UNFPA, ICM, WHO, UNICEF are organizing the 5th Global Midwifery Symposium at the IMNHC (Roof Terrace at CTICC 1). The Symposium brings together not only global midwifery leaders, but also stakeholders, policy makers, programme managers and other SRMNH healthcare professionals. Together we will discuss how the midwife-led model of care is best suited to provide quality respectful women centered care and end preventable maternal and newborn deaths; the challenges and opportunities that are there; the enabling environment that is needed and the inter-professional collaboration necessary for bringing about optimum health outcomes for a woman and her newborn. We will also learn about what global partners and countries are doing and commitments they want to make to strengthen this important cadre to help achieve the Health Sustainable Goal in ending preventable maternal and newborn mortality by 2030.

This is an invite-only event with a limited number of 60 open slots to be filled on first come first served basis. Requests for inclusion should be sent to masuda@unfpa.org and Lal@unfpa.org 

If for some reason you are unable to upload your presentation by the deadline of 04 May, you may bring it on a USB drive no less than 24 hours prior to your scheduled presentation(s) to the Presenter Assistance Room (Room 1.51-1.52). The Presenter Assistance Room will be open on the following dates/times:

- Sunday, 07 May, 13:00-18:00

- Monday, Tuesday, and Wednesday, 08-10 May, 08:00-17:00 Please bring a picture ID with you to the Presenter Assistance Room.

If for some reason you are unable to upload your presentation by the deadline of 04 May, you may bring it on a USB drive no less than 24 hours prior to your scheduled presentation(s) to the Presenter Assistance Room (Room 1.51-1.52). The Presenter Assistance Room will be open on the following dates/times:

- Sunday, 07 May, 13:00-18:00

- Monday, Tuesday, and Wednesday, 08-10 May, 08:00-17:00 Please bring a picture ID with you to the Presenter Assistance Room.

To accelerate progress on maternal and newborn health (MNH) outcomes, countries need to rethink how health systems are organized. Service Delivery Redesign (SDR) is a deliberate process of organizing care to make comprehensive obstetric and newborn services acceptable and available to all families within 30 minutes of place of birth. What are the requirements, opportunities, and challenges of this process?

For addressing the shocking stagnation in declines of maternal and newborn mortality, quality midwifery care provides the most needed, cost-effective solution. Come hear why! The United Nations Population Fund (UNFPA), International Confederation of Midwives (ICM), World Health Organization (WHO), United Nation's Children's Fund (UNICEF), and a host of global partners, including the International Federation of Gynecology and Obstetrics (FIGO), IPA, Jhpiego, and Laerdal, come together to launch a joint Global Call for Enhanced Investments in Midwifery.

The World Health Organization (WHO) is leading a collaborative effort to develop a knowledge translation toolkit for respectful maternal and newborn care that aims to enable implementation, scale-up, and cross-contextual learning. This is an interactive session with global stakeholders using a human-centered design approach to refine, contextualise, and operationalise the toolkit.

Sexual, reproductive, maternal, and newborn health (SRMNH) services are essential components of any humanitarian response, including infectious disease outbreaks. Come learn about two new operational guidance documents aimed at helping managers prepare for and provide SRMNH services during outbreaks in humanitarian and fragile settings.

-Croissants filled with seared beef, homemade pickled cucumber and creamed mustard 

-Scones with jam and fresh cream 

-Beverage service 

Group antenatal care (G-ANC) in more than 20 low- and middle-income countries (LMICs) has improved the quality and experience of care. So why isn't it being routinely offered to pregnant women? Participants will be engaged and equipped with practical step-by-step guidance to introduce and scale up G-ANC. The session is organized by the Group ANC Global Collaborative.

This interactive session will share early learning from Indonesia and Nigeria for implementing the World Health Organization (WHO) model for small and sick newborn (SSNB) care in level-2 facilities. Then the African Neonatal Network, a quality improvement and leadership community, will lead a hands-on workshop for clinicians to practice using data to improve care for SSNBs.

Perinatal mental health (PMH) disorders are the most frequent complication of pregnancy, childbirth, and the postpartum period globally. In this interactive and action-oriented session, participants will learn from and engage with world-renowned PMH providers, advocates, researchers, and survivors.

The aim of the session is to raise awareness on the impact of climate change (with a focus on extreme heat) on maternal and newborn health (MNH) and to start discussions on priority actions for global, national, and subnational MNH programmes to consider.

Video #1 

"WHO's programme on Climate Change and Health" Recorded Message from Elena Villalobos Prats, Department of Climate Change and Health at World Health Organization.

Video #2 

Too hot to Thrive: Effects of Heat on Pregnant Women and Newborns. Video produced by Dr Adelaide Lusambili and colleagues from CHAMNHA (Climate, Heat and Maternal and Neonatal Health in Africa). https://www.youtube.com/watch?v=A9_j6mr5QEA

Video #3

Recorded Message from Eugenia Kargbo, Chief Heat Officer, Freetown, Sierra Leone. 

-Mini bobotie pies

-Spinach and feta phyllo parcels

-Beverage service 

• Mini Durban Lamb Bunny chows with fresh coriander and apricot chutney 
• Mini Ostrich Boerewors Rolls with tomato and onion relish 
• Masala Fried Fish and Chip boats with tartare sauce on the side 
• Beef and brie sliders on mini seeded cocktail rolls with onion marmalade 
• Vegetable bobotie pies with apricot chutney 
• Cape Malay Chicken curry and basmati rice Bowl with crisp pappadum and fresh coriander 
• Spinach and feta linguine bowls with pesto and black olives 
• Falafel sliders with humus and chopped salad 
• Moroccan style vegetable tagine with herbed couscous and apricot compote 
• Dessert buffet 
  • Selection of truffles, macarons, caramelised hazelnut clusters, macadamia tarts, meringue nest with fruits, tiramisu Paris- Brest, glazed chocolate brownies mini fruit salad pots, fresh sliced fruits and condiments 
• Cheese buffet 
  • Brie and Camembert, potted Stilton, mature and mild Cheddar, Gouda, goat's cheese, savoury cheesecake, blue cheese and selection of bread and crackers, grapes, fig preserve and waatlemoenkonfyt (watermelon preserve) 
• Local beers, wines, soft drinks, semi espresso machine 

The opening plenary will set the stage for the week and celebrate the opening of the conference. It will feature remarks from our co-hosts, the AlignMNH Secretariat and the Government of South Africa, as well as representatives from the Bill and Melinda Gates Foundation, USAID, and advocates for midwifery as well as for prevention of stillbirth.

If for some reason you are unable to upload your presentation by the deadline of 04 May, you may bring it on a USB drive no less than 24 hours prior to your scheduled presentation(s) to the Presenter Assistance Room (Room 1.51-1.52). The Presenter Assistance Room will be open on the following dates/times:

- Sunday, 07 May, 13:00-18:00

- Monday, Tuesday, and Wednesday, 08-10 May, 08:00-17:00 Please bring a picture ID with you to the Presenter Assistance Room.

The second plenary, titled Exemplars of Country Success in Improving Maternal and Newborn Survival, will highlight countries that have achieved significant and measurable progress in maternal newborn health with comparable investments to other countries. It will feature what factors led them to this success and what other countries might adapt.

Every seven minutes a mother dies from postpartum hemorrhage, and approximately half of these deaths occur following a vaginal birth. The primary reasons for the deaths are non- or delayed diagnosis of postpartum hemorrhage and inconsistent delivery of effective interventions. The E-MOTIVE intervention addresses these challenges through early and accurate detection of postpartum hemorrhage (E) using a calibrated blood collection drape, and timely and consistent delivery of effective interventions via the MOTIVE bundle (MOTIVE: uterine Massage, Oxytocic drugs, Tranexamic acid, Intra-Venous fluids, and Examination and Escalation). The E-MOTIVE trial is a multi-centre (78 hospitals), multi-country (Nigeria, Kenya, Tanzania, and South Africa) cluster-randomized trial that recruited more than 200,000 participants. The preliminary findings of this trial will be shared at this conference. 

Introduction of an Evidence-Based Program of Early Essential Newborn Care (EENC) in Sudan: How Can EENC Reduce Neonatal Morbidity and Mortality?

In Sudan, the newborn mortality rate is estimated to be 33/1,000 live births and has declined at a slower rate than older child mortality over the last 10 years. Newborn deaths currently represent 49% (statistical report, WHO 2012) of under-five child deaths and 64% of all infant deaths, highlighting that the newborn period remains the period of highest risk for all infants. Sepsis and birth asphyxia are the most important immediate causes of infant mortality, with prematurity and low birthweight (LBW) contributing factors to a high fraction of newborn deaths; 32% of all babies are estimated to be low birthweight. Skilled birth attendants attend an estimated 78% of all births, although only 28% of these births take place in a health facility. In this paper, we explore the effort made by the Sudan Ministry of Health to strengthen newborn care by adopting Early Essential Newborn Care (EENC), a package of evidence-based interventions delivered during delivery and in the immediate newborn period using a coaching approach by the World Health Organization (WHO).

Improving Access to Quality Sexual and Reproductive Health for Internally Displaced Women and Girls and Vulnerable Host Communities within the COVID-19 Context in the Northwest and Southwest Regions in Cameroon: Late-Breaker

The six-year-long armed conflict in the Northwest (NW) and Southwest (SW) regions in Cameroon facilitated the displacement of skilled health workers. This contributed to decreased access to basic health care for pregnant women (PW). Many internally displaced persons (IDPs) and vulnerable populations (VPs) lost their income sources and experience exacerbated needs for sexual and reproductive health and rights (SRHR) services including family planning (FP), antenatal care (ANC), and delivery services. Funded by GIZ Pro-Passar, Reach Out Cameroon implemented a humanitarian response project aimed to improve access to and uptake of quality SRHR services for women and girls in these conflict-affected regions.

Last Mile Interventions to Eliminate Mother-to-Child Transmission in Post-disaster Settings: Experience from Rural Haiti 

Despite global ambition to end the AIDS epidemic, women from countries with civil and political conflicts live a different reality. With over 150,000 adults living with HIV, Haiti has the largest epidemic in the Caribbean. Haitian women pay the highest price, constituting 60% of people living with HIV (PLWH). Following the 2010 earthquake in Haiti, political instability, collective fear, and poor readiness of public health facilities limited access to HIV testing, which contributed to persistently high mother-to-child transmission of HIV. In collaboration with Haiti's Ministry of Health, Zanmi Lasante launched a breakthrough project to increase access to HIV testing at hard-to-reach facilities. We describe a model intervention to increase early HIV diagnosis among pregnant women and changes in HIV incidence among exposed infants.

The Relationship between Women's Self-Reported Experiences and Observed Occurrence of Mistreatment during Childbirth: A Linked Analysis in Ghana, Guinea, and Nigeria

There has been substantial progress in developing approaches to measure mistreatment of women during childbirth; however, less is known about the trade-offs between different approaches to inform future measurement. This is a comparative analysis of data between labour observations and a community-based survey with women in Ghana, Guinea, and Nigeria.

