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Safe motherhood initiative: 20 years and counting

Over the past three decades, substantial progress has been made in reducing maternal mortality worldwide. However, the historical focus on mortality reduction has been accompanied by comparative neglect of labour and birth complications that can emerge or persist months or years postnatally. This paper addresses these overlooked conditions, arguing that their absence from the global health agenda and national action plans has led to the misconception that they are uncommon or unimportant. The historical limitation of postnatal care services to the 6 weeks after birth is also a contributing factor. We reviewed epidemiological data on medium-term and long-term complications arising from labour and childbirth beyond 6 weeks, along with high-quality clinical guidelines for their prevention, identification, and treatment. We explore the complex interplay of human evolution, maternal physiology, and inherent predispositions that contribute to these complications. We offer actionable recommendations to change the current trajectories of these neglected conditions and help achieve the targets of Sustainable Development Goal 3. This paper is the third in a Series of four papers about maternal health in the perinatal period and beyond.

Physiological and psychological changes increase the risk of depression in prenatal women. This study aimed to assess the determinants of depressive symptoms (DS) among pregnant women attending public health centers in Ilorin South local government area (LGA), Kwara state.

A cross sectional research design was used for this study and a semi-structured, interview-based questionnaire was used for data collection. DS were categorized into high (≥ 13) and low (<13), social support was categorized into poor (12–24), moderate (25–33), and strong (34–48), depression literacy was categorized as good (≥ 50%) and poor (< 50%).

320 women enrolled in this study with mean age of 33.13 ± 7.23 years. The women showed high depression tendency (91.3%), good literacy (96.9%) and poor social support (77.2%). The participants who were single (OR: 5.717 (1.440–22.691); p = 0.013, or divorced/widowed/separated (OR: 7.803 (2.141–28.44); p = 0.002) were more likely to have higher tendency of DS than married. There was higher DS tendency among women with poor depression literacy (OR: 18.180 (15.135- 25.350); p < 0.001)

This study was carried out in one LGA in Kwara State. The trimesters of the women used in this study was not documented.

This study showed a high level of antenatal depression tendency, depression literacy but a low level of perceived social support among the participants. There is a need for regular mental health education and advocacy for social support to prenatal women to improve depression outcomes.

To explore the perceptions and experiences of healthcare professionals, including female health visitors, female health workers, community midwives, and heads of departments of healthcare facilities, regarding the importance of the Safe Motherhood Initiative (SMI), its pillars, and its foundational principles.

Qualitative descriptive exploratory study.

This study was conducted in healthcare centres in 10 districts in Pakistan: six in Gilgit Baltistan, two in Chitral, and two in Sindh.

Healthcare professionals were recruited using a purposive sampling technique. In total, 14 in-depth interviews were conducted.

The following themes emerged through thematic analysis: (1) health and well-being of mothers and newborns; (2) strengthening the SMI pillars; (3) equity of health services; and (4) effective strategies for behaviour modification. Each theme had two categories.

The health and well-being of mothers and newborns are key indicators; as such, interventions should be made to promote their quality of life. Capacity building and refresher training on antenatal care, childbirth, postnatal care, postabortion care, and family planning can be considered effective to enhance the competencies of healthcare professionals.

The findings of this study suggest that healthcare professionals should receive training to enhance their competencies and provide safe care.

The majority of indigenous Guatemalan women give birth at home with traditional birth attendants (TBAs), and maternal mortality rates are high (Ministerio de Salud, 2017). Our objective was to better understand decision-making around whether to remain in the home or to seek facility-level care for obstetric complications.

This study was a qualitative analysis using semi-structured interviews in a Maya population in the Western Highlands of Guatemala who received prenatal care between April 2017 and December 2018. We used qualitative interviews with women who were identified as medically high-risk and needing facility-level care, offered assistance with acquiring such care, and yet declined this option. Women interviewed were connected to a primary care organization called Maya Health Alliance, through care with TBAs involved in a program utilizing a smartphone-based decision support application to identify maternal and neonatal complications of pregnancy. Interviews were analyzed using Dedoose (www.dedoose.com). Deductive and inductive analysis was performed.

Barriers to care included a disagreement between the respondent and TBA about indications for facility care, fear of hospital care, concerns about the quality of hospital care, logistical obstacles, and lack of control; and they were more often described by respondents who had previous healthcare experiences. Therapeutic misalignment occurred more with conditions perceived to be less severe. Participants described a balancing of fears and apprehensions against concerns of low quality and disrespectful maternity care, and in the setting of emergent conditions, disregarded barriers that were often described as inhibiting non-urgent obstetric care.

The decision to engage in medical care in this population of Maya women involves a weighing of the perception of seriousness of the medical complication against fears of facility level care and concerns of a poor quality of care.

In Ethiopia, it is encouraged that labour and delivery care are performed under the observation of skilled/trained midwifery or medical professionals. However, 70% of all births occur outside the healthcare system under the care of unskilled birth attendants, family members, or without any assistance at all.

This study aimed to assess the reasons for choosing homebirth and the role of traditional birth attendants in Arba Minch Health and Demographic Surveillance Site.

A qualitative, exploratory study was carried out between May and June 2017. Twenty-nine semi-structured interviews were conducted with various respondent groups such as traditional birth attendants, pregnant women, skilled birth attendants, and health extension workers. Data were transcribed and for analysis, structured as per the participants’ responses, sorted and categorized as per the topic guide, and presented in narrative form.

The study revealed that traditional birth attendants are actively engaged in assisting homebirths in the selected area. It was also found that many women still prefer traditional birth attendants for childbirth assistance. Reasons for choosing homebirth included lack of transport to health care facilities, distance to health care facilities, lack of respectful care at health care facilities, and the friendliness of traditional birth attendants. Lack of formal partnerships between traditional birth attendants and the health system was also observed.

There is a need to incorporate traditional birth attendants as a link between healthcare facilities and pregnant women; thereby, improving respectful care at the healthcare facilities.