Maternidade em tempos de pandemia de Covid-19: o que nos revelam as mães atendidas em um hospital de referência / Maternidad en tiempos de pandemia de Covid-19: lo que nos revelan las madres atendidas en un hospital de referencia / Maternity in times of the Covid-19 pandemic: what mothers admitted in a reference hospital have to tell us

A pandemia de Covid-19 afetou todas as esferas da nossa vida. Mulheres no período perinatal têm necessidades únicas, demandando diretrizes de saúde e segurança devido aos riscos do isolamento social. Objetivou-se conhecer a vivência de mulheres na gestação ou puerpério no contexto da pandemia durante atendimento em hospital de referência. Estudo qualitativo pautado em referenciais da integralidade do cuidado e cotidiano. Participaram 18 mulheres, gestantes e puérperas. Três temas emergiram: repercussões na gestação e puerpério; repercussões na vida prática; e estratégias de enfrentamento criadas pelas mulheres. Os relatos desvelam diferentes repercussões da pandemia na vida das mulheres e de suas famílias, bem como estratégias e cuidados usados para mitigar os efeitos adversos. Sugere-se o direcionamento de medidas preventivas e políticas públicas que priorizem mulheres grávidas e puérperas, reconhecendo e acolhendo questões subjetivas envolvidas nesse momento na vida da mulher.(AU)

La pandemia de Covid-19 afectó todas las esferas de nuestra vida. Mujeres en el período perinatal tienen necesidades únicas, que demandan directrices de salud y seguridad con relación a los riesgos debido al aislamiento social. El objetivo fue conocer la experiencia de mujeres en la gestación o el puerperio en el contexto de la pandemia durante su atención en un hospital de referencia. Estudio cualitativo pautado en factores referenciales de la integralidad del cuidado y del cotidiano. Participaron 18 mujeres, gestantes y puérperas. Surgieron tres temas: Repercusiones en la gestación y el puerperio, repercusiones en la vida práctica y estrategias de enfrentamiento creadas por las mujeres. Los relatos muestran diferentes repercusiones de la pandemia en la vida de las mujeres y sus familias, así como estrategias y cuidados usados para mitigar los efectos adversos. Se sugiere la dirección de medidas preventivas y políticas públicas para que se prioricen las mujeres embarazadas y puérperas, reconociendo y recogiendo cuestiones subjetivas presentes en ese momento en la vida de la mujer.(AU)

The Covid-19 pandemic has affected all aspects of our lives. Women in the perinatal period have unique needs, demanding health and safety guidelines regarding the risks associated to social isolation. The objective was to know the women's experience during pregnancy or puerperium in the pandemic while being cared at a hospital. Qualitative study referenced on concepts of integrality of care and daily life. Eighteen pregnant and postpartum participated. Three themes emerged: Repercussions on pregnancy and puerperium, repercussions on practical life, and coping strategies created by women. The reports reveal different repercussions of the pandemic in the lives of women and their families, also the strategies and precautions used to mitigate its adverse effects. We suggest directing preventive measures and public health policies to prioritize pregnant and postpartum women, recognizing and embracing subjective issues involved at this moment in women's lives.(AU)

Improving maternal and child nutrition in China: an analysis of nutrition policies and programs initiated during the 2000-2015 Millennium Development Goals era and implications for achieving the Sustainable Development Goals.

