global leaders—researchers, program implementers and funders—in maternal and newborn health to accomplish the following three objectives:
- Review the knowledge base on integration of maternal and newborn health care and the promising approaches, models and tools that exist for moving this agenda forward
- Identify the barriers to and opportunities for integrating maternal and newborn care across the continuum
- Develop a list of actions the global maternal and newborn health communities can take to ensure greater programmatic coherence and effectiveness
Biologically, maternal and newborn health are inseparable; yet, programmatic, research, and funding efforts often address the health of mothers and newborns separately. This persistent divide between maternal and newborn health training, programs, service delivery, monitoring, and quality improvement systems limits effectiveness and efficiency to improve outcomes. In order to improve both maternal and newborn health outcomes, ensuring the woman’s health before and during pregnancy is critical.
Reviewing the Knowledge Base
The meeting focused on a variety of themes as global experts led presentations and gathered for small group work to discuss next steps for integration of maternal and newborn health care. While little research thus far has been specifically devoted to maternal and newborn integration, it was shown that great inequity exists among maternal and newborn health interventions and that while about 90% of women receive at least one antenatal care visit, only slightly more than half deliver with a skilled attendant at birth, and about 40% receive postnatal care. These disparities along the continuum of care helped meeting participants identify service delivery points in need of strengthening and optimization to ensure the health of both the mother and newborn. Given the limited knowledge base, leaders were encouraged to strengthen the evidence by engaging in research to identify both the costs, and potential risks of integration.
Opportunities and Barriers for Integration
Overarching themes that emerged while evaluating integration at the meeting included optimization of service delivery points to prevent “content free contact” and the need for efforts to be context specific. There was broad consensus that programmatic and policy efforts for integration need to recognize and reflect the local environment and the capacity of the health system. The meeting concluded that integration should not be viewed as an intervention in and of itself, but rather as a method of reevaluating and designing health systems to effectively provide better maternal and newborn health care, ensure better outcomes, and incur less cost. In approaching integration in the future, it was made clear that some of the most important factors for integration include assessing and understanding contextual factors, as well as anticipating what the woman, family, and health care workers need and want.
Case studies were presented from Ecuador, Nigeria, and the Saving Mothers Giving Life program. Each presenter evaluated approaches for integrating health systems, programmatic strategies, and service delivery in order to optimize maternal and newborn health outcomes. These case studies provided potential models for maternal and newborn health integration in future programmatic efforts.
Actions for Greater Programmatic Coherence
Lastly, and perhaps most importantly, small groups presented action items and next steps to strengthen the evidence for integration and promote integrated care so that no mother or newborn is neglected in programmatic efforts. These action items were created for three levels: facility and service delivery; national policy and programming; and technical partners and donors.
Proposed action items include improving and redesigning health workforce training; ensuring quality improvement; integrating health information systems; aligning global maternal and newborn health initiatives; integrating advocacy tools for maternal and newborn health care; and unifying measurement frameworks.
Join us over the next two weeks as the Maternal and Newborn Integration Blog Series unfolds. This blog series will dive into the details of the meeting discussions and action items. In addition, meeting participants and speakers will share their reactions to maternal and newborn integration from a variety of perspectives.