Individual and Facility-Level Factors That Affect Quality of Care: Self-Reported Provision of Respectful Care among Providers in Malawi

Over the past decade, there has been increased attention on disrespect and abuse in childbirth and development of interventions to improve women's experiences. However, most studies focus on women's perspectives. The nature of disrespect and abuse is complex, and health care professionals often work in suboptimal and high-stress conditions without routine training and support to effectively care for patients. We describe self-reported provision of respectful maternity care (RMC) among providers and identify areas for workforce support.

Women's Experience of Birth Companions and Respectful Maternity Care in Malawi

In Malawi, a family member or friend escorts women to a health facility for childbirth. These "guardians" or companions generally provide food, wash clothes, and support woman during labour/childbirth. However, systematic use of birth companions (BCs) attending women throughout labour and delivery is fragmented and not routine, even though it is Ministry of Health policy. We examine women's experiences, including respectful maternity care (RMC), following the introduction of job aids/tools to formalize BCs.

Interventions Co-designed by Providers and Clients for Improving Their Therapeutic Relationships in Maternal and Child Health Care in Rural Tanzania

Evidence indicates that clients' dissatisfaction with providers' competencies within maternal and child health (MCH) continues to impact trust in formal health care systems, service uptake, continuity with care, and MCH outcomes. Existing interventions have failed to address all the complexities of provider-client relationships, necessitating targeted, contextualized, and innovative solutions that place providers and clients at the forefront as agents of change in optimizing intervention design and implementation. The study aimed at engaging providers and MCH clients to co-design an intervention package (prototype) for improving nurse-client relationships using a human-centered design (HCD) approach.

Globally, one in six babies are born with a low birthweight and one in 10 are born preterm. The Global Nutrition Target for 30% reduction in low birthweight by 2025 is off track and preterm rates are rising in many countries.

Newborns with low birthweight include those born preterm or small for gestational age, and those with both conditions. Such infants are at risk of early mortality and poor health throughout their life course. However, birthweight and gestational age are often measured separately, meaning the two types of low birthweight cannot be distinguished; small for gestational age infants may not be recognized due to lack of knowledge of gestational age; and stillbirths are omitted. New approaches are needed.

The Vulnerable Newborn Measurement Collaboration has more than 250 members, including governments, implementers, and researchers. The collaborative has enabled a massive dataset of 279.3 million live births from 23 high-income and 14 low- and middle-income countries from 2000 to 2021. This dataset allows newborn types to be determined by combining gestational age (preterm vs. term) and size (small, appropriate, and large for gestational age), enabling more targeted care and elucidating aetiology to accelerate health of vulnerable newborns globally.

We share novel findings, and then a panel of country representatives and experts will map the way forward. This panel links to the Lancet Small Vulnerable Newborn series, "Born Too Soon Decade" report, and Vulnerable Newborn supplement in BJOG, which will be launched at the International Maternal Newborn Health Conference (IMNHC). We aim to inform actions before IMNHC 2025.

Integration of service delivery components is a challenge in the best of circumstances, not least because vertical funding streams often work against it. Yet in all settings, truly patient-centered care is integrated, maximizing efficiency of contact between care-seeking families and their care teams. In settings characterized by conflict, post-conflict, the effects of climate change, frequent government turnover, and other shocks and stresses, quality integrated care becomes that much more of an imperative.

In this panel, Save the Children will speak about the importance of supporting integrated primary health care in Somaliland; MOMENTUM Integrated Health Resilience will share immediate postpartum and postabortion family planning trends in supported counties in South Sudan; Building Foundation for Development will present their lessons learned implementing mobile medical teams providing an integrated package of services in Yemen; and the United Nations Population Fund (UNFPA) will speak about their success improving outcomes through the offer of cash assistance for healthy pregnancies and safe births in the Philippines.

Each panelist will highlight the ways in which integration helped overcome difficulties particular to the setting in which they work and improved holistic care for mothers and their newborns.

Data on intervention coverage (the proportion of individuals in need of an intervention who receive the intervention) and health service quality are essential for identifying under-served populations and gaps in service delivery, and for developing and evaluating quality improvement initiatives and maternal and newborn health programs. Traditional measures of intervention coverage do not account for the quality of the services received; effective coverage (EC) is an approach to incorporating quality in coverage measures. However, this area of newborn health metrics is rife with gaps: gaps in available data on coverage, readiness, and service quality for newborns, and gaps in the methods for assessing service quality and estimating effective coverage. These gaps limit our ability to understand the care currently received by newborns across low- and middle-income countries (LMICs), making it more difficult to develop evidence-based programs and interventions. This panel will present recent research that aims to define and address some of these gaps, including the development of methods and indices to assess service quality for newborn health; assessment of readiness and quality data on newborns in facility registers and routine data systems; and development of EC cascades and measures for postnatal care, care for small and sick newborns, and feeding small and sick newborns.

This panel, comprising stakeholders from the research community, government, and technology sector, will show how closer-to-reality travel time estimates to emergency obstetric care (EmOC) in sub-Saharan Africa's largest megacity, Lagos, Nigeria, were generated and used to support EmOC service planning and the development of an innovative digital tool to support future planning.

The panel will start with the premiere of a four-minute animated video titled "Mrs X lives in the city too," which challenges the depiction, in a widely acclaimed 1988 short film, of difficulty in EmOC access as a problem of poor rural dwellers. The new animation will highlight how traffic and insecurity influence travel to EmOC in urban settings, necessitating the need to rethink existing approaches to travel time estimates.

The panel will then discuss research from the On Tackling In-transit Delays for Mothers in Emergency (OnTIME) project, which leverages big data to generate closer-to-reality travel time estimates to EmOC. The panel will show how the project combined primary data on health facility functionality with Google Maps to compute closer-to-reality travel time estimates to the first, second, and third nearest public and private hospitals with EmOC capacity in Lagos. The panel will also discuss the application of the evidence generated in supporting policymakers with service planning and considerations identified by policymakers as essential in developing decision-making support tools for future service planning and realisation of equity in EmOC geographical accessibility in Lagos and similar low-resource urban settings.

Evolution des indicateurs de la santé de la reproduction avec le recrutement des sages-femmes communautaires

Les ressources humaines en santé (RHS) sont insuffisantes en nombre et en qualité et sont inégalement réparties sur l'ensemble du territoire national, notamment en ce qui concerne les personnels impliqués dans la santé de la reproduction (SR). En effet en 2020, le ratio professionnel de santé population (médecin, sage-femme, infirmier) était de 2 pour 10 000 habitants au niveau national et celui de la région de Sikasso était de 4 pour 10 000 habitants. L'objectif est d'apprécier l'évolution des indicateurs clés de la santé de la reproduction du second semestre 2020 et 2021 dans les CSCom ayant bénéficié des sages-femmes recrutées au niveau communautaire dans la région de Sikasso

Initiative déploiement des sage-femmes communautaires, Analyse des indicateurs à un an de mise en œuvre dans six régions du Mali

le ratio de professionnel de santé est de 2,16 contre 23 pour 10000hbts (OMS). L'initiative deploiement de 200 sages-femmes en milieu communautaire de janvier 2021 à décembre 2024 est une des reponses aux évidences issues de la mission conjointe d'évaluation des besoins en SR/PF en janvier 2020 et les repercussions de la crise multidimentionelle (sécuritaire, sanitaire COVID19). C'est un des axes stratégiques du huitième programme de coopération Mali- UNFPA (CPD8) et aligné avec les priorités nationales du Mali. Objectif : Décrire le processus d'implémentation de l'inititive de deploiement des sagefemmes communautaires, les défis et les leçons apprises.

Partage de l'expérience sur la Stratégie pour l'augmentation du nombre des sages-femmes dans le système de santé en République Démocratique du Congo (RDC)

La pénurie des sages-femmes est un des problèmes majeurs de la RDC dans la lutte contre la mortalité maternelle qui est à 846/100 000 naissances vivantes. La RDC compte actuellement moins d'1 sage-femme pour 10.000 habitant. Cependant il est important que le système de santé de la RDC ait une disponibilité suffisante de sages-femmes bien formés capables de dispenser des soins de haute qualité. Ce partage d'expérience décrit la stratégie développée par le gouvernement de la RDC avec l'appui technique et financier de l'UNFPA pour l'augmentation du nombre des sages-femmes dans le système sanitaire.

Analyse rapide de l'impact de la COVID-19 sur l'acces aux services de sante de reproduction au Mali

Mali fait face à de nombreux défis, Cependant, il faut noter que des progrès assez encourageants ont été enregistrés. entre l'EDS M V et l'EDS M VI, le ratio MM est passé de 364 à 325 pour 100 mille NV, le taux de mortalité néonatale est passé de 34 à 33 pour 1000. Toutefois, il est à craindre que tous ces efforts ne soient compromis du fait de l'avènement de la Covid-19, qui constitue aujourd'hui un des plus grands défis pour le système de santé. Analyser l'impact de la COVID-19 sur l'utilisation des services SR, en vue d'orienter les interventions pour la continuité des services

The Respectful Maternity Care (RMC) Charter: Universal Rights of Women and Newborns to Respectful Care - India Adaptations and Endorsements

Respectful maternity care (RMC) is a universal human right that is due to every childbearing woman in every health system around the world. To ensure that women do not undergo disrespect and abuse while availing of maternity care services and to advocate that women and their newborns have equal rights to respectful care, C3/White Ribbon Alliance India (WRAI) field-tested, adapted, and disseminated the global charter: Universal Rights of Women and Newborns to Respectful Care.

Experiences, Perceptions, and Preferences about Facility-Based Delivery Care in Rural Mexico: A Qualitative Study

The nongovernmental organization Compañeros En Salud (CES) has been attending births since 2017 at a birthing center located in the rural area of the Sierra Madre de Chiapas, Mexico. The main purpose of the center is to achieve the best birthing experience for its users. To gain insight into how to accomplish this, we explored the experiences, perceptions, and preferences about childbirth care of women living in the area of influence of the CES birthing center.

Evaluating Pregnant Women's Experiences with Respectful Maternity Care in a Midwifery-Led Antenatal Care Service in Karachi, Pakistan

Patient satisfaction is one of the most critical aspects for developing a healthy relationship between health care providers and their patients. In low- and middle-income countries (LMICs) where there is a shortage of care providers and access to tertiary facilities is challenging, midwives are the frontline care providers for pregnant women. Their experiences are key in relation to the use or nonuse of health care services. Hence, this study sought to understand pregnant women's perceptions of the quality of antenatal care (ANC) services provided by midwives at primary health centers (PHCs) in Karachi, Pakistan.