BACKGROUND: Although good progress was made in maternal and child nutrition during the Millennium Development Goals (MDGs) era, malnutrition remains one of the major threats on global health. Therefore, the United Nation set several nutrition-related goals in the Sustainable Development Goals (SDGs). There is much to be learned from individual countries in terms of efforts and actions taken to reduce malnutrition. China, as a developing country, launched a number of nutrition improvement policies and programs that resulted in dramatic progress in improving maternal and child nutrition during the MDGs era. This study explored the impact, experiences, and lessons learned from the nutrition policies and programs initiated in China during the MDGs era and implications to achieve the SDGs for China and other developing countries. METHOD: The CNKI database and official websites of Chinese government were searched for reviews on nutrition-related policies and intervention programs. A qualitative study was conducted among key informants from the Chinese government, non-governmental organizations (NGOs), and universities for two major national nutrition intervention programs. RESULTS: The literature review documented that during the MDGs era, six nutrition policies and eight trans-province and nationwide nutrition intervention programs collectively made good progress in improving maternal and child nutrition in China. Nutrition policies tended to be targeted at infants and children, with less attention on reproductive and maternal nutrition. Nutrition intervention programs focused primarily on undernutrition and have achieved positive results, while for breastfeeding improvement and prevention and control on overweight and obesity were limited. Results from the qualitative study indicated that effective nutrition program implementation was facilitated through the cooperation of multiple sectors and by the government and NGO partnerships, however, still face challenges of insufficient operational funds from local governments and inadequacy of program monitoring and management. CONCLUSION: Nutrition policies and intervention programs promulgated in China during the MDGs era have made major contributions to the rapid decline of undernutrition and are in line to achieve the SDGs related to child wasting, stunting, low birth weight, and anemia in reproductive-age women. However, appropriate policies and program implementation are needed to improve exclusive breastfeeding rates and reduce obesity to achieve the SDGs in years to come.

System Support Mapping: A Novel Systems Thinking Tool Applied to Assess the Needs of Maternal and Child Health Title V Professionals and Their Partners.

CONTEXT: The Maternal and Child Health (MCH) workforce aims to improve health outcomes for women, children, and families. The work requires coordination and partnerships that span disciplines and service systems. As such, workforce needs assessment requires an approach that is broad, flexible, and "systems-aware." OBJECTIVE: To illustrate the use of System Support Mapping, a novel systems thinking tool that was used to guide participants through a structured assessment of their discrete responsibilities, key needs, and specific resources required for each. PARTICIPANTS: Thirty-four Title V MCH professionals and partners from 15 states or jurisdictions. MAIN OUTCOME MEASURE(S): Description and frequency of Title V MCH professionals' coded roles, responsibilities, needs, resources, and wishes. An aggregated map illustrating interconnections between identified codes is presented. RESULTS: State- and local-level MCH professionals reported a range of roles, responsibilities, needs, resources, and wishes. The most and least frequently reported roles, responsibilities, needs, resources, and wishes by state- and local-level MCH professionals are listed, as well as the most frequent connections between those responses. The most frequent responsibility reported in local maps was "link to or provide care or resources" (82%), whereas the most frequent responsibility reported in state maps was "system management" (65%). System management was indirectly connected to 3 wishes: "access to data or information," "funding or resources," and "collaboration, coordination, or support from community or other external organizations." CONCLUSIONS: System Support Mapping can be used to support needs assessment with MCH professionals. System Support Maps show not only the most and least frequently reported roles, responsibilities, needs, resources, and wishes of participants but also how those responses are connected and potentially interdependent. System Support Maps may be useful for MCH leaders determining how best to organize their teams to take on complex public health challenges and prioritize improvements that will better support their work.

Expanding Maternal and Neonatal Survival in Indonesia: A program overview.

The Expanding Maternal and Neonatal Survival (EMAS) program was implemented from September 2011 to March 2017 to support the Indonesian Ministry of Health to improve the quality of emergency obstetric and newborn care, increase the efficiency and effectiveness of emergency referrals, and increase accountability through local government and civic engagement. EMAS worked in over 400 public and private referral hospitals and community health centers (puskesmas) in six provinces where over 50% of all maternal deaths were occurring. Mentoring was the main method used to improve performance at facilities and within referral systems. The use of data for prospective assessment of indicators of improved quality of care and referral efficiency was strengthened. Case reviews were used to examine contextual factors contributing to maternal deaths in EMAS-target hospitals and external evaluations were used in retrospective assessments of effectiveness of approaches. The vision of sustainability was infused into EMAS approaches from the outset. Collaboration and advocacy with district health offices in EMAS-supported districts enabled self-funding of selected interventions within 23 of 30 EMAS districts and 35 non-EMAS districts. Articles in this Supplement describe outcomes and impact of EMAS approaches over the term of the program.

