The Maternal Health Task Force (MHTF) 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.
EPMM Key Themes
Monitoring progress to support achievement of global goals
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.
Targets and strategies
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.
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, focused on building consensus on a set of supplemental “means of implementation” indicators for the 11 key themes identified in the EPMM Strategies report that will allow countries to track progress in these areas. These 11 themes highlight the broad social, political and economic determinants of maternal health and survival. Through an iterative, consultative process, stakeholders agreed on a balanced set of indicators that are relevant, important, useful, scientifically sound and feasible for monitoring the critical distal determinants of maternal health and survival.
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 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. In November 2016, the Phase II indicators were shared with the recently-formed WHO “Mother Newborn Information for Tracking Outcomes and Results” (MONITOR) expert advisory group. Papers describing the Phase II process and resulting indicators are in progress.
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.
EPMM timeline of activities
Efforts began in early 2013 to develop the EPMM strategies, targets and a comprehensive monitoring framework to aid in efforts to achieve them. Since then, a great deal of progress has been made, illustrated by the timeline below.
The identification of indicators to monitor progress towards ending preventable maternal mortality is not the end of this work. The EPMM working group continues to move the EPMM monitoring framework forward, and more information on the process and its anticipated outcomes will be provided here as it becomes available.
The EPMM working group
- Amy Boldosser-Boesch, FCI Program of MSH
- Michel Brun, UNFPA
- Liliana Carvajal, UNICEF
- Doris Chou, WHO
- Kathleen Hill, MCSP
- Jerker Liljestrand, Bill & Melinda Gates Foundation
- Betsy McCallon, White Ribbon Alliance
- Allisyn Moran, USAID
- Rima Jolivet, MHTF
- Mary Ellen Stanton, USAID
- Karen Fogg, USAID
- Lale Say, WHO
- Jeffrey Smith, Jhpiego
- Petra ten Hoope-Bender, UNFPA
- Mary Nell Wegner, MHTF
- Will Zeck, UNICEF
To learn more about EPMM, visit the MHTF blog.
Read the publications resulting from the EPMM project:
A common monitoring framework for ending preventable maternal mortality, 2015–2030: Phase I of a multi-step process | BMC Pregnancy & Childbirth (February 2016)
Ending preventable maternal and newborn mortality and stillbirths | BMJ (September 2015)