Maternal, Newborn, and Child Health

URC is committed to high-impact maternal, newborn, and child health (MNCH) practices: basic emergency obstetric and newborn care, comprehensive emergency obstetric and newborn care, post-abortion care, and postpartum care. To achieve that impact, we implement the best strategies, including water, sanitation, and hygiene (WASH), Kangaroo Mother Care for premature babies, and optimized nutrition for mothers and children in the "first 1,000 days" of life.

Our proven quality improvement and health systems strengthening activities emphasize the use of evidence-based solutions to improve health and social outcomes for mothers and children around the world. We work with policymakers, national health systems, facilities, community health workers, local leaders, and families to improve the service quality and increase private sector participation in MNCH care in resource-limited regions. 

We address the MNCH continuum of care by supporting global calls for action such as USAID’s Acting on the Call: Ending Preventable Child and Maternal Deaths. Through programs such as the USAID Health Care Improvement project and its follow-on project, ASSIST, URC’s methods have strengthened the continuum of care at community, primary, and referral levels in more than 20 countries. In Niger, we have seen truly extraordinary results from our contributions in closing the “know-do” gap for MNCH. 

Our work includes antenatal care, childbirth and postpartum care, newborn care, child health, and integrated nutrition.

 

Antenatal Care

URC implements evidence-based interventions to improve coverage and quality of essential antenatal care, including early detection and management of the most common obstetric complications, such as preeclampsia, obstructed labor, risk of premature labor/birth, HIV and other high-burden maternal infections, and care of nutritional deficiencies.

By supporting reliable and consistent delivery of best practices for antenatal care, these interventions decrease women’s risk of serious maternal morbidities and mortality, reduce poor outcomes for newborns, and contribute to USAID’s global agenda for ending preventable child and maternal deaths and the Every Newborn Action Plan to End Preventable Newborn Deaths.

Focused Antenatal Care

In recent years, the health community has shifted away from classifying pregnant women as “low risk” or high risk”—an approach that required many antenatal visits and was hard to implement effectively. Many pregnant women have at least one risk factor, and not all develop complications, but some low-risk women develop complications, particularly during childbirth.

URC is committed to increasing the proportion of women who benefit from focused antenatal care—a four-visit model of integrated, individualized care to help maintain normal progress through pregnancy and facilitate early detection and treatment of complications. Focused services provide specific, evidence-based interventions for all women, carried out at key times during pregnancy. Our work aims to improve the quality of each antenatal visit so that every pregnant woman fully benefits from the wide range of preventive, counseling, and testing services.

We believe that successful focused antenatal care visits open the gate for increasing deliveries at health facilities and provide opportunities to introduce other services, such as HIV counseling and testing and child survival services. 

Antenatal Care at Work

Malaria in pregnancy poses a substantial risk to mothers and their unborn or newborn children. Through the USAID Ghana Systems for Health Project, URC integrates an intervention package within routine antenatal care to prevent malaria, detect malaria cases with rapid diagnostic tests and microscopy, and provide intermittent preventive treatment in pregnancy. The project trains health workers in malaria case management and has developed and distributed a job aid to guide health workers on protocols for malaria in pregnancy.

Through USAID ASSIST, URC supports teams of more than 150 facilities to improve the quality of obstetric and newborn care. As a result, measures to prevent anemia among pregnant women (iron, folic acid supplementation, antimalarial medications, and deworming) in Mali increased from about 21% (17 sites) in November 2009 to 100% (144 sites) in August 2014, while compliance with eclampsia treatment standards increased from 0% (17 sites) to 85% (33 sites) in the same period.

 

Child Health

URC advocates increased support for child survival services and scale-up of preventive and curative child health services, such as vaccination and community case management of child illness. We apply quality improvement approaches to enhance the prompt and effective management of malaria, diarrhea, and pneumonia—the three leading causes of child deaths in developing countries. Our work in child nutrition aims to prevent acute malnutrition and stunting.

