MOMI · Missed Opportunities in Maternal and Infant Health: reducing maternal and newborn mortality and morbidity in the year after childbirth through combined facility- and community-based interventions

Improving maternal and newborn health requires innovative approaches that maximise opportunities for impact throughout the continuum of care. In the past decade, maternal health services have largely focused on the management of intrapartum complications and on rationalising the package of antenatal services to include emergency obstetric care provided by skilled birth attendants. These interventions have sought to target what are widely considered to be the most common and immediate causes of maternal death.Yet this approach fails to address many underlying morbidities that are instrumental in generating high rates of maternal mortality, such as anaemia and inadequate birth spacing. Also missing is a direct focus on the substantial proportion of maternal deaths in the postpartum. Indeed, as a component of maternal health, postpartum care has been neglected, along with the field of newborn health in Africa. The essential package and optimum structure of postpartum services for women and newborns in Africa remains poorly defined, with missed opportunities for improved care.We thus propose developing a package of interventions targeting newborn health and women in the early postpartum period and throughout the first year after childbirth. This package will be delivered through a combined facility- and community-based approach designed to integrate services and strengthen health systems. It will be implemented in four African countries (Burkina Faso, Kenya, Malawi and Mozambique) by a consortium of five African and three European partners.Intervention design will be preceded and informed by a situational analysis of postpartum policies and practices in the four countries and a feasibility assessment. This will ensure that interventions are amenable to scaling up and appropriately tailored to local contexts. Implementation will be followed by health systems research to evaluate effectiveness and impact, and to identify determinants of healthcare improvements.