Beyond Respectful Maternity Care: A Research Priority Exercise and Working Group Process on Respectful Newborn Care

As the respectful maternity care agenda expands, it is necessary to understand what the priorities are for improving respectful and high-quality care for newborns. The aim of these work processes and study was to catalyze and inform a developing research field by conceptualizing and framing the rights of newborns in health care settings, and identifying global research questions.

Decentralization Works! Improving Antenatal Care (ANC) Utilization and Coverage of Essential Interventions in 368 Health Centers and Health Posts in Ethiopia

Maternal infection, anemia, and poor nutrition are important causes of low birthweight in newborns. The Enhancing Nutrition and Antenatal Infection Treatment for Maternal and Child Health project in Ethiopia aimed to increase newborn birthweight through improved utilization and quality of antenatal care (ANC) with a focus on early ANC enrollment and improved ANC nutrition counseling, anemia prevention, and point of care (POC) testing and management of maternal infections and anemia.

Steps for Operationalizing Global Guidance on Nutrition Interventions in Antenatal Care: Lessons Learned in Four Countries

A package of evidence-based scalable nutrition interventions is urgently needed in low- and middle-income countries (LMICs). We aimed to document key steps and lessons learned in Bangladesh, Burkina Faso, Ethiopia, and India for adapting and integrating nutrition interventions into antenatal care (ANC) based on the World Health Organization (WHO) 2016 guidelines.

Validation of Maternal Report of Iron Folic Acid Supplementation during Pregnancy in Rural Nepal

Measuring and tracking coverage of nutrition-related services provided during antenatal care (ANC) is important for improving evidence-based interventions. For many low-income countries, the Demographic and Health Surveys (DHS) provide nationally representative data. However, it is unclear whether women can report accurately what services they received during pregnancy, often with a recall period of months to years.

Factors Affecting the Implementation of Calcium Supplementation Strategies during Pregnancy to Prevent Pre-eclampsia: A Mixed Methods Systematic Review

Hypertensive disorders of pregnancy are among the leading causes of maternal and neonatal morbidity and mortality globally. The World Health Organization recommends calcium-containing supplements daily from 20 weeks gestation for women at high risk of pre-eclampsia/eclampsia and for all women from populations with low calcium intake. This research aims to improve the understanding of factors (barriers and facilitators) influencing the uptake and use of calcium supplementation during pregnancy to prevent pre-eclampsia.

Health Protection Schemes and Maternal and Newborn Health: Role of the Sehat Sahulat Programme in Pakistan

To improve health outcomes and alleviate the financial burden of ill health, the federal and provincial governments have introduced a key social health protection program, Sehat Sahulat Programme (SSP), to cover more than 170 million Pakistanis, in addition to the existing relatively very small social health protection schemes under Zakat and Bait-ul-Mal.

Costing Zambia's Commitment to Reach the Every Newborn Action Plan Target 4

In the context of an increasing neonatal mortality trend for Zambia, the government has embarked upon the task of mobilising resources for the scale-up of level-2 inpatient care for small and sick newborns (SSNBs). Global guidelines and standards have been adapted to ensure best practice informs service delivery so that the scale-up leads not both increased coverage and improved quality of care. Costing "what it takes" to scale up quality of care in the country highlights pragmatic considerations and trade-offs that are usually off-sight when costings are estimated drawing on global parameters.

How Much Do Vulnerable Groups Count in the Global Financing Facility? Content Analysis of Stillbirths and Maternal-Newborn Investments in Policy Documents for 10 African Countries

The Global Financing Facility (GFF) aims to accelerate progress to meet 2030 Sustainable Development Goals for reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH-N). Our study examines how GFF policy documents address maternal and newborn health (MNH) plus stillbirths, given the high burden this group bears relative to investments made.

Remodelling the Government Resource Allocation to Address Inequities in Sexual, Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition (SRMNCAH&N) in Zambia

Resource allocation is the distribution of resources among competing groups of people or programs. Historically, the Ministry of Health in Zambia used the incremental budgeting method before shifting to a population-based resource allocation criteria. The population-based resource allocation criteria was later enhanced to include deprivation or poverty and discretionary proportional allocation based on demographic characteristics of the district. The current factors applied in the resource allocation are heavy on the demand side with no or little focus on the supply side. The resource allocation criteria did not address the capacity of districts to provide sexual, reproductive, maternal, newborn, child, and adolescent health and nutrition (SRMNCAHN) services. The objective of this paper is to develop a hybrid resource allocation formula that incorporates needs and equity with a view to allocating more resources to areas with higher capacity constraints to provide SRMNCAHN services.

Reducing Missed Opportunities for First Antenatal Care (ANC) Visits through Linkage of General Outpatient Department (OPD) to ANC Services in Rural Rwanda

Timely referral from the general outpatient department (OPD) and linkage to antenatal care (ANC) services has been found to be a promising strategy to reduce missed opportunities by improving first ANC attendance. This study aimed at exploring barriers and facilitators for linking pregnant women identified at the OPD with ANC services.

Factors Influencing Delivery of the Recommended Service Package for First Antenatal Care Visit in Rwanda: A Mixed Method Study

Rwanda has made great progress in improving access to antenatal care (ANC) services and neonatal mortality reduction. However, little is known about the quality of ANC services. This study assessed the completeness of delivering the recommended package of services for the first ANC visit and associated barriers and facilitators.

Strengthening Perinatal and Neonatal Quality of Care in Rwandan District and Provincial Government Hospitals

Global and regional progress on maternal and newborn mortality has stagnated. In Rwanda, success increasing service access revealed shortfalls in quality of facility-based maternal and neonatal care as a key progress obstacle, making it a national health priority.

Factors Associated with Labor Companionship in Rwanda

Evidence showed that labor companionship is beneficial for childbirth experience and outcomes. However, little is known about this practice in Rwanda. This study sought the perspectives and experiences of women and health care providers regarding labor companionship and possible associated factors in four hospitals in Rwanda: CHUK, Muhima, Remera Rukoma, and Kacyiru.

Enabling Traditional Birth Attendants (TBAs) as Community-Level First Responders to Advance Maternal and Neonatal Survival in Northern Nigeria

Globally, Nigeria contributes the greatest number of maternal and neonatal deaths and stillbirths. In northern Nigeria, most births occur at home and are often assisted by untrained traditional birth attendants (TBAs). To ultimately accelerate impacts on maternal and newborn survival, we aimed to improve the knowledge, skills, and confidence of TBAs.

Improving Newborn Health Outcomes in Yemen through Community-Led Kangaroo Mother Care

The Systems, Health and Resiliency Project (SHARP) implemented a pilot program called My Community, My Home (MCMH) in the Al-Maqatera District of Lahj Governorate in Yemen to improve newborn health outcomes through community-led kangaroo mother care (KMC). The program aimed to address the significant issue of newborn mortality in Yemen, which is estimated at 27 deaths per 1,000 live births.

Social Norms around Delays in Disclosing Pregnancy and Implications for Antenatal Care Initiation: A Qualitative Study among Ugandan Women

Delaying to disclose pregnancy among one's social networks can reduce individuals' ability to access social support, which facilitates perinatal care access. There are limited in-depth and contextualized data exploring social norms around delays in pregnancy disclosure, their reasons, and the potential impact on antenatal care seeking in Uganda. By better understanding the factors influencing this practice, we can account for this behavior when designing interventions to ensure pregnant individuals initiate antenatal care early enough in pregnancy to optimize health. Therefore, we collected qualitative data about antenatal care decision-making from Ugandan pregnant women at their first antenatal care visit and norms around disclosing pregnancy.

Community-Based Peer Support to Mitigate Social Isolation and Stigma of Adolescent Motherhood in Harare, Zimbabwe

Adolescent mothers often feel isolated, lacking coping skills, resources, social support, and educational opportunities. Unless addressed, these circumstances may have negative consequences on their mental health. To inform the development of a peer-support intervention to mitigate social isolation and stigma of adolescent motherhood, focus groups were conducted from October to December 2018 with adolescent mothers aged 14–18 years, community health workers (CHWs), and key community stakeholders (KCSs) in Harare, Zimbabwe.

The complexity of childbirth care is characterized by three interfaces: First, the two continua of care from pre-pregnancy to postpartum care and community to referral hospital, meaning that the key health system characteristics and the functioning of the linkages between services points, including the referral systems, have a major impact. Second, childbirth care includes preventive and promotive, thus routine care as well as time-sensitive emergency care. Third, quality childbirth care is provided by a team of nurses, midwives, and obstetricians, as well as neonatologists and pediatric staff, thus a multi-professional team with different pre-service training and professional values and identities, creating frictions. 

Over- and under-provision of evidence-based interventions are seen in all settings, with the overuse of caesarean sections being a well-known example. Abuse and neglect have been raised and responsiveness during birth is high on the international agenda. Improving quality of care within these complex systems demands a careful combination of strategies to address the complexity and the different drivers of this complex system. But complex interventions may also overburden implementers and systems. Complex interventions demand sufficient resources, long-term investments, and sufficient patience to mentor and support implementing teams and institutions. 

Here, we summarize our learning from three complex interventions. We apply a scalability and adaptability lens to highlight critical issues.

Measuring the Causes and Circumstances of Deaths beyond 42 Days Postpartum in Kenya, The Gambia, Malawi, and South Africa: Implications for Global Monitoring and Postpartum Care

Our previous research demonstrated that mortality remains elevated until four months postpartum in sub-Saharan Africa, but little is known about the causes of pregnancy-related deaths (PRD) beyond the standard 42-day postpartum period. This evidence gap is severe in sub-Saharan Africa, where cause of death information largely fails to meet international standards. We are now investigating the causes of deaths associated with this prolonged risk and the implications for measurement and clinical care.

Which First Trimester Risk-Estimation Method for Pre-eclampsia Is Most Suitable? A Model-Based Impact Study

Low-dose aspirin treatment reduces the risk of pre-eclampsia (PE) among high-risk pregnant women. Internationally, several risk-calculation strategies are available in the first trimester. The objective of this study was to assess costs and benefits of different first-trimester PE risk estimation algorithms - EXPECT (an algorithmic prediction model based on maternal characteristics), NICE (a checklist of risk factors), and the Fetal Medicine Foundation (a prediction model using additional uterine artery Doppler measurement and lab testing) - coupled with low-dose aspirin treatment, in comparison to no-screening, in nulliparous pregnant women.

Development of Risk-Prediction Models for Maternal and Neonatal Complications Using Machine Learning across the Continuum of Care in a Resource-Constrained Environment

To improve maternal and neonatal outcomes, health systems must identify individuals at risk to make informed decisions about priority clinical interventions and resource allocation. Our objective was to design risk stratification algorithms across the continuum of care.

