Global health systems strengthening: FIGO's strategic view on reducing maternal and newborn mortality worldwide.

OBJECTIVE: To demonstrate that successful health systems strengthening (HSS) projects have addressed disparities and inequities in maternal and perinatal care in low-income countries. METHODS: A comprehensive literature review covered the period between 1980 and 2022, focusing on successful HSS interventions within health systems' seven core components that improved maternal and perinatal care. RESULTS: The findings highlight the importance of integrating quality interventions into robust health systems, as this has been shown to reduce maternal and newborn mortality. However, several challenges, including service delivery gaps, poor data use, and funding deficits, continue to hinder the delivery of quality care. To improve maternal and newborn health outcomes, a comprehensive HSS strategy is essential, which should include infrastructure enhancement, workforce skill development, access to essential medicines, and active community engagement. CONCLUSION: Effective health systems, leadership, and community engagement are crucial for a comprehensive HSS approach to catalyze progress toward universal health coverage and global improvements in maternal and newborn health.

An Integrating Model for Rapid Reduction of Maternal Mortality Due to Primary Postpartum Haemorrhage - Novel Use of the Catalyst Approach to Public Health.

On average 16%-53% of maternal deaths are from postpartum haemorrhage (PPH), with confidence intervals for Eastern Asia reaching beyond 60%. Success in preventing PPH mortality across many large low-resource populations has been fairly limited. Niger's government and an international non-governmental organization (NGO) have developed a model aiming to rapidly reduce primary postpartum haemorrhage mortality, combining relatively new technologies, misoprostol, condom tamponade, and non- inflatable anti-shock garment, with systematic measurement of blood loss and a set of traditional public health tools that constitute the Catalyst Approach to Public Health, with action steps for each phase if haemorrhage occurs. This paper describes each component and testing of the hypothesis that the model can effectively reduce PPH mortality on a national scale. The Niger model is a 'complex intervention' aiming to maximise impact from existing health system resources even in remote areas. The broad applicability of Niger's approach to address a serious global public health problem, and its innovative nature warrant describing the model itself, with results to be published separately. Combining this set of individually proven technologies and a set of organisational tools from disease eradication settings as a single 'complex intervention', has to our knowledge not been described before.

The International Childbirth Initiative: 12 steps to safe and respectful MotherBaby-Family maternity care.

The ICI has developed a quality assurance program of 12 steps for safe and respectful MotherBaby­Family maternity care that all birthing units can implement.

No. 235-Active Management of the Third Stage of Labour: Prevention and Treatment of Postpartum Hemorrhage.

OBJECTIVE: To review the clinical aspects of postpartum hemorrhage (PPH) and provide guidelines to assist clinicians in the prevention and management of PPH. These guidelines are an update from the previous Society of Obstetricians and Gynaecologists of Canada (SOGC) clinical practice guideline on PPH, published in April 2000. EVIDENCE: Medline, PubMed, the Cochrane Database of Systematic Reviews, ACP Journal Club, and BMJ Clinical Evidence were searched for relevant articles, with concentration on randomized controlled trials (RCTs), systematic reviews, and clinical practice guidelines published between 1995 and 2007. Each article was screened for relevance and the full text acquired if determined to be relevant. Each full-text article was critically appraised with use of the Jadad Scale and the levels of evidence definitions of the Canadian Task Force on Preventive Health Care. VALUES: The quality of evidence was rated with use of the criteria described by the Canadian Task Force on Preventive Health Care. SPONSOR: The Society of Obstetricians and Gynaecologists of Canada. RECOMMENDATIONS: Prevention of Postpartum HemorrhageTreatment of PPHRecommendations were quantified using the evaluation of evidence guidelines developed by the Canadian Task Force on Preventive Health Care (Table 1).

No 235 - Prise en charge active du troisième stade du travail: Prévention et prise en charge de l'hémorragie postpartum.

OBJECTIF: Analyser les aspects cliniques de l'hémorragie postpartum (HPP) et fournir des lignes directrices visant à guider les cliniciens pour ce qui est de la prévention et de la prise en charge de l'HPP. La présente directive clinique est une mise à jour de la directive clinique précédente de la Société des obstétriciens et gynécologues du Canada (SOGC) sur l'HPP, publiée en avril 2000. RéSULTATS: Des recherches ont été menées dans Medline, PubMed, la Cochrane Database of Systematic Reviews, le ACP Journal Club et le BMJ Clinical Evidence afin d'en tirer les articles pertinents, en portant une attention particulière aux essais comparatifs randomisés (ECR), aux analyses systématiques et aux directives cliniques publiées entre 1995 et 2007. Chaque article a été analysé en vue d'en assurer la pertinence et nous avons fait l'acquisition du texte intégral, lorsque cela s'avérait pertinent. Chacun des articles intégraux a fait l'objet d'une évaluation critique en fonction de l'échelle Jadad et des définitions de qualité des résultats émises par le Groupe d'étude canadien sur les soins de santé préventifs. VALEURS: La qualité des résultats a été établie en fonction des critères décrits par le Groupe d'étude canadien sur les soins de santé préventifs. COMMANDITAIRE: La Société des obstétriciens et gynécologues du Canada. RECOMMANDATIONS: Prévention de l'hémorragie postpartum.

