Innovation for maternal and child health
In the past two decades, the world has seen a rapid decline in maternal and child deaths. New medicines and vaccines, efforts to increase skilled attendance at birth, and other clinical and programmatic interventions have saved millions of lives. However, challenges remain in reaching the most vulnerable women and children, and the context and causes of morbidity and mortality are evolving.
Further, some of the very innovations and practices we have developed to reduce morbidity and mortality – while indeed doing just that – have posed new challenges. For example, we’ve come to recognize that increasing facility births is insufficient in the absence of quality, woman-centered care, prompting a renewed focus on high-quality health systems and improving women’s agency in the healthcare context. With new technological advances, we must consider the evolving context in which they are implemented while ensuring women are at the center of these efforts.
At a session during the upcoming FIGO World Congress in Rio de Janiero, we will be exploring several areas of new knowledge and innovation that can prepare clinicians in low- and middle-income countries (LMICs) to respond to the changing maternal health landscape and improve outcomes for both mother and newborn.
Maternal immunisation presents an opportunity
One emerging innovation that will be discussed at the upcoming session is maternal immunization (MI). The Bill & Melinda Gates Foundation has been supporting efforts to develop and prepare for delivery of new vaccines intended for use in pregnant women. These vaccines are designed to confer immunity to the fetus in utero, protecting newborns at a particularly vulnerable time until they receive their own routine vaccines.
While concerted efforts have led to a steady reduction in under-five childhood deaths, mortality reduction in newborns and infants has been significantly slower; a relatively high proportion of these deaths, 23%, are due to infectious causes. It is our hope that these new vaccines will make a significant impact in addressing the newborn morbidity and mortality gap. In addition to protecting newborns during these first months of life, MI has potential benefits for maternal health and for preventing pre-term births and stillbirths.
Phase 3 trials are underway for a maternal respiratory syncytial virus (RSV) vaccine, and another vaccine for group B streptococcus (GBS) is also in early-stage development. In addition to protecting the newborn, GBS vaccines may provide substantial benefits for the mother, addressing maternal infections and providing an alternative to intrapartum antibiotic prophylaxis, which is often impractical in low-resource settings and can lead to antibiotic resistance.
In order to reach pregnant women with these new vaccines, immunization services will likely be integrated in antenatal care (ANC), which poses challenges and opportunities for existing maternal health care. Health systems, and ANC services in particular, are often weak in LMICs, and health workers are already stretched. Few of these countries have fully implemented WHO’s 2016 antenatal care guidelines, and most would not be prepared to introduce new technologies on top of an overburdened ANC platform.
But introducing new maternal immunizations brings an opportunity to strengthen ANC; quality must be strengthened in order to successfully introduce any new intervention. Such efforts can build off of the infrastructure of vaccine programs, and offering maternal vaccines could in fact incentivize women to attend ANC through the opportunity to receive a valued, concrete intervention. To realize these benefits, the maternal health community and providers must work alongside vaccine programs to prepare health systems and communities for successful introduction.
What’s ahead in maternal health care?
The Gates Foundation is honoured to present a distinctive session at the upcoming FIGO World Congress on the future of maternal health care worldwide, highlighting maternal immunization alongside other forward-looking topics that will inform the design and practice of maternal health care in the future, including:
- Pregnant Women’s Agency: What do pregnant women want – and how can we help them get it? Presented by Dr. Dorothy Shaw, Vice President – Medical Affairs, BC Women’s Hospital
- Maternal Immunization: Vaccinating pregnant women against maternal and perinatal infections – maternal immunization now and in the future. Presented by Dr. Ajoke Sobanjo ter-Meulen, Global Head, Maternal Immunization, Bill & Melinda Gates Foundation
- Labor Monitoring: What will be tomorrow’s best way to monitor labor? Presented by Dr. Olufemi Oladapo, Medical Officer – Maternal and Perinatal Health, World Health Organization
- The Vaginal Microbiome: What is the vaginal microbiome and what do we know about its role in maternal and newborn health outcomes? Dr. Jennifer Fettweis, Assistant Professor – Center for the Study of Biological Complexity & Department of Obstetrics and Gynecology, Virginia Commonwealth University
Please join us to learn more about these important emerging issues and approaches and how they will inform future practice.
This news item has been contributed by:
Jerker Liljestrand, M.D., Ph.D.
Deputy Director a.i., Innovation and Demonstration for Scale, Maternal, Newborn & Child Health
Bill & Melinda Gates Foundation; and
Ajoke Sobanjo-ter Meulen, M.D., M.Sc.
Global Head of Maternal Immunization
Bill & Melinda Gates Foundation