Critical Next Steps for the Maternal Health Community

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By: Katie Millar, Technical Writer, Women and Health Initiative, Harvard T.H. Chan School of Public Health

knowledge gaps maternal health research global low-income middle-incomeAs we reflect on lessons learned from the MDGs and set strategies for improving global maternal health, it’s time to identify what has worked and what more is needed to not only avert preventable maternal deaths, but also provide quality health care for every woman.

In a paper published today, Tamil Kendall, a post-doctoral fellow of the Maternal Health Task Force, summarizes priorities for maternal health research in low- and middle-income countries based on three broad questions she asked 26 maternal health researchers from five continents:

Critical maternal health knowledge gaps

We know what to do. But the interactions between the interventions and the health system have not been studied”

The most prominent knowledge gap that remains is implementation research for health systems strengthening. Not only do we need to identify the most effective ways to deliver, scale up and sustain both basic and comprehensive emergency obstetric care, especially for postpartum hemorrhage and pre-eclampsia, but implementation research is needed to ensure we deliver the right packages of care at the right levels of care.

Other priorities:

  • Improving the quality of maternal healthcare
  • Improving the quality and availability of information about maternal mortality
  • Supporting women’s empowerment
  • Increasing the availability and uptake of contraception
  • Increasing access to safe abortion services
  • New treatments for major causes of maternal deaths

Neglected and crucial issues

“The human resource crisis.”

The most neglected and crucial issue identified is strengthening the health workforce, another health systems issue. This topic is broad and includes assessing ideal models for task-shifting, training, supervising and assessing the competence of private or unregulated providers. In addition, other priorities are both global and region-specific:

  • Preventing and eliminating disrespect and abuse
  • Over-medicalization of birth
  • Demand generation for facility births, especially in Africa
  • Maternal morbidities

Future directions for implementation research

“Over and above medicine, we cannot forget about the socioeconomic situations­—poverty and inequity—that lead to morbidity and mortality.”

While globalization has affected the rising per capita income in many low- and middle-income countries, deep inequities still exist. What’s more is that measuring equity can be elusive. Researchers called for improved measures and better data to allow us to narrow equity gaps. Specifically, adolescents may suffer some of the most inequitable care, which include higher rates of obstetric complications and poorer neonatal health outcomes.

Future directions for implementation research:

  • Increasing burden of non-communicable diseases
  • Urbanization
  • Information and communication technologies to enhance maternal health
  • Translating knowledge about the developmental origins of health and disease into practice
  • Geopolitical factors influencing maternal health

To read more details about the way forward for research and programs in maternal health, access Critical maternal health knowledge gaps in low- and middle-income countries for post-2015: Researchers’ perspectives.