Global OB/GYN News

From Academics to Advocacy and Action

November 2019
Massachusetts General Hospital                                              Vincent Program in Global OB/GYN

Welcome to the November newsletter! Our goal is to share with you stories from our work around the world, important new publications from academia and the media on global women’s health, a few fun facts, and tips on how to stay safe while traveling. We’d love your input, so if you have a story, or wish to share a tip, send them our way!  globalobgynnews@partners.org

From the Editors: AK Goodman, Adeline Boatin, Tom Randall

 Maternal mortality continues to be alarmingly high, and approximately 94% of it occurs in developing countries, a telltale of a stark disparity in maternal health. In this newsletter, we would like to share stories and literature on maternal health disparity.

Notes from the Field
Rose Molina, MD, MPH


Picture: Ariadne Lab Booth in Women Deliver Conference, Vancouver, Canada (2019) 


Picture: BetterBirth Stakeholders Meeting, India (2019)
 
The BetterBirth Program at Ariadne Labs has led an ambitious study to evaluate a peer-coaching program for implementing the WHO Safe Childbirth Checklist in primary level facilities in Uttar Pradesh, India. The results demonstrated that the peer-coaching program to implement the Checklist resulted in improved quality of care through increased adherence with essential birth practices in frontline facilities. Such improvements, however, were insufficient to reduce overall maternal and perinatal morbidity and mortality. Additional health system strengthening and coordination is required to achieve transformative change in maternal and newborn outcomes.
 
In 2018, I worked with the BetterBirth team to analyze the >200 million data points generated from nearly 300,000 women and newborns in the study and identify key lessons and insights into how to improve the quality of care during childbirth globally. We organized our learnings into the four levels of the ecosystem of facility-based childbirth care: 1) Women & Community: Power Matters, 2) Birth Attendants: Competency and Workplace Matter, 3) Frontline Facility: Readiness Matters, and 4) Health System: Systemness Matters. Our final report was first presented to stakeholders in Delhi, India in January 2019. During the stakeholder meeting, we convened experts from the Ministry of Health, implementers, researchers, funders, and front-line providers to discuss the next steps to improve childbirth care in India. We also launched our BetterBirth final report to a global audience at Women Deliver in Vancouver, Canada in June 2019. Our online community of practice facilitates ongoing implementation support for the WHO Safe Childbirth Checklist through sharing resources and peer communication.

Editor's notes:
About the author: Rose Molina, MD, MPH is an Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School. She works as a board-certified obstetrician-gynecologist at The Dimock Center and Beth Israel Deaconess Medical Center. Dr. Molina works as Associate Faculty at Ariadne Labs to design, test and spread solutions to ensure that every woman receives appropriate, safe, and respectful care during pregnancy and childbirth. Her current research focuses on improving shared decision-making in obstetric care. Her current advocacy work seeks to advance access to language-concordant and culturally-humble health care for all, especially undocumented immigrants in the United States. Dr. Molina also serves as a Women’s Health Advisor for Partners In Health in Chiapas, Mexico, an organization she has worked with since 2008.

Below are some of Dr. Molina's recent extraordinary work in the field of global obstetrics: 

Ai-ris, Y. C., & Molina, R. L. (2019). Maternal mortality in the United States: updates on trends, causes, and solutions. NeoReviews, 20(10), e561-e574.

Molina, R. L., Bobay, L., & Semrau, K. E. (2019). Historical Perspectives: Lessons from the BetterBirth Trial: A Practical Roadmap for Complex Intervention Studies. NeoReviews, 20(2), e62-e66.

