MSD for Mothers

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.

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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.

A mother’s role is priceless. We call it the “Mom Effect.”

MSD for Mothers is our company’s 10-year, $500 million global initiative to create a world where no woman dies giving life.

Today, maternal mortality is prioritized under UN Sustainable Development Goal 3.1, 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.

Our Approach

MSD for Mothers is our company’s 10-year, $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 73 percent from 2017 levels.1

Over the past six years, MSD for Mothers has reached more than 6 million women in over 30 countries around the world, contributing to the global effort to save women’s lives, strengthen health systems and meet the United Nations’ Sustainable Development Goals.

We:

  • 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, non-governmental 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 MSD, leveraging our talent to generate fresh thinking and infuse new, business-minded approaches to help solve the longstanding challenge of maternal mortality.

Working alongside more than 100 partners, we have improved access to quality maternal care and family planning services for more than 6 million women around the world.

Through the MSD Fellowship for Global Health, RTC Fellows participated in 12-week assignments with our partners on the ground in India, Uganda and Zambia, providing assistance in business training, business planning, branding, marketing and demand generation, data management, quality assurance, feasibility studies and recommendations for income-generating activities.

In addition, more than 70 employees across the company serve as expert advisors, providing technical expertise to support our product innovation efforts and strengthen our programs. MSD scientists and regulatory, marketing and manufacturing experts are helping advance a heat-stable drug that has lifesaving potential to prevent women from hemorrhaging after childbirth. Other employees have guided our partners in improving digital-based tools to improve maternity care.

We’re also mobilizing our employees to raise awareness and champion maternal health efforts through MSD for Mothers. There are now more than 500 employee ambassadors in 35 countries that support the initiatives throughout the year, including our “May Is for Mothers” campaign and Safe Motherhood Week. Employees engage in a variety of activities, including assembling postnatal kits for mothers in Uganda, coordinating mobile phone collections and donations, sharing information about MSD for Mothers with their colleagues and communities, and volunteering with local nonprofit organizations related to maternal health care.

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.

HIGHLIGHTS

Major achievements in 2017 included:

  • Project CHAMPION: MSD for Mothers, in partnership with Ferring Pharmaceuticals, supported the World Health Organization’s completion of the largest clinical trial ever conducted in postpartum hemorrhage. Approximately 30,000 women participated in this 10-country trial to evaluate heat-stable carbetocin. If the results of the trial are favorable, this product could offer a new solution to prevent excessive bleeding after childbirth in countries where reliable refrigeration is challenging.
  • Utkrisht Bond: In collaboration with UBS, USAID, the government of Rajasthan, India and others, MSD for Mothers launched one of the first—and the largest—health development impact bonds. This innovative financing mechanism taps into new sources of private capital and rewards achievement of specific health-related goals—in this case, improved quality of private maternity care.
  • Global Financing Facility (GFF): MSD for Mothers became the first private-sector partner of the World Bank’s GFF. The GFF aims to end preventable maternal, newborn, child and adolescent deaths and improve the health and quality of life of women, children and adolescents by bringing together multiple sources of financing in a synergistic, country-led way. As a member of this partnership, we are amplifying our impact in reducing maternal mortality and leveraging private-sector solutions to accelerate progress.
  • Yeksi Naa (meaning “I have arrived,” in Wolof): This initiative, supported by MSD for Mothers and the Bill & Melinda Gates Foundation, has achieved significant declines in stockouts of contraceptives and has expanded broadly, enabling the government of Senegal to reliably distribute an additional 90 commodities, including critical medicines for pediatric illnesses, HIV/AIDS, tuberculosis and malaria. In 2017, the government of Senegal assumed financial and management responsibility for this innovative model that has helped transform the country’s public health supply chain.
  • MSD for Ugandan Mothers (MUM): The MUM project leveraged Uganda’s private health sector to expand access to high-quality maternal health services and products. The program improved access to quality care for more than 200,000 women and trained more than 800 health workers across 140 facilities in clinical and business skills.
  • Maternal Mortality Review Committees: We supported the publication of a multi-state report from the Centers for Disease Control and Prevention that highlighted the unique value of maternal mortality review committees in the United States in understanding why maternal mortality has been increasing and what targeted actions states should be taking to reverse the trend. The report is a key step toward producing the country’s first national report on maternal mortality.
  • Nigeria: We made significant new investments in Nigeria, the country that is the largest contributor to the global maternal burden. We have partnered with the Gates Foundation and a local NGO, the Society for Family Health, to improve access to quality postpartum family planning services, partnered with a local community-based NGO to implement village health worker and midwifery training programs, and extended our partnership with USAID and Pathfinder International to increase access to quality maternity care services through a total-market approach.

Our goal is to design, test 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.