Algorithms to Predict Newborn Complications in the First 28 days of Life in Eastern Uganda (N-COP Study)

Complications following preterm birth cause morbidity and mortality. Globally, newborn complications account for approximately 28% of neonatal deaths. Preemies are between six and 26 times more likely to die during the neonatal period than term newborns. Mathematical and statistical algorithms can be used to predict the risk of development of complications and adverse outcomes among preemies and can be used to drive proactive measures to anticipate, prevent, prepare management, and improve survival in the short and long run. We developed algorithms to predict newborn complications and estimate outcomes within the first 28 days of life.

Community Follow-Up to Prevent Recurrence of Fistula

Female genital fistula remains a global burden, and in Nigeria there are an estimated 12,000 new cases annually. Attention has focused on surgical repairs, community mobilization, and government guidelines. These target the condition, but not the "whole person." Women with fistula may experience psycho-social consequences, and difficult deliveries that leave women with nerve damage. Noncompliance with post-repair recommendations can result in fistula recurrence. Integration of community follow-up into holistic fistula care can help to address these needs.

Strengthening a Referral System through a Community-Owned Maternal and Newborn Transport Model Using Motorbike Ambulances in Luwingu, Lupososhi, and Lunte Districts, Northern Province, Zambia

Less than 25% of Zambia's population live within 15 km of an emergency obstetric facility, amplifying inequities for women accessing life-saving care during pregnancy and delivery. In 2018, the Ministry of Health (MoH) and Clinton Health Access Initiative (CHAI) implemented a community referral and transport intervention as part of the integrated reproductive maternal and neonatal health program in Northern Province, covering 143 health facilities. Northern Province is sparsely populated, characterized by long distances to health facilities, poor terrain, and inadequate public transport. There have been numerous community interventions to bridge gaps in maternal transport but they are often not sustained beyond partner support.

Leveraging Private Sector Partnerships to Sustainably Connect High-Risk Mothers to Emergency Transport and Appropriate-Level Quality Care in Kakamega County, Kenya

Delays in timely access to care drive a third of all maternal deaths in Kenya. Hospitals and health system managers lack means to rapidly identify at-risk mothers, service gaps, and gather clinical information on incoming patients, resulting in mothers being "bounced around" between facilities to find the appropriate level of care. Kakamega County has partnered with Jacaranda and Rescue.co to improve maternal survival by expediting access to emergency care.

Strengthening Management of Emergency Maternal Health Complications at the Emergency Unit of Public Health Facilities in Bangladesh

In Bangladesh, ante-and postpartum hemorrhage (APH, PPH) and pre-eclampsia/eclampsia (PE/E) contributed about 55% to overall maternal deaths (Bangladesh Maternal Mortality and Health Care Survey, 2016). Improved detection and management of maternal complications is crucial to avert these preventable deaths. The U.S. Agency for International Development (USAID)'s MaMoni Maternal and Newborn Care Strengthening Project (MNCSP) supported district- and subdistrict-level hospitals with the formation and training of emergency management teams and the availability of essential drugs through the government system to manage maternal complications in the emergency department. After initial stabilization, mothers with complications are referred to inpatient wards of hospitals or to other facilities for further management. Ongoing supervision helped to resolve technical and logistical issues and strengthen recording and reporting. There were no prereferral case management and reporting systems in the emergency units prior to this intervention.

Based on the results of the Maternal and Newborn Health (MNH) Exemplars study conducted during 2020–2022 in seven countries in Africa and Asia (Bangladesh, India, Nepal, Morocco, Ethiopia, Niger, and Senegal), four presentations use a maternal mortality, stillbirth, and neonatal mortality transition model to address the key lessons learnt from past progress for today's programs and for tomorrow's strategies.

#1 describes the transition model and its dimensions of causes of death, fertility, health systems, service delivery strategies, and inequalities, based on extensive analyses for 149 countries, and then applied to the seven MNH exemplar countries, with special attention to India's subnational progress and present issues.

#2 synthesizes how mortality and cause of death tracking and analyses are affected by major data gaps, hampering the ability to assess trends and inequalities. High coverage of births in health facilities afford new opportunities to collect better data.

#3 presents intrapartum service strategies, which vary considerably between countries. Future strategies can be informed by experiences of countries in more advanced stages of the transition model. High coverage of hospital deliveries with quality care and adequate cesarean section rates among the poorest women appear to be key.

#4 discusses how inequality patterns in neonatal mortality vary across the transition, but intervention coverage disparities reduced almost everywhere. A focus on disadvantaged women and neonates is a critical driver, but strategies vary by transition stage.

The panel will conclude with two invited comments from policymakers on the utility of the transition model approach, followed by a moderated discussion with participants.

Despite great improvements in health care in the past decades, fear is a prevailing emotion in childbirth. It increasingly influences women's decisions and health care providers' clinical practices, which can result in suboptimal quality of care.

Women and families fear pain, lack of support, disrespect/abuse during labour and childbirth, and adverse outcomes associated with vaginal delivery. Providers are afraid of the uncontrollable nature of childbirth, pressure from families, financial/judicial litigation, loss of practicing rights, reputational damage, and physical/verbal violence from families in case of adverse outcomes in vaginal birth.

Fears motivated by the belief that caesarean section is a safer option that guarantees the best outcomes is one of the factors driving the unprecedented increase of caesarean section use witnessed by contemporary societies worldwide. Although a caesarean is life-saving when needed, it is associated with risks that are higher for women with limited access to obstetric care.

We argue that a constructive dialogue needs to emerge between stakeholders to (i) improve understanding of each other's views, values, and needs; (ii) challenge misconceptions considering the evidence; and (iii) reconcile societies' lower tolerance for negative obstetric outcomes and the uncertain nature of childbirth, where although ideal outcomes cannot be promised, high-quality, evidence-based care should be ensured.

This panel brings together the findings of two projects that aim to improve understanding of fear as a driver for caesarean section decision-making (Re-Judge) and to adapt and implement nonclinical interventions to optimize the use of caesarean section (Quali-Dec).

Anaemia in pregnancy is a major public health burden with a higher incidence in low- and middle-income countries (LMICs) such as Nigeria. It is mostly caused by iron deficiency and has significant implications on maternal and neonatal health. This panel examines initial findings from an ongoing superiority, randomised controlled trial, "Intravenous versus oral iron for iron deficiency anaemia in pregnant Nigerian women (IVON trial)" with both effectiveness and implementation outcomes. In this four-abstract panel, we present recent estimates of prevalence of and risk factors for iron deficiency among pregnant women with moderate or severe anaemia in the two most populated states of Nigeria (Kano and Lagos states). This abstract goes on to describe the characteristics of pregnant women with iron deficiency anaemia in the study sites. In the second abstract, we capture perception of women on intravenous iron treatment for anaemia in pregnancy in the IVON trial. Building on this, we report considerations for acceptability of intravenous iron treatment for iron deficiency anaemia in pregnancy in Nigeria based on insights from a qualitative study with pregnant women, family decision makers and health care providers. Finally, being that large scale trials such as ours are rare in the LMIC maternal health space, we share lessons learnt from the conduct of this trial and how contextual solutions to challenges were generated to assure successful trial implementation.

Midwives play a pivotal role in reducing maternal and neonatal mortality and stillbirths in low- and middle-income countries and providing women and newborns with sexual and reproductive health services. Yet the midwifery workforce is in crisis. There is an estimated global shortage of 900,000 midwives due to fewer intakes into educational institutions; inadequate investment in recruitment, deployment, and remuneration; and a weak supportive environment.

White Ribbon Alliance (WRA) pioneered an innovative programmatic approach that both increases political will to invest in midwives and accelerates national policy change, all in accordance with midwives' priorities. Midwives' Voices, Midwives' Demands (MVMD) is a groundbreaking campaign launched in 2021 by WRA, the International Confederation of Midwives (ICM), and partners. The campaign was based on an open-ended question: "What do you want most in your role as a midwife?" WRA and ICM selected nine focus countries in Africa, Asia, and Europe for intensive outreach. Trained mobilizers queried health providers and recorded responses using the What Women Want Chatbot - a novel digital tool that uses WhatsApp and artificial intelligence to rapidly capture demands and analyze results. Responses from non-focus countries were collected via an e-survey.

MVMD reached 56,000+ midwives in 100 countries. The two largest demands were for more and better supported personnel, including increased salaries, and for supplies and functional facilities. This panel will explore how campaign partners have used the MVMD process and results to strengthen midwifery policy development and implementation in their countries, creating a more conducive environment based on what midwives say.

The World Health Organization (WHO) has been supporting multi-country research to support newborns to survive and thrive. This panel discussion will bring together critical new evidence for the survival of newborns. Four large WHO randomized controlled trials, some of which have been published recently, have led to new ongoing implementation research. The aim of the panel is to make participants aware of the research and to discuss the implications of the results for the country-level program and scale-up.

Caught in the Middle: Understanding the Experience of Maternal and Newborn Health (MNH) Providers through the Lens of Organizational Theory for Mistreatment in Childbirth

Reports of mistreatment in childbirth have emerged around the globe, reducing trust in health systems at a profound moment of human life. The similar patterns and dynamics indicate its systemic nature. Limited research to date has focused on developing explanatory theory. Organizational sociology provides one lens for theory development, unearthing the experience of providers within the broader system that leads to its persistence.

Organisational and Individual Readiness for Change to Respectful Maternity Care Practice and Associated Factors in Ibadan, Nigeria: A Survey

Readiness for change is a known determinant of implementation success. Respectful maternity care (RMC) has been recommended as the standard for all women during childbirth. However, many RMC-promoting interventions have been conducted without prior assessment of the readiness for change. This study explored the relevance of readiness for change theories to the RMC literature. Health providers' organisational and individual readiness for change to RMC practice and the associated factors were assessed.

Embedding Inclusive, Supportive, and Dignified Maternity Care (SDMC) in Public Health Facilities: An Evaluation of a Theory-Driven Service-Delivery Intervention Package

Disrespect, discrimination, abuse, and lack of emotional support characterise intrapartum care in many low- and middle-income countries. While the World Health Organization (WHO) provides affirmative guidelines to address this issue, no operational model has effectively incorporated those guidelines into routine public health services. Therefore, we developed and evaluated a theory-driven service-delivery intervention to promote inclusive, supportive, and dignified maternity care (SDMC) in public health systems. Our SDMC intervention worked with maternity teams in a participatory, consensus-driven process, theoretically underpinned by the COM-B framework (Capability, Opportunity and Motivation drivers for respectful maternity Behaviour). Components included (a) capacity-building of staff (respectful care, rights-based care, medical ethics, values clarification, psychosocial support), and (b) improved governance (enhanced management information systems, care coordination) and accountability mechanisms (patient feedback, performance review). Technical content drew from WHO's intrapartum care guidelines, WHO's mental health GAP strategy, and contextual evidence.

