John D. and Catherine T. MacArthur Foundation May 2010
Reducing MateRnal MoRtality
at-a-glance• Morethan340,000womendieeachyearduetocomplications
duringpregnancyandchildbirth,mostofwhichcouldbepreventedwithappropriatematernalhealthservicesandcare.
• In2008,morethan50percentofallmaternaldeathsoccurredinonlysixcountries:India,Nigeria,Pakistan,Afghanistan,Ethiopia,andtheDemocraticRepublicoftheCongo.
• Reducingmaternalmortalityisaworthygoalinitself,butitisalsoagoodindicatorthatwomenarereceivingthereproductivehealthservicestheyneed.
• Afteryearsofstagnationinthenumberofmaternaldeathsaroundtheworld,recentresearchshowssignsofprogress,offeringhopethatmaternalmortalitycanbereduced.
• MacArthur’sgrantmakingtoreducematernalmortalityfocusesondevelopinginnovativemodelsthatcaneventuallybescaledup,enhancingtheskillsofhealthprofessionals,promotinginformedadvocacyonissuesrelatedtomaternalmortality,andresearch.
DatausedinthisinformationsheetarefromHoganMC,etal.MaternalMortalityfor181countries,19802008:asystemicanalysisofprogresstowardsMillenniumDevelopmentGoal#5.Lancet2010.375:16091623.
MacArthur seeks to reduce maternal death and illness in the developing world, with a special focus on Mexico, Nigeria, and India, where the Foundation has offices.
ReducingMaternalMortality
John D. and Catherine T. MacArthur Foundation page 2
BackgRound
Fortwodecades,therewerefewsignsofprogressinreducingmaternalmortalityaroundtheworld.Recentestimatesshowthatsomeprogresshasbeenmade—between1980and2008theglobalmaternalmortalityratiodecreasedfrom422maternaldeathsper100,000livebirthsto251,althoughprogressvariesgreatlybycountry.
Althoughmostmaternaldeathsarepreventablewithsufficientresourcesandcommitment,morethan340,000womendieeachyearduetocomplicationsduringpregnancyandchildbirth.Thevastmajorityofthesedeathsoccurinthedevelopingworld.
Reducingmaternalmortalityisnotonlyaworthygoalinitself,butitisalsoanimportantindicatorthatwomenarereceivingthereproductivehealthservicestheyneed.TheinternationalcommunityidentifiedthereductionofmaternalmortalityasakeycomponentofalleviatingworldpovertyattheUnitedNationsMillenniumSummitin2000andagreedtoworktowardMillenniumDevelopmentGoal#5,reducingthematernalmortalityratioby75percentby2015.Accordingtorecentestimates,only23countriesareontracktoachievethisgoal.
Whileasolutiontohighratesofmaternaldeathliespartlyinthehandsofthehealthsystem,itisalsodependentupontheeducationalstatusofwomenandoncountries’legalsystems.Womenneedaccesstogoodcare,buttheyalsoneedanenablinglegalenvironmenttoprotecttheirrights,andtheirhealthneedsmustberecognizedandrespectedbytheirpartners,families,andcommunities.
What We Fund
MacArthur’sgrantmakingtoreducematernalmortalitystrivestoincreaseresourcesforwomen’shealthandtoimprovethequalityandreachofpubliclyprovidedreproductivehealthservices.MostofMacArthur’sgrantmakingtoreducematernalmortalityandmorbidityiscarriedoutinIndia,Nigeria,andMexico,wheretheFoundationmaintainsoffices.
MacArthur’ssupportforeffortstoreducematernalmortalityfocuseson:
• Developinginnovativemodels;
• Enhancingtheskillsofhealthprofessionalstoimprovethequalityandavailabilityofservices;
• Promotinginformedadvocacyoncriticalissuesrelatedtomaternalmortalitytoensurethatpolicymakershavetheevidenceandmotivationtosuccessfullyaddresstheproblem;and
• Researchthatcrossesdisciplinaryboundaries,coveringtopicssuchassocioeconomicconsequencesofmaternaldeaths,budgetanalysis,andcomputermodelingofreallifescenarios.
