- Email: [email protected]
Editor's Final Comment
International Journal of Gynecology and Obstetrics 115 (2011) 298–299
Contents lists available at SciVerse ScienceDirect
International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo
AVERTING MATERNAL DEATH AND DISABILITY
Editor's Final Comment
Just over a decade ago Professor Deborah Maine (now of Boston University) and the late Dean Allan Rosenfield of Columbia University's Mailman School of Public Health in New York City asked FIGO if we could assist them in recognizing those who made meaningful contributions to decreasing maternal deaths. Accordingly, at the 2000 FIGO World Congress held in Washington DC, a program was initiated to provide awards to clinicians who, by their individual efforts, were showing the world that progress could be made using local resources. The program was well received by the delegates attending the World Congress. At the same time, Professors Rosenfield and Maine felt that the maternal mortality community would benefit if the IJGO developed a regular section devoted to publishing papers on the topic of averting maternal death and disability. The Editorial Board (of which Professor Rosenfield was a member) and the publisher (Elsevier) developed an agreement with the Mailman School of Public Health to do this. I (JAF) was asked to edit this special section of the journal. The Editor-in-Chief (first Dr John Sciarra, and later Dr Timothy Johnson) and the Managing Editors (first Kelley Williams, and later Clare Addington), not to mention Elsevier, could not have been more helpful. Our first issue came out in August 2001, and the last one is the one you are reading now (December 2011). The Bill and Melinda Gates Foundation provided generous funding to this section of the IJGO for the past 10 years. In 1999, when the idea was first conceived, despite widespread interest in the too high levels of maternal mortality, it was not easy to publish in conventional journals articles that described programs designed to reduce maternal mortality. So-called “programmatic research” was largely restricted to the gray literature, while the mainstream journals would take articles on policy, measurement, strategy, women's rights, and anything clinical. We were after articles that described an intervention (nonclinical) intended to reduce maternal mortality and disability, why the authors thought it would work, the challenges in implementation, and which parts were successful and which were not. We also wanted to see research that identified the specific logjams to effective emergency obstetric care (EmOC). More journals are now willing to publish these kinds of papers. What we did not want to see (and many were submitted) were articles that merely bewailed the problem (“handwringing articles’) without offering and testing solutions. Up to and including the present issue, the IJGO has printed 32 special sections with 108 articles written by nearly 200 authors from 46 countries on every continent. Topics ranged widely. They were as varied as how to renovate a maternity ward in a small district hospital at minimal cost, how to manage equipment for EmOC, how to use motorcycles to transport women with obstetric emergencies, how to use audits to improve the quality of EmOC, how to reduce deaths from unsafe abortions,
and what contributions to reducing mortality can be made by professional organizations or mission hospitals. Some of the papers came from major programs run by well-known institutions of public health, such as Columbia University's AMDD program and its partners (UNICEF, UNFPA, and the Indian Institute of Management), The University of Aberdeen in the UK, or the Safer Motherhood program run by DfID in Nepal . But what was encouraging for the future of the world's mothers was the number of papers describing programs or projects with which we were previously unfamiliar. It is not only the projects themselves that are encouraging, but that the authors were willing and able to share their experiences and outcomes so that others might replicate them for the benefit of mothers everywhere. This is unusual. And for some it was not easy. English was not their first (or even second) language, and journal requirements were a struggle. Many people who work in programs focus on the program rather than on publishing papers. It was especially gratifying to work with these authors. Ten articles described results of needs assessments, which are standardized procedures designed to measure the availability of EmOC [1] to identify what needs to be done to increase the availability and quality of EmOC. More than 50 countries have conduced needs assessments and took action to correct the