Critical maternal health knowledge gaps in low- and middle-income countries for the post-2015 era

Abstract

Effective interventions to promote maternal health and address obstetric complications exist, however 800 women die every day during pregnancy and childbirth from largely preventable causes and more than 90 % of these deaths occur in low and middle income countries (LMIC). In 2014, the Maternal Health Task Force consulted 26 global maternal health researchers to identify persistent and critical knowledge gaps to be filled to reduce maternal morbidity and mortality and improve maternal health. The vision of maternal health articulated was comprehensive and priorities for knowledge generation encompassed improving the availability, accessibility, acceptability, and quality of institutional labor and delivery services and other effective interventions, such as contraception and safe abortion services. Respondents emphasized the need for health systems research to identify models that can deliver what is known to be effective to prevent and treat the main causes of maternal death at scale in different contexts and to sustain coverage and quality over time. Researchers also emphasized the development of tools to measure quality of care and promote ongoing quality improvement at the facility, district, and national level. Knowledge generation to improve distribution and retention of healthcare workers, facilitate task shifting, develop and evaluate training models to improve "hands-on" skills and promote evidence-based practice, and increase managerial capacity at different levels of the health system were also prioritized. Interviewees noted that attitudes, behavior, and power relationships between health professionals and within institutions must be transformed to achieve coverage of high-quality maternal health services in LMIC. The increasing burden of non-communicable diseases, urbanization, and the persistence of social and economic inequality were identified as emerging challenges that require knowledge generation to improve health system responses and evaluate progress. Respondents emphasized evaluating effectiveness, feasibility, and equity impacts of health system interventions. A prominent role for implementation science, evidence for policy advocacy, and interdisciplinary collaboration were identified as critical areas for knowledge generation to improve maternal health in the post-2015 era.

Obstetric violence: a new framework for identifying challenges to maternal healthcare in Argentina

“…30 However, these guidelines fail to translate in clinical practice. 31 For example, a study on public hospitals between 2004 and 2006 found that episiotomy is avoided only in 41.2% of primiparous pregnancies and that continuous support of women during childbirth occurs only in 17.9% of cases. 32 An analysis of cesarean rates also points in the same direction.…”

The role of community mobilization in the promotion of maternal health of women living with HIV in Zambia

“…On the other hand, strong evidence for women with HIV is still missing. The fact that strong evidence linking community mobilization to maternal health outcomes for women with HIV is still missing confirms Kendall and Langer's (2015) assertion that the intersection of HIV and pregnancy has generally been ignored in social science research (Kendall & Langer, 2015). This is despite the fact that women with HIV are more susceptible to morbidity and mortality during pregnancy (Kendall, et al, 2014).…”

“…In resource-poor settings where health systems are inefficient, research has shown that community mobilization can be a useful strategy for improving maternal care of HIV negative women (Colbourn, et al, 2013). Chapter 2 of this dissertation and other studies from SSA have shown that similar evidence for HIV positive women is still lacking despite them being more vulnerable given their HIV status (Kendall & Danel, 2004;Kendall & Langer, 2015). Besides the lack of evidence of the effect of community mobilization on maternal health care service provision for HIV positive women, there is a lack of evidence on local stakeholders' (HIV positive women) own perspectives of community mobilization vis-à-vis maternal health care (Kendall & Danel, 2004;Nhamo, et al, 2010;Lassi, et al, 2014).…”

“…Despite improvements in funding and policy recommendations by international organizations such as the WHO, maternal health remains a challenge in low income countries (ZDH, 2013;WHO, 2015;UNAIDS, 2013). Studies show that on average, in SSA countries, 720 women die each day during pregnancy and childbirth from causes which are largely preventable (Kendall & Langer, 2015). The worst maternal health outcomes are found in SSA (WHO, 2013;Kendall, et al, 2014).…”

“…This results from the uptake of antiretroviral treatment and caesarean births, which together promote PMTCT and the health of the mother (Sebitloane, et al, 2009;Ticconi, et al, 2003). Despite this, skilled maternal health utilization has remained unsatisfactory in most parts of SSA (Kendall & Langer, 2015). This means that the 'game-changing potential' of antiretroviral treatment aimed at radically reducing HIV-related maternal deaths is not being realized.…”