Empowering Women and Their 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. In the developing world, maternal health is typically thought to be a responsibility of the public sector even though women often turn to private providers as a critical source of care. 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 2017, we supported Jhpiego (a maternal health NGO) and the Indian OB/GYN association FOGSI in scaling up a model to improve and assure the quality of care that private maternity providers offer to women during labor and delivery. The model, 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.

Our goal is to 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 and the importance of working with them to help end preventable maternal deaths.

To support our programmatic and advocacy efforts, we continue to work with the London School of Hygiene and Tropical Medicine to measure and evaluate our programs and better understand the providers who deliver maternal health care to women.

Using Digital Innovations to Empower Women as Health Consumers

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. MSD for Mothers believes 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 2017, we helped develop and launch cutting-edge mobile platforms with the potential to equip any woman with the information she needs to make smart decisions about her reproductive health. Together for Health is a mobile phone and website platform that educates women on the quality of maternal health care and allows them to rate the care they receive, in turn helping providers to improve quality. Nivi is a mobile phone platform that enables women to select a contraceptive method that’s right for them, purchase the product from a nearby provider, and share feedback on their experience.

MSD for Mothers aims to be a catalyst in helping to leverage technology to address critical and potentially lifesaving needs for mothers around the world.

Advancing Life-Saving Products

We know from our work to address river blindness, HIV/AIDS, cervical cancer and other diseases that we cannot succeed if we work alone, and that partnership is essential to staying ahead of the curve in the rapidly changing world of global health.

As a research-based health care company, innovations in lifesaving products are one of the most important and distinct contributions we can make to improve maternal health. Our scientists and others are deeply involved in identifying, developing and advancing new and/or improved products to address unmet maternal health needs in the developing world.

In 2013, MSD for Mothers, Ferring Pharmaceuticals and the WHO established a unique collaboration—Project CHAMPION—to develop a proprietary formulation of carbetocin, used to prevent PPH in women after childbirth, that is designed to be heat-stable, even in hot and tropical climates.

The development of a medicine that can be stored at elevated temperatures has the potential to offer a new solution to prevent excessive bleeding following childbirth in many countries where refrigeration during storage and distribution of the medicine are difficult to achieve and maintain. The availability of a heat-stable carbetocin product could help reduce maternal deaths in these countries.

In 2017, the WHO completed a multi-country clinical study to evaluate the effectiveness of heat-stable carbetocin in vaginal deliveries as compared to the current standard of treatment, oxytocin. Participating countries include Argentina, Egypt, India, Kenya, Nigeria, Singapore, South Africa, Thailand, Uganda and the United Kingdom. By early 2018, approximately 30,000 women had been recruited to participate in the trial—completing enrollment in the largest clinical trial related to PPH. The results will be published in late 2018 and, if they are positive, our goal is to ensure access to heat-stable carbetocin at an affordable price in low- and lower-middle-income countries.

MSD’s scientists and regulatory, marketing and manufacturing experts have been providing guidance throughout the project—from designing and executing this large trial to planning for a launch of the product. These efforts have also helped build the capacity of low- and middle-income regions to meet the highest standards of excellence in conducting research trials.

MSD for Mothers is also interested in devising an easier-to-administer dosing regimen for magnesium sulfate, the current gold standard for managing seizures in pregnant women suffering from pre-eclampsia/eclampsia. 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 a leading cause of maternal mortality. To better understand how to address the issue, the 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 the WHO response to the Sepsis resolution adopted by the 70th World Health Assembly in 2017.

Strengthening Health Systems

Maternal mortality is often a leading indicator of the strength of a country’s health system. When a health system succeeds in lowering rates of maternal death, the benefits extend far beyond maternal health.

Transforming Supply Chains for Lifesaving Medicines

Family planning is recognized as one of the most cost-effective ways to lower maternal mortality rates, potentially averting one-third of maternal deaths by reducing the overall number of pregnancies and helping women plan and space their pregnancies.

In Senegal, as part of our collaboration with the Bill & Melinda Gates Foundation, we supported the scale-up of the Informed Push Model (IPM-3PL), an innovative supply chain model that has been highly successful in eliminating stock outs of contraceptives at health facilities—a serious barrier to family planning.

Working with our partner IntraHealth, we implemented a phased national expansion of IPM-3PL and, in 2017, the government of Senegal assumed financial and management responsibility for this supply chain innovation as part of a broader national supply chain reform effort called Yeksi Naa (meaning “I have arrived,” in Wolof). With support from MSD for Mothers, the government is adapting and expanding the initiative to reliably distribute an additional 90 commodities, including critical medicines for pediatric illnesses, HIV/AIDS, tuberculosis and malaria. We developed a novel business model that the country adopted to sustain this transformation in public health.

