Research 

Research Agenda

There is urgent need to test promising new interventions and to integrate proven cost-effective interventions into maternal, newborn and child health programs and to strengthen and scale-up these programs using a continuum of care approach. A continuum of care approach promotes care for mothers and children from pregnancy through birth, the immediate postnatal period and childhood, recognizing that safe birth is critical to the health of both the woman and the newborn and that a healthy start in life is an essential step towards a safe childhood and productive life. This approach also attempts to link family and community-based care to skilled clinical facility-based care by improving home-based practices, empowering families to seek the care they need, increasing access to and quality of care at health facilities. In high mortality settings where health systems are weak, a phased introduction of interventions will benefit both women and newborns through family and community-based care now, while the health system is strengthened for skilled facility-based clinical care over the long term. Both are required to achieve the MDGs for maternal, newborn and child health.

The center for Research on Maternal and Newborn Survival prioritizes research that seeks to improve family and community-based interventions and the linkages to skilled facility-based care to reduce maternal and newborn mortality. Key knowledge gaps exist in these regards. Illustrative examples:

• Effective approaches for promotion of best household and community practices and care seeking for illness by improving problem recognition, increasing demand for quality care, and overcoming cultural barriers to referral,

• Methods to improve family and community-based prevention and/or initial management of selected life threatening maternal and newborn complications, i.e., postpartum hemorrhage, prolonged labor, birth asphyxia, sepsis, low birth weight/premature newborns,

• Measurement of individual and community engagement, empowerment and mobilization, and demand for skilled care,

• Best combinations for family and community service delivery (by whom, what, how),

• Content and optimum timing of postnatal care for mothers and newborns, and

• Ways to monitor health systems performance, including vital registration, community-based surveillance, improved verbal autopsy methods to assess specific medical causes and contributing factors to morbidity and mortality.

The Center is currently involved in research and practice related to the introduction of the American College of Nurse Midwives' Home Based Life Saving Skills in Ethiopia, Haiti, India, and Liberia. Development and implementation of these strategies have the potential to decrease the maternal and newborn deaths and disabilities that occur each year. The Center is also conducting research in Matlab, Bangladesh, in collaboration with the Center for Health and Population Research: International Center for Diarrheal Disease Research (ICDDR,B) focusing on improving recognition and response to the major maternal and newborn complications.

Current research projects

• Traditional birth attendant training effectiveness for improving health behaviors and pregnancy outcomes (Cochrane Pregnancy and Childbirth Group, Cochrane Collaboration).

• Improving recognition of and response to postpartum hemorrhage, Matlab, Bangladesh (Partner, Center for Health and Population Research, International Center for Diarrheal Disease Research, Bangladesh/ ICDDR,B).

Research proposals in progress

• Improving recognition of and response to prolonged labor and birth asphyxia, Matlab, Bangladesh (Partner, Center for Health and Population Research, International Center for Diarrheal Disease Research, Bangladesh/ ICDDR,B).

• Influence of social networks on health seeking behavior and health system response: use of skilled birth attendants, Matlab, Bangladesh. (Partner, Center for Health and Population Research, International Center for Diarrheal Disease Research, Bangladesh/ ICDDR,B).

• Effects of a participatory intervention Home Based Life-Saving Skills on birth outcomes in Ethiopia: a cluster-randomized controlled trial. (Partners, The Carter Center/Ethiopian Public Health Training Initiative, and American College of Nurse Midwives)