Maternal and Reproductive Health

Preventing Maternal Mortality and Expanding Reproductive Health Access

Lack of Comprehensive Maternal and Reproductive Health Care Put Women’s Lives at Risk

 

  • Almost 300,000 women die from complications of pregnancy and childbirth every year and for every maternal death at least another 20 women suffer from injury or illness, often with lifelong consequences.
  • Today, 99% of maternal deaths occur in developing countries, with more than half in Sub-Saharan Africa.
  • 220 million women and girls in developing countries want to delay or avoid pregnancy, but are not using modern contraception. Reasons for non-use include lack of information; opposition from partners or others; and difficulty obtaining services and supplies.
  • 41% of global pregnancies are unintended and 43.8 million abortions occur each year – nearly half of these are unsafe and 98% of unsafe abortions occur in developing countries.

 
The vast majority of these maternal deaths are preventable – yet pregnant women around the world continue to die because they do not have access to timely emergency obstetric care. Adding to this problem is the high unintentional pregnancy rate of many developing countries – 41% of global pregnancies are unintended and 220 million women want to prevent pregnancy and are not using contraception. Bloomberg Philanthropies works to address these needs by providing access to quality maternal and reproductive health services, and advocating for the provision of these services by the national government in the countries where we work.

Applying the Bloomberg Philanthropies Approach to Preventing Maternal Deaths and Addressing Demand for Reproductive Health Services

 

  1. Strategic investments

    Bloomberg Philanthropies is committed to working with other donors to address the most critical public health issues of the day. Fondation H&B Agerup and the Blue Lantern Foundation co-invest in our Maternal and Reproductive Health Project in Tanzania, and we joined the Bill and Melinda Gates Foundation’s call to action when making our $50 million commitment to Family Planning 2020 (FP2020). Investing with other donors makes our program more impactful and cost effective.

  2. Effective Partnerships

    Strong partnerships enable us to work more effectively. In Tanzania, Bloomberg Philanthropies is working with Vital Strategies, the CDC Foundation, and EngenderHealth to provide quality emergency obstetric care and reproductive health services in the most remote areas of the country.  After pledging our commitment to Family Planning 2020, we partnered with them in launching the Rapid Response Mechanism to fill unanticipated, urgent gaps that countries face in fulfilling their reproductive health goals. Also under our Family Planning 2020 commitment, we’re working with Planned Parenthood Global to support local nonprofits to advocate for the expansion of reproductive health care in Nicaragua, Burkina Faso, Senegal, and Uganda.

  3. Data and Evaluation

    All of our public health programs are rigorously evaluated to ensure that our work is making a difference. The CDC Foundation performed an impact evaluation of our maternal health activities in Tanzania, as well as a reproductive health survey in Kigoma Region – these studies inform our decision-making to ensure our project is making positive impact.

  4. Local Actions

    The crux of the Bloomberg Maternal and Reproductive Health Program is to bring quality health care and services to the communities and villages where it is needed the most. Bloomberg Philanthropies is also committed to empowering local organizations to advocate for the services and care they need in their communities.

OUR APPROACH HAS THREE MAIN COMPONENTS:

 

Provision of clinical services in Tanzania

We have been supporting a maternal health program in remote regions of Tanzania since 2006. This program is:

  • upgrading village-level health centers by constructing operating rooms so that the centers can provide emergency obstetric care;
  • training non-physician healthcare workers – Assistant Medical Officers and nurse midwives – to provide emergency obstetric care;
  • incorporating family planning and comprehensive post-abortion care into targeted health centers;
  • providing family planning services through community service days; and
  • running mass media campaigns and employ community health workers to educate communities about the importance of skilled birth attendance and family planning.

Remote areas of Tanzania face extreme human resource shortages and medical doctors, let alone obstetricians are few and far between. To compensate for these shortages, the Tanzanian government supports “task-shifting” of medical services, which allows non-physician clinicians to deliver certain types of care, including emergency obstetric care, that have been traditionally provided medical doctors. By building operating rooms and training more healthcare workers, our program has expanded the coverage of maternal health and brought life-saving emergency obstetric care to the women who need it most.

