Suzanne Stalls - Academia.edu (original) (raw)
Papers by Suzanne Stalls
PLOS global public health, Feb 5, 2024
BMC Health Services Research
Introduction Respectful maternity care (RMC) is fundamental to women’s and families’ experience o... more Introduction Respectful maternity care (RMC) is fundamental to women’s and families’ experience of care and their decision about where to give birth. Studies from multiple countries describe the mistreatment of women during facility-based childbirth, though only a small number of studies from Guatemala have been published. Less information is available on women’s negative and positive experiences of childbirth care and health workers’ perceptions and experiences of providing maternity care. Methods As part of a program implemented in the Western Highlands of Guatemala to improve quality of reproductive maternal newborn and child health care, a mixed methods assessment was conducted in three hospitals and surrounding areas to understand women’s and health workers’ experience and perceptions of maternity care. The quantitative component included a survey of 31 maternity health workers and 140 women who had recently given birth in these hospitals. The qualitative component included in-...
Midwifery, Oct 1, 2018
A 0 ‘Midwifery matters more than ever’, states the landmark Lancet seies on midwifery ( Renfrew e... more A 0 ‘Midwifery matters more than ever’, states the landmark Lancet seies on midwifery ( Renfrew et al., 2014 ). The State of the World’s Midifery 2014 estimates that midwives who are well educated, trained, icensed and regulated are capable of providing 87% of the essential exual, reproductive, maternal and newborn healthcare services that imrove pregnancy, birth and postpartum outcomes, and increase access o universal health coverage ( United Nations Population Fund, 2014 ). uch a workforce can respond to the fundamental needs of women, baies and families that are, still too often, not met with skilled, comassionate care. Given the current emphasis on midwives as pivotal in trengthening health systems and service delivery throughout the world, hpiego, an organisation long supportive of nurses and midwives, has arefully examined the components of a sound approach to training and ducating midwives. Midwifery education is the foundation supporting he development of midwives who can provide skilled care upon gradution, and are poised for careers in which they influence the availability nd accessibility of high-quality care through example, leadership and dvocacy. In 2012, Jhpiego developed a conceptual model for organising its ork in pre-service education ( Johnson et al., 2013 ). The model, deeloped after an integrative review of the literature to determine the haracteristics of high-quality pre-service education, depicts the essenial inputs and influencing factors that determine an educational sysem’s ability to produce competent graduates. Although there are few tudies of the impact of high-quality pre-service education on health and ealth systems outcomes, it is logical to assume that a skilled workforce ontributes to the achievement of national and global health goals. The overarching principle of any educational approach must be cometence. Fig. 1 illustrates five essential inputs for an educational system o produce competent graduates: (a) curriculum; (b) infrastructure and anagement; (c) teachers, tutors and preceptors; (d) students; and (e) linical practice sites. These inputs are buttressed by the supporting reglatory and licensing architecture of the governmental system, which, f weak, can undermine even the best efforts in education. The scope f this discussion will not permit an exhaustive examination of the suporting architecture of the profession, but the importance of regulation nd licensing cannot be underestimated. The skilled midwifery workorce of the future will benefit from the recognition that each of these ve factors is essential, and that the interplay between them creates a ully enabled learning environment for midwives. Long thought to be the key that unlocks the kingdom of higher learnng, it is now understood that a curriculum must be evidence based and,
BMC Pregnancy and Childbirth, Apr 20, 2022
