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Delhi-Bound with the Future of Maternal Health on My Mind

Motherhood can be a wonderful rite of passage that brings so much joy—seeing a baby’s first smile and then step, watching a child grow up. But every year, for nearly 350,000 women, pregnancy is a death sentence. And many thousands more women are left with lifelong disabilities from pregnancy. Maternal death and disability continue at high rates, even though we know, in most cases, how to save these women’s lives and health by offering them:  access to the family planning method of their choice so they can choose if and when to get pregnant, high-quality antenatal care, delivery with a skilled birth assistant, magnesium sulfate for preterm labor or eclampsia, oxytocin for prevention of postpartum hemorrhaging, and basic emergency obstetric and newborn care.

Next week, IntraHealth will participate in the Global Maternal Health Conference in Delhi, India. I am honored to be a part of the IntraHealth delegation and am struck by how far we have come in maternal health and survival.  The 2010 revised global estimate of maternal deaths gives me hope and reflects years of commitment and grueling work by local governments and organizations, health workers, and international organizations, including IntraHealth and many others. We do have reason to celebrate; however, losing one woman because of preventable or treatable pregnancy complication is still one too many. We still have a long road ahead.

We work in countries across Africa, Eastern Europe, and Southeast Asia, in partnership with ministries of health, local and international non-governmental organizations to ensure that all women can get high-quality maternal health services. In Mali and Rwanda, we have worked with the nursing and midwifery schools to revise the curriculum on reproductive health and family planning, HIV/AIDS, child health, and gender to make it more performance-based and enable new nurses and midwives to better serve babies and pregnant women. In Armenia, we introduced national guidelines based on international standards of quality care for normal and emergency obstetric care to help health workers to practice evidence-based medicine. This includes guidance on the active management of third stage labor, a lifesaving approach that prevents postpartum hemorrhages. This also includes the development of Schools of Motherhood to help prepare couples for labor and delivery and teach them how to care for their newborns, similar to prenatal classes in the United States. In India, we have collaborated with the National Rural Health Mission to scale-up training of auxiliary nurse-midwives and expand the availability of skilled birth attendants. In Senegal, we are working with the Ministry of Health to track the practice of active management of third stage of labor through the national health information system and support health workers to employ mobile phone technology to track and react to health data from the communities where they work. We have so many stories to share about initiatives that expand the availability of maternity care; but there are still countless women who live in rural, isolated areas who cannot access the services they need.

How are we, the global health community, able to commit to reach more women? Part of the answer is in the systems approach. This means not just revising a module for an in-service training but also making sure, by collaborating with the ministry and other partners, that the ministry has a national training strategy. It can mean collaborating with a nursing school on its institutional strategic plan, as we have done in Mali and Rwanda, or working directly with government officials on a policy review of what services could be appropriately shifted to other cadres of health workers, a project undertaken in Malawi and Mozambique.

If we are to continue to see improvement in women’s and mothers’ lives and well-being, we need to continue to share experiences and lobby and negotiate with governments to make women’s lives and health a priority. Only when all women have affordable, accessible, and high-quality maternal health care will they be able to choose whether to pursue the joys of motherhood without wondering if they are risking their lives. 

Next week’s Global Maternal Health Conference will provide us all with the opportunity to share, to lobby, to advocate, to jump up and down about maternal health.  Let’s make sure that we bring practical and actionable recommendations out of this conference. We have a long way to go, but we have the road map. We need real commitment in countries to reach our destination: no women dying in pregnancy or childbirth.