Koki Agarwal | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: The day of birth is a high-risk time for both mothers and newborns with 40% of maternal and newborn deaths occurring on the day of birth. Delivery of a minimum package of day of birth interventions benefits mothers and newborns during the early post-partum period and helps protect the future health of women, newborns and families. Many obstacles, however, prevent women and newborns in low-resource settings from receiving a minimum package of services resulting in many missed opportunities to maximize care for mother and newborn on the day of birth.

Methodology: A global USAID Maternal Child Survival program (MCSP) with presence in more than 20 countries examined evidence and global strategies including the Essential Newborn Action Plan and Ending Preventable Maternal Mortality (EPMM) strategy to: 1) define a minimum package of day of birth interventions for mother and newborns; 2) to elucidate common barriers to delivery of this package in low-resource settings; and 3) to define promising implementation strategies rooted in health system strengthening and quality improvement. Feasibility testing of a tailored implementation strategy to strengthen delivery of a day of birth package was initiated in several countries supported by MCSP.

Results: A minimum day of birth package was defined that includes essential newborn care, immediate post-partum administration of a uteronic for prevention of Post-partum Hemorrhage, newborn vaccination, post-partum family planning and routine surveillance of mother and newborn and counseling for danger signs. A menu of simple indicators was developed for potential inclusion in routine information systems to support decision-making. Several countries adapted and began testing an implementation approach focused on strengthening essential system functions in conjunction with quality improvement in participating maternities.

Conclusion: Early results are promising and highlight important barriers and facilitators to accelerating coverage and quality of a minimal day of birth intervention package in low-resource settings.