Promoting Caregiver Well-Being as Part of Holistic Nurturing Care Programming in Ghana and the Kyrgyz Republic

The stress of parenting can have negative consequences on caregiver well-being, and the period immediately after birth is a particularly high-risk period for maternal depression. The Responsive Care and Early Learning (RCEL) Addendum is designed for integration with nutrition and health counseling packages to promote holistic nurturing care. One training module focuses on supporting caregivers to engage in self-care and support-seeking for their own well-being and also because a child's healthy development largely depends on their caregiver's capacity and well-being, particularly mothers. This study aims to understand the feasibility and acceptability of this training module among health workers and community volunteers, as well as initial effectiveness in reducing parenting stress in Ghana and the Kyrgyz Republic.

Landscape Analysis of Community Resilience to Disasters by Addressing Sexual and Reproductive Health and Rights in Gaibandha and Satkhira Districts

Bangladesh is one of the most vulnerable countries to climate change, which has a huge impact on maternal and child health. This study analyzed community resilience to disasters by addressing sexual and reproductive health and rights of the disaster-affected vulnerable population in Gaibandha and Satkhira districts. Following a mixed-method approach, combining both qualitative and quantitative methods attempted to sketch a holistic picture of socioeconomic and health stresses associated with disaster-related shocks and of people's decision-making processes and actions towards disaster resilience, with crucial attention to sexual and reproductive health care services.

The Effect of e-Registration and mHealth on Institutional Deliveries in the Hazard-Prone Areas of Southern Bangladesh: An Open-Label Two-Arm Nonrandomized Controlled Cluster Trial

Increasing facility delivery is mandatory to reach the goal of bringing down the maternal mortality ratio (MMR) to 70 deaths/100,000 live births by 2030. In the era of digitalization, the introduction of e-Registration and mHealth may aid the Government of Bangladesh to reach this target. The Southern part of Bangladesh is a hazard-prone area and service uptake from the institution is lower here. This study aimed to determine the effect of an e-registration tracking system and mHealth counseling on institutional deliveries to pregnant mothers in hazard-prone areas of Southern Bangladesh.

Social Determinants of Antenatal Depression among Women in Rural Bangladesh: A Cross-Sectional Study 

Perinatal mental health is recognised as a global health issue, with approximately 10% of pregnant women and 13% who have just given birth experiencing some sort of mental health condition worldwide, particularly depression. Literature focuses on the postnatal period, whereas studies suggest that approximately two-thirds of depression presents antenatally. Antenatal depression has negative impacts on the mother and child, such as suicidal ideations, low birthweight, and impaired fetal development. The prevalence of antenatal depression in Bangladesh has been found to be higher, ranging from 18% to 33%. There is a paucity of research investigating the social determinants of antenatal depression in rural Bangladesh. This study aims to determine the prevalence and social determinants of antenatal depression in rural Sylhet, Bangladesh, in collaboration with the Maternal Aid Association (MAA).

Service Loss during COVID-19 for Maternal Health and Immunization Services in Bangladesh 

The indirect effect of the COVID-19 pandemic upon mortality has been poorly monitored in low- and middle-income countries (LMICs) like Bangladesh, and the concern is that it might, indeed, be substantial. In this context, our objective was to quantify and explore support for the extent of service loss in routine immunization and preventive maternal health care services from health sector facilities in Bangladesh due to the COVID-19 pandemic.

Newborn Device Planning and Costing Tool: Systematic Tool Development to Inform Scale-Up of Small and Sick Newborn Care in Low-Resource Settings

High-quality neonatal care, a marker of health system function, is dependent on functional medical devices, with context-specific specifications, adequate numbers, and ongoing maintenance. Devices designed for high-income settings may break, lack consumables, or be unused. Currently, systematic tools for device planning and costing that allow health system managers to utilize data to allocate budgets and mobilize resources at district and/or national levels are lacking. To close this gap, we developed a tool to support countries working towards Every Newborn targets for scale-up of World Health Organization (WHO) level 2 neonatal care.

Culture Gap: Antibiotic Versus Blood Culture Use for 61 Facilities with NEST360 in Kenya, Malawi, Nigeria, and Tanzania 

Thirty million small and sick newborns require admission annually, many being prescribed antibiotics without blood cultures, the current "gold standard" for neonatal infection detection. Low neonatal blood culture use hampers antibiotic stewardship, fueling antimicrobial resistance (AMR), which threatens newborn survival. This study analyzes the gap between blood culture use and antibiotic prescribing for newborns admitted to facilities implementing Newborn Essential Solutions and Technologies (NEST360) in Malawi, Kenya, Tanzania, and Nigeria.

Target Product Profiles for Neonatal Care Devices: Systematic Development and Results with NEST360 and the United Nations Children's Fund (UNICEF) 

Medical devices are critical to provide high-quality, hospital-based newborn care. Many devices available in high-income countries are not available in low- and middle-income countries (LMICs) because they are not designed for these settings. This gap could be filled by medical devices designed specifically for LMIC settings. Target product profiles (TPPs) are developed early in the medical device development process to define the setting, target user, and range of performance characteristics.

Digitization and Adaptation of the World Health Organization (WHO) Integrated Management of Newborn and Childhood Illness for an Electronic Clinical Decision Support Tool for Sick Young Infants 

Adherence to evidence-based clinical guidelines is poor in many low- and middle-income countries (LMICs), obstructing progress in ending preventable newborn and young infant deaths. Electronic clinical decision support algorithms (CDSA) have improved care quality for older children, but few have been tested for young infants. We developed digital adaptations of evidence-based guidelines for implementation research of CDSA, with and without point-of-care diagnostics, to improve appropriate management of sick young infants.

Intrapartum Use of Oxytocin Injection: A Survey of Health Care Providers' Practice in Nigeria

Studies have demonstrated that more women who want to deliver babies have undergone inappropriate use of oxytocin for labor induction and augmentation at all levels of the health system, including primary health care facilities, in many parts of the world, including sub-Saharan Africa. This study assessed the pattern of intrapartum administration of oxytocin among different cadres of health care providers in Nigeria.

Labor Augmentation with Oxytocin in Low- and Lower-Middle-Income Countries: A Systematic Review and Meta-analysis 

Despite worldwide use, reviews of oxytocin for labor augmentation include mainly studies from high-income countries. Besides having potential benefits on labor progress, oxytocin may be harmful to the fetus, with potentially higher risks in low-resource settings. We therefore conducted a systematic review and meta-analysis of practices, benefits, and risks of oxytocin for labor augmentation in low- and lower-middle-income countries (LLMICs).

Effectiveness of SafeCare Methodology in Improving Quality of Maternal and Newborn Care: Case Study from Saving Mothers Giving Lives (SMGL) 2.0 Project in Kaduna, Nigeria 

High quality of care is the bedrock of improved health outcomes. With a maternal mortality ratio of 512/100,000, Kaduna State's neonatal mortality rate of 63/1,000 and low coverage (27%) of deliveries assisted by a skilled provider are worse than the national average. These outcomes are exacerbated by poor quality of care due to unskilled providers, lack of equipment, and inadequate basic amenities, among other factors. Saving Mothers Giving Lives (SMGL) 2.0, led by Pathfinder International in collaboration with PharmAccess Foundation and Kaduna State Government, is implementing a quality improvement (QI) program using the SafeCare methodology to ensure the delivery of quality-secured care for mothers and their newborns.

Is Delivery Conducted in Private Health Facilities and through Caesarean Section Associated with Higher Neonatal Mortality? Evidence from North Indian States 

In India, institutional delivery increased from 42% in 2005–2006 to 90% in 2019–2021. This had a huge impact on reducing the neonatal mortality rate (NMR) in the country, from 37 per 1,000 live births in 2005 to 22 in 2019. However, the progress is uneven. In states such as Bihar and Uttar Pradesh (UP), which contribute about one-fourth of the country's population, NMR is more than 30 per 1,000 live births. Due to insufficient and abysmal public health systems in these states, private health sectors are increasingly providing obstetric care and conducting cesarean section deliveries, which may have negative impact on child health if quality of service is compromised. The present study, therefore, intends to examine the effect of private sector and cesarean section deliveries on the early neonatal mortality rate [ENMR] and NMR in India and these two states.

Strengthening Leadership and Governance for Maternal and Perinatal Death Surveillance and Response in a Low-Income Urban Setting: Experiences from Kampala, Uganda

Robust leadership at all levels and a culture of accountability are key factors for the successful implementation and sustainability of maternal and perinatal death surveillance and response (MPDSR). The U.S. Agency for International Development (USAID) Maternal Child Health and Nutrition (MCHN) Activity supported Kampala Capital City Authority (KCCA) to establish a citywide MPDSR committee to conduct confidential inquiries on select maternal and perinatal deaths and ensure timely implementation of agreed-upon actions.

Maternal Death Surveillance and Response (MDSR) and Perinatal Death Surveillance and Response (PDSR) in Sierra Leone: Towards an Integrated MPDSR Approach

In Sierra Leone, the maternal mortality ratio (MMR) is estimated at 717 per 100,000 live births, and the neonatal and perinatal mortality rates at 31 per 1,000 live births and 34 per 1,000 total births, respectively. These are among the highest in the world. Sierra Leone established a nationwide maternal death surveillance and response (MDSR) system in 2016 to address the poor indicators. The MDSR is a platform for collecting, analysing, and reviewing data that will inform actions to prevent maternal deaths. The perinatal death surveillance and response (PDSR) system was established in four regional hospitals in 2019 and rolled out to 12 additional hospitals in 2021. Currently both systems operate independently.

Integrating Maternal Near-Miss Case Reviews with the Pre-existing Maternal Death Surveillance and Response System: Learning with Three Malawian Hospitals

The World Health Organization recommends inclusion of maternal near-miss case reviews along with the maternal death surveillance and response (MDSR) system as quality improvement initiatives with the aim to improve availability of useful metrics, promote accountability, and improve reporting of severe maternal outcomes. This study evaluates the process of integrating maternal near-miss case reviews within the pre-existing maternal death and surveillance system in three hospitals in Malawi.

Use of Digital Technology for Real-Time Reporting of Maternal Deaths: Development of a Maternal and Perinatal Death Surveillance and Response (MPDSR) Tool - An Experience from Pakistan 

Maternal mortality is considered a key indicator of a country's health status and its socio-economic development. Pakistan's estimated maternal mortality ratio (MMR) is 178. Over the past decades, Pakistan has managed to reduce MMR from 276/100,000 to 178/100,000. However, subnational data shows variation, with 140/100,000 in Punjab and 298/100,000 in Balochistan. This data is available through surveys only and there is a need for real-time data reporting with cause of maternal death in addition to surveys.

