This article offers four key lessons learned from a set of seven studies undertaken as part of the collection entitled, “Improving…
Improving Maternal Health Measurement
This collaboration between Harvard University T.H. Chan School of Public Health and PLOS collates the findings of original multi-country observational research conducted to validate indicators that are used to track progress relating to the systemic and structural determinants of maternal health, with the goal of supporting global and country-level efforts to improve maternal health measurement capacity, and use of valid and reliable measures.
As maternal deaths shift from being largely attributable to direct obstetric to indirect causes, addressing upstream, contextual factors are crucial for ending preventable maternal mortality, as outlined in the 2015 World Health Organization report, "Strategies toward Ending Preventable Maternal Mortality (EPMM)", which sets forth global targets and strategies for reducing maternal mortality in the Sustainable Development Goal (SDG) period. However, most health indicators at the policy and health system level are not research-validated, and there is no standard research methodology to do so.
The body of research comprised in this PLOS Collection includes original validity research with unique methods described in each report. Three research settings, selected based on their geographic diversity, are comprised within one overarching, multi-country, observational research project conducted in Argentina, Ghana, and India. The Collection compiles the methodological reports and original research findings that document the process and outcomes of a body of research that aims to improve maternal health measurement.
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Image creditBlue stethoscope by Jack Sem Semtrio, CC BY 2.0PLOS ONE Accountability for maternal and newborn health: Why measuring and monitoring broader social, political, and health system determinants matters
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PLOS ONE Measuring Social, Economic, Policy, and Health System Determinants of Maternal Health and Survival: An Urgent Global Priority
In 2015, the World Health Organization (WHO) released global targets and strategies for reducing maternal mortality in the Sustainable…
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PLOS Medicine Comparative analysis of 2 approaches to monitor countries’ progress towards full and equal access to sexual and reproductive health care, information, and education in 75 countries: An observational validation study
Background: Sustainable Development Goal (SDG) Indicator 5.6.2 is the “Number of countries with laws and regulations that guarantee full…
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PLOS ONE Improving measures of access to legal abortion: A validation study triangulating multiple data sources to assess a global indicator
Background: Global mechanisms have been established to monitor and facilitate state accountability regarding the legal status of abortion.…
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PLOS ONE “Factors associated with provider unwillingness to perform induced abortion in Argentina: A cross-sectional study in four provinces following the legalization of abortion on request”
Background: The 2020 Law on Access to the Voluntary Interruption of Pregnancy is a landmark piece of legislation regarding access to…
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PLOS ONE Validating the implementation of an indicator reporting policies and laws on free public maternal health-related services in the era of universal health coverage: A multi-country cross-sectional study
Background: The concept of universal health coverage (UHC) encompasses both access to essential health services and freedom from financial…
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PLOS ONE Authorization of midwives to perform basic emergency obstetric and newborn care signal functions in Argentina, Ghana, and India: A multi-country validation study of a key global maternal and newborn health indicator
Background: Midwives’ authorization to deliver the seven basic emergency obstetric and newborn care (BEmONC) functions is a core policy…
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PLOS ONE Validating midwifery professionals’ scope of practice and competency: A multi-country study comparing national data to international standards
Background: There is a global shortage of midwives, whose services are essential to meet the healthcare needs of pregnant women and…
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PLOS ONE Measuring adequacy of the midwifery workforce using standards of competency and scope of work: Exploring the density and distribution of midwives in three low- and middle-income countries using cross-sectional and geospatial data
Background: A global midwifery shortage hampers the goal of ending preventable maternal/newborn mortality and stillbirths. Whether current…
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PLOS ONE Validating indicators for monitoring availability and geographic distribution of emergency obstetric and newborn care (EmoNC) facilities: A study triangulating health system, facility, and geospatial data
Availability of emergency obstetric and newborn care (EmONC) is a strong supply side measure of essential health system capacity that is…
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PLOS ONE Validating the indicator “maternal death review coverage” to improve maternal mortality data: A retrospective analysis of district, facility, and individual medical record data
Background: Understanding causes and contributors to maternal mortality is critical from a quality improvement perspective to inform…
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PLOS ONE Validation of a measure to assess decision-making autonomy in family planning services in three low- and middle-income countries: The Family Planning Autonomous Decision-Making scale (FP-ADM)
Background: Integrating measures of respectful care is an important priority in family planning programs, aligned with maternal health…
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PLOS ONE Revising the definition of “demand satisfied for modern methods of family planning:” A cross-sectional study to explore incorporating person-centered constructs of demand, choice, and satisfaction
Several challenges to validity have been identified with standard approaches used to measure “demand satisfied for modern methods of…