Background: Mental health has long fallen behind physical health in attention, funding, and actio... more Background: Mental health has long fallen behind physical health in attention, funding, and action-especially in low-and middle-income countries (LMICs). It has been conspicuously absent from global reproductive, maternal, newborn, child, and adolescent health (MNCAH) programming, despite increasing awareness of the intergenerational impact of common perinatal mental disorders (CPMDs). However, the universal health coverage (UHC) movement and COVID-19 have brought mental health to the forefront, and the MNCAH community is looking to understand how to provide women effective, sustainable care at scale. To address this, MOMENTUM Country and Global Leadership (MCGL) commissioned a landscape analysis in December 2020 to assess the state of CPMDs and identify what is being done to address the burden in LMICs. Methods: The landscape analysis (LA) used a multitiered approach. First, reviewers chose a scoping review methodology to search literature in PubMed, Google Scholar, PsychInfo, and Scopus. Titles and abstracts were reviewed before a multidisciplinary team conducted data extraction and analysis on relevant articles. Second, 44 key informant interviews and two focus group discussions were conducted with mental health, MNCAH, humanitarian, nutrition, gender-based violence (GBV), advocacy, and implementation research experts. Finally, reviewers completed a document analysis of relevant mental health policies from 19 countries. Results: The LA identified risk factors for CPMDs, maternal mental health interventions and implementation strategies, and remaining knowledge gaps. Risk factors included social determinants, such as economic or gender inequality, and individual experiences, such as stillbirth. Core components identified in successful perinatal mental health (PMH) interventions at community level included stepped care, detailed context assessments, task-sharing models, and talk therapy; at health facility level, they included pre-service training on mental health, trained and supervised providers, referral and assessment processes, mental health support for providers, provision of respectful care, and linkages with GBV services. Yet, significant gaps remain in understanding how to address CPMDs. Conclusion: These findings illuminate an urgent need to provide CPMD prevention and care to women in LMICs. The time is long overdue to take perinatal mental health seriously. Efforts should strive to generate better evidence while implementing successful approaches to help millions of women "suffering in silence. "
BMC Pregnancy and Childbirth
BackgroundMental health has long fallen behind physical health in attention, funding, and action—... more BackgroundMental health has long fallen behind physical health in attention, funding, and action—especially in low- and middle-income countries (LMICs). It has been conspicuously absent from global reproductive, maternal, newborn, child, and adolescent health (MNCAH) programming, despite increasing awareness of the intergenerational impact of common perinatal mental disorders (CPMDs). However, the universal health coverage (UHC) movement and COVID-19 have brought mental health to the forefront, and the MNCAH community is looking to understand how to provide women effective, sustainable care at scale. To address this, MOMENTUM Country and Global Leadership (MCGL) commissioned a landscape analysis in December 2020 to assess the state of CPMDs and identify what is being done to address the burden in LMICs.MethodsThe landscape analysis (LA) used a multitiered approach. First, reviewers chose a scoping review methodology to search literature in PubMed, Google Scholar, PsychInfo, and Scop...
BMC Pregnancy and Childbirth
Common perinatal mental disorders are the most frequent complications of pregnancy, childbirth an... more Common perinatal mental disorders are the most frequent complications of pregnancy, childbirth and the postpartum period, and the prevalence among women in low- and middle-income countries is the highest at nearly 20%. Women are the cornerstone of a healthy and prosperous society and until their mental health is taken as seriously as their physical wellbeing, we will not improve maternal mortality, morbidity and the ability of women to thrive. On the heels of several international efforts to put perinatal mental health on the global agenda, we propose seven urgent actions that the international community, governments, health systems, academia, civil society, and individuals should take to ensure that women everywhere have access to high-quality, respectful care for both their physical and mental wellbeing. Addressing perinatal mental health promotion, prevention, early intervention and treatment of common perinatal mental disorders must be a global priority.