shortcomings that were identified. Four articles took advantage of this volume of experience to comment on their utility, to draw global conclusions from them, and to suggest refinements in the measures [2]. We are sometimes asked to indicate favorite articles that we have published. Three especially spring to mind. They were not from large externally run programs, but locally driven, designed, implemented, and evaluated. One described the approach used by a single hospital in Uruguay to reduce morbidity and mortality from unsafe abortion; it was so successful that the Ministry of Health expanded the program nationally, even though induced abortion remains illegal [3]. The second describes Jamaica's successful program to reduce mortality and morbidity from eclampsia [4]. The third describes a scheme in Malawi to transfer women with obstetric emergencies on motorcycles (with sidecars) to a hospital that can help them [5]. It is encouraging that there have been meaningful reductions in maternal mortality in recent years, although we are far from reaching the Millennium Developments Goals 4 and 5 by 2015. We would like to think that the efforts of FIGO and the IJGO and our contributing authors have helped in some way to bring about this positive development and that readers have found this special section to be both instructive and inspiring. We trust it will be possible for the IJGO to continue to publish these kinds of articles even though we no longer have the generous external funding that made the first 10 years possible. This final issue contains 4 papers that continue the tradition. Two use data from Ethiopia's assessment of its obstetric care program and
0020-7292/$ – see front matter © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2011.09.005
Averting maternal death and disability
both address very broad issues of crucial importance. For the first time we publish a paper [6] using a geographic information systems (GIS) analysis to determine the most efficient way to increase access to EmOC in one province of Ethiopia: build new roads or new hospitals? The second looks at the impact of the cost of care on use and quality of obstetric services [7]. Yet another paper from Ethiopia shows that a significant reduction can be made in abortion morbidity and mortality by a targeted training on safe abortion and making the public aware of safe services [8]. The final paper revisits a topic we've covered before—the acute shortage of human resources—and shows the importance of coordinating human resource policies and initiatives with regulatory bodies, preservice training, and Ministry of Health policies. New policies alone have little impact without this system-wide coordination [9].
299
[5] Hoffman JJ, Dzimadzi C, Lungu L, Ratsma EY, Hussein J. Motorcycle ambulances for referral of obstetric emergencies in rural Malawi: do they reduce delay and what do they cost? Int J Gynecol Obstet 2008;102(2):191–7. [6] Bailey PE, Keyes EB, Parker C, Abdullah M, Kebede H, Freedman L. Using a GIS to model interventions to strengthen the emergency referral system for maternal and newborn health in Ethiopia. Int J Gynecol Obstet 2011; [This issue – complete at compile]. [7] Pearson L, Ghandi M, Admasu K, Keyes EB. User fees and maternity services in Ethiopia. Int J Gynecol Obstet 2011; [This issue – complete at compile]. [8] Otsea K, Benson J, Alemayehu T, Pearson E, Healy J. Testing the Safe Abortion Care model in Ethiopia to monitor service availability, use, and quality. Int J Gynecol Obstet 2011; [This issue – complete at compile]. [9] Lobis S, Mbaruku G, Kamwendo F, McAuliffe E, Austin J, de Pinho H. Expected to deliver: Alignment of regulation, training, and actual performance of emergency obstetric care providers in Malawi and Tanzania. Int J Gynecol Obstet 2011; [This issue – complete at compile].
Judith A. Fortney References [1] UNICEF, WHO, UNFPA. Guidelines for monitoring the availability and use of obstetric services. 2nd edition. Geneva: WHO; 1997. Available at:http://www.who.int/making_ pregnancy_safer/documents/9280631985/en/index.html. [2] WHO, UNFPA, UNICEF, AMDD. Monitoring emergency obstetric care - A handbook. Geneva: WHO; 2009. Available at:http://www.who.int/reproductivehealth/publications/ monitoring/9789241547734/en/index.html. [3] Briozzo L, Vidiella G, Rodriguez F, Gorgoroso M, Faundes A, Pons JE. A risk reduction strategy to prevent maternal deaths associated with unsafe abortion. Int J Gynecol Obstet 2006;95(2):221–6. [4] McCaw-Binns AM, Ashley DE, Knight LP, MacGillivray I, Golding J. Strategies to prevent eclampsia in a developing country: I, Reorganization of maternity services. Int J Gynecol Obstet 2004;87(3):286–94.