TheFoundationalsofundsselectedinternationalorganizationsinthepopulationandreproductivehealthfieldwhoseworkpromotesinnovationinpolicy,programs,andservices.
Postpartum hemorrhage
In2003,theFoundationmadeitsfirstgrant(totheUniversityofCaliforniaSanFrancisco)toexploretheuseoftheAntiShockGarment(ASG)tohelpreducepostpartumhemorrhage,whichaccountsforapproximately30percentofallmaternaldeaths.Thegarmentisalowcost
neoprenesuitthatisdesignedtohelpstabilizewomenwhoexperienceseverebleedingafterchildbirth.Itrequireslittletrainingtoputonandcanbuytimeforwomenwhooftenmustbetransportedlongdistancesinordertoreachahealthfacility.TheASGisjustonepartofthecontinuumofcaremodelbeingdevelopedandtestedbyPathfinderInternational.Themodelpromotestheuseofactivemanagementofthethirdstageoflabor,theAntiShockGarment,andcommunitytransportationandcommunicationnetworks.Thehopeisthatitthatthiscontinuumofcaremodelwillbeincorporatedintothestandardpackageofservicesforpostpartumhemorrhageindevelopingcountries.
eclampsia
Globally,eclampsiaaccountsforabout12percentofmaternaldeaths.In2006,theFoundationbeganinvestingininterventionstopreventandtreateclampsia,withaspecialfocusontheprovendrugofchoice,magnesiumsulfate.MacArthurhasmadeaseriesofgrantstoidentifycountryspecificbarrierstotheavailabilityanduseofmagnesiumsulfate,developstrategiestoovercomethosebarriers,andestablishadialogueamongkeyinternationalandcountrylevelstakeholdersontheseissues.TheFoundationhasalsoinvestedininnovativemodelstoimproveclinicianeducationandtrainingonmagnesiumsulfateaswellasinresearchonappropriatedeliverysystemsandprocedures.
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RePResentative gRants
international
BIxByCENTERFoRGLoBALREPRoDUCTIvEHEALTHUNIvERSITyoFCALIFoRNIA,SANFRANCISCoSan Francisco, California$325,000toresearchanddisseminatefindingsontheAntiShockGarment.
ENGENDERHEALTHNew York, New York$310,000tosupporttheuseofmagnesiumsulfateforthetreatmentofeclampsia,viathedevelopmentofanelearningmodule.
FAMILyCAREINTERNATIoNALNew York, New York$500,000insupportofalongitudinalstudyonthecostsandconsequencesofmaternaldeathandmorbidity,andglobal
advocacyeffortstobuildpoliticalwillforMillenniumDevelopmentGoal#5.
GUTTMACHERINSTITUTENew York, New York$100,000toanalyzerecenttrendsinabortionincidencearoundtheworld.
GyNUITyHEALTHPRojECTSNew York, New York$100,000toraiseawarenessabouttheuseofmisoprostolforpostabortioncare.
ReducingMaternalMortality
John D. and Catherine T. MacArthur Foundation page 4
HARvARDUNIvERSITySCHooLoFPUBLICHEALTHBoston, Massachusetts$500,000insupportofthedevelopmentandapplicationofamaternalmorbidityandmortalitypolicymodel.
INTERNATIoNALCENTREFoRDIARRHoEALDISEASERESEARCH,BANGLADESHDhaka, Bangladesh$250,000toresearchtheeconomicandsocialconsequencesofmaternalmortality.
PATHFINDERINTERNATIoNALWatertown, Massachusetts$10,700,000toimplementapackageofinterventionsforreducingmaternalmortalityandmorbidityduetopostpartumhemorrhageinIndiaandNigeria.
PRoGRAMFoRAPPRoPRIATETECHNoLoGyINHEALTHSeattle, Washington$400,000tosupportthemanufactureandscaleupoftheAntiShockGarmentforpostpartumhemorrhagetreatment.
TURLyPICTURES,LLCWhite Plains, New York$55,000insupportofthedisseminationofamaternalhealthdocumentaryfilm.
