Promoting quality maternal and newborn care: a reference manual for program managers

An integrated approach to maternity care, involving the development of a comprehensive maternal health system as well as a change in behaviours and in women’s socio-economic situation, is essential to the reduction of maternal and neonatal mortality. Produced by CARE, this manual reviews the progress made in the last ten years by safe motherhood programmes. It is intended to assist programme managers in the selection, monitoring and implementation of programmes that meet the needs of the local community.

The manual begins by assessing the extent of the problem through a review of the causes of maternal and newborn deaths, both medical and social. It identifies pre-pregnancy and pregnancy-related factors that affect maternal and neonatal mortality. It then goes on to discuss programme design, monitoring and implementation, and reveals CARE’s strategic framework. The last two chapters assess which of the current strategies has been most effective in addressing the problems highlighted in the previous chapters. A review of various country programmes underlines the importance of context-specific interventions.

The first half of the book concentrates on identifying the scope of the problem. It finds that:

• There are socio-cultural factors indirectly influencing maternal and neonatal mortality, such as the low status of women, poor nutrition, poverty, lack of education and violence against women. These elements determine what situation a woman will be in when becoming pregnant
• Factors that directly affect maternal and neonatal deaths can also be socio-economic, such as beliefs and practices, but are mostly medical: nutrition during pregnancy, birth planning, antenatal care services, presence of skilled professionals during childbirth, and the ‘four delays’ in accessing good quality obstetric services and postpartum and newborn care
• Evaluation should be present at every stage of the programme including the design stage.

The last two sections of the manual review numerous programmes that have taken place worldwide over the last decade. The best current practices in safe motherhood programmes are identified as follows:

• Educating women and their families in how to be healthy during pregnancy and how to recognise danger signs
• Improving antenatal facilities through the training of health workers and encouraging birth planning and prompt referral systems
• Improving transport infrastructure to prevent delays in reaching health facilities
• Ensuring the quality of obstetric care at health facilities through the presence of skilled professionals and adequate equipment and supplies of emergency medicine and blood.

Various country programmes, both comprehensive and targeted at specific issues, show the importance of strategically selecting interventions that will be appropriate in a particular setting. There is no blueprint for safe motherhood programmes and the success of the latter will ultimately depend on how well it responds to local needs.