Skip to main content

Main menu

  • Home
  • Issues
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
    • COVID-19 Articles
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Submit Manuscript
  • About
    • About GHSP
    • Editorial Team
    • Editorial Board
    • FAQs
    • Instructions for Reviewers
  • Sign up for Alerts
  • Webinars
    • Local Voices Webinar
    • Connecting Creators and Users of Knowledge
    • Publishing About Programs in GHSP
  • News
    • GHSP Call for Papers
  • Other Useful Sites
    • GH eLearning
    • GHJournal Search

User menu

  • My Alerts

Search

  • Advanced search
Global Health: Science and Practice
  • Other Useful Sites
    • GH eLearning
    • GHJournal Search
  • My Alerts

Global Health: Science and Practice

Dedicated to what works in global health programs

Advanced Search

  • Home
  • Issues
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
    • COVID-19 Articles
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Submit Manuscript
  • About
    • About GHSP
    • Editorial Team
    • Editorial Board
    • FAQs
    • Instructions for Reviewers
  • Sign up for Alerts
  • Webinars
    • Local Voices Webinar
    • Connecting Creators and Users of Knowledge
    • Publishing About Programs in GHSP
  • News
    • GHSP Call for Papers
  • Visit GHSP on Facebook
  • Follow GHSP on Twitter
  • RSS
  • Find GHSP on LinkedIn
SYNTHESIS
Open Access

Saving Mothers, Giving Life: It Takes a System to Save a Mother (Republication)

Claudia Morrissey Conlon, Florina Serbanescu, Lawrence Marum, Jessica Healey, Jonathan LaBrecque, Reeti Hobson, Marta Levitt, Adeodata Kekitiinwa, Brenda Picho, Fatma Soud, Lauren Spigel, Mona Steffen, Jorge Velasco, Robert Cohen and William Weiss on behalf of the Saving Mothers, Giving Life Working Group
Global Health: Science and Practice March 2019, 7(1):20-40; https://doi.org/10.9745/GHSP-D-19-00092
Claudia Morrissey Conlon
aBureau for Global Health, U.S. Agency for International Development, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: Cconlon@usaid.gov
Florina Serbanescu
bDivision of Reproductive Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lawrence Marum
cCenters for Disease Control and Prevention, Lusaka, Zambia. Now retired.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jessica Healey
dU.S. Agency for International Development, Lusaka, Zambia. Now based in Monrovia, Liberia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jonathan LaBrecque
aBureau for Global Health, U.S. Agency for International Development, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Reeti Hobson
eBureau for Global Health, U.S. Agency for International Development, Washington, DC. Now with ICF, Rockville, MD, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Marta Levitt
fBureau for Global Health, U.S. Agency for International Development and RTI, Washington, DC, USA. Now with Palladium, Abuja, Nigeria.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Adeodata Kekitiinwa
gBaylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Brenda Picho
hInfectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Fatma Soud
iCenters for Disease Control and Prevention, Lusaka, Zambia. Now an independent consultant, Gainesville, FL, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lauren Spigel
jICF, Fairfax, VA, USA. Now with Ariadne Labs, Boston, MA, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mona Steffen
eBureau for Global Health, U.S. Agency for International Development, Washington, DC. Now with ICF, Rockville, MD, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jorge Velasco
kU.S. Agency for International Development, Papua, New Guinea.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Robert Cohen
aBureau for Global Health, U.S. Agency for International Development, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
William Weiss
aBureau for Global Health, U.S. Agency for International Development, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
PreviousNext
  • Article
  • Figures & Tables
  • Info & Metrics
  • Comments
  • PDF
Loading

Figures & Tables

Figures

  • Tables
  • FIGURE 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 1

    Saving Mothers, Giving Life Theory of Change Model

    Abbreviations: EmONC, emergency obstetric and newborn care; MCH, maternal and child health; MPDSR, maternal and perinatal death surveillance and response; MMR, maternal mortality ratio; NMR, neonatal mortality rate; PEPFAR, U.S. President's Emergency Plan for AIDS Relief; SMGL, Saving Mothers, Giving Life; USG, U.S. Government.

    Source: Adapted from Saving Mothers, Giving Life.57

  • FIGURE 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 2

    Saving Mothers, Giving Life-Designated Learning and Scale-Up Districts in Uganda and Zambia

    Source: Adapted from Saving Mothers, Giving Life.57

Tables

  • Figures
    • View popup
    TABLE 1.

