MOMENTUM Safe Surgery in Family Planning and Obstetrics

This project works to promote awareness of, equitable access to, and high quality of care for voluntary and consented safe surgeries within maternal health and family planning programs.

Carielle Doe for Namuh/USAID

Ninety-three percent of people in sub-Saharan Africa and ninety-seven percent of those in Southeast Asia are unable to access basic surgical care.1 This can be due to factors such as distance, lack of available services and health care personnel, or cost. Lack of access to obstetric surgeries, such as cesarean sections, can lead to maternal and perinatal death and injury.2 In some places, cesarean delivery rates are rapidly increasing without increased capacity to provide safe and appropriate care, which also poses dangers to mothers and babies. Maternal deaths associated with cesarean sections are 100 times higher in low- and middle-income countries than in high-income countries.3

MOMENTUM Safe Surgery in Family Planning and Obstetrics partners with country governments, academic institutions, professional associations, community-based organizations, and public and private sector health care providers to build awareness and improve equitable access to high-quality surgical care. Building on previous investments and accomplishments of USAID-supported projects, including Fistula Care and Fistula Care Plus, the project addresses entrenched obstacles that undermine the availability and use of safe surgery within maternal health and family planning through proven strategies and innovative approaches, emphasizing country leadership and ownership and local capacity building.

The project’s four technical areas include:

  • Cesarean delivery
  • Hysterectomy performed during or shortly after delivery
  • Obstetric and iatrogenic fistula prevention and repair
  • Long-acting reversible contraception and permanent family planning methods

Increase Community-Level Awareness and Care Seeking

Individuals and couples can face significant social, economic, and structural barriers that hinder access to safer obstetric care and voluntary family planning services and delay or discourage seeking care or treatment. For example, misperceptions about vasectomy’s effects on masculinity may deter men from seeking out this safe and effective permanent family planning method. When complications begin during labor at home, the decision to go to a health facility may happen too late because families may not be able to pay for transportation. Also, women suffering from fistula may be unaware of available care or unable to gather the resources necessary to access treatment.

MOMENTUM Safe Surgery in Family Planning and Obstetrics uses a human-centered design approach to create context-specific social behavior change strategies to promote universal access to information and services. These approaches may include social media and radio campaigns that share key health messaging or working with community members to help them recognize danger signs in pregnancy and to plan how they would seek care if needed. The project works to establish a strong link between communities and facility-based health systems, ensuring that individuals, couples, and their families have the knowledge they need to make informed decisions and access appropriate family planning and reproductive health services.

Carielle Doe for Namuh/USAID

Strengthen Health Facility and Staff Capacity to Provide Safer Surgeries

Health facilities often face human resource challenges, including overburdened staff who lack access to necessary skills development opportunities and strong supervisory support. MOMENTUM Safe Surgery in Family Planning and Obstetrics works within the public and private health sectors to ensure health workers are appropriately skilled, equipped, and supported to provide quality surgical maternal health and family planning care. Technical assistance includes:

  • Competency-based clinical capacity building for health workers.
  • Developing robust, team-based protocols for communication, decision-making, and service provision and referral.
  • Implementing comprehensive infection prevention and control protocols in health facilities.
  • Improving access to necessary surgical commodities and equipment.

The project emphasizes the importance of effective counseling and informed consent practices through training for health care workers and education efforts within communities to support client choices and provide respectful care.

Mubeen Siddiqui/MCSP

Support Leadership of Health Systems and Institutions

Health systems and institutions may be limited by insufficient financing for maternal health and family planning services, supply chain challenges, and lack of guidance on translating evidence-based guidance into practice. Health systems and institutions require strong leadership and adequate resources to provide evidence-based guidance and oversight. MOMENTUM Safe Surgery in Family Planning and Obstetrics supports collaboration and consensus-building across health institutions, private and faith-based organizations, professional associations, and regulatory bodies to set standards for best practices. The project provides technical assistance to governments to include cost estimates in their health planning processes and develop and update national policies, guidelines, and standards of care, training curricula, and protocols that reflect current best practices for surgical maternal health and family planning care.

Frank Baguma/EngenderHealth

Generate and Share Research and Learning

Lack of timely, relevant, and accurate information is a persistent barrier in responding to shifting community and health facility needs. MOMENTUM Safe Surgery in Family Planning and Obstetrics works to build on and enhance the existing evidence base through collaboration with global and local partners to identify knowledge and evidence gaps related to surgical maternal health and family planning care and implement research and test innovative approaches to address them. The project generates and disseminates clear results and recommendations to promote evidence-based best practices in policies, protocols, programs, and funding decisions. We work with country institutions to improve the quality of data within health management information systems and strengthen data utilization for adaptive learning to ensure services are effectively responding to and addressing client needs.

Karen Kasmauski/MCSP


  1. Alkire B.C., N.P. Raykar, M.G. Shrime, T.G. Weiser, S.W. Bickler, J.A. Rose, et al. 2015. “Global access to surgical care: a modelling study.” The Lancet Global Health 3(6):e316-23.
  2. Geleto, A., C. Chojenta, A. Musa, et al. 2018. “Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature.” Systematic Reviews 7: 183.
  3. Sobhy S., D. Arroyo-Manzano, N. Murugesu, G. Karthikeyan, V. Kumar, I. Kaur, et al. 2019. “Maternal and perinatal mortality and complications associated with caesarean section in low-income and middle-income countries: a systematic review and meta-analysis.” The Lancet 393 (10184): 1973-1982.

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