The global epidemic of abuse and disrespect during childbirth: History, evidence, interventions, and FIGO's mother-baby friendly birthing facilities initiative.

Recent evidence indicates that disrespectful/abusive/coercive service delivery by skilled providers in facilities, which results in actual or perceived poor quality of care, is directly and indirectly associated with adverse maternal and newborn outcomes. The present article reviews the evidence for disrespectful/abusive care during childbirth in facilities (DACF), describes examples of DACF, discusses organizations active in a rights-based respectful maternity care movement, and enumerates some strategies and interventions that have been identified to decrease DACF. It concludes with a discussion of one strategy, which has been recently implemented by FIGO with global partners-the International Pediatrics Association, International Confederation of Midwives, the White Ribbon Alliance, and WHO. This strategy, the Mother and Baby Friendly Birth Facility (MBFBF) Initiative, is a criterion-based audit process based on human rights' doctrines, and modeled on WHO/UNICEF's Baby Friendly Facility Initiative.

The role of obstetrics and gynecology national societies during natural disasters.

When a natural disaster occurs, such as an earthquake, floods, or a tsunami, the international response is quick. However, there is no organized strategy in place to address obstetric and gynecological (ob/gyn) emergencies. International organizations and national ob/gyn societies do not have an organized plan and rely on the good will of volunteers. Too often, local specialists are ignored and are not involved in the response. The massive earthquake in Haiti in 2010 exemplifies the lack of coordinated response involving national organizations following the disaster. The Society of Obstetricians and Gynaecologists of Canada (SOGC) engaged rapidly with Haitian colleagues in response to the obstetric and gynecological emergencies. An active strategy is proposed.

FIGO saving mothers and newborns initiative 2006-2011.

Reduction in maternal mortality is a key Millennium Development Goal (MDG 5). In an effort to contribute toward achievement of MDG 5, FIGO's Safe Motherhood and Newborn Health Committee worked with associations of obstetricians, gynecologists, and midwives in 10 low- and middle-income countries between 2006 and 2011. Contributions were made by professional associations in high-income countries through a structured north-south mentoring program. Each project focused on identified needs within each country and resulted in varied approaches and targets, ranging from clinical training, protocol development, and implementation of clinical audit through to legislative and policy change. Significant and largely sustainable results were achieved, particularly in relation to the relatively small-scale funding available. This resulted in direct improvements to maternal and newborn health outcomes. The capacity of both FIGO and national professional associations was also substantially strengthened in project design, management, and implementation, leading to opportunities to further support international development efforts in the future.

Drugs indicated for use during pregnancy.

The Society of Obstetricians and Gynaecologists of Canada (SOGC) advocates that drugs used during pregnancy be tested exclusively in women. The SOGC holds the opinion that drugs to be used exclusively in men or in women should not be tested in a small number of men and women. The SOGC, always cautious with the choice of pharmacological treatments recommended for use during pregnancy, welcomes the increased options resulting from the introduction of generic formulations of drugs shown to be bioequivalent to currently available brand name products. These formulations provide less expensive options to Canadian women in need of drug therapy. However, the Society does not believe that drugs should be substituted without the patient and the physician both agreeing to such a change. Generic substitutions of some products may mean a potentially clinically significant difference in drug dose, possibly resulting in a changed patient effect. Furthermore, substituting a product on the basis of price alone is not acceptable.The SOGC, as an organization with the role of advising its members on clinical practice, calls on Health Canada to review its guideline on testing of drugs for vulnerable populations, especially pregnant women.

The role of health professional associations in the promotion of global women's health.

Health professional associations, especially those from countries with the highest maternal death burden, have vital roles to play in improving maternal and newborn health and in achieving the Millennium Development Goals 4 and 5. Possessing the knowledge, skills, and influence to positively impact practice at the service delivery level, they can also advocate for change at the policy level and lobby for higher priority and greater investment in the maternal and newborn health field at the national level. The ability of professional associations to assume this leadership is nevertheless contingent on their institutional capacities to achieve planned goals and objectives in support of their organizational mission and strategic priorities. Since 1998, the Society of Obstetricians and Gynaecologists of Canada (SOGC) has been supporting the capacity development efforts of peer professional associations in low-resource countries. SOGC's work in this specific area has led it to develop and pilot an Organization Capacity Improvement Framework (OCIF) that guides professional associations, incrementally, in successive cycles of capacity development. Building on capacity developed within previous capacity-building cycles, this article summarizes and reports on the recent outcomes of the Asociación de Gynecoloígia y Obstetricia de Guatemala's (AGOG) organizational development efforts and the impact they have had in positioning the association as an important contributor in national efforts to improve maternal and newborn health outcomes in the country.