Background Maternal and perinatal death surveillance and response (MPDSR) is a system of identifying, analysing and learning lessons from such deaths in order to respond and prevent future deaths, and has been recommended by WHO and implemented in many low-and-middle income settings in recent years. However, there is limited documentation of experience with MPDSR in humanitarian settings. A meeting on MPDSR in humanitarian settings was convened by WHO, UNICEF, CDC and Save the Children, UNFPA and UNHCR on 17th–18th October 2019, informed by semi-structured interviews with a range of professionals, including expert attendees. Consultation findings Interviewees revealed significant obstacles to full implementation of the MPDSR process in humanitarian settings. Many obstacles were familiar to low resource settings in general but were amplified in the context of a humanitarian crisis, such as overburdened services, disincentives to reporting, accountability gaps, a blame approach, and politicisation of mortality. Factors more unique to humanitarian contexts included concerns about health worker security and moral distress. There are varying levels of institutionalisation and implementation capacity for MPDSR within humanitarian organisations. It is suggested that if poorly implemented, particularly with a punitive or blame approach, MPDSR may be counterproductive. Nevertheless, successes in MPDSR were described whereby the process led to concrete actions to prevent deaths, and where death reviews have led to improved understanding of complex and rectifiable contextual factors leading to deaths in humanitarian settings. Conclusions Despite the challenges, examples exist where the lessons learnt from MPDSR processes have led to improved access and quality of care in humanitarian contexts, including successful advocacy. An adapted approach is required to ensure feasibility, with varying implementation being possible in different phases of crises. There is a need for guidance on MPDSR in humanitarian contexts, and for greater documentation and learning from experiences.

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BackgroundScientific literature has provided clear evidence of the profound impact of sexual violence on women’s health, such as somatic disorders and mental adverse outcomes. However, consequences related to obstetric complications are not yet completely clarified. This study aimed to assess the association of lifetime exposure to intimate partner sexual violence with eclampsia.MethodsWe considered all the seven Demographic and Health Surveys (DHS) that included data on sexual violence and on signs and symptoms suggestive of eclampsia for women of reproductive age (15-49 years). We computed unadjusted and adjusted odds ratios (OR) to evaluate the risk of suggestive eclampsia by ever subjected to sexual violence. A sensitivity analysis was conducted restricting the study population to women who had their last live birth over the 12 months before the interview.ResultsSelf-reported experience of sexual violence ranged from 3.7% in Mali to 9.2% in India while prevalence of women reporting signs and symptoms compatible with eclampsia ranged from 14.3% in Afghanistan to 0.7% in the Philippines. Reported sexual violence was associated with a 2-fold increased odd of signs and symptoms suggestive of eclampsia in the pooled analysis. The sensitivity analysis confirmed the strength of the association between sexual violence and eclampsia in Afghanistan and in India.ConclusionsWomen and girls in low-and-middle-income countries are at high risk of sexual violence, which may represent a risk factor for hypertensive obstetric complication. Accurate counseling by health care providers during antenatal care consultations may represent an important opportunity to prevent adverse outcomes during pregnancy.

Background Each year, 2.7 million newborns die during their first day of life: a number that equals the entire population of Namibia. In the “Year of Nursing and Midwives”, this article highlights the importance of skilled birth attendants: researchers estimate a 56% of maternal, fetal and neonatal deaths reduction in case of midwife assisted delivery. Methods Authors propose an integrative review involving a mapping exercise of the literature. The search included peer reviewed research and discursive literature on variables to assess the capacity of HRH. Results Research shows that steps to recognize and support this working relationship require multipronged approaches to address imminent training, resource and infrastructure deficits, as well as broader health system strengthening. Central Africa Republic, Côte d'Ivoire, Democratic Republic of Congo, Ethiopia, Liberia, Madagascar, Rwanda, Sierra Leone, Uganda and Tanzania all experience a midwife density per 1000 population lower than 1. Improved service provision may be associated with development of supervision systems like the introduction of a human resources information system to help mobilise domestic resources. This review also looks at the level and the relative importance of each revenue. Conclusions Given issues such as shortages and poor retention of human resources for maternal and newborn health service delivery in low resources settings, international organizations should focus on strengthening capacity of midwives at community and facility level as a realistic measure to at least halve maternal and perinatal mortality. Information systems may contribute to the development of national and local policies in the country, which address the human resources needs of the health care system to meet regional and national demands. References World Health Organization. The World Health Report 2006-working together for health. UNFPA, ICM, WHO. The State of the World-s Midwifery (SoWMy) 2014. Key messages Information systems may contribute to the development of national and local policies in the country. international organizations should focus on strengthening capacity of midwives at community and facility level.