Yesterday marked the close of the International Maternal and Neonatal Health conference, held in Cape Town, South Africa and the first conference of its kind to be held since 2015. With more than 1,500 participants drawn from 50+ countries and representing governments, their partners, and other stakeholders, this was a long overdue opportunity to share learnings and convene around strategic priorities.
Opening the conference, participants listened in dismay to the story of Treasure Lwatale, a patient advocate from Malawi, who described her harrowing experience after suffering a stillbirth after 38 weeks. We listened in horror, though sadly not in surprise to an experience witnessed too many times by health workers attending the conference. Despite the traumatic experience, Treasure took great care to describe the support she received from her midwife throughout, reminding us of the difference healthcare workers can make and the importance of quality care.
Reflecting on the experience and highlights, some of CHAI’s key takeaways include:
1. It’s time to act and prioritize maternal health.
The eight years since the last international conference in 2015 have been a period of missed opportunities, with progress being disproportionally slow. The recently published UN study, ‘Trends in Maternal Mortality,’ reveals that maternal mortality rates have remained stagnant in 133 countries between 2016 and 2020, while in 17 countries key indicators have worsened. Consider Nigeria, for example. In 2017, the lifetime risk of a 15-year-old girl dying from maternal causes was one in 21, three years later that number has increased to a shocking one in 19. These statistics should alarm us all and remind us of the urgent need to act.
2. Preterm births represent the leading cause of child mortality.
Nearly one in five under-five deaths are preterm babies and progress has been painfully slow. In 2010, the global preterm birth rate was 9.8 percent, ten years later, it’s 9.9 percent. More is needed to address this critical issue. That’s why we’re supporting the ‘Born to Soon’ initiative, marking the beginning of a decade of action aimed at improving preterm birth outcomes. At CHAI, we’re committed to doing our part to ensure that this initiative is a success. For example, our market-shaping program is working to ensure sustainable access to caffeine citrate, which is the number one drug prescribed in neonatal intensive care units in the US and Europe but rarely used in Africa. By improving access to critical medications like caffeine citrate, we can help ensure that preterm babies receive the care they need to survive and thrive.
3. Networks of Care are crucial toward driving mortality reductions.
Networks of Care show real promise toward addressing the complex task of reducing maternal and neonatal mortality rates. Influenced by CHAI’s integrated sexual reproductive, maternal, and newborn health (SRMNH) strategy, Networks of Care provide a culture of inclusivity, strong management oversight, and data-driven decision-making to drive dramatic change. The results speak for themselves, Networks of Care strategy has led to a remarkable 40+ percent reduction in the proportion of maternal and neonatal deaths in Northern Province, Zambia. The Networks of Care approach has the potential to be a game-changer toward reducing mortality rates and ensuring they are sustained.
4. Identifying and addressing social determinants is crucial towards improving maternal and newborn health outcomes.
Up to 10 percent of pregnant women and 13 percent of women who have just given birth worldwide experience a mental disorder. Antenatal depression can have significant effects on both the mother and child, such as low birth weight and impaired fetal development, so it’s essential to prioritize mental health support during the prenatal and postnatal periods. Further research is needed to identify contributing factors and inform effective strategies for promoting the well-being of the mother and baby.
5. Safe Blood availability is crucial to reduce maternal death from obstetric hemorrhage and other diseases.
Approximately 26 percent of post-partum hemorrhage deaths are due to the absence of blood products, despite their inclusion in the World Health Organization Essential Medicines List. CHAI has implemented initiatives in countries, including Liberia, Ethiopia, Zambia, and Uganda to increase the availability of safe blood for women and newborns, and wider populations during emergencies. Building on a growing momentum identified during the conference, advocacy is required to increase visibility and investment in safe blood as part of maternal mortality reduction efforts.
6. Lasting improvements are only possible by partnering with governments to strengthen national systems.
The conference learned about CHAI’s work which includes:
- Support to state governments in Northern Nigeria that enabled traditional birth attendants to better serve as community-level first responders.
- Helping to remodel the Zambian government’s allocation of resources to address SRMNH inequities.
- Support to the South African National Department of Health to implement Quality Improvement Plans at health facilities to improve maternal and neonatal services.
- Support to Zambia to leverage geospatial intelligence to identify hotspots for maternal and neonatal mortality as well as prioritizing investment for infrastructure in hotspot sites.
- Work in Nigeria to introduce innovative approaches for postpartum hemorrhage prevention and management.
- Work in Zambia to introduce the Non-pneumatic Anti-shock
Garment (NASG) on a large scale in Zambia.
- Assisting the Zambian government at national and subnational levels to better understand how traditional, socio-cultural gender norms and practices influence the uptake of maternal health services.
7. Climate and health are inexorably linked.
While climate change impacts all human lives, it disproportionately affects vulnerable populations, such as pregnant women and newborns. Extreme heat can lead to adverse outcomes such as hypertensive disorders, gestational diabetes, preterm birth, stillbirths, reduced breastfeeding, and service disruptions. It’s crucial that a series of potential innovations are integrated within the current packages of care for maternal and newborn health to prevent worsening mortality trends.
In two years’ time the global community plans to meet again at the next International Maternal Newborn Health conference. There is so much to be done before then. CHAI remains committed to remaining a key partner to ministries of health; catalyzing efforts for change; and driving significant reductions in the number of women and babies dying preventable deaths.