Safe Surgical Care for Women
Improving surgical care prevents millions of women from experiencing disability or death due to complications from childbirth.
Millions of women in low- and middle-income countries (LMICs) disproportionately suffer or die each year from preventable complications of childbirth.1,2 The vast majority (94 percent) of maternal deaths occur in low-resource settings, 86 percent in South Asia and Sub-Saharan Africa.2 More than two billion people around the world lack adequate access to essential, safe surgical care. Enormous disparities between and within countries remain in quality, access, and availability of surgical care for obstetric complications, including Caesarean section and hysterectomy. Unsafe surgery can also contribute to complications and chronic injury, such as iatrogenic fistula.3-5 Without adequate care, prolonged and obstructed labor can lead to obstetric fistula. It is estimated that up to one million women live with fistula in sub-Saharan Africa and South Asia.6 Obstetric fistula often results in incontinence and infertility, contributing to depression, social isolation, and stigma. Although fistula is surgically repairable, many countries lack surgical teams with the necessary skills to perform the surgery.
A lack of surgical capacity also impacts family planning. Many LMICs have a shortage of skilled providers able or willing to offer contraceptive implant removal, postpartum intrauterine device (IUD) insertion, and permanent family planning methods. This shortage inhibits women’s access to a range of voluntary family planning options and puts them at risk for unintended pregnancies.
We aim to dramatically increase access to safe surgical care for women in USAID partner countries. This approach prevents current and future pregnancy-related mortality and morbidity by improving medically necessary Caesarean delivery and childbirth-related hysterectomy. MOMENTUM also improves voluntary family planning surgical services, including postpartum IUD insertion, removal of contraceptive implants, and voluntary permanent methods such as tubal ligation and vasectomy. Safe surgical care also restores dignity to women suffering from obstetric fistula.
Increase community-level awareness and care seeking
Many women and couples face significant socioeconomic and structural barriers to safer obstetric and voluntary family planning surgeries. When complications begin during labor at home, for example, diagnosis and the decision to go to a health facility are often delayed. Families are often not prepared to provide or pay for transportation to a health facility or for health care once there. MOMENTUM addresses community obstacles that prevent prompt care seeking for prolonged labor and symptoms of obstetric fistula, as well as access to voluntary IUD or implant removal.
Strengthen health system capacity to provide safer surgeries
MOMENTUM improves public and private health providers’ abilities to deliver high-quality surgical care from patient entry to discharge and follow-up care. Project technical assistance includes strengthening integrated preoperative and postoperative health care; safe and effective anesthesia and pain management; availability of trained midwives and medical staff; management of complications; and availability of surgical commodities and equipment.
Generate and share evidence and lessons learned
MOMENTUM collaborates with a range of public and private sector partners to ensure that country experiences and evidence on safer surgeries inform national policy and guideline development. This collaboration includes testing innovative approaches to country-specific barriers to safer surgical care for women, such as organizing services for around-the-clock provider coverage and improving caseload management.
- Firoz T, Chou D, von Dadelszen P, Agrawal P, Vanderkruik R, Tunçalp O, Magee LA, van Den Broek N, Say L; Maternal Morbidity Working Group. Measuring maternal health: focus on maternal morbidity. Bull World Health Organ. 2013 Oct 1;91(10):794-6.
- Trends in maternal mortality: 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2019.
- Alkire BC, Raykar NP, Shrime MG, Weiser TG, Bickler SW, Rose JA, Nutt CT, Greenberg SL, Kotagal M, Riesel JN, Esquivel M, Uribe-Leitz T, Molina G, Roy N, Meara JG, Farmer PE. Global access to surgical care: a modelling study. Lancet Glob Health. 2015 June;3(6):e316-23.
- Benova, L., Cavallaro, F. L., and Campbell, O. M. R. 2017. The landscape of cesarean sections in Sub-Saharan Africa and South and Southeast Asia. New York: EngenderHealth/Fistula Care Plus. https://fistulacare.org/app/uploads/2015/10/LSHTM-report_Nov-8_final_for-web.pdf
- Raassen TJ, Ngongo CJ, Mahendeka MM. Iatrogenic genitourinary fistula: an 18-year retrospective review of 805 injuries. Int Urogynecol J. 2014 Dec;25(12):1699-706.
- Adler AJ, Ronsmans C, Calvert C, Filippi V. Estimating the prevalence of obstetric fistula: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2013 Dec 30;13:246.