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. 2019 Mar 13;7(Suppl 1):S6-S26.
doi: 10.9745/GHSP-D-18-00427. Print 2019 Mar 11.

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

Claudia Morrissey Conlon  1 , Florina Serbanescu  2 , Lawrence Marum  3 , Jessica Healey  4 , Jonathan LaBrecque  5 , Reeti Hobson  6 , Marta Levitt  7 , Adeodata Kekitiinwa  8 , Brenda Picho  9 , Fatma Soud  10 , Lauren Spigel  11 , Mona Steffen  6 , Jorge Velasco  12 , Robert Cohen  5 , William Weiss  5
Affiliations

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

Claudia Morrissey Conlon et al. Glob Health Sci Pract. .

Abstract

Background: Ending preventable maternal and newborn deaths remains a global health imperative under United Nations Sustainable Development Goal targets 3.1 and 3.2. Saving Mothers, Giving Life (SMGL) was designed in 2011 within the Global Health Initiative as a public-private partnership between the U.S. government, Merck for Mothers, Every Mother Counts, the American College of Obstetricians and Gynecologists, the government of Norway, and Project C.U.R.E. SMGL's initial aim was to dramatically reduce maternal mortality in low-resource, high-burden sub-Saharan African countries. SMGL used a district health systems strengthening approach combining both supply- and demand-side interventions to address the 3 key delays to accessing effective maternity care in a timely manner: delays in seeking, reaching, and receiving quality obstetric services.

Implementation: The SMGL approach was piloted from June 2012 to December 2013 in 8 rural districts (4 each) in Uganda and Zambia with high levels of maternal deaths. Over the next 4 years, SMGL expanded to a total of 13 districts in Uganda and 18 in Zambia. SMGL built on existing host government and private maternal and child health platforms, and was aligned with and guided by Ugandan and Zambian maternal and newborn health policies and programs. A 35% reduction in the maternal mortality ratio (MMR) was achieved in SMGL-designated facilities in both countries during the first 12 months of implementation.

Results: Maternal health outcomes achieved after 5 years of implementation in the SMGL-designated pilot districts were substantial: a 44% reduction in both facility and districtwide MMR in Uganda, and a 38% decrease in facility and a 41% decline in districtwide MMR in Zambia. Facility deliveries increased by 47% (from 46% to 67%) in Uganda and by 44% (from 62% to 90%) in Zambia. Cesarean delivery rates also increased: by 71% in Uganda (from 5.3% to 9.0%) and by 79% in Zambia (from 2.7% to 4.8%). The average annual rate of reduction for maternal deaths in the SMGL-supported districts exceeded that found countrywide: 11.5% versus 3.5% in Uganda and 10.5% versus 2.8% in Zambia. The changes in stillbirth rates were significant (-13% in Uganda and -36% in Zambia) but those for pre-discharge neonatal mortality rates were not significant in either Uganda or Zambia.

Conclusion: A district health systems strengthening approach to addressing the 3 delays to accessing timely, appropriate, high-quality care for pregnant women can save women's lives from preventable causes and reduce stillbirths. The approach appears not to significantly impact pre-discharge neonatal mortality.

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Figures

FIGURE 1
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.
FIGURE 2
FIGURE 2
Saving Mothers, Giving Life-Designated Learning and Scale-Up Districts in Uganda and Zambia Source: Adapted from Saving Mothers, Giving Life.
See this image and copyright information in PMC

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