AMDD Evolution
Overview
It’s been over a decade since our founding, and AMDD continues evolving to help lead the global effort to reduce maternal and newborn death and disability.
What makes AMDD unique is our ability to respond and adapt to new evidence, insights, and changing needs within the field of maternal and newborn health.
We draw upon the expertise found at Columbia University’s Mailman School of Public Health, and our United Nations, non-governmental, and government partners, to innovate and advance evidence-based action that saves lives.
See how we’ve evolved to make change.
Phase One: 1999 through 2005
In 1999, Dr. Allan Rosenfield and Dr. Deborah Maine founded AMDD in the Department of Population & Family Health in the Mailman School of Public Health at Columbia University with support from the Bill & Melinda Gates Foundation.
AMDD was conceived to work with developing countries to improve emergency obstetric care (EmOC) services for women. The basic premise of AMDD still holds true: Most obstetric complications that lead to maternal death cannot be predicted or prevented, but the vast majority of women can be saved through prompt emergency treatment.
Through advocacy and research, AMDD worked to promote EmOC as a critical solution to saving women’s lives. We sought changes in policy and practical approaches to reducing maternal mortality. Through field projects in 18 developing countries that covered a total population of over 270 million, we helped build evidence to support EmOC as a critical intervention.
In just three to four years, EmOC facilities in project areas doubled the number of obstetric complications treated and cut in half the chances of dying from them.
By 2005, the global and maternal health fields reached consensus that EmOC was essential to reducing maternal mortality, as well as newborn mortality and stillbirths. At AMDD, Lynn Freedman, JD, MPH became AMDD Director to take AMDD into the next phase of its work.
Phase Two: 2006 through today
In 2006, AMDD was among the growing number of voices in the global community calling for a major shift in thinking needed to significantly reduce maternal and newborn mortality and to meet Millennium Development Goals 4 & 5. Recognizing the critical role of health systems to achieve large-scale reduction in mortality, AMDD began to focus more intensively on the health systems barriers to equitable access to EmOC.
Over the next three years AMDD repositioned to give new attention to the role of health systems and to addressing EmOC as a crucial part of the home-to-hospital continuum of care for women and newborns. We have since focused on researching, advocating, and providing technical support for strengthening the many parts of the health system needed to deliver EmOC equitably and country-wide. We have also continued to develop tools and strategies that countries rely on to improve access to EmOC.
Looking to the Future: 2010 and beyond
AMDD’s focus continues to progress as we research health systems and learn more about what it takes to achieve universal access to EmOC. It is absolutely critical that the health system works at every step of the way to provide seamless emergency care – from transporting patients to maintaining supplies and training health workers. Simply producing evidence, changing policy, and dedicating funding to those steps does not automatically ensure that quality care is delivered.
We are now giving systematic attention to "implementation science," as we examine how to successfully implement each step consistently so that emergency care is accessible to all women and newborns. We work with partners to better understand how to translate policies and strategies into sound action on the ground. This is absolutely critical to creating sustainable change and to meeting the Millennium Development Goals by 2015.
An AMDD case study: Saving women’s Lives in a remote, underserved region of Peru
In 2000, AMDD partnered with CARE to initiate the FEMME Project (Foundations to Enhance Management of Maternal Emergencies Project) in Ayacucho, Peru. Nestled in a mountainous region 200 miles northwest of Machu Picchu, Ayacucho is isolated, geographically and culturally diverse, and very poor. The average monthly income is half the national average.
The five-year FEMME project sought to increase availability, quality, and use of emergency obstetric care (EmOC) among 48,000 pregnant women in living in northern Ayacucho. AMDD provided technical support and funding.
While the national government had focused significant attention to improving the health system in recent years, maternal and newborn care was still grossly lacking. Ayacucho claimed the third highest maternal mortality ratio (560 per 100,000 live births) of Peru’s 24 regions. There were fewer than four OB/GYNs for every 10,000 women of reproductive age.
The health system provided seemingly little support to its health workers. In turn, they tended to show little attention to clients and little sensitivity toward local cultures, which made women reluctant to utilize EmOC services.
In response, the project focused on human rights to improve quality of care and access to EmONC. The facilities redesigned their labor and delivery wards to respect women’s privacy during childbirth. All staff began referring to the women by name and not their bed number. The project also made specific efforts to ensure it was providing non-discriminatory services to indigenous clients. They rewrote signs in both Spanish and the local language. One health team redesigned the birthing chairs to accommodate the vertical birthing positions that most women preferred. In the end, the project’s human rights approach likely saved many lives. Women felt more respected and found the health system more acceptable. In turn, many more women utilized the EmOC services they had once avoided.
By the end of the project, northern Ayacucho had 6 functioning EmOC facilities: 3 comprehensive (including a non-FEMME project facility) and 3 basic. This exceeds the U.N. minimum recommendation of 5 EmOC facilities per 500,000 population. Other changes in the U.N. process indicators indicate an increase in quality and utilization of EmOC services. Met need for EmOC increased significantly from 30% in 2000 to a high of 84% in 2004. Case fatality rates declined, the direct obstetric case fatality rate decreased from 1.7% to 0.1%, and the number of maternal deaths in the entire region declined. AMDD’s work in Ayacucho made an impact on policies and programs related to EmOC throughout the region.