The FIGO Saving Mothers and Newborns Initiative

The FIGO Saving Mothers and Newborns Initiative (2006 – 2011)  comprised ten country projects led by professional associations of obstetricians and gynecologists. The Initiative was funded by the Swedish International Development Cooperation Agency (Sida) and FIGO and managed by Dr André Lalonde, Chair of the FIGO Committee for Safe Motherhood and Newborn Health and former Executive Vice President of the Society of Obstetricians and Gynaecologists of Canada (SOGC). The Ukraine project was funded in part by USAID, SOGC and FIGO.

 The main goal of the Initiative – that of contributing to the reduction of maternal and newborn morbidity and mortality to help achieve Millennium Development Goals 4 and 5 – was complemented by critically important secondary objectives: to strengthen the capacity of national professional associations to engage in maternal and newborn health through the design and implementation of projects, and to strengthen co-operation between FIGO and national societies, and between societies in regions of differing economic levels.

Further secondary aims were to strengthen the co-operation between national societies and the national stakeholders involved in safe motherhood and newborn health, and to increase the credibility of national societies locally to provide technical support to Ministries of Health and national professional councils. The participating professional associations were:

Haiti – Association des Infirmieres et Sage Femmes d’Haiti (AISFH), Société Haïtienne d’Obstétrique et de Gynécologie (SHOG)

• Kenya – Kenya Obstetrical and Gynaecological Society (KOGS)
• Kosovo – Kosovo Midwives Association (KMA), Kosovo Obstetrics & Gynecology Association (KOGA)
• Moldova – Society of Obstetricians and Gynecologists of the Republic of Moldova (SOGM), Moldovan Association of Midwives (MAM)
• Nigeria – Society of Gynaecology and Obstetrics of Nigeria (SOGON), Nigerian Association of Nurses and Midwives (NANM)
• Pakistan – Society of Obstetricians and Gynaecologists of Pakistan (SOGP), Midwifery Association of Pakistan (MAP)
• Peru – Peruvian Society of Obstetricians and Gynecologists (SPOG)
• Uganda – Association of Obstetricians and Gynaecologists of Uganda (AOGU), African Midwives Research Network Uganda Chapter (AMRN)
• Ukraine – Ukrainian Association of Obstetricians and Gynaecologists (UAOG)
• Uruguay – Sociedad Ginecotocologica de Uruguay (SGU), Uruguayan Obstetric Midwives Association

Individual country associations designed, managed and implemented a range of projects focused on identified needs within each country. Depending on the perceived needs, projects were implemented covering a wide number of activities including clinical training, development and introduction of standards, protocols and clinical audit, refurbishment of health facilities, and advocacy for policy and legislative change around abortion.

A key feature of the Initiative was North-South mentoring by obstetricians and midwives. This resulted in shared learning, additional resources being leveraged and strengthening of project activities and reports.

The majority of projects achieved remarkable results, particularly considering their size and funding, and the voluntary nature of the undertaking. In fact, country teams were largely voluntary and undertook project work alongside existing clinical and professional commitments.

In many cases the scale of achievements (sometimes resulting in national-level uptake of training, audit and, in one case, national change to legislation) were beyond initial expectations.  Here follow some examples:

• Haiti, ‘Strengthening the health center of Croix des Bouquets’ – Primary health clinic transformed into functioning hospital; ambulance purchased and on-call driver contracted; furthermore, the project responded to the enormous humanitarian disaster following the 2010 earthquake, through making the project maternity centre one of the few maternities in Port au Prince able to offer essential obstetrical care;
• Kenya, ‘Improving quality of prenatal, delivery, and postnatal care through clinical audit’ –  Update of clinical audit extended beyond maternity into general surgery and mobilised the healthcare professionals to provide better care;
• Kosovo, ‘Reduction of maternal and newborn mortality’ – First set of national standards developed by a clinical body produced by national association and approved by the Ministry of Health;
• Moldova,  ‘Beyond the numbers – implementation of new approaches in reviewing perinatal deaths’ – National registration of all perinatal deaths;
• Nigeria, ‘Saving mothers and newborns in Edo, Amambra, and Kaduna States’ – Magnesium sulphate supplied to all state hospitals by Kaduna State Government; manufacturers reduced its cost;
• Pakistan,‘Community-based interventions to reduce maternal and perinatal mortality and morbidity in rural Sindh’ – Recruited and trained local women as midwives to provide essential obstetrical care; renovations led to functioning operating theatre;
• Peru, ‘Improving obstetric and neonatal emergency care in Morropón Chulucanas Health Network, Piura’ –  Emergency Obstetric Care (EOC) and Comprehensive Essential Obstetric Care (CEOC) in rural mountain area audits;
• Uganda, ‘Reduction of maternal and newborn mortality’  – Paradigm shift in professional organisational thinking led to collaborative working with non-health community staff to achieve improved health outcomes for rural women;
• Ukraine, ‘EmOC improvement by advances in labor and risk management (ALARM) international program (AIP)’  – Reduction in inappropriate clinical interventions during delivery;
• Uruguay ‘To protect the life and health of Uruguayan women by reducing unsafe abortions’ – Abortion policy and legislative change; Presidential support for the project; creation of a sexual and reproductive health department within the Ministry of Health.

To date, the majority of projects are continuing beyond the period of funding. In many cases dissemination of project achievements and their integration into wider clinical practice has come about through individual project team members taking on significant positions within national associations, or incorporating lessons learnt during the project into new clinical positions and departments.