FCI’s earliest field work focused on maternal health, building on our core strengths and passion. In Benin, Botswana, Eritrea, Ghana, Laos, Namibia, Tanzania, Zambia, and Zanzibar, we helped governments assess their maternal health programs and develop national strategies. In Kenya and Niger, we helped improve care for women suffering from unsafe abortion, including providing them with family planning methods to prevent another unintended pregnancy. In Bolivia and Ecuador, we worked with rural women to help them access high-quality maternal health services. FCI also develops a wide range of essential materials — beginning with our groundbreaking 1995 book Healthy Women, Healthy Mothers — to provide health workers with accurate, easy-to-understand information for providing high-quality counseling and care.

© 2000 Liz Gilbert/David and Lucile Packard Foundation, Courtesy of Photoshare Still, for the majority of the women living in the developing world, pregnancy and childbirth are fraught with risks. Each year, 350,000 women die from pregnancy-related causes, and millions more suffer injuries or develop life-long disabilities. Over more than two decades, FCI has worked in 25 countries, often under difficult conditions and in complex environments, to build better policies and services for maternal and reproductive health. At the center of FCI’s approach is a commitment to ensuring that every one of the 200 million women who become pregnant each year has access to skilled care throughout her pregnancy, childbirth, and the postpartum period, as well as to emergency obstetric care when complications arise.

Improving quality and increasing use of services

Skilled maternity care throughout pregnancy, childbirth, and the postpartum period is recognized as a critical key to reducing maternal mortality. Today in many developing countries, however, more than half of women go through childbirth without such care. These women suffer disproportionately from pregnancy and childbirth complications that, far too often, lead to death or serious disability.

In the year 2000, with support from the Bill & Melinda Gates Foundation, FCI launched the five-year Skilled Care Initiative, which improved pregnancy and childbirth care in more than 100 health facilities in four poor rural districts of Burkina Faso, Kenya, and Tanzania. A rigorous two-year evaluation provided invaluable evidence about the impact of these efforts. In these countries, around the region, in a series of scientific publications, and through our website, we widely share the lessons we and our partners learned from the Initiative, in order to increase both the quality and women’s use of skilled maternity care before, during, and after childbirth.

Our results highlighted the importance of community leadership in encouraging women to seek skilled care:

  • In Burkina Faso, when village leaders actively promoted the use of skilled maternity care, maternity care-seeking during delivery more than doubled.
  • In Kenya, when community leaders responsible for overseeing the local clinic worked with medical staff, reviewed maternity caseloads, mobilized and informed community members, and raised funds, services improved and more women came in and used them.

Since the conclusion of this project, FCI has worked in Africa, Latin America, and the Caribbean to build and expand on these results, exploring the important role of communities and their leaders in improving the quality and utilization of maternal health services.

Read more
about the Skilled Care Initiative, and download our survey, assessment, and training tools and reports of the project findings

Learn about FCI's community engagement projects and the Missing Partner Initiative

Read about our work to empower grassroots advocacy for better maternal health services

Improving policies and programs

FCI’s capacity-building programs are designed to help local governments and civil society organizations develop and deliver high-quality, rights-based, and sustainable maternal and reproductive health services that address the specific needs and priorities of their Photo credit: Joey O'Loughlincommunities — especially those of the most marginalized and vulnerable groups. We don’t provide health services ourselves, but we work to improve the services that our partners deliver, increase use of those services by the women who need them, and build the knowledge base on maternal and reproductive health and rights. We work to integrate well-established practices and effective innovations into national and community-level programs, ensure they are included in national maternal health norms and protocols, and support their scale-up in additional districts and countries. Our goal is to help poor nations build health systems that can provide skilled care, emergency treatment, post-partum care, and family planning for every woman, everywhere. Our work promoting stronger maternal health policies and practices includes:

  • Since 2007, FCI has worked in Latin America to identify and address the cultural barriers that prevent indigenous women from seeking maternal health services. We have led participatory training programs to enable doctors, nurses, and health clinics to build cultural sensitivity into the services they provide to women, and worked with health ministries in Bolivia, Ecuador, and Peru to make their national maternal health norms and protocols more responsive to the values and cultures of indigenous peoples. In 2011, FCI is working with indigenous communities in two rural districts in Bolivia to improve maternal health services by fostering structured dialogues on improving quality of care between community members, traditional healers and health care providers about users’ cultural expectations.
  • In Burkina Faso, FCI is working with district-level Ministry of Health teams in the Sahel Region to build their capacity to develop strategic health plans and monitor their performance, with an emphasis on maternal health programming. The government has asked FCI to scale up this work in new regions in 2012.
  • In a multi-year project in partnership with Gynuity Health Projects, FCI is working to evaluate and promote the use of the drug misoprostol as a therapy to prevent and treat postpartum hemorrhage, the leading cause of maternal death in developing countries. In the current stage of the project, FCI is developing an evidence-based policy and advocacy agenda to promote wider understanding, use, and acceptance of misoprostol for PPH.
  • FCI is on the executive committee and acts as secretariat of the Regional Task Force for the Reduction of Maternal Mortality (Grupo de Trabajo Regional para la Reducción de la Mortalidad Materna, or GTR), which promotes coordinated strategies for reducing maternal death; advances implementation of evidence-based practices and policies; and shares lessons learned and innovative models in Latin America and the Caribbean.
  • Working with the United Nations Population Fund—UNFPA, FCI reviewed research on how best to build demand for sexual and reproductive health information and services. After identifying effective strategies, compiling case studies, and outlining key recommendations, FCI and UNFPA will promote these lessons learned so that governments and international organizations can advance efforts to increase utilization of services, improve health outcomes, and save more lives.

