Maternal, Newborn, and Child Health
- Birthing Centers Staffed by Skilled Birth Attendants: Can They Be Effective … at Scale?
Peripheral-level birthing centers may be appropriate and effective in some circumstances if crucial systems requirements can be met. But promising models don’t necessarily scale well, so policy makers and program managers need to consider what requirements can and cannot be met feasibly at scale. Apparently successful components of the birthing center model, such as engagement of traditional birth attendants and use of frontline staff who speak the local language, appear conducive to use in other similar settings.
- Casas Maternas in the Rural Highlands of Guatemala: A Mixed-Methods Case Study of the Introduction and Utilization of Birthing Facilities by an Indigenous Population
In an isolated mountainous area of Guatemala with high maternal mortality, an NGO-sponsored approach engaged communities to operate local, culturally appropriate birthing facilities and is achieving high and equitable utilization. Likely success factors:
Community engagement and ownership
Close location of facilities
Perceived high quality of services
Engagement of traditional birth attendants in the birthing process and as advocates for facility use
- A Dedicated Postpartum Intrauterine Device Inserter: Pilot Experience and Proof of Concept
Use of the inserter was found to be safe, with high fundal placement in 82% of cases. Complete expulsion occurred in 7.5% of cases and partial expulsion was detected in 10%, comparable with rates in other studies using standard IUD insertion techniques. Further study and use of the dedicated inserter may reveal increased convenience and reduced risk of infection among users and could improve acceptability of postpartum IUD provision among providers.
- Role of Social Support in Improving Infant Feeding Practices in Western Kenya: A Quasi-Experimental Study
Fathers and grandmothers who participated in separate nutrition dialogue groups supported mothers to improve infant feeding practices including dietary diversity, food consistency, and use of animal-source foods. Future studies should explore using a family-centered approach that engages mothers together with key household influencers.
- Meeting Postpartum Women’s Family Planning Needs Through Integrated Family Planning and Immunization Services: Results of a Cluster-Randomized Controlled Trial in Rwanda
Integrating contraceptive services into infant immunization services was effective, acceptable, and feasible without negatively affecting immunization uptake. Yet unmet need for contraception remained high, including among a substantial number of women who were waiting for menses to return even though, at 6 months or more postpartum, they were at risk of an unintended pregnancy. More effort is needed to educate women about postpartum return to fertility and to encourage those desiring to space or limit pregnancy to use effective contraception.
- Mapping the Prevalence and Sociodemographic Characteristics of Women Who Deliver Alone: Evidence From Demographic and Health Surveys From 80 Countries
An estimated 2.2 million women surveyed in low- and middle-income countries between 2005 and 2015 gave birth alone. This practice was concentrated in West and Central Africa and parts of East Africa. Women who delivered with no one present were very poor, uneducated, older, and of higher parity. Experience from northern Nigeria suggests the practice can be reduced markedly by mobilizing religious and civil society leaders to improve community awareness about the critical importance of having an attendant present.
- Behavior Change Fast and Slow: Changing Multiple Key Behaviors a Long-Term Proposition?
An intensive radio campaign in rural areas of Burkina Faso addressed multiple key behaviors to reduce child mortality, using a randomized cluster design. After 20 months, despite innovative approaches and high reported listenership, only modest reported change in behavior was found, mainly related to care seeking rather than habitual behavior such as hand washing. Various methodologic difficulties may have obscured a true greater impact. Analysis of the intervention after its full 35-month duration may reveal more impact, including on actual child mortality. Improving a number of key behaviors is essential to child survival efforts, and much of it may require strong and sustained efforts.
- Pre-eclampsia as Underlying Cause for Perinatal Deaths: Time for Action
Pre-eclampsia is a major underlying cause of late fetal and early neonatal death, accounting for somewhere between 1 in 10 and 1 in 4 perinatal deaths; it warrants greater efforts from the maternal-newborn community.
- The Saturation+ Approach to Behavior Change: Case Study of a Child Survival Radio Campaign in Burkina Faso
This randomized radio campaign focused on the 3 principles of the Saturation+ approach to behavior change: (1) saturation (high exposure to messages), (2) science (basing design on data and modeling), and (3) creative storytelling. Locally developed short spots and longer dramas targeted multiple child survival-related behaviors and were delivered entirely by local radio stations. Innovative partnerships with radio stations provided free airtime in return for training, equipment, and investment in solar power.