Strengthening access to nutrition and healthcare services for pregnant women and newborns in Africa
Supporting SDG 3: towards universal coverage
The Micronutrient Initiative (MI) is focused on improving nutrition for the world’s most vulnerable, especially women and girls. This includes helping more pregnant women and their newborns receive access to essential health care services, medicines and other commodities, including vitamins and minerals.
In collaboration with governments and key partners, and through support from the Government of Canada through Global Affairs Canada, we undertook an extensive five-year research project in four African communities to increase access to antenatal care (ANC), birth care and postnatal care (PNC) for pregnant women and their newborns.
Interested parties in other regions of Africa – and in other similar contexts or communities – will be enabled to identify the intervention best suited for their own context and be able to replicate the program to address relevant issues within their own communities.
In 2015, approximately 300,000 women around the world died due to pregnancy related causes.
In the same year, almost 3 million newborns died in their first 28 days of life. Many of these causes are preventable and have affordable and proven solutions.
Women who live in low income countries in sub-Saharan Africa and who do not have the resources available or needed for a healthy pregnancy and birth experience are at particular risk.
With inadequate information and access to maternal nutrition and vital health services, many of these women are ill-equipped to meet the special nutritional needs of pregnancy.
In order to make a meaningful impact, it is vital to tailor a series of interventions to the exact needs and realities of women in their communities.
The World Health Organization estimates up to two-thirds of newborn deaths could be prevented if skilled health workers performed effective health measures at birth and during the first week of life, yet 18 million births in sub-Saharan Africa were not attended by a skilled health professional.
In partnership with key stakeholders, we undertook community-based demonstration projects to prove how to increase the quality, access and uptake of ANC, birth care, and PNC in four high-burden communities.
Learn more about each of the community-based approaches:
In the regions targeted by this project, the link between community and health facilities was crucial.
Health facilities offer life-saving interventions and emergency care but are often located far from the communities they serve.
In some cases, the barriers for women to access health services throughout pregnancy, birth care and postnatal care include prevailing community practices that place a higher value on respected, but untrained, traditional birth attendants than on the formal healthcare system.
This project set out to demonstrate community and health facilities do not have to be mutually exclusive.
The approach taken in Ethiopia was to improve coverage and quality of care for women and newborns by focusing on training community-level providers, and ensuring participation by facility staff in monitoring and quality improvement. The approach also aimed to engage the community in creating innovative ideas and projects geared toward improving the health of mothers and infants, in order to further strengthen the link between the community and the facility.
The approach taken in Kenya was to build a community-based health model to increase the uptake of antenatal, birth and postnatal care services for pregnant women and improve the quality of care provided at the facility level. With a focus to strengthen the link between community and facility, we also aimed to improve the connection between traditional birth attendants (TBAs) and the local health facilities, and thus support safer and healthier pregnancies to reduce maternal and newborn morbidity and mortality.
The approach taken in Senegal was to develop and demonstrate an integrated package of community-level interventions to increase uptake and improve the quality of maternal and newborn health services. Improving local health huts so they could serve as a gateway to access was another strategy to strengthen the link between the community and the facility; training healthcare providers in outreach activities, such as local health visits to the community, also supported this goal.
Over the project’s five-years (2011-2015), we brought together global experts and partners to create a multi-country project model focused on improving access to health services for pregnant women and their newborns.
Governments took an active role throughout the project implementation, including the dissemination of project results and commitment to scale-up.
By involving communities in the healthcare systems and processes, it was possible to pave the way for safer pregnancies and births.
Some of the project results highlights include:
- 200,000 women and newborns were reached – doubling the project’s initial goal.
- More than 8,000 community and facility-based health personnel were trained to improve antenatal care (ANC), birth and postnatal care (PNC) – more than tripling the project’s initial goal.
- More women and newborns were reached, supporting healthier pregnancies and birth outcomes, and resulting in country governments committing to sustainability activities.
- In Ethiopia, 24% more pregnant women attended four or more antenatal care visits.
- In Kenya, 33% more women delivered with a skilled birth attendant.
- In Senegal, 22% more women received postnatal care from a skilled attendant.
One of the most innovative elements was the modular design of the demonstration projects. Rather than applying one blanket approach to three distinct target areas, each intervention was specifically designed to meet the unique needs of the target area.
