MSD for Mothers
The ripple effects of a mother’s death can be enormous—devastating families and communities.
But a healthy pregnancy and childbirth leads to a lifetime of benefits, both for a woman’s own health and prosperity as well as that of her children, family, community and nation.
A positive experience during pregnancy and childbirth also builds a woman’s trust in the health care system. Depending on the care she receives, this short period in a woman’s life can either be life-threatening or empowering. Her experience will have an indelible influence on how—and whether—she seeks health care for herself, her newborn and her family.
We call it the “Mom Effect.”
Today, maternal mortality is prioritized under UN Sustainable Development Goal (SDG) 3, which calls for a global reduction in the maternal mortality ratio to fewer than 70 deaths per 100,000 live births by 2030.
Although there has been impressive progress and we have much to be proud of, we also have more work left to do.
MSD for Mothers is our company’s $500 million global initiative to create a world where no woman dies giving life. Contributing our scientific and business expertise, as well as our financial resources, we are working to ensure that women have access to two of the most powerful means to end preventable maternal deaths: quality maternity care and modern contraception. It is estimated that meeting women’s needs in these two areas would reduce maternal deaths by more than 70 percent.1
MSD for Mothers has reached more than 9 million women in 48 countries around the world since 2011, furthering the global effort to save women’s lives, strengthen health systems and meet the SDGs.
We support programs that:
- Empower women to make informed choices about contraceptives and the quality care they need for a healthy pregnancy and safe childbirth
- Equip health care providers with the skills, tools and technologies they need to deliver high-quality services wherever women seek care
- Strengthen health systems to sustain the delivery of high-quality services that benefit women and their communities
We collaborate across sectors—working with governments, nongovernmental organizations (NGOs), patient groups, physician, nursing and midwife associations, entrepreneurs, UN agencies, research institutions, other businesses and even other pharmaceutical companies. Likewise, we collaborate across our company, leveraging our talent to generate fresh thinking and infuse new, business-minded approaches to help solve the longstanding challenge of maternal mortality.
We’re also mobilizing our employees to raise awareness and champion maternal health efforts. There are now more than 600 employee ambassadors in 43 countries who support MSD for Mothers throughout the year. They work to encourage fellow employees to become involved in activities such as our “May is for Mothers” campaign in the U.S. and MSD for Motherhood Week in Europe.
Employee ambassadors also coordinate mobile phone collections and donations, share information about MSD for Mothers with their colleagues and communities, and volunteer with local nonprofit organizations that support pregnant women.
Major achievements in 2018 included:
Supporting innovation to prevent postpartum hemorrhage
MSD for Mothers is collaborating with the World Health Organization (WHO) and Ferring Pharmaceuticals in an effort to advance postpartum hemorrhage (PPH) prevention and improve maternal health outcomes.
Strengthening health systems
Publishing the first U.S. report on maternal mortality
We supported the publication of the United States’ first multi-state report on maternal mortality from the Centers for Disease Control and Prevention, which highlights the unique value of maternal mortality review committees in providing data on why women are dying and how to prevent future tragedies.
Expanding access to family planning in Nigeria
We supported a new project—as part of our commitment to Family Planning 2020—to work with local private drug shops and community pharmacies to expand access to a broad range of family planning options.
Achieving dramatic reductions in maternal mortality in sub-Saharan Africa
Saving Mothers, Giving Life (SMGL), a five-year public-private partnership, ended last year and produced impressive results: 44 percent decline in maternal mortality in target districts in Uganda and 41 percent decline in Zambia. In only three years, maternal mortality declined by 66 percent in target facilities in Nigeria, the country with the highest number of maternal deaths in the world.
Improving quality maternity care in India
We supported scale-up of a quality improvement and quality assurance model (Manyata) that helps private maternity providers improve their care and certifies those who consistently deliver high quality care.
Our goal is to support the design and testing of, and advocate for innovative models that expand women’s access to quality care and can be scaled for greater impact. We’re striving to find solutions to end preventable maternal mortality, today and for years to come.
Equipping health providers
Enabling providers to improve the quality of maternity care
Ensuring high-quality maternity care is a critical step in reducing maternal mortality. Health providers have an important role to play in delivering high-quality care, as do women in demanding better care.
One way in which we’re working to increase access to quality maternal health services is by improving the care delivered by local private providers such as independent doctors, midwives and pharmacy owners. Women seek care from private providers for a range of reasons, including proximity to their home, flexible hours, a sense of personalized care, and sensitivity to local needs and customs. However, this care can be unregulated, expensive and of variable quality.
Given the surprisingly high proportion of women who receive health services from private maternity providers, we believe that strengthening the ability of these providers to meet the health needs of pregnant women could have an impact on reducing maternal mortality.
In 2018, we supported Jhpiego (a maternal health NGO) and the Indian OB/GYN association FOGSI in scaling up a model to improve and help assure the quality of care that private maternity providers offer to women during labor and delivery. Manyata is a quality-improvement and quality-assurance model that helps private maternity providers improve their care and certifies those who consistently deliver high-quality care. We are working with national accreditation organizations to institutionalize quality standards across the country. Manyata is currently available in Uttar Pradesh, Jharkhand and Maharashtra and has expanded to Rajasthan through India’s first maternal health development impact bond: Utkrisht. As of 2018, almost 400 private providers have become Manyata-certified, serving over 200,000 women.
