Maternal and Neonatal Health Programs

USAID's approach to maternal and neonatal health includes community involvement, the promotion of evidence-based policies, and compassionate, high-quality services. Promoting the attendance of skilled personnel at birth is central to USAID's approach. Skilled attendance is essential for recognizing and treating unpredictable maternal and newborn complications. USAID also promotes good nutrition and control of infectious diseases to improve pregnancy outcomes.

Maternal health and nutrition profoundly affect newborn survival and health, and regional trends in neonatal mortality (death during the first 28 days of life) parallel trends in maternal mortality. Countries in USAID?s Asia/Near East and Latin America/Caribbean regions, for example, have seen declines in neonatal mortality as maternal health has improved. In sub-Saharan Africa, however, some countries are experiencing increases in neonatal mortality as HIV/AIDS and other factors adversely affect maternal health and survival.

USAID supports quality health services delivered by medically trained providers. These services target vulnerable, high-mortality populations in areas with weak health services but a strong commitment to improving maternal and neonatal health. Programs prepare communities for births through improved maternal care, recognition of complications, and transportation and payment arrangements. USAID helps policymakers develop practical evidence-based care standards and quality assurance systems to ensure satisfaction and positive results. Key evidence-based interventions emphasize:

• Iron-folate supplementation
• Tetanus toxoid immunization
• Syphilis control
• Intermittent presumptive malaria treatment and use of bednets for malaria prevention
• Prevention of mother-to-child transmission of HIV
• Counseling on safe health practices and birth planning
• Safe, clean delivery
• Treatment of obstetric and newborn complications
• Early, exclusive breastfeeding and birth spacing

USAID will soon launch a special initiative to spotlight prevention of postpartum hemorrhage, the greatest cause of maternal mortality, in the context of maternal and neonatal health services. The initiative will address the critical issues of scientific standards of care and availability of essential drugs and supplies. The initiative's goal is to equip birth attendants – including home birth attendants and attendants in health centers and hospitals – with the skills, drugs, and supplies to deliver lifesaving care and reduce the toll of preventable maternal mortality.

USAID's Key Achievements in Maternal and Neonatal Health Programs:

• Antenatal care in Tanzania links with anemia, malaria, HIV, syphilis care.
  USAID supported nurse and midwife training to provide antenatal care that included prevention, diagnosis, and treatment for anemia and infectious diseases such as malaria, HIV/AIDS, and syphilis. A survey of USAID-supported facilities found that 59 percent of pregnant women received the first dose of preventive malaria treatment and 41 percent the second dose, compared with, respectively, 52 percent and 22 percent nationally.
  
  
• Fistula centers treat more than 3,000 women.
  Obstetric fistula is a debilitating condition that results from obstructed labor. It can cause permanent urinary and fecal incontinence, and affected women are often ostracized by their families and communities. In 2007, USAID supported 24 fistula repair centers in Bangladesh, Ethiopia, Uganda, Rwanda, the Democratic Republic of the Congo, Nigeria, Ghana, Sierra Leone, Guinea, Mali, and Niger. The centers repaired 3,106 fistulas, more than triple the number in 2006. USAID assistance included facility renovations,
  training, and support for improved detection and treatment of prolonged labor, as well as repair of fistulas.
  
  
• Postpartum hemorrhage program protects women in 37 countries.
  USAID is spearheading a global effort to prevent postpartum hemorrhage (PPH) through “active management of the third stage of labor” (AMTSL), in which drugs and physical procedures are used to reduce blood loss and transfusions. In 2007, USAID supported prevention programs in 37 countries, and more than 700,000 women in 31 of these countries received AMTSL. A project in Nepal that served more than 10,000 women with interventions to prevent PPH in home deliveries reduced mortality to a level one-eighth of the national rate. Kazakhstan also reduced PPH and blood transfusions with increased AMTSL. In Armenia, the Ministry of Health plans to expand AMTSL nationally after successfully introducing it in 2007, with USAID support, in target facilities. In addition, USAID supported a study in 10 countries in Africa, Asia, and Latin America that found a wide variation in the correct use of AMTSL and gave clear directions for program improvements.
  
  
• Quality improvement collaboratives expand PPH prevention in Ecuador and Niger.
  After a USAIDsupported quality improvement collaborative for obstetric care achieved 90 percent AMTSL coverage in nearly 40 percent of Ecuador’s maternity facilities, the Ministry of Health adopted AMTSL as national policy. Within nine months, 80 percent of facilities had adopted the practice. In Niger, USAID support reached one-third of facility births nationwide. Among 46,000 women who delivered in 39 health facilities, AMTSL coverage increased from 5 percent in 2006 to 98 percent in 2007, with significant declines in hemorrhage from 2 to 0.4 percent.
  
  
• Countries adopt, expand essential newborn care.
  USAID helped countries implement interventions such as exclusive breastfeeding, clean delivery, umbilical cord care, and early recognition of and referral for complications. In Bangladesh, community health workers in a community-based maternal and newborn program reached about 15,000 mothers and newborns (about 80 percent) within the first week of life to provide them with essential newborn care in their homes. USAID-supported research has shown that such simple home-and community-based interventions can reduce neonatal mortality by approximately 34 percent.
  
  
• USAID pilot projects in Russia reduce maternal mortality, abortion rates.
  Over the last four years, USAID-funded integrated maternal and child health/family planning projects in Vologda and Yakutiya helped these two regions cut maternal mortality rates in half and reduce abortion rates. USAID’s maternal and child health care program in Russia covers 21 pilot regions that share best practices for integrating family planning into family doctor training, providing contraceptives through health insurance, educating rural health care providers in family planning counseling, and providing postpartum and postabortion care.
  
  
• Programs focus on preventing hypothermia in newborns.
  USAID helped programs in Rwanda, Nigeria, Malawi, Nepal, and Bangladesh plan, introduce, or scale up interventions to prevent hypothermia in newborns. Low-birthweight babies are especially vulnerable to cold stress, which can be prevented by placing them
  on the chest of the mother or another caregiver, a practice known as kangaroo mother care. Research and interventions in India and Ukraine have shown that in combination with other newborn care behaviors, this practice can reduce neonatal mortality by 50 percent.