Midwifery, Oct 3, 2018
A 0 ‘Midwifery matters more than ever’, states the landmark Lancet seies on midwifery ( Renfrew e... more A 0 ‘Midwifery matters more than ever’, states the landmark Lancet seies on midwifery ( Renfrew et al., 2014 ). The State of the World’s Midifery 2014 estimates that midwives who are well educated, trained, icensed and regulated are capable of providing 87% of the essential exual, reproductive, maternal and newborn healthcare services that imrove pregnancy, birth and postpartum outcomes, and increase access o universal health coverage ( United Nations Population Fund, 2014 ). uch a workforce can respond to the fundamental needs of women, baies and families that are, still too often, not met with skilled, comassionate care. Given the current emphasis on midwives as pivotal in trengthening health systems and service delivery throughout the world, hpiego, an organisation long supportive of nurses and midwives, has arefully examined the components of a sound approach to training and ducating midwives. Midwifery education is the foundation supporting he development of midwives who can provide skilled care upon gradution, and are poised for careers in which they influence the availability nd accessibility of high-quality care through example, leadership and dvocacy. In 2012, Jhpiego developed a conceptual model for organising its ork in pre-service education ( Johnson et al., 2013 ). The model, deeloped after an integrative review of the literature to determine the haracteristics of high-quality pre-service education, depicts the essenial inputs and influencing factors that determine an educational sysem’s ability to produce competent graduates. Although there are few tudies of the impact of high-quality pre-service education on health and ealth systems outcomes, it is logical to assume that a skilled workforce ontributes to the achievement of national and global health goals. The overarching principle of any educational approach must be cometence. Fig. 1 illustrates five essential inputs for an educational system o produce competent graduates: (a) curriculum; (b) infrastructure and anagement; (c) teachers, tutors and preceptors; (d) students; and (e) linical practice sites. These inputs are buttressed by the supporting reglatory and licensing architecture of the governmental system, which, f weak, can undermine even the best efforts in education. The scope f this discussion will not permit an exhaustive examination of the suporting architecture of the profession, but the importance of regulation nd licensing cannot be underestimated. The skilled midwifery workorce of the future will benefit from the recognition that each of these ve factors is essential, and that the interplay between them creates a ully enabled learning environment for midwives. Long thought to be the key that unlocks the kingdom of higher learnng, it is now understood that a curriculum must be evidence based and,
Journal of the Association of Nurses in AIDS Care, 2016
Nurses and midwives constitute the majority of the global health workforce and the largest health... more Nurses and midwives constitute the majority of the global health workforce and the largest health care expenditure. Efficient production, successful deployment, and ongoing retention based on carefully constructed policies regarding the career opportunities of nurses, midwives, and other providers in health care systems are key to ensuring universal health coverage. Yet nurses are constrained by practice regulations, workplaces, and career ladder barriers from contributing to primary health care delivery. Evidence shows that quality HIV care, comparable to that of physicians, is provided by trained nurses and associate clinicians, but many African countries' health systems remain dependent on limited numbers of physicians and fail to meet the demand for treatment. The World Health Organization endorses task sharing to ensure universal health coverage in HIV and maternal health, which requires an investment in nursing education, retention, and professional growth opportunities. Exemplars from Haiti, Rwanda, Republic of Georgia, and multi-country efforts are described.
MCN. The American journal of maternal child nursing, 2012
The mission of the American College of Nurse-Midwives (ACNM) is to promote the health and well-be... more The mission of the American College of Nurse-Midwives (ACNM) is to promote the health and well-being of women and newborns within their families and communities through development and support of the profession of midwifery. The United Nations Millennium Development Goals 4 and 5 are to reduce infant and child mortality and improve maternal health through universal access to reproductive and reduction of maternal mortality. Significant, multilevel efforts are needed to achieve these goals. Over the last three decades, ACNM has mentored several generations of midwives in more than 30 countries who have contributed talent and commitment to making the world a safer place for women and children. We have developed invaluable institutional knowledge of the components required to build a profession of competent and qualified healthcare providers of maternal and infant care. The major focal areas of our Department of Global Outreach include (1) development and implementation of in-service t...
BMC Pregnancy and Childbirth, 2010
Background: Maternal and newborn mortality rates remain unacceptably high, especially where the m... more Background: Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes. Methods/Design: We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and improvement of quality of care in health facilities on perinatal mortality in low and middle-income countries where the majority of births take place in homes or first level care facilities. This trial will take place in 106 clusters (300-500 deliveries per year each) across 7 sites of the Global Network for Women's and Children's Health Research in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. The trial intervention has three key elements, community mobilization, home-based life saving skills for communities and birth attendants, and training of providers at obstetric facilities to improve quality of care. The primary outcome of the trial is perinatal mortality. Secondary outcomes include rates of stillbirth, 7-day neonatal mortality, maternal death or severe morbidity (including obstetric fistula, eclampsia and obstetrical sepsis) and 28-day neonatal mortality. Discussion: In this trial, we are evaluating a combination of interventions including community mobilization and facility training in an attempt to improve pregnancy outcomes. If successful, the results of this trial will provide important information for policy makers and clinicians as they attempt to improve delivery services for pregnant women and newborns in low-income countries.
