“Lives in the balance”: The politics of integration in the Partnership for Maternal, Newborn and Child Health: Table 1.

Abstract

A decade ago, the Partnership for Maternal, Newborn and Child Health (PMNCH) was established to combat the growing fragmentation of global health action into uncoordinated, issue-specific efforts. Inspired by dominant global public-private partnerships for health, the PMNCH brought together previously competing advocacy coalitions for safe motherhood and child survival and attracted support from major donors, foundations and professional bodies. Today, its founders highlight its achievements in generating priority for ‘MNCH’, encouraging integrated health systems thinking and demonstrating the value of collaboration in global health endeavours. Against this dominant discourse on the success of the PMNCH, this article shows that rhetoric in support of partnership and integration often masks continued structural drivers and political dynamics that bias the global health field towards vertical goals. Drawing on ethnographic research, this article examines the Safe Motherhood Initiative’s evolution into the PMNCH as a response to the competitive forces shaping the current global health field. Despite many successes, the PMNCH has struggled to resolve historically entrenched programmatic and ideological divisions between the maternal and child health advocacy coalitions. For the Safe Motherhood Initiative, the cost of operating within an extremely competitive policy arena has involved a partial renouncement of ambitions to broader social transformations in favour of narrower, but feasible and ‘sellable’ interventions. A widespread perception that maternal health remains subordinated to child health even within the Partnership has elicited self-protective responses from the safe motherhood contingent. Ironically, however, such responses may accentuate the kind of fragmentation to global health governance, financing and policy solutions that the Partnership was intended to challenge. The article contributes to the emerging critical ethnographic literature on global health initiatives by highlighting how integration may only be possible with a more radical conceptualization of global health governance.

Civil society participation in global public private partnerships for health

“…Our anaysis of 18 such partnerships shows that most of them indeed describe some level of engagement with actors they label civil society ‘partners’ and emphasise its value. However, our findings confirm the existence of a ‘rhetoric-reality gap’ when it comes to civil society participation ( Kapilashrami and Hanefeld, 2014 , Storeng and Béhague, 2016 ).…”

Whose Global, Which Health? Unsettling Collaboration with Careful Equivocation

“…For example, I would learn by watching Anne interact with her different global health audiences that she explicitly used the epidemiologist's conversion from story to number to challenge existing agendas of global health, which routinely deprioritize maternal health (Storeng and Béhague ). She measured the bodies of Mam women, but she also listened to them.…”

Accounting for abortion: Accomplishing transnational reproductive governance through post-abortion care in Senegal

“…In contrast to population control, which emphasized the overabundant, irresponsible fertility of ‘Third World women’ (McCann, 2016; Murphy, 2012; Takeshita, 2012), the SMI gained political support through its representation of motherhood as vulnerable and selfless (Rance, 1997). Organizations like the Partnership for Maternal, Newborn, and Child Health have leveraged the affective and physical bonds between newborns and mothers into increased funding for maternal health (Storeng & Behague, 2016). The connection between Safe Motherhood and child survival has been increasingly salient in consolidating the SMI’s political respectability in a global reproductive health landscape dominated by the anti-abortion policies of the US since the early 1980s (Crane & Dusenberry, 2004; Dixon-Mueller, 1993).…”

“…They maintain professional jurisdiction over obstetric care by recording most hospitalized abortions as cases of miscarriage rather than induced abortion. The sanitized account of post-abortion care produced in hospitals, circulated throughout the health information system, and deployed by national health policymakers and international reproductive health non-governmental organizations (NGOs) and donor agencies engenders a reproductive subject—an expectant mother experiencing the miscarriage of a desired pregnancy—that resonates with global health programs such as the Safe Motherhood Initiative that have not only valorized the vulnerability of motherhood, but also privileged it as the primary reproductive identity worthy of investment by governments, aid donors, and other stakeholders (AbouZahr, 2003; Rance, 1997; Storeng & Behague, 2016). …”