The Maternal Health Task Force (MHTF) of the Women and Health Initiative plays an integral role in advancing the global goals and strategies for Ending Preventable Maternal Mortality (EPMM) by driving the efforts of the EPMM working group and co-leading the technical work to develop a comprehensive monitoring framework for EPMM. As a coalition composed of representatives from the FCI Program of Management Sciences for Health (MSH), Jhpiego, the Maternal and Child Survival Program (MCSP), MHTF, United Nations Population Fund (UNFPA), UNICEF, United States Agency for International Development (USAID), White Ribbon Alliance (WRA) and the World Health Organization (WHO), the EPMM working group seeks to promote and track progress towards strategic priorities for maternal health and survival and to build the necessary momentum to end preventable maternal deaths within a generation.
In February 2015, WHO published “Strategies toward ending preventable maternal mortality (EPMM)” (EPMM Strategies), a direction-setting report outlining global targets and strategies for reducing maternal mortality under the Sustainable Development Goals (SDGs). The result of extensive consultations with stakeholders around the globe, the targets and strategies in the EPMM Strategies report are grounded in a human rights approach to maternal and newborn health and focus on eliminating significant inequities that lead to disparities in access, quality and outcomes of health care within and among countries.
The EPMM Strategies report is part of the larger effort by the global health community to ensure healthy lives and promote wellbeing for all under the SDG agenda. Given the critical role of women in families, economies, societies and the development of future generations, the report provides specific guidance for improving maternal health and survival as a priority issue for all countries.
Average global maternal mortality ratio (MMR) of less than 70 maternal deaths per 100,000 live births by 2030
Supplementary National Target
By 2030, no country should have an MMR greater than 140 deaths per 100,000 live births, a number twice the global target
- For countries with an MMR less than 420 per 100,000 live births in 2010: Reduce the national MMR by at least two-thirds from the 2010 baseline by 2030
- For countries with an MMR greater than 420 per 100,000 live births in 2010: The rate of decline should be steeper so that in 2030, no country has an MMR greater than 140
- For all countries with low MMR in 2010: Achieve equity in MMR for vulnerable populations at the subnational level
EPMM Key Themes
- Empower women, girls, families and communities
- Integrate maternal and newborn care; protect and support the mother-baby relationship
- Prioritize country ownership, leadership and supportive legal, regulatory and financial mechanisms
- Apply a human rights framework to ensure that high-quality reproductive, maternal and newborn health care is available, accessible and acceptable to all who need it
- Improve metrics, measurement systems and data quality
- Allocate adequate resources and effective health care financing
- Address inequities in access to and quality of sexual, reproductive, maternal and newborn health care
- Ensure universal coverage for comprehensive sexual, reproductive, maternal and newborn health care
- Address all causes of maternal mortality, reproductive and maternal morbidities and related disabilities
- Ensure accountability to improve quality of care and equity
The global maternal mortality ratio (MMR) target proposed by the EPMM Strategies report was adopted into both the SDGs and the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) (Global Strategy). The guiding principles and strategic objectives from EPMM were harmonized with those outlined in the Every Newborn Action Plan (ENAP), which were combined in a technical working paper on ending preventable maternal and newborn deaths and stillbirths that also informed the development of the Global Strategy.
A Comprehensive Monitoring Framework for EPMM
Following the launch of the report, the EPMM working group initiated plans to develop a comprehensive monitoring framework for the strategies outlined in the report. This technical work, conducted in two phases, has been led by the MHTF in collaboration with USAID and WHO and has incorporated input from multiple stakeholders during each stage of the process. Together, the indicators from Phases I and II comprise a comprehensive monitoring framework for EPMM. The ultimate goal of this effort is to support the SDGs and the Global Strategy – across the full spectrum of its “Survive, Thrive and Transform” agenda – and to complement other global monitoring efforts.
Phase I of the process to develop a monitoring framework for EPMM was completed in October 2015. During Phase I, stakeholders participated in a series of technical consultations to identify a set of 12 indicators closely linked to direct causes of death for global monitoring and reporting by all countries. The resulting indicators fall into three categories – coverage, impact and input/counting – which mirror those of the ENAP core metrics. Phase I also identified four areas in which indicators are needed, but currently unavailable, for monitoring at the global level. The final set of Phase I EPMM indicators informed the development of the Indicator and Monitoring Framework for the Global Strategy (2016-2030). The Phase I process and resulting indicators are described by Moran, et al. in the 2016 paper, “A common monitoring framework for ending preventable maternal mortality, 2015-2030: Phase I of a multi-step process.”
Phase II, completed in November 2016, utilized an iterative, consultative process in which stakeholders agreed on a balanced set of indicators for monitoring the broad social, political and economic determinants of maternal health and survival as outlined by the 11 key themes in the EPMM Strategies report.
The final outcome of Phase II includes two sets of indicators: core indicators and additional indicators for further development. Core indicators are those that stakeholders agreed are relevant, important, useful, scientifically sound and feasible for monitoring these critical distal determinants of maternal health and survival at national and global levels. The core set includes 25 indicators and 6 stratifiers. The list of additional indicators for further development represents an important research agenda for maternal health monitoring. They are indicators that were identified as important, relevant and useful for tracking progress toward ending preventable maternal mortality, but in need of further definition and research before they can be tracked at national or global levels.
The Phase II process and resulting indicators are described by Jolivet, et al. in the 2018 paper, “Ending preventable maternal mortality: phase II of a multi-step process to develop a monitoring framework, 2016–2030.”
Improving Maternal Health Measurement Capacity and Use
Currently, the MHTF is leading the “Improving Maternal Health Measurement Capacity and Use” project designed to develop, test and validate a subset of the indicators in the monitoring framework. The project will engage in-country researchers and partners from the EPMM Working Group to provide technical assistance and develop resources that can encourage adoption and routine use of EPMM indicators. In so doing, the project aims to improve measurement capacity for maternal health through a) the development and validation of indicators to inform global standards and b) focused support to countries for the adoption and use of the indicators. The ultimate goal of this project is to provide much-needed knowledge, research and evaluation data as well as validated measurement tools for tracking progress towards ending preventable maternal mortality effectively and efficiently.
Learn more about the Improving Maternal Health Measurement Capacity and Use project>>