Our goal is to help ensure that women have access to affordable, quality maternal health services wherever they seek care, through public or private sources. That’s why we are raising awareness among policy makers, donors and other global health stakeholders about the complementary role of private providers. We believe it is important to improve the quality of maternity care that both public and provide health providers deliver to help end preventable maternal deaths.
Digital innovations to empower women
Digital innovations, especially mobile technology solutions, are playing an increasingly important role in advancing global health and development efforts, empowering people to learn and make decisions about their health and to receive much-needed health services in new and interactive ways. We believe that disruptive innovation through digital technology has the power to transform the quality of maternal health care around the world and reduce the number of women who die during pregnancy and childbirth. That’s why we are collaborating with entrepreneurs to design digital solutions that are highly targeted and effective in reaching women and adolescent girls.
In 2018, we supported development and scale-up of cutting-edge mobile platforms with the potential to equip any woman with the information she needs to make smart decisions about her reproductive health. Nivi is a simple, mobile phone-based service that uses SMS and interactive voice response to help women learn about their family planning options, identify the method(s) they want and find local providers who offer quality services and have their preferred options available. Nivi has over 85,000 users in Kenya.
Together for Her Health is a mobile phone and website platform that educates women about quality maternal health care and encourages them to rate the care they receive, in turn helping providers to improve quality. As of 2018, the platform has reached over 31,000 women who have provided more than 27,000 reviews.
MSD for Mothers aims to be a catalyst in helping leverage technology to address critical and potentially lifesaving needs for women around the world.
Advancing life-saving solutions
Every day, nearly 200 women around the world die from bleeding complications after childbirth, also known as postpartum hemorrhage (PPH). Most deaths due to PPH are preventable, yet it is still the leading, direct cause of maternal mortality worldwide. Annually, 14 million women suffer from PPH—and some 70,000 women do not survive.
In 2013, MSD for Mothers, Ferring Pharmaceuticals and WHO established a unique collaboration—Project CHAMPION—to evaluate an investigational formulation of carbetocin to prevent postpartum hemorrhage that is designed to be heat-stable, even in hot and tropical climates.
In 2018, along with our collaborators at WHO and Ferring Pharmaceuticals, we announced the completion of a WHO-led multi-country clinical study to evaluate the effectiveness of heat-stable carbetocin in vaginal deliveries compared to the current standard of care, oxytocin. Participating countries include Argentina, Egypt, India, Kenya, Nigeria, Singapore, South Africa, Thailand, Uganda and the United Kingdom.
Approximately 30,000 women were recruited to participate in the trial—one of the largest clinical trials ever conducted in PPH prevention. The results demonstrated that heat-stable carbetocin is clinically non-inferior to the standard of care, oxytocin, for the primary outcome of ≥500 ml blood loss or additional uterotonic use. Non-inferiority was not demonstrated for the second primary outcome of blood loss of ≥1,000 ml or more.
With the results from this trial and other evidence, WHO, for the first time, recommended carbetocin, including the heat-stable formulation, for the prevention of PPH for the first time in December 2018 and added it to the Essential Medicines List in July 2019. Ferring is currently engaged in efforts to submit the results of this trial to regulatory authorities and together with MSD for Mothers and WHO aims to ensure access to heat-stable carbetocin at an affordable and sustainable price in the public sector in low- and lower-middle-income countries.
MSD has been providing scientific and business expertise throughout the project and is committed to working with governments in the developing world to help reduce the toll of PPH on women’s lives.
MSD for Mothers is also interested in devising an easier-to-administer dosing regimen for magnesium sulfate, the current standard of care for managing seizures in pregnant women suffering from pre-eclampsia/eclampsia—a leading cause of maternal mortality. The first step toward this goal, identifying a dose range using our internal modeling and simulation expertise and data from collaborating universities and hospitals around the world, was completed in 2017.
Maternal sepsis is another leading cause of maternal mortality. To better understand how to address the issue, WHO—with the support of MSD for Mothers—embarked on a multi-country study (known as the Global Maternal Sepsis Study, or “GLOSS”), that engaged 53 low-, middle- and high-income countries across all six WHO regions to assess the issue of maternal sepsis.
GLOSS recruited more than 3,000 women with suspected or confirmed infection in over 600 participating facilities in late 2017. The study is part of WHO’s response to the sepsis resolution adopted by the 70th World Health Assembly in 2017.
Building local health system capacity
Maternal mortality is often a leading indicator of the strength of a country’s health system. And when a health system succeeds in lowering rates of maternal death, the benefits extend far beyond maternal health.
Launched in 2012, Saving Mothers, Giving Life (SMGL) is a five-year public-private partnership led by the U.S. government to reduce maternal and newborn mortality using a district-level approach to strengthen health systems. MSD for Mothers is a founding partner and our programs in Uganda, Zambia and Nigeria have contributed to SMGL’s work to put in place lifesaving maternal and newborn health interventions.
