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Date: Thu, 01 Nov 2001 15:22:35 -0500
From: Sonia Elabd <[log in to unmask]>
Subject: MNH Update, October 2001
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Please click on the website address http://www.mnh.jhpiego.org/updates/index.htm to read the October MNH Update. For those who cannot access the version on the website, please scroll down below for a text version.
BOLIVIA ISSUES MINISTERIAL RESOLUTION OFFICIALLY MANDATING EVIDENCE-BASED MATERNAL AND NEWBORN HEALTH PRACTICES
As a result of the MNH Program's advocacy efforts, the Bolivian Ministry of Health (MOH) has issued a Ministerial Resolution officially incorporating evidence-based practices from the Managing Complications in Pregnancy and Childbirth manual as the national standard in MOH and private health facilities throughout the country. The resolution not only promotes practices such as active management of the third stage of labor, birth preparedness and complication readiness, but also discusses how to improve quality of care and increase community involvement. The MOH is also adopting the revised World Health Organization (WHO) partograph.
Basic Health Insurance, a World Bank-funded Health Reform project, will provide administrative, financial and logistical resources for the implementation of these practices.
This resolution is an important policy-level change in Bolivia that will not only serve as a solid foundation to expand training, community-level efforts and potential cost-related studies in the country, but also provide an opportunity to scale up program activities to the national level.
PREVENTING POSTPARTUM HEMORRHAGE: MANAGING THE THIRD STAGE OF LABOR
The September issue of Outlook, a publication of Program for Appropriate Technology in Health (PATH), is devoted to an important topic in maternal and neonatal health. The issue, "Preventing Postpartum Hemorrhage: Managing the Third Stage of Labor," reviews the impact of postpartum hemorrhage on maternal deaths and the effectiveness of active management of the third stage of labor as an intervention to prevent and manage postpartum hemorrhage. This issue, which is available on the PATH website (www.path.org), is the result of a collaboration between PATH and the MNH Program.
ANTENATAL CARE: OLD MYTHS, NEW REALITIES
On 4 October 2001, Barbara Kinzie, Director of Midwifery Health Services, and Cindy Stanton, Director of Monitoring and Evaluation, MNH Program, gave a presentation on focused antenatal care as part of the USAID/Washington Maternal Health (PHN/SO2) Technical Series. The presentation, titled "Antenatal Care: Old Myths, New Realities," is summarized below.
Antenatal care, the care a woman receives throughout her pregnancy, is essential to ensuring that mothers and newborns survive pregnancy and childbirth. The traditional approach to antenatal care, which is based on European models developed in the early 1900s, emphasizes the frequency and number of visits and categorizes women by risk to determine their chances of developing complications during childbirth.
The limitations of this approach are the following:
· Frequent visits do not necessarily improve pregnancy outcomes. In developing countries, these visits are logistically and financially difficult for women.
· Many women categorized as "high risk" never develop complications, and women categorized as "low risk" often do. In fact, women who may have risk factors often consume scarce resources and divert resources away from the improvement of services for all women.
· Women who are categorized as "low risk" have a false sense of security and are not prepared to recognize or respond to signs of complications.
Because every pregnant woman is at risk for complications, every pregnant woman should receive the same quality of care.
Therefore, focused antenatal care is an updated approach to antenatal care that emphasizes goal-directed interventions that address the most prevalent health issues affecting mothers and newborns. These interventions include the following elements:
· Early detection of problems and prevention. If left untreated, conditions such as HIV and syphilis can severely affect the health of the mother and newborn, so early treatment is essential. Tetanus toxoid and iron and folate supplements are two preventive interventions that can prevent many maternal and neonatal deaths.
· Counseling and health promotion. Talking to the woman about signs of complications, her nutrition during pregnancy and other issues related to her pregnancy can help ensure she has a safe and healthy pregnancy and childbirth.
· Birth preparedness and complication readiness. Preparing for the location of, transportation to and items needed for the birth is just as important as the birth itself. Planning for complications, if they arise, is equally important.
The full text of the presentation, as well as other materials on focused antenatal care, is available on the MNH website (http://www.mnh.jhpiego.org/news/index.htm).
Burkina Faso, Ghana, Guatemala, Nepal and Tanzania have implemented focused antenatal care into healthcare services at various sites around each country. For more details, please read the Promoting Focused Antenatal Care at the Country Level document on the MNH website.
The MNH Program will give several presentations as part of the SO2 Technical Series during the next 6 months; the December and January presentations are described below.
6 December 2001 - Social Mobilization: Moving from Community to Global Action
Nancy Russell, Director of Social Mobilization, will present the MNH Program approach to social mobilization, including examples from country programs in Burkina Faso, Indonesia and Nepal. The MNH social mobilization framework is based on birth preparedness and complication readiness and engages multiple levels of society in collective action. The presenter will also share the tools that the MNH Program is developing to assist coalitions and networks to get meaningful results from their various activities.
10 January 2002 - Regional Expert Development for Maternal and Neonatal Health
Patricia Gomez, Midwifery Advisor, Barbara Kinzie, Director of Midwifery Health Services, Gloria Metcalfe, Midwifery Advisor, and Lois Schaefer, Chief of Clinical Services, will present the MNH Program process of developing regional maternal and neonatal health experts in Africa, Asia and Latin America. The presentation will also describe some of the activities in which these experts are involved as trainers, educators, change agents and leaders in maternal and neonatal health in their regions.
The MNH Program has released several new fact sheets about its work. Now available on the MNH website (http://www.mnh.jhpiego.org/resources/index.htm) are the following information sheets:
· Detection and Management of Hypertensive Disorders of Pregnancy
· Focused Antenatal Care
· Addressing Gender in Maternal and Newborn Healthcare
· Tanzania Country Profile
· Burkina Faso Country Profile
· Promoting Focused Antenatal Care at the Country Level
· Beyond the Call of Duty: Midwives Work to Improve Care in Ugandan Hospital
· Simple Approaches Save Newborns in Respiratory Distress
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The Maternal & Neonatal Health (MNH) Program at the JHPIEGO Corporation produces MNH Updates for those working to promote maternal and neonatal health. Activities reported are those of the MNH Program. Please notify us of other Safe Motherhood activities of interest to our readers. Your comments and suggestions are welcomed! Previous editions of MNH Updates can be viewed on our website at www.mnh.jhpiego.org/updates/index.htm. To obtain more information about MNH Updates, e-mail Sonia Elabd, [log in to unmask], or visit our website, www.mnh.jhpiego.org
This publication was made possible through support provided by the Office of Health and Nutrition, Center for Population, Health and Nutrition, Bureau for Global Programs, Field Support and Research, U.S. Agency for International Development, under the terms of Award No. HRN-A-00-98-00043-00. The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of the U.S. Agency for International Development.
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Dr Jane Sandall
Professor of Midwifery and Women's Health
King's College
57 Waterloo Road
London
SE1 8WA
Tel: 020 7848 3605
Fax: 020 7848 3506
email: [log in to unmask]
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