Implementation Experiences of the Group Antenatal Care (ANC) Model for Adolescent Girls and Young Women in Public Health Facilities in Kampala, Uganda: A Qualitative Study

Teenage pregnancies are a public health problem in Uganda, associated with adverse maternal and perinatal outcomes. Pregnant teenagers have special reproductive health needs and social and emotional requirements, yet adolescent-friendly maternal services are limited. Group antenatal care (G-ANC) is provided to groups of adolescent girls and young women (AGYW) with similar gestation and/or client age and is designed to provide health education, social support, and training on self-care to address the unique needs of AGYW. The U.S. Agency for International Development (USAID) Maternal Child Health and Nutrition (MCHN) Activity seeks to strengthen maternal and newborn health service delivery to adolescent mothers by functionalizing group ANC in seven public facilities in Kampala. The purpose of documenting the implementation experiences of G-ANC is to inform scale-up.

Leveraging Digital Health Coaching to Improve Exercise Regimens in Pregnant Women 

Exercise during pregnancy can prevent and limit adverse maternal and fetal morbidities and provide long-term benefits through reduction of maternal weight gain during pregnancy and improvement in cardiovascular fitness. Regular exercise during pregnancy has shown benefits to the mother and the fetus in several ways, for example, it reduces back pain, eases constipation, and decreases the risk of gestational diabetes, gestational hypertension, pre-eclampsia, and caesarean birth. The World Health Organization (WHO) suggests that pregnant women get at least 150 minutes of moderate-intensity aerobic activity every week. In Nigeria, studies have shown that 47.6% of pregnant women have minimal knowledge about exercise while 15.8% of them showed a negative attitude towards exercise. In this presentation, we will describe how we have leveraged a virtual self-care health coaching platform to support low-income pregnant women to follow exercise regimens. The objective was to evaluate the impact of digital health coaching on exercise in pregnant women in Nigeria.

Improved Blood Pressure Outcomes through Digital Health Coaching via CompleteHealth™ in Nigerian Women with Hypertensive Disorders in Pregnancy 

Hypertensive disorders in pregnancy are known contributory factors to increased morbidity and mortality of both mother and baby, especially in sub-Saharan Africa. They cause 16% of maternal deaths within the region. Early detection, management, and compliance to treatment are critical to improving pregnancy outcomes. The principle of health coaching has been known to improve patients' compliance with therapy, including hypertension treatment. The application of digital technologies that offer health coaching services is still an evolving concept. At mDoc Healthcare, self-efficacy in managing chronic disease is afforded to members registered on the CompleteHealth^TM platform through the receipt of nudges from health coaches via voice calls and messages. Pregnant women registered on the platform receive these services and also access their imputed health metrics such as weight, blood pressure, and exercise to monitor their health progress.

Demand-Side Interventions Improve Adherence to Iron and Folic Acid (IFA) Supplements in Pregnancy in Bangladesh, Burkina Faso, Ethiopia, and India 

Adequate iron intake during pregnancy is essential to meet the needs of a growing fetus, blood volume expansion, and replacement of blood loss during childbirth. A daily iron and folic acid (IFA) supplement during pregnancy is recommended by the World Health Organization, however, adherence is universally low. Strategies have failed to adequately address adherence. Our aim was to draw lessons from developing and operationalizing demand-side adherence interventions in Bangladesh, Burkina Faso, Ethiopia, and India.

Intrapartum Oral Azithromycin to Prevent Maternal and Newborn Sepsis or Death: A Multinational Randomized Controlled Trial (RCT)

We tested the hypothesis that a single oral dose of azithromycin (AZI) given during labor in women planning a vaginal delivery would reduce maternal death or perinatal death or sepsis.

Prevention of Infant Respiratory Syncytial Virus (RSV) Illness with a Bivalent RSVpreF Vaccine in Pregnancy: Results from a Global Efficacy Trial 

Maternal vaccination is a promising strategy to protect young infants against respiratory syncytial virus (RSV) illness from birth through the period of highest risk.

From Global to Local: Accelerating Access to Essential Postpartum Haemorrhage Medicines 

Concept Foundation, WACI Heath, the International Federation of Gynecology and Obstetrics (FIGO), and International Confederation of Midwives (ICM) conducted an advocacy initiative with the purpose of accelerating access and safe use of quality-assured heat-stable carbetocin (HSC) for prevention, and tranexamic acid (TXA) for treatment of postpartum haemorrhage (PPH) in nine sub-Saharan African (SSA) countries (funded by MSD for Mothers). The scope of work covered updating national norms and standards and developing contextualized clinical protocols and job aids for health care providers who will be trained in implementing these interventions. The objectives of the initiative were to raise awareness of the importance of quality maternal health medicines and support the national revision and update of PPH guidelines and essential medicines lists to include HSC and TXA, in line with recent World Health Organization (WHO) PPH recommendations.

Can Oxytocin and Tranexamic Acid Be Mixed for Co-administration by IV Infusion for the Treatment of Postpartum Haemorrhage? 

The World Health Organization (WHO) has defined a postpartum haemorrhage (PPH) "first-response" treatment bundle that comprises the five key elements of uterine massage, uterotonic drugs, tranexamic acid, intravenous fluids, and examination of the genital tract and escalation of care. A key implementation approach that we explored is the co-administration (infusion) of oxytocin and tranexamic acid in intravenous fluids. This approach could simplify administration, which may be particularly important in resource-constrained settings with limited numbers of health care practitioners to attend a PPH emergency. Following an extensive literature review, no reports were identified providing evidence of the compatibility of oxytocin and tranexamic acid when mixed for intravenous administration. Therefore, the aim of this study was to investigate the compatibility of oxytocin and tranexamic acid injection products when mixed for the purpose of co-administration by intravenous infusion as part of the treatment bundle for PPH.

The third plenary, The Road to 90/90/80/80 for Maternal and Newborn Health: Progress and Gaps at SDG Midpoint, will launch the highly anticipated Improving maternal and newborn health and survival and reducing stillbirth. Progress report 2023. This joint progress report for the Every Newborn Action Plan and Ending Preventing Maternal Mortality will highlight progress in achieving maternal and newborn health targets, including countries that are on track, targets for the future, and what has worked for focus countries.

IMNHC 2023 offers a unique opportunity for countries to gather in person to network, exchange knowledge, and learn from one another.

Nearly 28 official country delegations were selected through an expression of interest and competitive review process. Delegations will have the opportunity to share learnings, innovations, and best practices through a special Country Showcase session. Below are the topics each country will be presenting on.

All newborns deserve the chance to survive and thrive. However, a quarter of the world's newborns are born too early or too small, with wide-ranging implications.

Please join Kate McIntosh, Senior Editor of The Lancet Global Health, and a panel of experts as they unpack a new Lancet Series focused on the small vulnerable newborn (SVN). Richard Horton, Editor-in-Chief of The Lancet, will provide opening remarks before panelists address questions such as:

-Why it is important to increase attention to SVN, i.e., newborns who are preterm, small-for-gestational-age, or have low birth weight.
-How common are SVN births are in different world regions? Where has progress faltered, and why?
-What are the biological pathways that lead to SVN births?
-How a large share of SVN births and associated ill health could be prevented with a package of low-cost antenatal interventions.

The Lancet Series provides a scientific basis for action and calls for a global response to support a healthy start for every baby everywhere.

Register in advance via http://easycode.com/lancetsvn2023

MOMENTUM is hosting a marketplace-style evening reception on Tuesday, May 9. Stop by the Westin East Ballroom at 5:30pm to learn about MOMENTUM's work to save the lives of mothers and newborns in almost 40 countries worldwide. Refreshments will be provided.

No RSVP necessary.

The fourth plenary, How to Prioritize and Finance MNH Programs in Primary Health Care, will focus on the importance of keeping maternal newborn health at the center of primary health care. As the world moves out of the crisis stage of COVID-19 response, how can we ensure that women and newborns' needs are at the center of health programming? As important, how can we ensure those programs are funded?

If for some reason you are unable to upload your presentation by the deadline of 04 May, you may bring it on a USB drive no less than 24 hours prior to your scheduled presentation(s) to the Presenter Assistance Room (Room 1.51-1.52). The Presenter Assistance Room will be open on the following dates/times:

- Sunday, 07 May, 13:00-18:00

- Monday, Tuesday, and Wednesday, 08-10 May, 08:00-17:00 Please bring a picture ID with you to the Presenter Assistance Room.

Anemia, a potentially debilitating condition that can affect physical and neurocognitive capacity, has become a leading proxy indicator for nutrition and broader human development. Anemia among women 15-49 years of age remains a significant and enduring global health problem, associated with increased maternal mortality and adverse birth outcomes, as well as reduced productivity and economic losses. SDG2 includes a goal set by the World Health Assembly to reduce anemia among women of reproductive age (WRA) by 50% by 2025. However, there has been little progress over the last decade, with global prevalence stagnated at approximately 30%. Exemplar countries have shown promising progress and offer lessons we can learn from. In this session, panelists from Exemplars in Global Health* will present synthesized findings from four countries that showed exemplary performance in reducing anemia among WRA (i.e., Philippines, Senegal, Pakistan, and Uganda). A rigorous mixed methods approach was used, including a comprehensive, systematic review of anemia relevant programs and policies and their financing, and quantitative analyses complemented by qualitative data from in depth interviews. Findings on consistent drivers of anemia reduction across geographies and context specific multisectoral interventions will be shared, providing transferrable lessons on the prevention of anemia. Additionally, two country case studies, the Philippines and Uganda, will be presented by in-country research partners.

* The Exemplars in Global Health WRA Anemia project is led by a consortium of global research partners from SickKids, Food and Nutrition Research Institute, Makerere University, Aga Khan University, and Institut de Technologie Alimentaire.

Achievement of Elective Cesarean Following Surgical Repair of Female Genital Fistula in Uganda

Childbearing following recovery from female genital fistula in lower-resource settings is important for some women. Cesarean birth is recommended by fistula caregivers to reduce adverse outcomes, yet is inconsistently achieved. Understanding factors influencing post-repair elective cesarean may inform clinical and counseling interventions. We sought to understand perinatal experiences and care-seeking among Ugandan women who previously underwent fistula repair.

Improving Quality and Access to Safe Cesarean Section: Comprehensive Emergency Obstetric and Newborn Care (CEmONC) Mentorship and Onsite Simulation-Based Training in Developing Regional States of Ethiopia 

The World Health Organization estimates that around 295,000 women die due to complications of pregnancy and childbirth. Cesarean section (CS) is an essential part of comprehensive emergency obstetric and newborn care (CEmONC) and a life-saving intervention for women and newborns when it is done safely, timely, and with absolute indication. Access to safe CS is still suboptimal in low- and middle-income countries including Ethiopia. Nonavailability of competent providers to provide safe CS is a major barrier. The Ethiopian Society of Obstetricians and Gynecologists (ESOG) collaborated with partners and the Ministry of Health to improve CEmONC services in selected hospitals.

