Measuring Content of Contacts Reveals Missed Opportunities to Deliver Quality Maternal and Newborn Health Care

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By: Tanya Marchant, Deputy Director, MARCH Centre

This post originally appeared on the IDEAS blog

Content of maternal and newborn health care needs to be measured to improve the quality of contacts between families and health workers, highlights research carried out by the IDEAS project, and published in PLoS ONE. The data supporting this analysis is now freely available online.

Quality of health care is a big issue globally. One facet of quality is the content of care across the continuum from pregnancy through to 28 days after birth, and this must be considered in future global maternal and newborn health strategies. For example, if a pregnant woman makes an antenatal care visit, but does not have her blood pressure measured, there has been a missed opportunity to prevent possible complications during pregnancy or childbirth.

Measuring the content of contacts with frontline workers

The IDEAS study measured how many women and their babies not only accessed routine antenatal, intra-partum, post-partum and post-natal care, but also received the recommended routine health checks during those contacts. The study was carried out in 2012 across three settings: Ethiopia, Gombe State, Northeast Nigeria, and the state of Uttar Pradesh, India.

Few women and babies received healthcare with all required content

The number of families that had contact with frontline workers suggested that demand for health care was increasing compared to previous reports from the same study sites. However, the percentage of women and babies who received care with all the recommended content was considerably lower across all stages of the continuum of care. For example, of the 61% of women who had an antenatal check while pregnant in Gombe State, Northeast Nigeria, just 11% reported receiving all the recommended content of antenatal care by the end of their pregnancy. Similar findings were observed in all three study settings.

Charts showing few women and babies received healthcare with all required content © IDEAS/LSHTM

Charts showing few women and babies received healthcare with all required content © IDEAS/LSHTM

Developing strategies to reduce missed opportunities for delivering high quality care

The study reveals the importance of measurement to inform implementation strategies that target the content of care, as highlighted recently by the Maternal Health Task Force. With increased demand for health services and global commitments to reduce maternal and newborn mortality (such as the Every Newborn Action Plan, Strategies toward ending preventable maternal mortality and Every Mother, Every Newborn strategy), the findings of the IDEAS study show improving content is key to reducing the number of missed opportunities to deliver lifesaving care in the future.

What does ‘content of care’ mean?

The content of a routine health visit should include all recommended aspects of care:

Antenatal care (care during pregnancy):

  • Weight and height measured
  • Blood pressure measured
  • Urine and blood tests carried out
  • Counselling for breastfeeding, danger signs, and birth preparedness

Intra-partum care (care during childbirth, including prevention of excessive bleeding [haemorrhage] during skilled birth attendance):

  • Administration of prophylactic uterotonics to prevent post-partum haemorrhage
  • Active management of third stage of labour

Post-partum care (care of the mother within 48 hours of birth):

  • Breasts and bleeding checked
  • Counselled on danger signs, nutrition, and family planning

Post-natal care (care of the newborn within 48 hours of birth):

  • Weigh newborn
  • Check cord care
  • Counsel caregiver on breastfeeding, thermal care and danger signs