MSD for Mothers has reached over 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.
MSD for Mothers:
• Empowers women to make informed choices about contraceptives and the quality care they need for a healthy pregnancy and safe childbirth
• Equips health care providers with the skills, tools and technologies they need to deliver high-quality services wherever women seek care
• Strengthens health systems to sustain the delivery of high-quality services that benefit women and their communities
MSD for Mothers collaborates 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.
Enabling Providers to Improve the Quality of Maternity Care
In 2018, MSD for Mothers supported non-profit health Jhpiego and 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. The partnership is 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. To date, almost 400 private providers have become Manyata-certified, serving over 200,000 women.
DIGITAL INNOVATIONS TO EMPOWER WOMEN
In 2018, MSD for Mothers 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 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. To date, the platform has reached over 31,000 women who have provided more than 27,000 reviews.
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 a major contributor to the leading, direct cause of maternal mortality worldwide. Annually, 14 million women suffer from PPH – and of these some 70,000 women do not survive.
In 2013, MSD for Mothers, Ferring Pharmaceuticals and the WHO established a unique collaboration—Project CHAMPION—to evaluate an investigational formulation of carbetocin to prevent excessive bleeding after childbirth (post partum hemorrhage) that is designed to be heat-stable, even in hot and tropical climates.
In 2018, along with our collaborators at the WHO and Ferring Pharmaceuticals, MSD for Mothers 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 treatment, 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 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 Merck for Mothers and the 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 address the significant burden presented by PPH.
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 41percent in Zambia. And in only two years, maternal mortality dropped by 28 percent in Cross River State, 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 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.
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.
*MSD known as Merck & Co., Inc. in the United States & Canada