    Saving Mothers, Giving Life Supplement Articles

    Article No.Article Title
    1Saving Mothers, Giving Life: it takes a system to save a mother
    2Impact of the Saving Mothers, Giving Life approach on decreasing maternal and perinatal deaths in Uganda and Zambia
    3Addressing the first delay in Saving Mothers, Giving Life districts in Uganda and Zambia: approaches and results for increasing demand for facility delivery services
    4Addressing the second delay in Saving Mothers, Giving Life districts in Uganda and Zambia: reaching appropriate maternal care in a timely manner
    5Addressing the third delay in Saving Mothers, Giving Life districts in Uganda and Zambia: ensuring adequate and appropriate facility-based maternal and perinatal health care
    6The costs and cost-effectiveness of a district-strengthening strategy to mitigate the 3 delays to quality maternal health care: results from Uganda and Zambia
    7Saving lives together: a qualitative evaluation of the Saving Mothers, Giving Life public-private partnership
    8Community perceptions of a 3-delays model intervention: a qualitative evaluation of Saving Mothers, Giving Life in Zambia
    9Did the Saving Mothers, Giving Life initiative expand timely access to lifesaving care in Uganda? A spatial district-level analysis of travel time to emergency obstetric and newborn care
    10Saving Mothers, Giving Life approach for strengthening health systems to reduce maternal and newborn deaths in 7 scale-up districts in northern Uganda
    11Sustainability and scale of the Saving Mothers, Giving Life approach in Uganda and Zambia
    • View popup
    TABLE 2.

    Uganda and Zambia National-Level Indicators at the Start of the SMGL Initiative

    IndicatorUgandaZambia
    Maternal mortality ratio (per 100,000 live births)420a262a
    Deliveries in facilities57%b48%c
    Births by cesarean delivery5%b3%c
    Birth attended by skilled birth attendant57%b47%c
    Antenatal care coverage: at least 4 visits48%b60%c
    HIV prevalence among adults 15–497%d12%d
    Pregnant women with HIV receiving antiretroviral therapy61%d93%d
    Total fertility rate6.2b6.2c
    Modern contraceptive prevalence rate among all women 15–4921%b25%c
    Neonatal mortality rate (per 1,000 live births)27b34c
    • Abbreviation: SMGL, Saving Mothers, Giving Life.

    • ↵a 2010 data from Trends in Maternal Mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division (https://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/).

    • ↵b 2011 data from Uganda Demographic and Health Survey 2011 (https://dhsprogram.com/pubs/pdf/FR264/FR264.pdf).

    • ↵c 2007 data from Zambia Demographic and Health Survey 2007 (https://www.dhsprogram.com/pubs/pdf/FR211/FR211[revised-05-12-2009].pdf).

    • ↵d 2011 data from UNAIDS AIDSinfo (http://aidsinfo.unaids.org/).

    • View popup
    TABLE 3.

    Emergency Obstetric and Newborn Care 9 Signal Functions

    Basic ServicesComprehensive Services
    1. Administer parenteral antibioticsPerform signal functions 1 through 7 plus:
    2. Administer uterotonic drugs (i.e., parenteral oxytocin, misoprostol)8. Surgery (cesarean delivery)
    3. Administer parenteral anticonvulsants for preeclampsia (i.e., magnesium sulfate)9. Blood transfusion
    4. Manually remove the placenta
    5. Remove retained products of conception (e.g., manual vacuum extraction, misoprostol, dilation and curettage)
    6. Perform assisted vaginal delivery (e.g., vacuum extraction, forceps delivery)
    7. Perform basic neonatal resuscitation (e.g., bag and mask)
    • Source: WHO, UNFPA, UNICEF, and Mailman School of Public Health.27

    • View popup
    TABLE 4.

    Key Results at Baseline and Phase 2 Endline in the SMGL Learning Districts

    SMGL IndicatorUgandaZambia
    2012 Baseline2016 Phase 2 Endline% Change Baseline to Phase 2Significancea2012 Baseline2016 Phase 2 Endline% Change Baseline to Phase 2Significancea
    GOAL
    Institutional MMR (per 100,000 live births)534300−44***370231−37.6***
    Community MMR (per 100,000 live births)452255−44***480284−40.8***
    Pre-discharge neonatal mortality rate (per 1,000 live births)8.47.6−10NS7.78.7+14NS
    Institutional perinatal mortality rate (per 1,000 births)39.334.4−13***37.928.2−26***
    Institutional total stillbirth rate (per 1,000 births)31.227.0−13***30.519.6−36***
    DEMAND
    Health facilities that report having a VHT (Uganda) or SMAG (Zambia) (%)1892+400***6493+46***
    Institutional delivery rate (%)4667+47***6390+44***
    Deliveries in EmONC facilities (%)2841+45***2629+12***
    Deliveries in lower-level facilities (health center II, III) (%)1726+48***3761+67***
    ACCESS
    Facilities that report having an associated mother's shelter (%)04NANA2949+69***
    Institutional deliveries supported by transport vouchers (%)624+277***Vouchers not provided in Zambia
    Number of BEmONC facilities where the 7 signal functions were performed in last 3 months39+200NA38+167NA
    Number of CEmONC facilities where the 9 signal functions were performed in last 3 months717+143NA45+25NA
    24/7 services at health centers (%)7589+18NS6596+41***
    QUALITY OF CARE
    Facilities reporting having performed newborn resuscitation in the previous 3 months (%)3488+155***2775+173***
    Facilities providing active management of the third stage of labor (%)7596+28***7296+33***
    Population-based cesarean delivery rate (%)5.39.0+71***2.74.8+79***
    Hospitals that currently have at least 1 long-acting family planning method (%)6394+51**5075+50NS
    Number of women receiving PMTCT treatment12622155+71NA9301036+11NA
    HEALTH SYSTEMS STRENGTHENING
    Hospitals conducting maternal death audits or reviews (%)3194+201***50100+100NA
    Health facilities that did not experience stock-outs of oxytocin in the last 12 months (%)5682+46***7575−0.4NS
    Health facilities that did not experience stock-outs of magnesium sulfate in the last 12 months (%)4864+34***2043+115***
    • Abbreviations: EmONC, emergency obstetric and newborn care; BEmONC, basic emergency obstetric and newborn care; CEmONC, comprehensive emergency obstetric and newborn care; MMR, maternal mortality ratio; NA, not applicable; NS, nonsignificant; SMAG, Safe Motherhood Action Group; VHT, Village Health Team; PMTCT, prevention of mother-to-child transmission of HIV.