UNIvERSITyoFABERDEENAberdeen, United Kingdom$500,000toresearchinfectioncontrolpracticesforreducingmaternaldeathsandforinitialdevelopmentofajournalonmaternalandnewbornhealth.
WHITERIBBoNALLIANCEFoRSAFEMoTHERHooD,GLoBALSECRETARIATWashington, D.C.$400,000insupportofgeneraloperations.
WoRLDHEALTHoRGANIzATIoNGeneva, Switzerland$500,000tosupportthePartnershipforMaternal,Newborn,andChildHealthtoincreaseglobalawarenessandreducematernalmortalityandmorbidity.
other international grants
INTERNATIoNALRESCUECoMMITTEEWoMEN’SREFUGEECoMMISSIoNNew York, New York$300,000tobridgethegapinreproductivehealthinterventionsfordisplacedwomenandgirls.
PATHFINDERINTERNATIoNALWatertown, Massachusetts$365,000tostrengthenreproductivehealthcareservicesinrefugeeanddisplacedpersonscamps.
PLANETCARE/GLoBALHEALTHACCESSPRoGRAMBerkeley, California$270,000topilotanddocumenteffectsofaprojecttoincreaseaccesstoreproductiveandchildhealthservicesbyinternallydisplacedpersons.
UNITEDNATIoNSPoPULATIoNFUNDNew York, New York$500,000toidentifyneartermpostearthquakeneedsinHaitiandtosupportfundingforlongertermmaternalhealthefforts.
WoRLDHEALTHoRGANIzATIoNGeneva, Switzerland$440,000tostrengtheninstitutionalcapacitytodeliverreproductiveandmaternalhealthcareinemergencyhumanitariansettings.
Mexico
CoMUNICACIoNEINFoRMACIoNDELAMUjERMexico City, Mexico$180,000InsupportofusingnewInternetbasedtechnologiestoincreasethequantityandimprovethequalityofmediacoverageonmaternalmortalityandmorbidityinMexico.
EqUIDADDEGENERoCIUDADANIA,TRABAjoyFAMILIAMexico City, Mexico$250,000topromoteMillenniumDevelopmentGoal#5todecreasematernalmortality.
FUNDAR,CENTRoDEANALISISEINvESTIGACIoNMexico City, Mexico$270,000tomonitorandreportontheoperationsandbudgetsofprincipalmaternalhealthprograms.
IPASChapel Hill, North Carolina$300,000insupportofadvancingaccesstosafelegalabortioninthreeMexicanstates.
K’INALANTSETIKMexico City, Mexico$210,000toscaleupamodelforcommunitybasedmaternalmortalitypreventionstrategiesinMexico.
MExICoNATIoNALSAFEMoTHERHooDCoMMITTEEComite Promotor Por Una Maternidad Sin Riesgos En MexicoSanCristobaldelasCasas,Mexico$350,000tosupporteffortstodecreasematernalmortalityinMexico.
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NUEvELUNAS,S.C.Oaxaca, Mexico$180,000toimprovethedeliveryofskilledattendanceatbirthinruralindigenousareasofoaxacaandgeneratingsupportformidwiferytrainingsystems.
SoCIEDADMExICANAPRoDERECHoSDELAMUjERMexico City, Mexico$700,000tostrengthenlocalcapacityandorganizingtodecreasematernalmortalityinruralindigenousareasofMexico.
india
ACTIoNRESEARCH&TRAININGFoRHEALTHUdaipur, India$375,000toimprovethequalityofmaternalnewbornhealthservices,andpilotaninterventiontoimproveyoungwomen’saccesstoreproductivehealthservicesinRajasthan.
CENTREFoRDEvELoPMENTANDPoPULATIoNACTIvITIESWashington, D.C.$260,000tosupporttheWhiteRibbonAllianceforadvocacytoreducematernalmortalityandmorbidityinIndiaandthestateofRajasthan.
INDIANINSTITUTEoFMANAGEMENTAHMEDABADAhmedabad, India$190,000toevaluatetwogovernmentprogramsthataimtoreducematernalmortalityandmorbiditybypromotinginstitutionaldeliveryinthestatesofGujaratandMadhyaPradesh.
