The Opportunity and the Challenge

Delivering More for Mothers and Newborns on the Day of Birth

Koki Agarwal, M.D. Dr. PH Director Maternal and Child Survival Program /

Jhpiego, USA

Outline• Why focus on the

day of birth?• Opportunities for

achieving better care on the day of birth

• Challenges for delivering integrated services for mother and newborn

• Aligning with global initiatives

When do Newborns Die?

0

20

40

60

80

100

120

140

160

Source: Ronsmans and Koblinsky 2006

Perc

enta

ge

Almost half of all newborn occur on the day of birth

Source: 2005 Lancet Every Newborn Series

When Do Newborn Deaths Occur?

Birth is the Time of Greatest

Risk of Death and Disability

for Mothers and Newborns

Photo Credit: John Healey /ACCESS

40% of all maternal and newborn deaths occur within 24 hours of birth

1.2 million intrapartum stillbirths 1 million neonatal deaths 113,000 maternal deaths

Day of Birth…

Source: Lancet Every Newborn:progress, priorities, and potential beyond survival

The Opportunity: Better Care on the Day of BirthPregnancy

• Focused ANC• IPTp• GBV screening• Immunizations• Messages on danger

signs for mother and newborn• Messages on healthy

life conditions• Emergency & delivery

plans• FP counseling• Post abortion care• Management of

preterm labor

Day of Birth

Infection preventionRespectful care at birth

Effective labor careAMSTL

Immediate newborn careNeonatal resuscitation

Immediate postnatal careVacuum extractionEarly postnatal careManagement of PPHEarly detection and

management of complications

PPFP

Postnatal

• Essential newborn care• Management of

newborn and maternal sepsis• KMC• Nutrition messages• FP counseling and

services: IUD & implants

• Messages on health life conditions

• Immunizations• Messages on danger

signs for mother and newborn

• Emergency plan

Challenges for Achieving: Better Care on the Day of Birth• Vertical policy, programming,

measurement, and funding (e.g. ENAP, EPMM)

• Poor alignment of maternal and newborn interventions

• Compartmentalized provider training/capacity-building strategies

Photo Credit: Karen Kasmauski/MCSP

Local Realities: Access

Photo Credits: MCSP/MCHIP

Where the Rubber Hits the Road

Local Realities

Photo Credits: MCSP/MCHIP

Photo Credits: MCSP/MCHIP

Photo Credits: Jhpiego

Bringing the pieces together: Opportunities To Improve Care on the Day of

BirthBetter Health

Outcomes

ANC PNCBetter Care

on the Day of Birth

Commodities

Quality Improvement

Measurement

Capacity-

building

Health Systems Strengthening

WHO Quality of

Care Framework

for Childbirth

Source: BJOG 2015

Maternal and Child Survival

Program (MCSP)

Well Positioned to Strengthen Day of Birth Services for

Mothers and Newborns

FAMILY PLANNING

MATERNAL HEALTH

NEWBORNHEALTH

CHILDHEALTH

IMMUNIZATION

NUTRITIONHIV/TB

MALARIA

WASHMCSP

MCSP’s Commitment to Implementing at Scale

• Strengthening local health systems (e.g. district)

• Integrated capacity building• Ensuring commodities for mothers and

newborns• Continuous measurement of core DoB

indicators• Delivery of high-impact maternal &

newborn interventions • Supporting health workers and

managers

Photo Credit: Kate Holt/MCSP

Continuous quality improvement to achieve effective, safe and people-centered care for

mothers, newborns and families around the day of birth

Moving the Needle on the Day of Birth:

MCSP working in 22 of USAID 24 priority countriesCommitment to continuous shared learning across

countries

Contextual learning from Bangladesh, Pakistan and Tanzania

Thank You

Learn more at: www.mcsprogram.org

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For more information, please visitwww.mcsprogram.org

This presentation was made possible by the generous support of the American people through the United States Agency for International Development (USAID),

under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of the authors and do not necessarily reflect the views of

USAID or the United States Government.

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