    • ↵a *** P <.01; ** P <.05; * P <.10. NA in cases where significance testing was not warranted.

    • Source: Serbanescu et al.38

    • View popup
    TABLE 5.

    Select Indicators by Delivery Care Service Sector in Uganda, 2016

    IndicatorPublic-Sector FacilitiesPrivate-Sector FacilitiesSignificancea
    Maternal mortality ratio (per 100,000 live births)301295NS
    Direct case fatality rate1.81.5NS
    Perinatal mortality rate (per 1,000 births)34.036.4NS
    Intrapartum stillbirth rate (per 1,000 births)13.817.0**
    Total stillbirth rate (per 1,000 births)26.628.7NS
    Pre-discharge neonatal mortality rate (per 1,000 live births)7.67.9NS
    • Abbreviation: NS, nonsignificant.

    • ↵a ** P<.05.

    • Source: Serbanescu et al.38

PreviousNext
Back to top

In this issue

Global Health: Science and Practice: 7 (1)
Global Health: Science and Practice
Vol. 7, No. 1
March 22, 2019
  • Table of Contents
  • About the Cover
  • Index by Author
  • Complete Issue (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Global Health: Science and Practice.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Saving Mothers, Giving Life: It Takes a System to Save a Mother (Republication)
(Your Name) has forwarded a page to you from Global Health: Science and Practice
(Your Name) thought you would like to see this page from the Global Health: Science and Practice web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Saving Mothers, Giving Life: It Takes a System to Save a Mother (Republication)
Claudia Morrissey Conlon, Florina Serbanescu, Lawrence Marum, Jessica Healey, Jonathan LaBrecque, Reeti Hobson, Marta Levitt, Adeodata Kekitiinwa, Brenda Picho, Fatma Soud, Lauren Spigel, Mona Steffen, Jorge Velasco, Robert Cohen, William Weiss
Global Health: Science and Practice Mar 2019, 7 (1) 20-40; DOI: 10.9745/GHSP-D-19-00092

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Saving Mothers, Giving Life: It Takes a System to Save a Mother (Republication)
Claudia Morrissey Conlon, Florina Serbanescu, Lawrence Marum, Jessica Healey, Jonathan LaBrecque, Reeti Hobson, Marta Levitt, Adeodata Kekitiinwa, Brenda Picho, Fatma Soud, Lauren Spigel, Mona Steffen, Jorge Velasco, Robert Cohen, William Weiss
Global Health: Science and Practice Mar 2019, 7 (1) 20-40; DOI: 10.9745/GHSP-D-19-00092
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Statistics from Altmetric.com

Jump to section

  • Article
    • ABSTRACT
    • INTRODUCTION
    • THEORY OF CHANGE
    • COUNTRY CONTEXT
    • PROJECT DESIGN, IMPLEMENTATION, AND ASSESSMENT
    • RESULTS
    • DISCUSSION
    • CONCLUSIONS
    • Acknowledgments
    • Footnotes
    • Notes
    • REFERENCES
  • Figures & Tables
  • Info & Metrics
  • Comments
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Institutionalization of Projects Into Districts in Low- and Middle-Income Countries Needs Stewardship, Autonomy, and Resources
  • Google Scholar

More in this TOC Section

  • Saving Mothers, Giving Life: It Takes a System to Save a Mother
Show more SYNTHESIS

Similar Articles

US AIDJohns Hopkins Center for Communication ProgramsUniversity of Alberta

Follow Us On

  • Twitter
  • Facebook
  • LinkedIn
  • RSS

Articles

  • Current Issue
  • Advance Access Articles
  • Past Issues
  • Topic Collections
  • Most Read Articles
  • Supplements

More Information

  • Submit a Paper
  • Instructions for Authors
  • Instructions for Reviewers
  • GH Journals Database

About

  • About GHSP
  • Editorial Board
  • FAQs
  • Contact Us
  • Privacy Policy

© 2022 Creative Commons Attribution 4.0 International License. ISSN: 2169-575X

Powered by HighWire