Module 3: Interventions

The public health field has increasingly recognized the importance of promoting the health of mothers, infants, and children, and many non-profits have been founded based on this mission. Pregnancy has recently come to the forefront of this field, as it is a crucial window of time in terms of preventing serious health issues in women and children. Here, we will consider two influential organizations that are working in this particular vein of public health.

Case Study: Bill & Melinda Gates Foundation

Global Focus

The Bill & Melinda Gates Foundation, the largest private foundation in the world, plays a major role in global health efforts, contributing approximately $800 million annually towards their global health program.(1) The Gates Foundation emphasizes the importance of the health of women and children as “one of the world’s most urgent priorities” and this is a “core focus” of the foundation’s work.   

Maternal, Neonatal, and Newborn Child Health

In developing countries, millions of mothers and babies die annually during childbirth due to preventable complications.(2) To combat this trend, one primary focus of the Gates Foundation is to improve maternal, neonatal, and newborn child health on a global scale. This involves directing resources and care towards mothers and infants.(3) In various developing nations, such life-saving resources are not readily accessible, despite the discovery of cost-effective interventions that could save up to 70% of newborns, such as access to inexpensive tools (including antibiotics for infections and sterile blades to cut umbilical cords) as well as knowledge of best practices (i.e. exclusive breastfeeding and skin-to-skin contact with babies to keep them warm)(4)(5)(6). In many cases, even mothers in developing countries who are assisted during childbirth by a skilled provider do not have these tools available that would decrease the rate of infection. Moreover, a skilled provider may not incorporate the necessary education regarding best practices into his or her time with the expecting mother.

The Gates Foundation supports funding for the development and delivery of innovative tools to save lives, and works to address the main causes of death during pregnancy and childbirth in developing countries, proposing solutions for prevention and treatment. The organization focuses on providing resources in areas with the greatest need, and carrying out high-impact public health interventions in a culturally-appropriate context. Research is also conducted to find effective ways to communicate to frontline workers about the importance of practicing evidence-based birthing practices. This will hopefully decrease the risks and fatalities associated with delivery complications.

Progress has been made over the past few decades regarding global child health. Preventing disease through immunization, for instance, has been a particularly effective intervention. Unfortunately, maternal and newborn health has made little improvement in recent years.(7) Since childbirth is a particularly high-risk time, it is critical that efforts are directed towards finding cost-effective, evidence-based solutions that can eliminate preventable deaths during delivery.(8) For instance, the Gates Foundation supports family planning as a cost-effective way to save lives and empower families to have healthy babies, thereby improving the health of the next generation.(9)

Case Study: March of Dimes

March of Dimes is a 501(c)(3) not-for-profit organization with a mission that is both domestic and global.(10) Originally the National Foundation for Infantile Paralysis (NFIP), March of Dimes was founded in 1938 by President Franklin Delano Roosevelt as an effort to eradicate polio.(11) When this goal was accomplished, the focus shifted to preventing premature births and birth defects.(12) In the 1970s, the organization expanded its mission to encompass the reduction of the number of newborns with low birth weight, a risk factor that affects health later in life. Today, March of Dimes aims to help mothers around the world have full-term pregnancies, by supporting research on genetic causes of birth defects, promoting newborn screening, and educating medical professionals and the public about best practices for healthy pregnancies.(13)

Successes

March of Dimes has achieved numerous organizational successes. One critical accomplishment was the rubella immunization program that effectively eliminated rubella in the United States. Efforts to eradicate the disease globally are currently being carried out through partnerships with UNICEF and other organizations.(14) Moreover, through the Newborn Intensive Care Units and NICU Family Support Program, specialized care for preterm babies has been made available at medical centers, and support and information for families with sick or premature babies in the NICU is also now accessible.(15) In addition, funding was allocated for research on fetal alcohol syndrome, culminating in the 1989 law mandating a warning label about the risks of birth defects on alcoholic beverages.(16) Nationally, the Newborn Screening Saves Lives Act was issued to help promote newborn screening programs for all babies in the United States for life-threatening, treatable disorders.(17) Additionally, the 2006 PREEMIE (Prematurity Research Expansion and Education for Mothers Who Deliver Infants Early) Act led to the first Surgeon General’s Conference on the Prevention of Preterm Birth to raise global awareness about the dangers of preterm births.

