Community-Based Maternal and Newborn Care

The burden of maternal and newborn death is disproportionately high in countries affected by humanitarian crises – 64% of global maternal deaths, 50% of newborn deaths, and 51% of stillbirths occur in the 29 countries with UN Humanitarian Appeals in 2023.

Although facility-based care is among the most effective ways to reduce maternal and newborn deaths, this is not an option for millions of women living in fragile and conflict-affected communities where health facilities are inaccessible. For many communities, the distance to the nearest facility is too far and transport is unavailable or prohibitively expensive, or even when able to make the trip, the facilities are often lacking the skilled provider or resources necessary for treatment. The maternal and newborn mortality rates are often highest in humanitarian settings, where vulnerability is compounded by multiple fronts of insecurity.

Community-based MNH care is an evidenced-based solution to reduce the risk of death

While recognizing that quality services delivered by skilled providers at well resourced facilities is ultimately the best solution for women who require maternal or newborn care, it is critical to acknowledge that for many women living in fragile contexts, this is not an option available to them. There is an increasing body of evidence that MNH services delivered at the community level can reduce maternal deaths by 20% and newborn deaths by 25%.

The International Rescue Committee (IRC) is leveraging our research and innovation expertise to design and test evidence-based MNH interventions that can be safely delivered at the community level to reach mothers and newborns who would otherwise be unable to access services. We have launched activities in two countries with some of the highest maternal mortality rates and the greatest potential for breakthrough impact, Somalia and South Sudan, and will seek to use the evidence generated to inform governmental policy as well as seeking to roll-out successful models in other contexts.

IRC’s approach to Community-based MNH care

The IRC is delivering this multi-year initiative to design, test, and evaluate context-appropriate, client-demanded, community-based MNH care packages in Somalia and South Sudan. To date we have:

• Constrained optimization: Partnered with the University of Chicago, Booth School of Business to develop a constrained optimization model to help national stakeholders prioritize interventions by taking into account local constraints including the cost of commodities and services, time and capacity of CHWs, bandwidth for training, existing policies, and more. This has been conducted in both Somalia and South Sudan and informed the project design.

• Behavioral insights (BI) and user-centered design: Conducted research with mothers and healthcare practitioners to understand a woman’s pregnancy and postpartum journey, with the purpose of identifying behaviors and better understanding the rationale behind them. The user-centered design team are now developing prototypes to test to address the underlying assumptions and barriers to behavior change.

• Research and evaluation: The EQUAL research consortium – led by IRC in South Sudan and by IRC in Somalia in partnership with the Somali Research and Development Institute (SORDI) – will conduct implementation research to evaluate the IRC’s community-based MNH care programs. This will increase understanding of the factors – including those unique to humanitarian contexts – that affect the process and results of a community-based MNH care program delivering evidence-based, life-saving services in areas with limited access to health facilities.

• Advocacy and influence: Coupling the program and research with ongoing advocacy and communications. This includes consulting national stakeholders at every step of the research process, engaging in/establishing platforms to elevate this topic as a priority for concerted effort and investment, and establishing a high-level strategic advisory group.

Next steps

Learnings from the start of community-based MNH service delivery in Somalia will generate lessons to inform the rollout of activities in South Sudan in April 2024. Baseline research activities are commencing in South Sudan as project design work moves into its final stage ahead of service launch. Approaches will be designed, tested and refined in these pilot countries with a view to informing similar initiatives in other IRC countries such as Nigeria, CAR, Chad and DRC.