Over the last three weeks, we’ve heard from authors around the world who have seen concrete practice and policy results from their articles in our MHTF-PLOS Collection for Maternal Health. Our Translating Research into Practice Series featured these authors and the influence of their papers. Find a summary of the collection below.
While a maternal death is devastating in its own right, a mother’s death is not an isolated event; when a mother dies there are immediate and lasting repercussions for her children, her family, and the broader community. As the dawn of the Sustainable Development Goals fast approaches, it is important that we turn to evidence from the Impacts of Maternal Death on Living Children Study to inform advocacy efforts toward the inclusion of women’s reproductive health and gender equality as a central, fundamental part of global development. Toward this end, we convened a panel of maternal health experts for a live webcast to discuss the implications of this research and the strategies advocates can use to mobilize influential donors and decision-makers to prioritize investments in sexual and reproductive health.
Emergency obstetric referral and transport in low- and middle-income countries: the direction of travel
Our study called for research to understand how referral and transport interventions work for obstetric emergencies. This research is crucial since decisions to seek care can be deferred or hindered, and even if decisions are rapidly made to seek care, transport may be unavailable or slow. This call has been met with research from Wilson and colleagues that elicited key factors that affect the use and uptake of transport in obstetric emergencies and Nwolise and colleagues that found where community-based loan funds were used along with other interventions, the utilization of health facilities for childbirth increased. Our topic has also received international attention with the World Health Organization supporting an international panel that recently identified research on transport and referral solutions as a priority area to improve maternal and newborn health in low-resource settings.
Developing countries lack vital registrations that are present in high-income countries. Because of the shortage of such essential information, translating policy into action and monitoring programmes to reduce maternal and neonatal deaths is difficult. As a follow-up to our paper, Maternal and Neonatal Mortality in South-West Ethiopia: Estimates and Socio-Economic Inequality, we developed, validated, and used community-based birth registration in a population of about half a million people in four woredas, or districts, in rural southern Ethiopia. The most important lesson we learnt is that it is possible to obtain high-coverage birth registration and measure maternal mortality in rural communities with trained community health workers.
Our paper—When Women Deliver with No One Present in Nigeria: Who, what, where and so what—revealed that over one in five births in Nigeria was delivered with no one present (NOP) with 94% of those deliveries occurring in northern Nigeria. Our paper has shaped the discourse on maternal and newborn health in Nigeria in the following ways:
- The start of a statewide community-based distribution of misoprostol and chlorhexidine to link mothers to providers
- A policy dialogue involving influential local religious leaders who now promote facility births
- Given the influential nature of our paper, it was chosen as one of three presented at a launch event at Harvard for the MHTF-PLOS collection in November 2013
The Midwives Service Scheme (MSS) was set up as a game changer to reduce maternal and child mortality so Nigeria could achieve the Millennium Development Goals (MDGs) on maternal and child health (MCH). Since the publication of our PLoS Medicine paper, the MSS has subsequently been scaled up from 625 PHC facilities to an additional 375 facilities, providing 1,000 facilities across Nigeria with an additional 4,000 midwives and 1,000 community health extension workers. The MSS, in addition to the MCH component of the Subsidy Reinvestment and Empowerment Programme (SURE-P) it inspired, has decreased maternal and neonatal mortality. In addition, it inspired a national policy change to allow community health extension workers, who form the bulk of the PHC workforce in Northern Nigeria, to provide contraceptive injectables to women. Lastly, it has also increased community engagement and inspired a conditional cash transfer program, which has increased facility birth by 27%.