Learn more about FCI's work to build the evidence base on maternal health

Read about building demand for services by engaging communities


Read The FCI Blog

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Learn more about the results of FCI's Skilled Care Initiative

Read about the Skilled Care Initiative

View FCI's Technical Brief: Testing Approaches for Increasing Skilled Care During Childbirth: Key Findings, October 2007

Read peer-reviewed articles on Skilled Care Initiative results:

Improving poor women’s access to maternity care: Findings from a primary care intervention in Burkina Faso,” Social Science & Medicine, September 2009

Out-of-pocket costs for facility-based maternity care in three African countries,” Health Policy and Planning, April 2009

Towards reduction of maternal and perinatal mortality in rural Burkina Faso: communities are not empty vessels,” Global Health Action, Vol. 2 (2009)

"Evaluating skilled care at delivery in Burkina Faso: principles and practice," Tropical Medicine & International Health, July 2008

"Practical lessons from global safe motherhood initiatives: time for a new focus on implementation," The Lancet, 13 October 2007

"Encouraging Women to Deliver with Skilled Care - Lessons Learned," Global Health Council HealthLink, 1 September 2007

FCI hosts expert meeting on misoprostol for post-partum hemorrhage

In July 2011 in New York City, a two-day meeting hosted by FCI, in collaboration with Gynuity Health Projects, brought together more than 50 obstetricians, midwives, women’s rights advocates, public health programmers, researchers, and policy makers from around the world for discussion about the use of the drug misoprostol for the prevention and treatment of postpartum hemorrhage (PPH). In the developing world, uncontrolled post-partum bleeding is the leading cause of death in childbirth, killing a woman every five minutes, and misoprostol — a medicine that comes in tablet form and doesn't require refrigeration — has proven to be safe and effective for both prevention and treatment of PPH. Discussions included promising results from several countries where distribution of misoprostol tablets to women in their communities has proven effective in addressing the risk of hemorrhage among women who give birth at home — where more than half of births in the developing world still take place. Learn more at The FCI Blog...

A price too high to bear: improving services by understanding the costs of maternal mortality

At a meeting in Nairobi in July 2011, FCI-Kenya launched a three-year research study (in collaboration with ICRW and the Kenya Medical Research Institute) that will shed new light on the impact of a woman’s death in pregnancy or childbirth on her family, her community, and her nation. This will provide a critical resource for work — in Kenya, in other developing countries, and at the global level — to increase political commitment and financial investment for improving the availability, quality, and utilization of maternal health services. Read more at The FCI Blog...

FCI selected to be strategic partner of Burkina Faso Ministry of Health

FCI-Burkina Faso has been selected as a strategic partner of the Ministry of Health, and asked to provide technical assistance in the implementation of national health policies in the country’s Sahel region. As one of only 10 such strategic partners selected from among more than 80 applicants, FCI provides technical assistance to the ministry in the areas of sexual and reproductive health and maternal health, focusing its work on strengthening the capacity of grassroots and community organizations.

FCI attends high-level intercultural care conference

As a partner in the Organismo Andino de Salud, a regional framework in the Andean region, FCI was one of only a few NGOs invited to attend the High Level Meeting on Reproductive Health and Intercultural Care in Latin America, held in Lima, Peru, in June 2011. In Latin American and the Caribbean, maternal mortality was reduced by 41% between 1990 and 2008.But maternal death remains much more common in indigenous communities, and there remain substantial gaps in indigenous women's access to reproductive health services, information, and commodities. Since 2009, FCI has been working to strengthen the advocacy capacity of indigenous women’s organizations to demand culturally-appropriate health care, and to promote their direct participation in the design and monitoring of maternal health care services that are sensitive to their cultural traditions. This conference reviewed progress made so far, shared lessons learned, and offered an opportunity for health ministers to commit to strengthening efforts to provide culturally-friendly maternal health services. Learn more at The FCI Blog...





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