Through funding provided by the John D. and Catherine T. MacArthur Foundation, our overriding objective is to use analytical methods from the field of decision science to estimate the clinical, population-based, and societal benefits associated with different strategies to improve the safety of pregnancy and childbirth.

By linking decision analytic methods to the best biologic, epidemiologic, and economic data, our model-based analyses can provide important insight into alternative investment options to promote safe motherhood, and stimulate development and adoption of new technology that might be more feasibly implemented in a sustainable manner in resource poor settings.

During phase I of this project, we developed a Maternal Morbidity and Mortality Policy Model, which we used to simulate a population of women through their childbearing years, calibrated the model to country-specific data, and conducted a policy analysis to evaluate alternative strategies for maternal death and disability reduction in Mexico at the national and state level. Our results indicate that there are several strategic options that could significantly reduce morbidity and mortality, narrow disparities existing between states, and that would be cost-effective, and in some cases, cost-saving relative to the current standard of care. [Click here to view the manuscript]

Among the most effective packages of services were those that emphasized provision of safe abortion and family planning, and strategies to enhance expedient access to skilled health care providers within a setting able to manage post-partum hemorrhage, eclampsia, sepsis, and obstructed labor. We found the resources required to invest in these areas were more than recovered in the form of cost savings from averted morbidity and mortality.

We are currently continuing our work by refining and adapting the Global Maternal Morbidity and Mortality Policy Model. We intend to adapt this model to permit evaluation of strategies for the reduction of maternal death and disability in India and Nigeria, as well as to conduct select focused analyses around specific key questions in other countries that leverage data availability or programmatic opportunities. In addition to enhancing our analytic model to better account for heterogeneity in the population, we plan to conduct analyses that include new dimensions and interventions not considered in our previous work, broaden the range of maternal outcomes included in the model, and allow for effectiveness of a strategy to be conditional on efficacy of the intervention, compliance at the level of the individual, and population-based coverage. These enhancements will permit the contextualization of evidence-based approaches in a manner that considers a country’s health infrastructure, available human resources (e.g., skilled attendants and health providers to manage obstetrical emergencies), cultural preferences, and political realities. We aim to identify the most effective and cost-effective strategies to attain, or at least approach, reduction of maternal mortality by 75% by 2015, a Millennium Development Goal.