Post-discharge Tracking of Surgical Site Infections among Caesarean Section Clients in Makueni County, Kenya 

Most surgical site infections (SSIs) following cesarean section (CS) occur following discharge of the mother from the hospital. In Kenya, poor follow-up of the client after she leaves the facility, lack of self-care awareness of post-CS women, and delayed care seeking are major gaps in improving detection and timely management of SSIs, as well as in providing accurate estimation of SSI rates. The Johnson and Johnson-funded Obstetric Safe Surgery (OSS) project in Makueni County, Kenya, aimed to strengthen community-level follow-up of mothers and newborns at days 7 and 30 following CS.

A Multidisciplinary Team-Based Approach to Strengthen the Quality and Safety of Caesarean Sections in Makueni County, Kenya 

Women in African countries continue to suffer high complications and death from unsafe caesarean section (CS) due to lack of surgical and nonsurgical skills. A multidisciplinary team-based approach is an essential, effective, and patient-centered service delivery approach that enables positive outcomes. The Johnson and Johnson-funded Obstetric Safe Surgery (OSS) project in Makueni County, Kenya, aimed to overcome barriers to safe, timely, and quality CS by using a multidisciplinary team-based approach tailored to the local context. The interventions included improvement of nontechnical skills of surgical teams (e.g., to improve teamwork and communication), by standardizing clinical care and creating a patient safety culture.

Mycoplasma Genitalium and Other Reproductive Tract Infections in Pregnancy Associated with an Increased Risk of Adverse Birth Outcomes in a High-Burden Setting

Being born too small is a major risk factor for neonatal and infant mortality and childhood stunting. Sexually transmitted infections (STIs) are preventable and curable infections that can contribute to poor pregnancy outcomes. Mycoplasma genitalium is increasingly recognized as an STI with high prevalence in some populations and has a high propensity to develop antimicrobial resistance. Little data are available on the impact of M. genitalium on adverse birth outcomes, particularly in the context of other STIs. In Papua New Guinea (PNG), we previously demonstrated a high burden of multiple STIs (M. genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and bacterial vaginosis [BV]). Here, we have investigated the association between M. genitalium and other STIs and birthweight, preterm birth, and perinatal mortality.

The Clinical Presentation and Detection of Tuberculosis during Pregnancy and in the Postpartum Period in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis 

For women infected with Mycobacterium tuberculosis (TB), pregnancy is associated with an increased risk of developing or worsening TB disease. TB in pregnancy increases the risk of adverse maternal and neonatal outcomes; however, the detection of TB in pregnancy is challenging. We aimed to identify and summarise the findings of studies regarding the clinical presentation and diagnosis of TB during pregnancy and the postpartum period (within six months of birth) in low- and middle-income countries (LMICs).

Sero-prevalence and Risk Factors for Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Women and Children in a Rural District of Bangladesh: A Cohort Study 

Bangladesh reported its first COVID-19 case on March 8, 2020. Despite lockdowns and promotion of behavioral interventions, as of December 31, 2021, Bangladesh had reported 1.5 million confirmed cases and 27,904 COVID-19-related deaths. To understand the course of the pandemic and identify risk factors for SARs-Cov-2 infection, we conducted a cohort study from November 2020 to December 2021 in rural Bangladesh.

Does the Continuous Presence of Mothers in a Newborn Intensive Care Unit to Provide Immediate Kangaroo Mother Care Increase Neonatal Sepsis? 

A multi-country randomized controlled trial conducted in five countries (India, Ghana, Tanzania, Nigeria, and Malawi), coordinated by the World Health Organization (WHO) (iKMC study), from November 2017 to January 2020 showed a 25% reduction in mortality by immediate kangaroo mother care (KMC) in neonates with birthweight 1 to 1.8 kg. This study was published in the New England Journal of Medicine (NEJM) (May 2021). To implement the immediate KMC intervention, mother and baby needed to be together continuously, which led to the concept of the "Mother–Newborn Care Unit (MNCU)." Health care providers and administrators were concerned about the potential increase in infections due to the presence of mothers/surrogates in the MNCU. We present a post hoc analysis of the iKMC study to see the effect of immediate KMC on neonatal sepsis.

Interventions Targeting Health Care Providers to Optimise the Use of Caesarean Section: A Qualitative Comparative Analysis to Identify Important Intervention Features

Rapid increases in caesarean section (CS) rates have been observed globally; however, CS rates exceeding 15% at a population level have limited benefits for women and babies. Many interventions targeting health care providers have been developed to optimise use of CS, typically aiming to improve and monitor clinical decision-making. However, interventions are often complex, and effectiveness is varied. Understanding intervention and implementation features that likely lead to optimised CS use is important to optimise benefits. The aim of this study was to identify important components that lead to successful interventions to optimise CS, focusing on interventions targeting health care providers.

An Example of Too Much Too Soon? A Review of Caesarean Sections Performed in the First Stage of Labour in Kenya 

Caesarean section (CS) is the most commonly performed major surgical procedure, with global rates rising. When performed for appropriate indications, CS can be life-saving for mothers and babies. However, the procedure has potential short- and long-term complications, with reported rates of caesarean-associated death in sub-Saharan Africa at 10.9 per 1,000 procedures. In many health facilities, decisions to perform CS are made by nonspecialist doctors, without support from experienced obstetricians. This can result in suboptimal decision-making and inappropriate surgery. Our study assesses decision-making in CS performed in the first stage of labour.

ReJudge: Development and Testing of an Intervention to Reduce Cesarean Section (CS) Carried Out Due to Fear of Litigation 

Obstetrics is a leading area for litigation worldwide, which can result in defensive health care practices including the use of interventions to protect against litigation. Caesarean section (CS) rates are over 80% in some regions of India, which is likely to result in medically generated harms. Existing interventions that aim to reduce unnecessary CS include educational interventions and clinical guidelines. Fear of litigation is recognised as a factor that stimulates unnecessary CS. We were unaware of an existing intervention specifically targeted to this driver of unnecessary CS. The ReJudge project was designed to develop an intervention to reduce CS carried out due to fear of litigation.

Implementing the Robson Ten Group Classification System (TGCS) to Monitor Hospital Cesarean Section Rates in Nepal: Some Early Lessons 

Nepal's population-based caesarean section (CS) rate has increased over the years but the (CS) rate of 9% (2016) is still within the World Health Organization (WHO) reference of 5–15%. Observed rates at the facility level vary due to case-mix, and their appropriateness is difficult to assess as they could reflect either overuse or unmet need for CS. Unsafe provision of CS quality of care endangers patient outcomes. The Family Welfare Division (FWD) adapted the WHO Robson Ten Group Classification System (TGCS) Guideline 2017, piloted it in four hospitals, and has recently rolled it out to 33 hospitals across the country.

The World Health Organization (WHO) and partners in the maternal and perinatal death surveillance and response (MPDSR) technical working group are working together to strengthen implementation of MPDSR to enhance the quality of maternal and perinatal care and improve health outcomes.

A key intervention for improving maternal, perinatal, and neonatal survival is understanding the number and causes of deaths. This panel will show how creating a community of practice of MPDSR data use with specific implementation experiences from Uganda, Indonesia, and other countries is possible in order to actively track number of deaths and respond to these deaths. Moreover, we will present to the audience an important new tool, the "Legislating maternal death surveillance and response" manual. This tool is based on a desk review study of a cross-section of countries that have instituted a legal or regulatory framework for implementing maternal death surveillance and response (MDSR) systems or are aspiring to develop such a framework. Countries increasingly find legislation is a useful accountability tool that has the capacity to supplement policy by establishing a legal or regulatory mandate for reporting and reviewing maternal deaths. This enhances transparency and promotes MPDSR as a system where confidentiality must always be observed and respected.

The session will actively seek contributions from the audience on what further the WHO with partners and policymakers can do to ensure further improvement and implementation of MPDSR cycle at country and global levels.

Actions to achieve Sustainable Development Goal (SDG) 2030 targets for maternal and newborn health are supported by Every Newborn Action Plan (ENAP) and Ending Preventable Maternal Mortality (EPMM) partnerships. ENAP and EPMM have launched five joint coverage targets and milestones for tracking progress, and the first joint ENAP/EPMM progress report launches at the International Maternal Newborn Health Conference (IMNHC) in May 2023. 

Data for action is an important ENAP and EPMM milestone and includes strengthening data systems to better track these targets at subnational, national, and global levels. To this end, the ENAP/EPMM partnership has developed a joint Measurement Improvement Roadmap 2023-2025 to list priority indicators with a focus on ENAP/EPMM targets, identify what to do now to improve data (especially in routine systems), and outline what next for improving measurement and use of data. The previous ENAP Measurement Improvement Roadmap 2015-2020 resulted in improved data guidance and also large multi-country validation studies to inform measurement change. We propose a dynamic session showcasing actions in the roadmap. 

Three presentations will cover what to measure now and next for indicators regarding impact, coverage/quality, and service availability. A country-led panel discussion will follow. Building on evidence from the 2023 EPMM/ENAP report, this session will use the roadmap to show current maternal and newborn health (MNH) data availability, and how to drive improvements in data quantity, quality, and utility at local, district, and national levels. Panelists will include national policymakers, donors, and thought leaders to share experiences and realities of how we can transform data for action in MNH and move faster, including what can be achieved by the next IMNHC in 2025.

Over the past 20 years, the emergency obstetric care (EmOC) indicators and framework have been used extensively to plan and monitor EmOC services at national and subnational levels. The current framework and indicators have provided critical information to help develop data-driven approaches to reducing maternal mortality and set targets and track progress towards strengthening EmOC services. At the same time, health systems have evolved, the evidence base has expanded, and implementation lessons have been collected about what works and what remains challenging across different settings. With these developments in mind, a global initiative led by Columbia University's Averting Maternal Death and Disability program, the London School of Hygiene and Tropical Medicine, the United Nations Population Fund (UNFPA), United Nations Children's Fund (UNICEF), and World Health Organization (WHO) is updating, improving, and expanding the EmOC framework and indicators to better meet the needs of countries for the next 20 years. This process has been designed using principles and practices of human-centered design to ensure the indicators meet the needs of key users, particularly national and subnational planners and managers. This includes learning from countries' experiences using the emergency obstetric and newborn care (EmONC) framework and indicators and their ideas for improvement. A global modified Delphi study and in-depth studies in Senegal, Malawi, and Bangladesh using human-centered design methods generated insights on what is needed and wanted for planning and monitoring implementation. These findings were integrated into the re-visioning process. This panel will present the near final draft of the revised EmONC framework and indicators and provide an opportunity for participants to share feedback.

The reduction of maternal mortality has long been a global health priority and remains a prominent part of the Sustainable Development Goals (SDG) agenda. The SDGs include a direct emphasis on reducing maternal mortality while also highlighting the importance of moving beyond survival. SDG target 3.1, "reduce global MMR to less than 70 per 100 000 live births by 2030" is an ambitious target and will require sustained commitments to ensure that women and adolescent girls get quality care and support when and where needed.