Maternal characteristics and type of prenatal care associated with peregrination before childbirth / Características maternas e da assistência pré-natal associadas à peregrinação no anteparto

ABSTRACT OBJECTIVE To analyze the maternal characteristics and type of prenatal care associated with peregrination before childbirth among pregnant women in a northeastern Brazilian state. METHODS Quantitative and transversal study, with descriptive and analytical approaches, part of the Nascer em Sergipe research held between June 2015 and April 2016. A total of 768 puerperal women proportionally distributed across all maternities of the state (n = 11) were evaluated. Data were collected in interviews and from prenatal records. The associations between antepartum peregrination and the exposure variables were described in absolute and relative frequencies, crude and adjusted odds ratios and their respective confidence intervals. RESULTS Antepartum peregrination was reported by 29.4% (n = 226) of the interviewees, most of whom sought care in a single service before the current one (87.6%; n = 198). It should be noted that antepartum peregrination was less frequent among women aged ≥ 20 years old (OR = 0.50; 95%CI 0.34-0.71), with high education level (OR = 0.42; 95%CI 0.31-0.59) and a paid job (adjusted OR = 0.59; 95%CI 0.41-0.82), who had been instructed during prenatal care about the referral maternity for childbirth (adjusted OR = 0.88; 95%CI 0.42-0.92), and who used the private service to receive prenatal (adjusted OR = 0.44; 95%CI 0.18-0.86) or childbirth (adjusted OR = 0.96; 95%CI 0.66-0.98) care. No statistical evidence of associations between gestational characteristics and the occurrence of peregrination was observed. CONCLUSIONS Antepartum peregrination suffers interference from the mother's socioeconomic characteristics, the type of prenatal care received and the source of funding for childbirth.

RESUMO OBJETIVO Analisar as características maternas e da assistência pré-natal associadas à peregrinação no anteparto entre gestantes de um estado do Nordeste brasileiro. MÉTODOS Estudo quantitativo e transversal, com abordagens descritiva e analítica, vinculado à pesquisa Nascer em Sergipe, realizada entre junho de 2015 e abril de 2016. Foram avaliadas 768 puérperas proporcionalmente distribuídas entre todas as maternidades do estado (n = 11). Os dados foram coletados por meio de entrevistas e consultas aos cartões de pré-natal. As associações entre a peregrinação no anteparto e as variáveis de exposição foram descritas em frequências absoluta e relativa, razões de chances brutas e ajustadas e seus respectivos intervalos de confiança. RESULTADOS A peregrinação no anteparto foi referida por 29,4% (n = 226) das entrevistadas, a maioria das quais procurou atendimento em apenas um serviço antes do atual (87,6%; n = 198). Ressalta-se que a peregrinação no anteparto foi menos frequente entre as mulheres com idade ≥ 20 anos (OR = 0,50; IC95% 0,34-0,71), com alta escolaridade (OR = 0,42; IC95% 0,31-0,59), com trabalho remunerado (OR ajustada = 0,59; IC95% 0,41-0,82), orientadas durante o pré-natal sobre a maternidade de referência para o parto (OR ajustada = 0,88; IC95% 0,42-0,92) e que utilizaram o serviço privado para realização do pré-natal (OR ajustada = 0,44; IC95% 0,18-0,86) ou do parto (OR ajustada = 0,96; IC95% 0,66-0,98). Não foi observada evidência estatística de associação entre as características gestacionais e a ocorrência da peregrinação. CONCLUSÕES A peregrinação no anteparto sofre interferência das características socioeconômicas maternas, da assistência pré-natal e do tipo de financiamento para o parto.

Stunted scale-up of a performance-based financing program on HIV and maternal-child health services in Mozambique - a policy analysis.