Mailman School of Public Health, Columbia University, New York, USA Corresponding author. E-mail address: [email protected]. John J. Sciarra IJGO Editor 1985–2007
Contents lists available at SciVerse ScienceDirect
International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo
AVERTING MATERNAL DEATH AND DISABILITY
Editor's Final Comment
Just over a decade ago Professor Deborah Maine (now of Boston University) and the late Dean Allan Rosenfield of Columbia University's Mailman School of Public Health in New York City asked FIGO if we could assist them in recognizing those who made meaningful contributions to decreasing maternal deaths. Accordingly, at the 2000 FIGO World Congress held in Washington DC, a program was initiated to provide awards to clinicians who, by their individual efforts, were showing the world that progress could be made using local resources. The program was well received by the delegates attending the World Congress. At the same time, Professors Rosenfield and Maine felt that the maternal mortality community would benefit if the IJGO developed a regular section devoted to publishing papers on the topic of averting maternal death and disability. The Editorial Board (of which Professor Rosenfield was a member) and the publisher (Elsevier) developed an agreement with the Mailman School of Public Health to do this. I (JAF) was asked to edit this special section of the journal. The Editor-in-Chief (first Dr John Sciarra, and later Dr Timothy Johnson) and the Managing Editors (first Kelley Williams, and later Clare Addington), not to mention Elsevier, could not have been more helpful. Our first issue came out in August 2001, and the last one is the one you are reading now (December 2011). The Bill and Melinda Gates Foundation provided generous funding to this section of the IJGO for the past 10 years. In 1999, when the idea was first conceived, despite widespread interest in the too high levels of maternal mortality, it was not easy to publish in conventional journals articles that described programs designed to reduce maternal mortality. So-called “programmatic research” was largely restricted to the gray literature, while the mainstream journals would take articles on policy, measurement, strategy, women's rights, and anything clinical. We were after articles that described an intervention (nonclinical) intended to reduce maternal mortality and disability, why the authors thought it would work, the challenges in implementation, and which parts were successful and which were not. We also wanted to see research that identified the specific logjams to effective emergency obstetric care (EmOC). More journals are now willing to publish these kinds of papers. What we did not want to see (and many were submitted) were articles that merely bewailed the problem (“handwringing articles’) without offering and testing solutions. Up to and including the present issue, the IJGO has printed 32 special sections with 108 articles written by nearly 200 authors from 46 countries on every continent. Topics ranged widely. They were as varied as how to renovate a maternity ward in a small district hospital at minimal cost, how to manage equipment for EmOC, how to use motorcycles to transport women with obstetric emergencies, how to use audits to improve the quality of EmOC, how to reduce deaths from unsafe abortions,
and what contributions to reducing mortality can be made by professional organizations or mission hospitals. Some of the papers came from major programs run by well-known institutions of public health, such as Columbia University's AMDD program and its partners (UNICEF, UNFPA, and the Indian Institute of Management), The University of Aberdeen in the UK, or the Safer Motherhood program run by DfID in Nepal . But what was encouraging for the future of the world's mothers was the number of papers describing programs or projects with which we were previously unfamiliar. It is not only the projects themselves that are encouraging, but that the authors were willing and able to share their experiences and outcomes so that others might replicate them for the benefit of mothers everywhere. This is unusual. And for some it was not easy. English was not their first (or even second) language, and journal requirements were a struggle. Many people who work in programs focus on the program rather than on publishing papers. It was especially gratifying to work with these authors. Ten articles described results of needs assessments, which are standardized procedures designed to measure the availability of EmOC [1] to identify what needs to be done to increase the availability and quality of EmOC. More than 50 countries have conduced needs assessments and took action to correct the shortcomings that were identified. Four articles took