The United Nations Maternal Mortality Estimation Interagency Group (MMEIG) comprising WHO, UNICEF, UNFPA, the World Bank Group, the United Nations Population Division has collaborated with external academic teams and technical experts on a new round of maternal mortality estimates covering the period 2000 2020. These new MMR estimates supersede all previous estimates and are based on the most up to date data and methods, assessing national, regional and global trends monitoring progress towards 2030. The panel will also report updated cause of maternal death estimates from WHO.

Having targets for maternal mortality reduction is important but accurate data remains the key to robust policy and programming. Authors from Sri Lanka and Jamaica will share data and processes to quantify and reduce missed and misclassified maternal deaths. Enhanced reporting will allow better data use, informing maternal cause of death attribution, informing interventions and tracking including interpretation of the gaps in coverage.

Factores contribuyentes al aumento de la mortalidad materna y perinatal durante la pandemia de COVID-19 en América Latina

En 2020, la infección por COVID-19 en gestantes estuvo asociada a razones más altas de mortalidad, sobre todo en mujeres con comorbilidades. Las muertes maternas aumentaron, también, como consecuencia de la disrupción en la oferta y la subutilización de los servicios de salud, dada por reducciones en el acceso y la calidad de éstos. Se realizó un estudio multi-país en Chile, Colombia y Ecuador para indagar sobre los determinantes de la mortalidad materna y su relación con las políticas en el período marzo 2020-julio 2021.

Proyecto de mejora de la calidad: Aumentando el tamizaje completo para gestantes en situación de vulnerabilidad en su primer contacto con los servicios de salud en Chiapas, México. 

Compañeros en Salud (CES) es una organización dedicada a la prestación de servicios de salud gratuitos para población vulnerada en Chiapas, México. Se oferta cuidado prenatal en 10 clínicas que atienden más de 400 gestantes anualmente. Debido a que los estudios complementarios y los servicios de atención especializada son de difícil acceso, CES ofrece un catálogo de tamizaje basado en pruebas rápidas de diagnóstico que de realizarse en el primer contacto con la gestante permiten una oportuna determinación de riesgo. Para los casos que requieren servicios especializados estos ofrecen la mejor ventana de tiempo para que la organización otorgue el apoyo social y se obtengan los mejores resultados para el binomio.

Formación e incorporación de técnicas universitarias en partería al sistema de salud de Guatemala, como estrategia para la reducción de mortalidad materna y neonatal. 

Según el Plan Nacional de Reducción de Muerte Materna y Neonatal 2021-2025, Guatemala ha definido la estrategia de formación de Técnicas Universitarias en Partería (TUP), recurso humano calificado para brindar atención materna y neonatal. La estrategia inicio en el año 2018, con el reconocimiento oficial del Ministerio de Salud Pública y Asistencia Social (MSPAS), el asocio de las Universidades Da Vinci de Guatemala, San Martín de Porres de Lima Perú y el apoyo del Proyecto Salud y Nutrición financiado por USAID.

The Indirect Effects of the COVID-19 Pandemic on Maternal and Newborn Health Services and Outcomes in Latin America 

The indirect effects of COVID-19 on maternal and newborn health outcomes is largely unknown. In Latin America, thousands of excess maternal deaths were estimated to take place as a result of the reduction in coverage of health care services during the early efforts to contain COVID-19 transmission, ranging from 1,200 to 8,000 excess deaths during the first year; thousands more neonatal deaths would be expected. The aim of this study was to estimate the average indirect effect of COVID-19 on maternal and newborn health services and outcomes in Latin America between 2019 and 2021. The study findings may be used to inform future policies and programs that advocate for strengthening maternal and newborn health services during a global health crisis.

Concordance of a Modified Downes' Score by Physicians and Nurses When Assessing Respiratory Distress Syndrome in the Ethiopian Neonatal Network

Respiratory distress syndrome (RDS) is the leading cause of mortality of preterm infants in low- and middle-income countries (LMICs). Lack of diagnostic tools along with scarcity of human resources highlight the need for objective clinical assessments of RDS that can be implemented by multidisciplinary newborn care providers. Our objective was to assess the correlation of modified Downes' scores (MDS) assigned by physicians and nurses in the Ethiopian Neonatal Network (ENN).

Lessons Learnt from Community Referral and Follow-Up of Sick Young Infants with Possible Severe Bacterial Infection in Turkana County, Kenya 

Management of possible severe bacterial infections in young infants (0-59 days) requires timely identification of danger signs and prompt administration of efficacious antibiotic treatment. The possible severe bacterial infection guidelines underscore the importance of close follow-up in an outpatient basis to ensure treatment adherence and early detection of illness-related complications. The purpose of this study was to strengthen the follow-up and referral of sick young infants on days 4 and 8 by introducing community-led interventions that facilitated community health volunteers to identify sick young infants, conduct community reviews, link data with responsive facilities, and refer appropriately.

What Do Health Workers Know and Do about Developmentally Supportive Care for Preterm Infants in a Low-Income Setting: Evidence from Uganda 

Premature birth disrupts in-utero brain development, and preterm infants are at risk of long-term neurodevelopmental issues. The neonatal unit (NICU) can be stressful for a preterm infant at a time of rapid brain growth and plasticity, and this may contribute to poorer developmental outcomes. Modifying the environment to protect against negative sensory experiences and ensure positive stimuli from caregivers is the standard of care in many high-income settings. Little is known about developmentally supportive care in low- or middle-income settings, yet this is where 81% of preterm infants are born. To add to this sparse knowledge base, we determined current knowledge and practice relating to developmentally supportive care among health workers in Uganda.

Using Machine Learning to Determine the Association of Maternal Characteristics and Maternal Serum-Related Biomarkers with Newborn Outcomes 

In 2018, around 40% of children under five years of age were stunted in South Asia, which makes the prevalence of stunting higher in this region than others worldwide. Stunting contributes towards poor health outcomes later in life and is strongly correlated with impaired cognitive development. In most cases, stunting starts in utero, which is why prenatal identification of children at risk for stunting at birth is crucial. The aim of this study was to identify the maternal characteristics and maternal serum biomarkers that are strong predictors of stunting at birth.

A Quality Improvement Collaborative to Enhance Maternal and Newborn Health (MNH) Care Delivery by Adopting Global Guidance within Local Contexts in Low-Resource Settings

In private hospitals in Southern India, the gap between current and ideal performance in labour room practices warranted a quality improvement (QI) initiative. The World Health Organization (WHO) Safe Childbirth Checklist (SCC) is a patient safety tool to improve adherence to 28 essential birth practices. A QI Collaborative was initiated with the Obstetric Clinical Society of Southern India (OGSSI) and Consortium of Accredited Healthcare Organisations (CAHO) to implement SCC in member hospitals and enhance childbirth care delivery. The objectives were to implement SCC in hospitals via low-cost innovations and to evaluate key metrics in resource-challenged settings using quality tools.

Implementing a Multifaceted Approach to Reduce Fresh Stillbirths in Mbarara District, Uganda 

The fresh stillbirth (FSB) rate in Uganda in 2019/2020 was 12 per 1,000 births; in Mbarara District, it was 7.3 per 1,000 births. These rates exceed the national target of less than 5 per 1,000 births. Research shows that 40% of the FSBs in Uganda can be prevented by improving the quality of service.

Assessing the Needs for Emergency Obstetric and Newborn Care (EmONC) Health Facilities in Burundi to Support Maternal and Newborn Health Service Delivery Redesign (MNH-Redesign) 

Despite Burundi having formed a network of 112 emergency obstetric and newborn care (EmONC) health facilities, the country continues to struggle with high rates of maternal and newborn deaths. This study generated evidence on the needs of EmONC health facilities to improve maternal and newborn survival.

Feasibility of a Sustainable Emergency Obstetric Care Training System in Nigeria 

As part of a maternal mortality reduction strategy, emergency obstetric and newborn care (EmONC)-competent skilled health personnel (SHP) working within integrated teams to provide good quality care are required. Standard EmONC training approaches in Nigeria are the partner funding-dependent National Life Saving Skills (LSS) programme and the annual Nursing and Midwifery Council of Nigeria (NMCN) Mandatory Continuous Professional Development Programme (MCPDP) for practice license renewal. We designed and implemented a center of excellence (CoE) for EmONC approach embedded in the college of Nursing and Midwifery Kwara State, Nigeria. The CoE was equipped for competency-based EmONC training and linked to the MCPDP practice license renewal programme. We conducted a feasibility study on the CoE approach to train SHP in EmONC in Nigeria.

Targeting Postnatal Care to Mothers and Babies Most at Risk: Factors that Increase the Risk of Poor Outcomes in the Postnatal Period Identified through a Scoping Review

Maternal and newborn deaths in the early postnatal period can be averted with the provision of timely, quality, postnatal care including postnatal home visits from community health workers (CHWs). Yet in many low- and middle-income countries (LMICs), coverage of early, postnatal home visits (within the first 72 hours of life) has been hampered by underresourced and overburdened CHW cadres. A targeted postnatal care (PNC) approach that prioritizes home visits to mother-baby dyads with identified risk factors could optimize limited resources. This study sought to determine the key risk factors that predict poor outcomes for mothers and newborns in LMICs during the postnatal period.

Effect of Community-Based Interventions on Preventing Stillbirths in Sub-Saharan Africa (SSA): A Mixed-Method Systematic Review and Meta-analysis 

Globally, there were two million stillbirths in 2019; 98% occurred in low-middle-income countries. The burden was highest in sub-Saharan Africa (SSA) despite efforts to reduce the incidence. We conducted a mixed-methods systematic review and meta-analysis to investigate the types, effectiveness, and acceptability of community-based interventions for preventing stillbirths in SSA.

Vulnerable Newborn Types: Analysis of Subnational, Population-Based Birth Cohorts for 541,285 Live Births in 23 Countries, 2000 to 2021 

Preterm and small newborns are at higher risk for mortality and long-term adverse health outcomes. Yet there are major gaps in global and national systems to measure and track the prevalence of newborn outcomes, especially in countries without strong national data systems. Currently, estimates for prevalence of low birthweight and preterm are produced separately, and these ignore important contributions of small for gestational age (SGA) and large for gestational age (LGA). Absence of a unified classification system to estimate prevalence of detailed newborn outcomes presents challenges for effectively targeting policies and programs. We described the prevalence of newborn types among live births and assessed data quality using subnational, population-based birth cohorts.

Which Low- and Middle-Income Countries Have Midwife-Led Birthing Centres and What Are the Main Characteristics of These Centres? A Scoping Review and Scoping Survey 

Evidence about the benefits of midwife-led care during childbirth has led to midwife-led settings being recommended for women with uncomplicated pregnancies. However, most of the research on this topic comes from high-income countries. Relatively little is known about the availability and feasibility of midwife-led birthing centres (MLBCs) in low- and middle-income countries (LMICs). This study aimed to identify which LMICs have MLBCs, and to document their main characteristics. It is the first part of a project that will document "what works" and "why" for MLBCs in LMICs.