In 2018, SMGL came to a close, showing impressive results—a maternal mortality decline of 44 percent in SMGL districts in Uganda and a decline of 41 percent in Zambia. And in only three years, maternal mortality declined by 66 percent in target facilities in Nigeria.
Health systems strengthening is the backbone of the SMGL approach—enhancing the interconnected components of the health system simultaneously to address the three delays to accessing lifesaving maternity care: the delays in deciding to seek, reaching and receiving quality care.
SMGL is a public-private partnership involving the U.S. government, the Norwegian Ministry of Foreign Affairs, the American College of Obstetricians and Gynecologists, Every Mother Counts, Project C.U.R.E. and MSD for Mothers to reduce maternal mortality in sub-Saharan Africa.
Addressing the distance challenge
In Zambia, distance challenges are a leading contributor to the country’s high maternal mortality ratio of 213 maternal deaths for every 100,000 live births. Women often have to travel long distances to reach the nearest health facility, making it difficult for them to get the care they need during pregnancy and childbirth and immediately postpartum.
MSD for Mothers helped launch the Mothers’ Shelters Alliance in 2015 to address this challenge by building and strengthening mothers’ shelters—residences near health facilities where pregnant women can stay until they go into labor and immediately after childbirth.
The goal was to make these shelters and the services they offer sustainable by empowering local communities to both effectively manage them and generate income to support their operations through creative entrepreneurial activities.
In early 2019, the project came to a close and generated impressive results. Nearly 10,000 women have stayed in a mothers’ shelter and more than 600 community health workers are encouraging their use.
Local communities have helped establish over 20 micro-businesses that generate enough revenue to cover almost all of the shelters’ operating costs. Today, community members have proudly taken ownership to manage and sustain the shelters in partnership with nearby facilities so pregnant women have a safe place to stay before and immediately after giving birth in a quality health facility.
The Mothers’ Shelters Alliance is a collaboration among MSD for Mothers, the Bill & Melinda Gates Foundation and the ELMA Foundation, with partners Africare, the University of Michigan, Boston University and Right to Care. The Alliance had been working in conjunction with Saving Mothers, Giving Life.
Our work in the United States
Even in settings with advanced medical technology, too many women—especially from marginalized and underserved communities—die from complications that could have been prevented or treated.
In the United States, MSD for Mothers is working to address the country’s trend in maternal mortality. We are supporting projects in states across the country to help standardize clinical care, enhance data collection, and strengthen linkages to comprehensive care to improve maternal health for all women.
In hospitals, partners are implementing standard approaches to ensure that mothers get timely and consistent emergency obstetric care. At the state level, processes are now in place to find out why women are dying in pregnancy and childbirth, to prevent future deaths. And community-based initiatives are underway to help women with chronic health conditions receive timely, appropriate care and supportive services.
In late 2018, MSD for Mothers launched the Safer Childbirth Cities Initiative to support community-based organizations in cities across the U.S. with a high burden of maternal mortality and morbidity. In 2019, the Safer Childbirth Cities Initiative will fund nine community-based organizations to implement evidence-based interventions and innovative approaches to save women’s lives, improve maternal health and narrow disparities.
Other key accomplishments include:
- Scaling evidence-based obstetric practices: Building upon our early efforts to scale up evidence-based practices to treat the three leading causes of maternal death in the United States—PPH, pre-eclampsia and embolism—MSD for Mothers is now working with the Institute for Healthcare Improvement to ensure that all hospitals in the U.S. adopt these lifesaving tools.
- Strengthening maternal mortality review programs: The Centers for Disease Control and Prevention (CDC) and the CDC Foundation published the first multi-state report on maternal mortality in the United States: Report from Nine Maternal Mortality Review Committees as well as a Vital Signs report featuring data from 13 states.
- MSD for Mothers supported the CDC to provide technical assistance to 42 states to strengthen their maternal mortality review programs to understand why women are dying during pregnancy and childbirth. The recent Preventing Maternal Deaths Act will direct federal funds to states to establish and sustain maternal mortality review committees.
|1 Guttmacher Institute. Greater Investments Needed to Meet Women's Sexual and Reproductive Health Needs in Developing Regions. Available at: https://www.guttmacher.org/news-release/2017/greater-investments-needed-meet-womens-sexual-and-reproductive-health-needs|
|PRIORITY COUNTRY DATA (CUMULATIVE)||2017||2018|
|Facilities strengthened to provide quality care||3,352||4,739|
|Providers equipped to offer quality care||73,999||135,289|
|Women empowered to demand quality care||325,859||748,902|
|Women with improved quality of care||2,900,355||3,396,659|
|Women with improved access to modern contraception||3,775,907||4,038,980|
|People with improved access to lifesaving products1||15,411,614||15,411,614|
|People with improved access to quality facilities||21,311,854||29,943,800|
|1 MSD for Mothers’ support to nationally scale a supply chain innovation improved access to lifesaving products for the entire population of Senegal in 2017—an estimated 15 million people. Consequently, MSD for Mothers is transitioning its funding and working with partners to ensure sustained success in reducing stock-outs.|