Over the years of working in Tanzania, the healthcare workers we support saw many women die from complication dues to an unsafe abortion, and many mothers at the clinics said they want access to reproductive health services. In response, we enthusiastically joined the Family Planning 2020 partnership in 2012, pledging $50 million to global family planning efforts. With this new commitment, we enhanced our Tanzanian program in 2013 to include access to contraception, post-abortion care, and family planning counseling at the health clinics we support.

 

Fund unanticipated needs in any Family Planning 2020 country

Co-convened by the Bill and Melinda Gates Foundation, Department for International Development, and the UN Population Fund, Family Planning 2020 is a global partnership that supports the rights of women and girls to decide, freely, and for themselves, whether, when, and how many children they want to have. Family Planning 2020’s goal is to enable 120 million more women and girls to use contraceptives by 2020. As a member of this partnership, we have committed funds to a Rapid Response Mechanism. These grants will support one-time, urgent, unanticipated gaps that any of the 69 Family Planning 2020 countries may encounter as they work towards achieving their Family Planning 2020 goals.

 

Support local advocates in 4 target countries

To additionally support the Family Planning 2020 partnership, we decided to make strategic investments in 4 of the partnership’s countries. Starting in 2014, we began supporting local nonprofit organizations in Burkina Faso, Senegal, Uganda, and Nicaragua to advocate for better policies in their countries that will expand access to comprehensive reproductive health services. These organizations will receive technical assistance from Planned Parenthood Global, the international division of Planned Parenthood Federation of America, to help augment their capacity for effective advocacy. In all of these countries, the local advocates are determining the agenda based on their deep understanding of the challenges women face to access reproductive health services.

All of these programs aim to address local demand for reproductive health services – we listen to women and health advocates in the countries and support them in achieving their goals.


TANZANIA’S HIGH BURDEN

Tanzania has the sixth highest number of maternal deaths in the world and fourth highest in Sub-Saharan Africa. In Tanzania, a woman dies from complications of pregnancy and childbirth almost every hour. For every woman that dies, another 20 suffer an injury, illness or disability, often with life-long consequences.

BROADER CONSEQUENCES

Maternal survival is closely linked to child survival. The same conditions that cause death and illness in pregnant women also result in death and illness in millions of newborn babies. Furthermore, threats to a mother’s life also jeopardize the survival of her other children, especially if they are girls.

THE MOST COMMON CAUSES OF MATERNAL DEATH ARE

  • Bleeding
  • Pregnancy-induced high blood pressure
  • Obstructed labor
  • Infection
  • Unsafe abortion

We know that access to comprehensive emergency obstetric services can prevent most of these deaths, yet women continue to die because health care facilities with skilled personnel are few and far between. Approximately 15% of pregnancies and childbirths will result in a life-risking complication. It is impossible to predict when a complication will occur – that is why all pregnant women need access to life-saving care.

A CLOSER LOOK: JOY

A SUCCESS STORY: HOW ONE WOMAN'S LIFE WAS SAVED

Read the Case Study

Expanding Capacity to Reduce Maternal Mortality Rates in Tanzania

Preliminary results suggest that the situation is improving in Tanzania.

PROGRESS SO FAR:

  • 14 remote health centers have been upgraded and equipped to provide comprehensive emergency obstetric care, including cesarean section.
  • More than 160 non-physician clinicians have been trained in comprehensive emergency obstetric care or anesthesia.
  • To date, over 72,000 deliveries were attended and nearly 4,000 cesarean sections were performed in the upgraded health centers.
  • Between April 2013 – April 2016, nearly 125,000 clients accessed family planning services in our target regions. Additionally, 861 post-abortion clients were counseled on family planning services.
  • Between May 2015 – April 2016, 76,005 unintended pregnancies were averted, 23,562 abortions were averted, and 189 maternal deaths were averted due to the family planning services provided by our partner, EngenderHealth.

 

what lies ahead?

The next phase of the program will focus on creating demand within communities for maternal and reproductive health services. We will run more media campaigns to educate communities, recruit and deploy community health workers to reach remote villages, and ensure that every woman and girl who wants contraception can access the method of her choice.

FILLING URGENT FAMILY PLANNING NEEDS

INCREASING DEMAND FOR FAMILY PLANNING AMONG YOUTH

Read the Case Study