Toolkit for assessing the impact of safe motherhood interventions

Reducing maternal mortality remains a commonly stated goal, from the district level within individual developing countries to the international level of major organisations and global agreements. It remains so because of the huge burden that pregnancy-related complications and avoidable deaths place on poor populations, and because of the lack of reliable evidence of any significant downward trend. Judging the effectiveness of single interventions or composite programmes is not however a simple matter. In the case of safe motherhood, there is not only this challenge to be faced but also the difficulty of reliably measuring maternal mortality as the target outcome.

Whilst there is now a greater awareness of this double dilemma, there remains a great reluctance on the part of both those funding and those implementing safe motherhood programmes to move away from mortality-based outcomes in order to judge “success”. This project will develop and test a toolkit for tracking progress using both process and outcome measures, and includes new methods for estimating maternal and perinatal mortality. The toolkit comprises six modules which can be used individually as stand-alone data collection activities. These modules have particular added value when applied together as a comprehensive impact assessment package.

The package would comprise:

• A new method for estimating maternal mortality, utilising population-based information on place of maternal deaths and health facility statistics on number of maternal deaths
• A new method for estimating perinatal mortality, based on delivery histories gathered from women in population-based surveys
• A module for monitoring relevant process indicators, to aid the interpretation of trends in maternal and perinatal mortality
• A module for measuring key poverty-related differentials in these process and outcome indicators
• Guidelines on linking process and outcome indicators in causal relationships
• A module to determine the cost of using the components of the toolkit together or singularly.

This 24-month project started in October 2000, and is funded by the Department for International Development of the United Kingdom.

Investigators:

• Professor Wendy J Graham
  Director, Dugald Baird Centre for Research on Women’s Health, Department of Obstetrics & Gynaecology, University of Aberdeen
• Dr Paul Arthur
  Kintampo Health Research Centre (Ministry of Health), Kintampo, Brong-Ahafo, Ghana
• Dr Colin HW Bullough
  Senior Clinical Research Fellow, Dugald Baird Centre for Research on Women’s Health
• Dr Gillian C  Penney
  Clinical Senior Lecturer, Department of Obstetrics & Gynaecology, University of Aberdeen
• Dr Ann Phoya
  National Safe Motherhood Initiative Adviser, Ministry of Health and Population, Lilongwe, Malawi.
• Ms Aoife Doyle
  Research Assistant, Dugald Baird Centre for Research on Women’s Health, Department of Obstetrics & Gynaecology, University of Aberdeen
• Mr Garth Reid
  Research Assistant, Dugald Baird Centre for Research on Women’s Health, Department of Obstetrics & Gynaecology, University of Aberdeen

For further information on the project contact:

Professor Wendy Graham, Dugald Baird Centre for Research on Women’s Health, Aberdeen Maternity Hospital, Cornhill Road, Aberdeen, AB25 2ZL. Tel. +44 1224 553924. Fax. +44 1224 404925. Email: w.graham@abdn.ac.uk