Learn more about the each pilot project and what was achieved, through the following links:
- Afar, Ethiopia
27,090 women and newborns reached. The whole package of interventions will be scaled up to other areas in Afar and to Benishangul region. In addition, the facility and community quality improvement teams will be scaled up across areas in six regions of Ethiopia.
- Kakamega, Kenya
73,766 women and newborns reached. The government has already adopted the project model to transition former traditional birth attendants (TBAs) into Birth Companions and the Kakamega County Government is continuing the community personnel incentives.
- Kolda, Senegal
95,685 women & newborns reached.Based on the project outcomes, the Ministry of Health is scaling up the Community Watch groups (CVAC) across the country.
- Zinder, Niger
2,305 women were reached through an in-depth research study. Niger’s Ministry of Health is currently working on a five-year strategic plan for nutrition. The findings of the research study should guide the development of this plan.
Integrating nutrition into maternal healthcare
Micronutrient supplements are essential for preventing many of the disorders that lead to maternal and neonatal mortality and morbidity, but they are not enough on their own.
Access to – and improvement of – prenatal and postnatal care, as well as emergency obstetric care as most deaths happen or within 28 hours of birth, is essential.
MI continues to work with experienced partners to strengthen maternal and neonatal health services.
Reducing iron-deficiency anaemia
A woman needs more iron during pregnancy because her blood volume increases, and both the fetus and placenta need additional iron.
However, it is almost impossible for a woman to consume enough iron-rich food to fill those needs. Iron supplementation during pregnancy helps reduce iron deficiency anaemia, low birth weight, and post-partum haemorrhage.
In addition, folic acid supplementation during pregnancy is almost as important as iron, as it improves folate status and can also help reduce anaemia.
Reducing the risk of hypertensive disorders with calcium
Among the greatest risks to pregnant women are hypertensive disorders. We are working to expand our reach with calcium supplementation to reduce the risk of pre-eclampsia and eclampsia, which are the second leading cause of maternal mortality worldwide.
Preventing physical and mental impairment at birth
While of less risk to a woman’s own health, maternal folate and iodine deficiencies can seriously affect foetal development, with sometimes grave consequences for children. Maternal iodine deficiency is the greatest cause of preventable mental impairment in the world.
Delayed cord clamping
A newborn’s main source of iron going into the first six months of life is transferred from mother to child through the umbilical cord.
Delayed cord clamping (waiting at least 60 seconds or until the cord stops pulsing to cut it) is recommended to both prevent post-partum hemorrhage and improve the infant’s iron storage.
The World Health Organization (WHO) recommends cord clamping one to three minutes after birth while initiating simultaneous essential newborn care. Early cord clamping (less than one minute after birth) is not recommended unless the neonate is asphyxiated and needs to be moved immediately for resuscitation.
While the practice of waiting for the cord to stop pulsing may be standard traditional practice in many clinical settings, immediate cord clamping is still uncommon.
MI is working with partners to ensure this life-saving interventions is integrated into all labour and delivery care projects.
Early initiation of breastfeeding
Early and exclusive breastfeeding reduces the risk of infection, diarrhoea and death. WHO and UNICEF recommend early initiation – within the first hour of life – of breastfeeding.
While breastfeeding is common in many parts of the world, initial breastfeeding rates are often low due to customs and negative beliefs about colostrum, the first milk to be expelled from the breast. For example, colostrum is some of the most nutrient rich part of breast milk, yet many believe it is dirty or unsafe for the baby to consume.
Additionally, some cultures believe the newborn’s diet should be supplemented with water or soft foods. Sadly, these practices can be detrimental to the newborn’s health.
MI and partners are working to create innovative messaging for women, families and healthcare workers to promote initial and exclusive breastfeeding.
The strategy provided a blueprint to scale-up initiatives within Kenya, Ethiopia and Senegal.
In addition, other regions of Africa – and in other similar contexts/communities – can identify the intervention best suited for their context and replicate to address relevant issues within their communities and ensure better health for women.
Project fact sheets:
Project case studies:
- Calcium supplementation in pregnancy for prevention of preeclampsia
- Lessons from iron and folic acid supplementation and their application to potential calcium supplementation initiative
- The Micronutrient Initiative’s community-based maternal and newborn health and nutrition project: Operations Research on Calcium Supplementation