OBJECTIVE: A performance-based financing (PBF) program was implemented for services for HIV, prevention of mother-to-child transmission (PMTCT) and maternal/child health (MCH) in two provinces of Mozambique. This study investigates the determinants of policy scale-up to help accelerate the expansion of PBF in Mozambique and globally from pilot projects to national policies. METHODS: A retrospective policy programme analysis was carried out using in-depth key informant interviews. A total of 24 interviews were conducted with stakeholders from donor agencies, the implementing NGO, district and provincial health offices, and the Ministry of Health. RESULTS: Stakeholders reported that the scale-up process of PBF was influenced by three key determinants: political power, financial sustainability, and available capacity and evidence. In Mozambique, PBF scaled-up provincially but not nationally due to these determinants. The adoption of PBF in Mozambique involved a restricted range of policy actors at the central level and was strongly driven by the donor and a PBF champion. Provincial scale-up was fostered by political support and increasing capacity over time. CONCLUSION: There was a generalised ambivalence and lack of incentive to scale-up PBF from the implementing NGO. Coupled with the lack of evidence of a positive effect, and of cost-effectiveness in comparison with other models to improve health service delivery and health system strengthening, it is difficult to argue for the need to scale up the PBF programme studied. Care needs to be taken to base the adoption of health policies, including PBF, on a situational analysis and on evidence of intervention effectiveness, cost-benefits and contextual fit.

Home Visiting Start-Up: Lessons Learned From Program Replication in New Mexico.

Growth in federal, state, and private funding is fueling the initiation of home visiting programs around the country. As communities expand home visiting programs, they need information to help them successfully start up new sites. This paper documents lessons learned about home visiting installation and initial implementation from the replication of the First Born(®) Program in six counties in New Mexico. Specifically, we examine how well sites met staffing, family referral and enrollment, program model fidelity, and financing goals in the first year of providing services. Data come from semi-structured interviews with program staff and document review. The findings are likely to be valuable to a wide spectrum of communities starting or expanding home visiting services, as well as to public and private funders of programs.

A new performance measurement system for maternal and child health in the United States.

OBJECTIVE: The Title V Maternal and Child Health (MCH) Block Grant is the linchpin for US MCH services. The first national performance measures (NPMs) for MCH were instituted in 1997. Changing trends in MCH risk factors, outcomes, health services, data sources, and advances in scientific knowledge, in conjunction with budgetary constraints led the Maternal and Child Health Bureau (MCHB) to design a new performance measurement system. METHODS: A workgroup was formed to develop a new system. The following guiding principles were used: (1) Afford States more flexibility and reduce the overall reporting burden; (2) Improve accountability to better document Title V's impact; (3) Develop NPMs that encompass measures in: maternal and women's health, perinatal health, child health, children with special health care needs, adolescent health, and cross-cutting areas. RESULTS: A three-tiered performance measurement system was proposed with national outcome measures (NOMs), NPMs and evidence-based/informed strategy measures (ESMs). NOMs are the ultimate goals that MCHB and States are attempting to achieve. NPMs are measures, generally associated with processes or programs, shown to affect NOMs. ESMs are evidence-based or informed measures that each State Title V program develops to affect the NPMs. There are 15 NPMs from which States select eight, with at least one from each population area. MCHB will provide the data for the NOMs and NPMs, when possible. CONCLUSIONS: The new performance measurement system increases the flexibility and reduces the reporting burden for States by allowing them to choose 8 NPMs to target, and increases accountability by having States develop actionable ESMs. SIGNIFICANCE: The new national performance measure framework for maternal and child health will allow States more flexibility to address their areas of greatest need, reduce their data reporting burden by having the Maternal and Child Health Bureau provide data for the National Outcome and Performance Measures, yet afford States the opportunity to develop measurable strategies to address their selected performance measures.

Por un parto culturalmente adecuado: un derecho de las mujeres y de los recién nacidos / For a culturally appropriate birth: a right for women and newborns

En este sentido, el presente documento recopila y visibiliza los aprendizajes y avances en la atención de parto con pertinencia cultural y enfoque de derechos, de agosto 2010 a diciembre 2011, donde las mujeres y sus parejas son protagonistas del nacimiento de sus hijos/as con el acompañamiento de personal de salud institucional y comunitario calificado. Aspiramos que nuestra experiencia contribuya al mejoramiento de la calidad de vida de la población y al ejercicio de los derechos de las mujeres embarazadas y recién nacidos en el marco de la interculturalidad. Los logros alcanzados hasta el momento han sido posibles gracias al compromiso humano y profesional de nuestros funcionarios/as quienes merecen nuestro mayor reconocimiento y gratitud. (AU)