BMC Medicine, 2013
Background: Fetal and neonatal mortality rates in low-income countries are at least 10-fold great... more Background: Fetal and neonatal mortality rates in low-income countries are at least 10-fold greater than in high-income countries. These differences have been related to poor access to and poor quality of obstetric and neonatal care. Methods: This trial tested the hypothesis that teams of health care providers, administrators and local residents can address the problem of limited access to quality obstetric and neonatal care and lead to a reduction in perinatal mortality in intervention compared to control locations. In seven geographic areas in five low-income and one middle-income country, most with high perinatal mortality rates and substantial numbers of home deliveries, we performed a cluster randomized non-masked trial of a package of interventions that included community mobilization focusing on birth planning and hospital transport, community birth attendant training in problem recognition, and facility staff training in the management of obstetric and neonatal emergencies. The primary outcome was perinatal mortality at ≥28 weeks gestation or birth weight ≥1000 g. Results: Despite extensive effort in all sites in each of the three intervention areas, no differences emerged in the primary or any secondary outcome between the intervention and control clusters. In both groups, the mean perinatal mortality was 40.1/1,000 births (P = 0.9996). Neither were there differences between the two groups in outcomes in the last six months of the project, in the year following intervention cessation, nor in the clusters that best implemented the intervention. Conclusions: This cluster randomized comprehensive, large-scale, multi-sector intervention did not result in detectable impact on the proposed outcomes. While this does not negate the importance of these interventions, we expect that achieving improvement in pregnancy outcomes in these settings will require substantially more obstetric and neonatal care infrastructure than was available at the sites during this trial, and without them provider training and community mobilization will not be sufficient. Our results highlight the critical importance of evaluating outcomes in randomized trials, as interventions that should be effective may not be. Trial registration: ClinicalTrials.gov NCT01073488
Journal of midwifery & women's health
PLOS global public health, Feb 5, 2024
BMC Health Services Research
Introduction Respectful maternity care (RMC) is fundamental to women’s and families’ experience o... more Introduction Respectful maternity care (RMC) is fundamental to women’s and families’ experience of care and their decision about where to give birth. Studies from multiple countries describe the mistreatment of women during facility-based childbirth, though only a small number of studies from Guatemala have been published. Less information is available on women’s negative and positive experiences of childbirth care and health workers’ perceptions and experiences of providing maternity care. Methods As part of a program implemented in the Western Highlands of Guatemala to improve quality of reproductive maternal newborn and child health care, a mixed methods assessment was conducted in three hospitals and surrounding areas to understand women’s and health workers’ experience and perceptions of maternity care. The quantitative component included a survey of 31 maternity health workers and 140 women who had recently given birth in these hospitals. The qualitative component included in-...