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John D. and Catherine T. MacArthur Foundation page 6
IPASChapel Hill, North Carolina$400,000tosupportscalingupofComprehensiveAbortionCareservicesinthepublicsectorinthestatesofMaharashtra,Gujarat,andRajasthan.
KARUNATRUSTBangalore, India$400,000toscaleupapublicprivatepartnershipmodelofdeliveringmaternalandreproductivehealthservicesinIndia.
MAHILASEWATRUSTAhmedabad, India$200,000toscaleuphealthinsurancetoreducematernalmortalityandmorbidityinGujaratandnationally.
SEvAMANDIRUdaipur, India$150,000tosupportacomprehensivecommunitybasedprojecttoreducematernalmortalityandmorbidityintheUdaipurandRajsamanddistrictsofruralRajasthan.
SoCIETyFoREDUCATIoNWELFAREANDACTIoNRURALDist. Bharuch, India$200,000totestmodelinterventionstoreducematernalmortalityandmorbidityinthestateofGujarat.
SoCIETyFoREDUCATIoN,ACTIoN&RESEARCHINCoMMUNITyHEALTHGadchiroli, India$550,000toresearchanddemonstrateaprogramonreducingmaternalmortalityandmorbidityandpromoteyoungpeople’ssexualandreproductivehealthinMaharashtra.
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nigeria
AHMADUBELLoUNIvERSITyTEACHINGHoSPITALZaria, Nigeria$300,000tosupporttheCommunityPreventionofPostpartumHemorrhageInitiative.
CENTREFoRDEvELoPMENTANDPoPULATIoNACTIvITIESWashington, DC$270,000toaccelerateeffortstosavemothers’livesthroughtaskshiftingofhumanresourcesforhealthandintegratedambulanceservices.
CoMMUNITyHEALTHANDRESEARCHINITIATIvEKano, Nigeria$175,000toworkwith10localgovernmentsandtheKanostategovernmenttorepositionthecommitmenttoaddressmaternalmortalityandmorbiditythroughimprovedbudgetaryallocationandservicedelivery.
FEDERALMINISTRyoFHEALTHAbuja, Nigeria$500,000insupportofpromotingtheuseofmagnesiumsulfate.
IPASChapel Hill, North Carolina$500,000toincreaseaccesstopostabortioncareservicesinNigeria.
SoCIETyoFGyNECoLoGyANDoBSTETRICSoFNIGERIAJos, Nigeria$250,000insupportofreducingmaternalmortality.
WoMEN’SHEALTHANDACTIoNRESEARCHCENTREBenin City, Nigeria$250,000insupportofresearchtoimprovepoliciesandprogramsforpromotingmaternalhealthinsixstatesofNigeria.
John D. and Catherine T. MacArthur Foundation May 2010
ReducingMaternalMortality
about the Macarthur FoundationThejohnD.andCatherineT.MacArthurFoundationsupportscreativepeopleandeffectiveinstitutionscommittedtobuildingamorejust,verdant,andpeacefulworld.InadditiontoselectingtheMacArthurFellows,theFoundationworkstodefendhumanrights,advanceglobalconservationandsecurity,makecitiesbetterplaces,andunderstandhowtechnologyisaffectingchildrenandsociety.
For more information, or to sign up for our free electronic newsletter, please visit www.macfound.org.
johnD.andCatherineT.MacArthurFoundation140SouthDearbornSt.,Suite1200,Chicago,Illinois606035285Telephone:(312)7268000www.macfound.orgTDD:(312)9206285
For More informationAboutMacArthur’seffortstoreducematernalmortality
Judith F. helznerDirector,Population&ReproductiveHealth(Chicago)[email protected]
erin sinesProgramofficer(Chicago)[email protected]
Poonam MuttrejaDirector(India)[email protected]
dipa nag chowdhuryProgramofficer(India)[email protected]
kole shettimaDirector(Africa)[email protected]
sharon Bissell soteloActingDirector(Mexico)[email protected]