advantage of this volume of experience to comment on their utility, to draw global conclusions from them, and to suggest refinements in the measures [2]. We are sometimes asked to indicate favorite articles that we have published. Three especially spring to mind. They were not from large externally run programs, but locally driven, designed, implemented, and evaluated. One described the approach used by a single hospital in Uruguay to reduce morbidity and mortality from unsafe abortion; it was so successful that the Ministry of Health expanded the program nationally, even though induced abortion remains illegal [3]. The second describes Jamaica's successful program to reduce mortality and morbidity from eclampsia [4]. The third describes a scheme in Malawi to transfer women with obstetric emergencies on motorcycles (with sidecars) to a hospital that can help them [5]. It is encouraging that there have been meaningful reductions in maternal mortality in recent years, although we are far from reaching the Millennium Developments Goals 4 and 5 by 2015. We would like to think that the efforts of FIGO and the IJGO and our contributing authors have helped in some way to bring about this positive development and that readers have found this special section to be both instructive and inspiring. We trust it will be possible for the IJGO to continue to publish these kinds of articles even though we no longer have the generous external funding that made the first 10 years possible. This final issue contains 4 papers that continue the tradition. Two use data from Ethiopia's assessment of its obstetric care program and
0020-7292/$ – see front matter © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2011.09.005
Averting maternal death and disability
both address very broad issues of crucial importance. For the first time we publish a paper [6] using a geographic information systems (GIS) analysis to determine the most efficient way to increase access to EmOC in one province of Ethiopia: build new roads or new hospitals? The second looks at the impact of the cost of care on use and quality of obstetric services [7]. Yet another paper from Ethiopia shows that a significant reduction can be made in abortion morbidity and mortality by a targeted training on safe abortion and making the public aware of safe services [8]. The final paper revisits a topic we've covered before—the acute shortage of human resources—and shows the importance of coordinating human resource policies and initiatives with regulatory bodies, preservice training, and Ministry of Health policies. New policies alone have little impact without this system-wide coordination [9].
299
[5] Hoffman JJ, Dzimadzi C, Lungu L, Ratsma EY, Hussein J. Motorcycle ambulances for referral of obstetric emergencies in rural Malawi: do they reduce delay and what do they cost? Int J Gynecol Obstet 2008;102(2):191–7. [6] Bailey PE, Keyes EB, Parker C, Abdullah M, Kebede H, Freedman L. Using a GIS to model interventions to strengthen the emergency referral system for maternal and newborn health in Ethiopia. Int J Gynecol Obstet 2011; [This issue – complete at compile]. [7] Pearson L, Ghandi M, Admasu K, Keyes EB. User fees and maternity services in Ethiopia. Int J Gynecol Obstet 2011; [This issue – complete at compile]. [8] Otsea K, Benson J, Alemayehu T, Pearson E, Healy J. Testing the Safe Abortion Care model in Ethiopia to monitor service availability, use, and quality. Int J Gynecol Obstet 2011; [This issue – complete at compile]. [9] Lobis S, Mbaruku G, Kamwendo F, McAuliffe E, Austin J, de Pinho H. Expected to deliver: Alignment of regulation, training, and actual performance of emergency obstetric care providers in Malawi and Tanzania. Int J Gynecol Obstet 2011; [This issue – complete at compile].
Judith A. Fortney References [1] UNICEF, WHO, UNFPA. Guidelines for monitoring the availability and use of obstetric services. 2nd edition. Geneva: WHO; 1997. Available at:http://www.who.int/making_ pregnancy_safer/documents/9280631985/en/index.html. [2] WHO, UNFPA, UNICEF, AMDD. Monitoring emergency obstetric care - A handbook. Geneva: WHO; 2009. Available at:http://www.who.int/reproductivehealth/publications/ monitoring/9789241547734/en/index.html. [3] Briozzo L, Vidiella G, Rodriguez F, Gorgoroso M, Faundes A, Pons JE. A risk reduction strategy to prevent maternal deaths associated with unsafe abortion. Int J Gynecol Obstet 2006;95(2):221–6. [4] McCaw-Binns AM, Ashley DE, Knight LP, MacGillivray I, Golding J. Strategies to prevent eclampsia in a developing country: I, Reorganization of maternity services. Int J Gynecol Obstet 2004;87(3):286–94.
Mailman School of Public Health, Columbia University, New York, USA Corresponding author. E-mail address: [email protected]. John J. Sciarra IJGO Editor 1985–2007