Midwifery, Oct 1, 2018
A 0 ‘Midwifery matters more than ever’, states the landmark Lancet seies on midwifery ( Renfrew e... more A 0 ‘Midwifery matters more than ever’, states the landmark Lancet seies on midwifery ( Renfrew et al., 2014 ). The State of the World’s Midifery 2014 estimates that midwives who are well educated, trained, icensed and regulated are capable of providing 87% of the essential exual, reproductive, maternal and newborn healthcare services that imrove pregnancy, birth and postpartum outcomes, and increase access o universal health coverage ( United Nations Population Fund, 2014 ). uch a workforce can respond to the fundamental needs of women, baies and families that are, still too often, not met with skilled, comassionate care. Given the current emphasis on midwives as pivotal in trengthening health systems and service delivery throughout the world, hpiego, an organisation long supportive of nurses and midwives, has arefully examined the components of a sound approach to training and ducating midwives. Midwifery education is the foundation supporting he development of midwives who can provide skilled care upon gradution, and are poised for careers in which they influence the availability nd accessibility of high-quality care through example, leadership and dvocacy. In 2012, Jhpiego developed a conceptual model for organising its ork in pre-service education ( Johnson et al., 2013 ). The model, deeloped after an integrative review of the literature to determine the haracteristics of high-quality pre-service education, depicts the essenial inputs and influencing factors that determine an educational sysem’s ability to produce competent graduates. Although there are few tudies of the impact of high-quality pre-service education on health and ealth systems outcomes, it is logical to assume that a skilled workforce ontributes to the achievement of national and global health goals. The overarching principle of any educational approach must be cometence. Fig. 1 illustrates five essential inputs for an educational system o produce competent graduates: (a) curriculum; (b) infrastructure and anagement; (c) teachers, tutors and preceptors; (d) students; and (e) linical practice sites. These inputs are buttressed by the supporting reglatory and licensing architecture of the governmental system, which, f weak, can undermine even the best efforts in education. The scope f this discussion will not permit an exhaustive examination of the suporting architecture of the profession, but the importance of regulation nd licensing cannot be underestimated. The skilled midwifery workorce of the future will benefit from the recognition that each of these ve factors is essential, and that the interplay between them creates a ully enabled learning environment for midwives. Long thought to be the key that unlocks the kingdom of higher learnng, it is now understood that a curriculum must be evidence based and,
BMC Pregnancy and Childbirth, Apr 20, 2022
Background: Mental health has long fallen behind physical health in attention, funding, and actio... more Background: Mental health has long fallen behind physical health in attention, funding, and action-especially in low-and middle-income countries (LMICs). It has been conspicuously absent from global reproductive, maternal, newborn, child, and adolescent health (MNCAH) programming, despite increasing awareness of the intergenerational impact of common perinatal mental disorders (CPMDs). However, the universal health coverage (UHC) movement and COVID-19 have brought mental health to the forefront, and the MNCAH community is looking to understand how to provide women effective, sustainable care at scale. To address this, MOMENTUM Country and Global Leadership (MCGL) commissioned a landscape analysis in December 2020 to assess the state of CPMDs and identify what is being done to address the burden in LMICs. Methods: The landscape analysis (LA) used a multitiered approach. First, reviewers chose a scoping review methodology to search literature in PubMed, Google Scholar, PsychInfo, and Scopus. Titles and abstracts were reviewed before a multidisciplinary team conducted data extraction and analysis on relevant articles. Second, 44 key informant interviews and two focus group discussions were conducted with mental health, MNCAH, humanitarian, nutrition, gender-based violence (GBV), advocacy, and implementation research experts. Finally, reviewers completed a document analysis of relevant mental health policies from 19 countries. Results: The LA identified risk factors for CPMDs, maternal mental health interventions and implementation strategies, and remaining knowledge gaps. Risk factors included social determinants, such as economic or gender inequality, and individual experiences, such as stillbirth. Core components identified in successful perinatal mental health (PMH) interventions at community level included stepped care, detailed context assessments, task-sharing models, and talk therapy; at health facility level, they included pre-service training on mental health, trained and supervised providers, referral and assessment processes, mental health support for providers, provision of respectful care, and linkages with GBV services. Yet, significant gaps remain in understanding how to address CPMDs. Conclusion: These findings illuminate an urgent need to provide CPMD prevention and care to women in LMICs. The time is long overdue to take perinatal mental health seriously. Efforts should strive to generate better evidence while implementing successful approaches to help millions of women "suffering in silence. "
BMC Pregnancy and Childbirth
BackgroundMental health has long fallen behind physical health in attention, funding, and action—... more BackgroundMental health has long fallen behind physical health in attention, funding, and action—especially in low- and middle-income countries (LMICs). It has been conspicuously absent from global reproductive, maternal, newborn, child, and adolescent health (MNCAH) programming, despite increasing awareness of the intergenerational impact of common perinatal mental disorders (CPMDs). However, the universal health coverage (UHC) movement and COVID-19 have brought mental health to the forefront, and the MNCAH community is looking to understand how to provide women effective, sustainable care at scale. To address this, MOMENTUM Country and Global Leadership (MCGL) commissioned a landscape analysis in December 2020 to assess the state of CPMDs and identify what is being done to address the burden in LMICs.MethodsThe landscape analysis (LA) used a multitiered approach. First, reviewers chose a scoping review methodology to search literature in PubMed, Google Scholar, PsychInfo, and Scop...
