Despite remarkable global progress, the most essential maternal and reproductive health interventions still do not reach the poorest and most vulnerable women, girls and children in the developing world.
Although the number of maternal and child deaths has decreased considerably, the Sustainable Development Goals that focus on reducing maternal (SDG3.1) and child (SDG3.2) mortality are far from being reached. Half of women in developing regions do not receive the recommended amount of health care they need. Around 287,000 women die every year as a result of complications related to pregnancy, childbirth or postpartum, and almost all of these preventable deaths occur in developing countries. The difference in maternal mortality rates between developed and developing countries is the biggest global health inequity today. Moreover, every year more than eight million children under five years of age die from preventable causes, many within the first month of life.
Despite progress over the last decade, women and children still face disproportionate inequalities in access to and quality health careClara Menéndez, Director of the Maternal, Child and Reproductive Health Initiative
Maternal and newborn mortality in low- and middle-income countries is heavily exacerbated by indirect causes: taken together HIV/AIDS, malaria and tuberculosis are among the leading causes of maternal mortality. In addition, the lack of reliable data on the number of deaths and their causes continues to hamper progress towards the SDG targets and must be a priority at the national and global level.
Improving the health outcomes of the most marginalized and fragile populations in the development regions, such as women, adolescents and children, is at the heart of our work.
The Maternal, Child and Reproductive Health Initiative, which integrates all areas of the institution (research, training, analysis and global development), generates knowledge, innovation and capacity through projects and activities focused on the following areas:
Malaria in Pregnancy: Malaria infection during pregnancy is one of the main contributors to maternal and neonatal mortality, mostly due to low birth weight and prematurity, and to maternal anaemia or maternal malaria infection (placental parasitaemia). As a result, an estimated 10,000 women and 200,000 infants die every year in Africa. We are currently working on: operations research for improved delivery mechanisms of Intermittent Preventive Treatment of malaria during pregnancy (IPTp) in malaria endemic countries, aimed at improving the coverage of this preventive treatment (TIPTOP); and pharmacosurveillance studies and research on possible interactions between antimalarials and antiretroviral drugs in pregnant women and children (MAMAH). Previous research undertaken in this area includes: safety and efficacy of alternatives to sulfadoxine-pyrimethamine for IPTp during pregnancy (MIPPAD); epidemiological and clinical features of Plasmodium vivax malaria in pregnancy (PregVax); cost-effectiveness of malaria control interventions in infants and pregnant women; and intermittent preventive treatment in infants (IPTi) for preventing malaria in the first year of life (findings of this research led the WHO to recommend the implementation of IPTi in malaria endemic areas).
ISGlobal is member of the WHO-Roll Back Malaria Malaria in Pregnancy Working Group (RBM MiPWG) whose goal is to provide strategic advice on best practices for scaling up interventions for the prevention and control of malaria during pregnancy.
Causes of death: One of the problems that continues to hamper progress in the reduction of maternal and child mortality in developing regions is the lack of reliable data on the levels and causes of mortality. To that end we are working to design, validate and implement Minimally Invasive techniques for investigating causes of death in low-resource settings and in different cultural, religious and geographical backgrounds. Minimally Invasive Tissue Sampling (MITS) is a technique that consists in using very fine needles to recover tissue samples from different organs, and analysing such tissues through anatamopathological and microbiological techniques, thus allowing an accurate establishment of the cause of death. In contrast to the complete autopsy, MITS can be performed by specially trained technicians and with limited infrastructure. The technique was developed through the CADMIA and CADMIA-plus projects, set the basis for CHAMPS, a global child mortality prevention and surveillance network, and has become the cornerstone of a new pathology-based surveillance alliance.
Maternal immunisation: Maternal immunisation offers an exceptional opportunity to protect women and their babies from diseases that cause substantial morbidity and mortality. We work to determine the burden of vaccine-preventable diseases that affect pregnant women and their infants in preparation for the evaluation of vaccines during pregnancy in resource-limited settings.
Inequalities in maternal and reproductive health: As part of the efforts to achieve SDG3 on health (targets 1 and 2 on maternal and child health), SDG5 on gender equality (targets 1 and 6) and SDG10 on reducing inequality within and between countries, we work to generate evidence on inequalities in access to quality RMNCAH services and on the factors contributing to such inequalities in low-resource settings.
Capacity building: In 2014 ISGlobal, the Maternal Health Task Force at the Harvard T.H. Chan School of Public Health (MHTF-HSPH) and the Center of Excellence in Women and Children Health/ Aga Khan University (AKU) developed and launched the Safe Mothers and Newborns Leadership Workshop (SMNLW) in collaboration with many members of the RMNCAH community. The workshop format - designed as a week-long, intensive, highly applied training program is specifically aimed to strengthen LMICs health professionals’ technical and leadership skills