Molina, R. L., Villar, J., Reyes, A., Elliott, J., Begley, M., Johnson, M., ... & Palazuelos, D. (2019). Delivery practices and care experience during implementation of an adapted safe childbirth checklist and respectful care program in Chiapas, Mexico. International Journal of Gynecology & Obstetrics, 145(1), 101-109. https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1002/ijgo.12771

Uribe-Leitz, T., Barrero-Castillero, A., Cervantes-Trejo, A., Santos, J. M., de la Rosa-Rabago, A., Lipsitz, S. R., ... & Molina, R. L. (2019). Trends of caesarean delivery from 2008 to 2017, Mexico. Bulletin of the World Health Organization, 97(7), 502.
https://www.who.int/bulletin/volumes/97/7/18-224303.pdf
Fun Fact
WHO recommends Kangaroo Mother Care for low-birth and preterm babies. Find out more about the method of care at https://www.who.int/maternal_child_adolescent/documents/9241590351/en/
Paperchase
"Inequalities in perinatal and maternal outcome persist in women from lower socioeconomic groups, from specific ethnic groups, and from those living in deprived areas. In view of the lifelong consequences, these marked social disparities pose an important challenge for the political decision-makers and the healthcare system."
https://journals.lww.com/co-obgyn/fulltext/2013/04000/Inequalities_in_perinatal_and_maternal_health.3.aspx
 
The availability of basic infrastructure like electricity increases the uptake of critical vaccinations by children and antenatal care by pregnant women. Learn more about the study conducted in Gujrat, India at https://jhpn.biomedcentral.com/articles/10.1186/s41043-019-0164-6.

The outcome of pregnancy is determiend long before pregnancy begins. "Approaches that simultaneously consider the entire life span, as well as multiple determinants, may need to be adopted. The life span perspective focuses attention toward the preconceptional and interconceptional periods as targets for intervention in improving perinatal health."
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.570.3647&rep=rep1&type=pdf
News Bulletin
Travel and Safety
ProMED-mail is a program of the International Society for Infectious Diseases that tracks ongoing infectious disease outbreaks worldwide: https://www.promedmail.org/. Check out the map of current worldwide outbreaks: https://healthmap.org/promed/.
 
South-Asian countries- Philipines, Bangladesh, and Nepal-  and South American countries- Honduras, Guatemala, El Salvador, and Nicaragua- are grappling with the worst Dengue outbreaks. Take necessary precautions if traveling to these regions.
https://www.sciencenews.org/article/nepal-reeling-from-unprecedented-dengue-virus-outbreak
https://www.aljazeera.com/news/2019/08/bangladesh-grappling-record-dengue-fever-outbreak-190807091210915.html
https://reliefweb.int/disaster/ep-2019-000072-hnd 
https://www.aljazeera.com/news/2019/09/philippines-worst-dengue-outbreak-years-kills-thousand-190917020550489.html
 
 
Announcements and Events
Save the Dates!!
 
Physicians for Human Rights 2019 National Student Conference
Registration: https://2019phrconference.eventbrite.com/
Conference Website: https://tinyurl.com/PhrConf2019

Friday, Nov. 15, 6 pm-8 pm (Opening remarks, Poster Session)

Saturday, Nov. 16, 8:30 am- 5:30 pm (Screening of Birth at the Border, Human Trafficking, Attack on Healthcare Workers, Climate Change & Human Rights, Asylum and Immigration, Sexual Violence

Sunday, Nov, 17 9 am- 12 pm (Advocacy Day)
 
Gender-Based Violence training seminars focused on disaster responders will be held on Nov 19, 2019, and Dec10, 2019 from 12:00-1:00 pm at MGH Founders Building. To register for training sessions, please email achaudhary@mgh.harvard.edu

Gender-Based Violence Symposium (June 9, 2020, Assembly Square Row, Somerville)
Travel Grant of $2000.00 is available to support residents, fellows, and faculty who would like to embark upon a global health trip. If interested, please contact Ak Goodman (agoodman@partners.org). 

International Tumor Board ECHO Sessions: International Gynecologic Cancer Society holds monthly gynecologic oncology tumor board meetings including gynecologic oncologists and GYN-ONC trainees all over the globe. Interested fellows and residents, please email Thomas Randall (TRANDALL@mgh.harvard.edu) or Ak Goodman (AGOODMAN@mgh.harvard.edu)






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