BMC Pregnancy and Childbirth
Common perinatal mental disorders are the most frequent complications of pregnancy, childbirth an... more Common perinatal mental disorders are the most frequent complications of pregnancy, childbirth and the postpartum period, and the prevalence among women in low- and middle-income countries is the highest at nearly 20%. Women are the cornerstone of a healthy and prosperous society and until their mental health is taken as seriously as their physical wellbeing, we will not improve maternal mortality, morbidity and the ability of women to thrive. On the heels of several international efforts to put perinatal mental health on the global agenda, we propose seven urgent actions that the international community, governments, health systems, academia, civil society, and individuals should take to ensure that women everywhere have access to high-quality, respectful care for both their physical and mental wellbeing. Addressing perinatal mental health promotion, prevention, early intervention and treatment of common perinatal mental disorders must be a global priority.
Midwifery, Oct 3, 2018
A 0 ‘Midwifery matters more than ever’, states the landmark Lancet seies on midwifery ( Renfrew e... more A 0 ‘Midwifery matters more than ever’, states the landmark Lancet seies on midwifery ( Renfrew et al., 2014 ). The State of the World’s Midifery 2014 estimates that midwives who are well educated, trained, icensed and regulated are capable of providing 87% of the essential exual, reproductive, maternal and newborn healthcare services that imrove pregnancy, birth and postpartum outcomes, and increase access o universal health coverage ( United Nations Population Fund, 2014 ). uch a workforce can respond to the fundamental needs of women, baies and families that are, still too often, not met with skilled, comassionate care. Given the current emphasis on midwives as pivotal in trengthening health systems and service delivery throughout the world, hpiego, an organisation long supportive of nurses and midwives, has arefully examined the components of a sound approach to training and ducating midwives. Midwifery education is the foundation supporting he development of midwives who can provide skilled care upon gradution, and are poised for careers in which they influence the availability nd accessibility of high-quality care through example, leadership and dvocacy. In 2012, Jhpiego developed a conceptual model for organising its ork in pre-service education ( Johnson et al., 2013 ). The model, deeloped after an integrative review of the literature to determine the haracteristics of high-quality pre-service education, depicts the essenial inputs and influencing factors that determine an educational sysem’s ability to produce competent graduates. Although there are few tudies of the impact of high-quality pre-service education on health and ealth systems outcomes, it is logical to assume that a skilled workforce ontributes to the achievement of national and global health goals. The overarching principle of any educational approach must be cometence. Fig. 1 illustrates five essential inputs for an educational system o produce competent graduates: (a) curriculum; (b) infrastructure and anagement; (c) teachers, tutors and preceptors; (d) students; and (e) linical practice sites. These inputs are buttressed by the supporting reglatory and licensing architecture of the governmental system, which, f weak, can undermine even the best efforts in education. The scope f this discussion will not permit an exhaustive examination of the suporting architecture of the profession, but the importance of regulation nd licensing cannot be underestimated. The skilled midwifery workorce of the future will benefit from the recognition that each of these ve factors is essential, and that the interplay between them creates a ully enabled learning environment for midwives. Long thought to be the key that unlocks the kingdom of higher learnng, it is now understood that a curriculum must be evidence based and,
Journal of the Association of Nurses in AIDS Care, 2016
Nurses and midwives constitute the majority of the global health workforce and the largest health... more Nurses and midwives constitute the majority of the global health workforce and the largest health care expenditure. Efficient production, successful deployment, and ongoing retention based on carefully constructed policies regarding the career opportunities of nurses, midwives, and other providers in health care systems are key to ensuring universal health coverage. Yet nurses are constrained by practice regulations, workplaces, and career ladder barriers from contributing to primary health care delivery. Evidence shows that quality HIV care, comparable to that of physicians, is provided by trained nurses and associate clinicians, but many African countries' health systems remain dependent on limited numbers of physicians and fail to meet the demand for treatment. The World Health Organization endorses task sharing to ensure universal health coverage in HIV and maternal health, which requires an investment in nursing education, retention, and professional growth opportunities. Exemplars from Haiti, Rwanda, Republic of Georgia, and multi-country efforts are described.