Leveraging Financial Resources for Greater Impact

MSD for Mothers is a founding member of a new partnership with USAID, UBS Optimus Foundation and others to develop the largest—and one of the first—development impact bonds focused on health. This innovative financing mechanism, which taps into private capital, is supporting targeted efforts to improve the quality of private maternity care. By rewarding achievement of specific health-related goals, the Utkrisht Development Impact Bond is a more results-oriented and sustainable approach to enhance health outcomes, especially in growing markets.

Building Local Capacity to Save Women’s Lives

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 in sub-Saharan Africa. MSD for Mothers is a founding partner of the initiative, and our programs in Uganda and Zambia contribute to SMGL’s work to put in place lifesaving maternal and newborn health interventions. SMGL has produced impressive results and will be publishing a final report on its achievements in June 2018.

For a complete list of our partners, please visit the MSD for Mothers website.

Addressing the Distance Challenge

In Zambia, distance challenges are considered a leading contributor to the country’s high maternal mortality ratio of 224 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.

The Mothers’ Shelters Alliance was launched 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.

The shelters are now fully operational across eight districts of Zambia; more than 5,000 women have stayed in a mothers’ shelter and approximately 600 community health workers are encouraging their use. Local communities have also helped establish over 20 micro-businesses that generate enough revenue to cover half of the shelters’ operating costs.

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 the Zambia Center for Applied Health Research and Development. The Alliance is working in conjunction with Saving Mothers, Giving Life, a public-private partnership between 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.

Reaching Vulnerable Women in Middle- and High-Income Countries

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.

Bolstering Maternal Health in the United States

In the United States, MSD for Mothers is working in 18 states to address inconsistent clinical care, lack of good data, and poor linkages to comprehensive care to improve maternal health for all women. In hospitals, partners are implementing standard approaches for action 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, so we can prevent future deaths. And community-based initiatives are underway to help women with chronic health conditions receive timely, appropriate care and supportive services.

Key accomplishments include:

  • Building upon 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 studied the enablers of and barriers to implementing “safety bundles” to address these causes
  • The Association for Women’s Health, Obstetric and Neonatal Nurses (AWHONN) trained nurses at four hospitals to share postpartum warning signs with new mothers before discharging them from the hospital. Our goal is to scale these interventions more broadly across the United States.
  • MSD for Mothers supported a new effort by the NYC Department of Health and Mental Hygiene and the Fund for Public Health in New York to incorporate severe maternal morbidity review into its maternal mortality review to learn more about these cases and how to prevent them in New York and nationally
  • The Centers for Disease Control and Prevention (CDC) and the CDC Foundation published a multi-state report on maternal mortality in the United States: Report from Nine Maternal Mortality Review Committees. This effort, supported by MSD for Mothers, helps states identify national trends in maternal mortality and includes data from Colorado, Delaware, Georgia, Hawaii, Illinois, North Carolina, Ohio, South Carolina and Utah. Key findings revealed that: (1) most pregnancy-related deaths are preventable; (2) mental health, substance use and chronic conditions are major drivers of maternal mortality; and (3) there are many potential causes for racial disparities in maternal mortality.
  • MSD for Mothers partnered with Columbia University’s Averting Maternal Death and Disability program to explore how women are treated by providers during childbirth to help ensure that all women in the United States receive appropriate and respectful maternity care 

Ensuring Equitable Access to High-Quality Maternity Care

In Canada, indigenous women are dying from complications during pregnancy and childbirth at approximately twice the rate of non-indigenous women. Indigenous communities face a number of barriers that lead to poor maternal health outcomes, including poverty, food insecurity, racism, discrimination, cultural insensitivity, domestic violence, substance use, homelessness, and stigma.

To narrow the gap, we are working closely with indigenous communities to develop programs that are tailored to their needs, especially during pregnancy. In 2017, we launched a new partnership, “Kind Faces Sharing Places,” with a diverse group of health, social service, and housing organizations that connects indigenous mothers in Ontario to prenatal care and other services to help ensure a healthy pregnancy and safe childbirth. Components of the community-based project include prenatal care that is closer to home, culturally competent childbirth education, peer support in the weeks before and after birth, referrals to mental health providers and addiction treatment, traditional counseling and healing, and improved care coordination.

Performance

In 2017 we revised our metrics to more comprehensively reflect the reach and impact of MSD for Mothers’ (MfM) programming across more than 30 countries. We added four new metrics to capture the wider communities we reach and expanded the number of countries and MfM-supported programs we include to more fully represent our results to date.

Priority Country Data2017
Districts/regions reached253
Facilities strengthened to provide quality care3,352
Providers equipped to offer quality care73,999
Women empowered to demand quality care325,859
Women with improved quality of care2,900,355
Women with improved access to modern contraception3,775,907
Women reached6,388,321
People with access to lifesaving products17,050,674
People with access to quality facilities21,311,854