Child Health at Work

URC has extensive experience improving care and strengthening local health systems to prevent and treat childhood illnesses at all system levels, including diarrheal disease, pneumonia, malaria and acute malnutrition. In Georgia’s Imereti Region, USAID ASSIST dramatically improved average compliance with best practices for management of acute respiratory infections among children in three hospitals, four ambulatory clinics, and 17 village ambulatory practices. The hospitals and clinics reached an average compliance of 98-100% and a 42-58% improvement in indicators after 32 months.

In Guatemala, Nutri-Salud operates within a continuum-of-care framework for integrated child health, focusing on the first 1,000 days. All first-level personnel have been trained in opportune and complete vaccination of children from birth to 5 years, with an emphasis on children under 2 years. The project has provided training in safe vaccination, cold-chain establishment and maintenance, and the epidemiology of preventable diseases with vaccination surveillance guidelines. As a result, healthcare providers are better able to identify and manage immune-preventable diseases, and Nutri-Salud has seen a significant reduction in missed vaccinations.

In Iraq, where internal displacement has led to an increase in communicable diseases (including polio) among children and adults, URC’s team for the USAID Primary Health Care Project worked with the Ministry of Health to train more than 80 master trainers and 2,000 primary healthcare staff in Iraq’s Expanded Program on Immunization. With this expanded capacity, the ministry can continue rolling out training and increase the number of healthcare staff involved in direct responses to outbreaks. In 2015, the ministry adopted a national immunization plan, developed jointly with the project. The project also developed a series of public service announcements that aired on major TV channels with positive messages about breastfeeding, vaccination, good hygiene, and nutrition to promote child and maternal health.

 

Childbirth and Postpartum Care

URC is improving childbirth and postpartum services in several resource-constrained settings by examining task shifting for Caesarean sections; ensuring the proper and routine use of the partograph, a tool that monitors the progress of labor; improving the quality of essential and emergency obstetric care; and preventing postpartum hemorrhage through the routine and effective application of active management of the third stage of labor.  In all our work, we examine the crucial role that health workers and midwives play in providing basic and comprehensive emergency obstetric and newborn care to reduce maternal mortality and morbidity. 

Childbirth and Postpartum Care at Work

In Ghana, through the USAID Systems for Health Project, URC is facilitating completion of the Essential Medicine List for maternal, newborn, and child health. The project is reproducing 5,000 copies of the approved list for distribution across five regions. Systems for Health also co-funds the small-scale introduction of oxytocin, in cold-chain storage, in health facilities in the Volta region.

Globally, through the USAID-funded Translating Research into Action (TRAction) Project, URC plays a leading role in testing innovative approaches to integrate family planning counseling and services into postpartum care and advocate globally for respectful maternal care in childbirth.

Emerging global literature, as well as URC’s field experiences, supports the importance of addressing several key factors that facilitate effective task shifting—a practice that can expand the reach of lifesaving services—in maternal and newborn care: Our experience suggests that task shifting should be considered as a part of the larger health system and designed to equitably meet the needs of mothers, newborns, children, and families. 

Additional emerging evidence indicates one reason for underutilization of skilled delivery care is that women confront a range of negative experiences during facility-based childbirth. URC has supported studies that describe and quantify disrespectful and abusive care related to facility-based childbirth in Tanzania, Kenya, and Guatemala and supported efforts to promote respectful maternal care with research into interventions that promote and supporting advocacy around respectful maternal care.

 

Integrated Nutrition

URC follows the WHO’s Essential Nutrition Actions, an internationally accepted set of tools for improving maternal, newborn, infant, and young child health and nutrition that is the basis for counseling, community mobilization, and educational messages. The Essential Newborn Actions include seven recommended actions, each equally vital for ending preventable maternal and child deaths:

  • Promotion of optimal nutrition for women
  • Adequate intake of iron and folic acid and prevention and control of anemia for women and children (including anemia in pregnancy, an important contributor to maternal mortality)
  • Adequate intake of iodine by all members of the household
  • Optimal breastfeeding during the first 6 months
  • Optimal complementary feeding starting at 6 months with continued breastfeeding in 2 years of age and beyond
  • Optimal nutritional care of sick and severely malnourished children
  • Prevention of vitamin A deficiency in women and children

Integrated Nutrition at Work

The USAID Ghana Systems for Health Project is improving maternal, newborn, infant, and young child health and nutrition by implementing the Essential Nutrition Actions. This includes work with Ghana Health Services and UNICEF to provide iron and folic acid supplements, vitamin A supplements, multiple micronutrient powders, and ready-to-use therapeutic foods.