MCN. The American journal of maternal child nursing, 2012
The mission of the American College of Nurse-Midwives (ACNM) is to promote the health and well-be... more The mission of the American College of Nurse-Midwives (ACNM) is to promote the health and well-being of women and newborns within their families and communities through development and support of the profession of midwifery. The United Nations Millennium Development Goals 4 and 5 are to reduce infant and child mortality and improve maternal health through universal access to reproductive and reduction of maternal mortality. Significant, multilevel efforts are needed to achieve these goals. Over the last three decades, ACNM has mentored several generations of midwives in more than 30 countries who have contributed talent and commitment to making the world a safer place for women and children. We have developed invaluable institutional knowledge of the components required to build a profession of competent and qualified healthcare providers of maternal and infant care. The major focal areas of our Department of Global Outreach include (1) development and implementation of in-service t...
BMC Pregnancy and Childbirth, 2010
Background: Maternal and newborn mortality rates remain unacceptably high, especially where the m... more Background: Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes. Methods/Design: We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and improvement of quality of care in health facilities on perinatal mortality in low and middle-income countries where the majority of births take place in homes or first level care facilities. This trial will take place in 106 clusters (300-500 deliveries per year each) across 7 sites of the Global Network for Women's and Children's Health Research in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. The trial intervention has three key elements, community mobilization, home-based life saving skills for communities and birth attendants, and training of providers at obstetric facilities to improve quality of care. The primary outcome of the trial is perinatal mortality. Secondary outcomes include rates of stillbirth, 7-day neonatal mortality, maternal death or severe morbidity (including obstetric fistula, eclampsia and obstetrical sepsis) and 28-day neonatal mortality. Discussion: In this trial, we are evaluating a combination of interventions including community mobilization and facility training in an attempt to improve pregnancy outcomes. If successful, the results of this trial will provide important information for policy makers and clinicians as they attempt to improve delivery services for pregnant women and newborns in low-income countries.
BMC Medicine, 2013
Background: Fetal and neonatal mortality rates in low-income countries are at least 10-fold great... more Background: Fetal and neonatal mortality rates in low-income countries are at least 10-fold greater than in high-income countries. These differences have been related to poor access to and poor quality of obstetric and neonatal care. Methods: This trial tested the hypothesis that teams of health care providers, administrators and local residents can address the problem of limited access to quality obstetric and neonatal care and lead to a reduction in perinatal mortality in intervention compared to control locations. In seven geographic areas in five low-income and one middle-income country, most with high perinatal mortality rates and substantial numbers of home deliveries, we performed a cluster randomized non-masked trial of a package of interventions that included community mobilization focusing on birth planning and hospital transport, community birth attendant training in problem recognition, and facility staff training in the management of obstetric and neonatal emergencies. The primary outcome was perinatal mortality at ≥28 weeks gestation or birth weight ≥1000 g. Results: Despite extensive effort in all sites in each of the three intervention areas, no differences emerged in the primary or any secondary outcome between the intervention and control clusters. In both groups, the mean perinatal mortality was 40.1/1,000 births (P = 0.9996). Neither were there differences between the two groups in outcomes in the last six months of the project, in the year following intervention cessation, nor in the clusters that best implemented the intervention. Conclusions: This cluster randomized comprehensive, large-scale, multi-sector intervention did not result in detectable impact on the proposed outcomes. While this does not negate the importance of these interventions, we expect that achieving improvement in pregnancy outcomes in these settings will require substantially more obstetric and neonatal care infrastructure than was available at the sites during this trial, and without them provider training and community mobilization will not be sufficient. Our results highlight the critical importance of evaluating outcomes in randomized trials, as interventions that should be effective may not be. Trial registration: ClinicalTrials.gov NCT01073488
Journal of midwifery & women's health