Uganda, the USAID Production for Improved Nutrition project is reducing the burden of undernutrition among children, pregnant women, breastfeeding mothers, and people living with HIV and AIDS. URC-led activities focus on behavior change communication for improved household nutrition, quality improvement, and monitoring and evaluation. The project gives URC a unique opportunity to be at the forefront of the USAID Forward strategy by supporting a local partner to lead a complex Feed the Future project.

In Guatemala, Nutri-Salud works to prevent chronic malnutrition by addressing risk factors during the first 1,000 days and implementing the Essential Nutrition Actions. URC also supports the Ministry of Public Health and Social Assistance and the private sector Alliance for Nutrition to deploy the Wheel of Practices for Better Living, a home-visit and counseling program that promotes healthy practices for mothers, children, and households.

 

Newborn Care

URC is improving services for mothers and newborns by strengthening health systems in resource-constrained settings and improving frontline health worker and manager skills, motivation, and performance by building clinical skills and quality improvement capacities. Our programs ensure that proven, high-impact essential newborn care, including care for major complications, is implemented reliably, every time. 

Our work contributes to the Every Newborn Action Plan, which advances the goals of the United Nations’ Global Strategy for Women’s and Children’s Health and the Every Woman Every Child  movement, the “A Promise Renewed” commitment to child survival, and Family Planning 2020.

Newborn Health at Work

URC works globally and at country level to advance newborn care. In all of our work, we support national, district, and local capacities to scale up the application of essential newborn care.

Globally, we support Survive and Thrive Global Development Alliance partners to build integrated clinical and quality improvement competencies of providers, managers, and professional associations to continuously improve best practices in USAID priority countries. The project is working with the American Academy of Pediatrics to develop, test, and support use of a quality improvement workbook and materials for low- and middle-income countries.

Through USAID ASSIST, URC has supported quality improvement at 20 sites in four Saving Mothers Giving Life districts of western Uganda and has supported facility-based quality improvement teams to improve provision of the Essential Newborn Care Package. ASSIST also collaborated with the Newborn Resuscitation Working Group of the UN Commission on Life Saving Commodities to develop a quality framework to help managers and providers understand common gaps and improvement approaches for achieving and sustaining effective resuscitation care for every baby in need.

In collaboration with World Health Organization in Mali, URC is implementing the WHO Safe Childbirth Checklist to ensure delivery of 29 essential interventions addressing the major causes of maternal death, intrapartum-related stillbirths, and neonatal death in low-income countries, including hemorrhage, infection, obstructed labor, hypertensive disorders, inadequate intrapartum care, birth asphyxia, and complications related to prematurity.

Strategic partnerships with newborn health

In addition to project-specific partnerships, URC is a member of several global alliances promoting newborn health:

  • Through our partnership with 1,000 Days, we advocate for improved maternal and child nutrition in the 1,000 days between the start of a woman’s pregnancy and her child’s second birthday.
  • As an implementing partner on Helping Babies Breathe, we support a global initiative to reduce asphyxia-related newborn death by scaling up newborn resuscitation capacity in resource-limited countries.
  • As a member of the White Ribbon Alliance for Safe Motherhood, we are part of a global organization that seeks to decrease maternal and newborn death and ensure that all women know their right to a safe pregnancy and childbirth.
  • We also maintain a partnership with Alianza Neonatal (the Newborn Alliance), an interagency group that supports Latin American and Caribbean countries in their efforts improve newborn health through evidence-based policy and programmatic interventions at facility and community levels. 

 

In Ecuador, a mother snuggles her premature baby close to her chest, practicing Kangaroo Mother Care to increase her baby’s chances of survival