Current Activities

In the US, more than 500,000 babies are born prematurely every year, and the premature birth rate has risen by over 30% since the 1980s.(18) According to the Institute of Medicine, since preterm babies are at a higher risk for numerous health problems and complications at birth, “the annual societal economic burden associated with preterm birth in the United States was at least $26.2 billion in 2005, or $51,600 per infant born preterm.”(19) With premature birth as the primary reason for newborn mortality, March of Dimes launched a prematurity campaign back in 2003.(20) As such, the current focus of the organization is to reduce premature birth rates, raise awareness about the health risks associated with prematurity, and support research on the causes of preterm births. The “Healthy Babies are Worth the Wait” program that began in 2011 focuses on eliminating preventable preterm births, largely through professional education and prenatal care for women. The program supports advertising and social media efforts that educate women about the health risks associated with preterm births, including cerebral palsy, mental retardation, blindness, and hearing loss.(21)

Global Movement

Premature births and birth defects affect 21 million babies worldwide each year.(22) In 1998, March of Dimes went global, extending its reach through international programing. The new approach is to implement evidence-based interventions to prevent birth defects, preterm births, and infant mortality in developing countries by partnering with in-country academic medical centers, international organizations, and non-governmental organizations. Partners share the March of Dimes mission, and carry out in-country programs through collaborative projects with a focus on measurable results.

March of Dimes shares best practices in perinatal health and helps to improve birth outcomes in countries with the most urgent need. To date, March of Dimes has worked with partners in 33 developing countries spanning the globe.(23) Through these partnerships, the organization supports efforts to provide education on perinatal health, give financial support for programing, share technical expertise and resources, and implement interventions addressing specific risk factors. Professional and public health education materials are adapted to local conditions to respect the individual cultures of partner organization locations.

March of Dimes also continually works to collect and publish data on premature birth and birth defects at the regional and national levels, and identifies steps to reduce these occurrences. These publications have gotten the attention of international policymakers, leading to increased funding for maternal and newborn health programs. Additionally, March of Dimes has hosted international conferences to facilitate networking among developing and developed nations and to share ideas, programs, and best practices. Moreover, the organization has published two reports, “The March of Dimes Global Report on Birth Defects” (2006) and “Global and Regional Toll of Preterm Birth” (2009), which have been identified as the first publications to present rates of birth defects and preterm births worldwide by location.(24)

March of Dimes plans to continue its work with partners in developing countries to decrease complications associated with high-risk pregnancies. The organization also recently expanded to include education about best practices in preconception health to promote health earlier among expecting mothers and their babies.(25)

International Efforts

Through the “Global Strategy for Women’s and Children’s Health” program, the United Nations has $40 billion available to be used for “saving the lives of more than 16 million women and children, preventing 33 million unwanted pregnancies, protecting 120 millions of children from pneumonia and 88 million children from stunting, advancing the control of deadly diseases such as malaria and HIV/AIDS, and ensuring access for women and children to quality facilities and skilled health workers.”(26) In 2010, UN Secretary-General Ban Ki-moon launched the “Every Woman, Every Child” global effort to improve women’s and children’s health. With this call to action, policymakers, the UN, philanthropic foundations, global businesses, health workers, and research institutions have collaborated across the globe to achieve this mission.(27)

Footnotes

(1) Paulson, Tom. "Gates Foundation out to Break the Cycle of Disease." 8 Dec. 2003. Web. 13 Sept. 2011.

(2)“Maternal, Newborn, and Child Health.” Bill & Melinda Gates Foundation. Web. 12 Sept. 2011.

(3)“Maternal, Newborn, & Child Health: Overview & Approach.” Bill & Melinda Gates Foundation. Web. 12 Sept. 2011.

(4) Haws, R. A., A. L. Thomas, Z. A. Bhutta, and G. L. Darmstadt. 2007. Impact of packaged interventions on neonatal health: a review of the evidence. Health Policy Plan. 22:193–215.

(5) Darmstadt G. L., Z. A. Bhutta, S. Cousens, T. Adam, N. Walker, and L. de Bernis. 2005. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet. 365:977–88.

(6) Darmstadt, G. L., N. Walker, J. E. Lawn, Z. A. Bhutta, R. A. Haws, and S. Cousens. 2008. Saving newborn lives in Asia and Africa: cost and impact of phased scale-up of interventions within the continuum of care. Health Policy Plan. 23:101-17.

(7) "Progress Towards Maternal, Newborn, and Child Health - Improving Health and Saving Lives." Living Proof Project. Bill & Melinda Gates Foundation, Oct. 2009. Web. 9 Sept. 2011.

(8) "Maternal, Neonatal, and Child Health." Strategy Overview. Bill & Melinda Gates Foundation, Nov. 2009. Web. 9 Sept. 2011.

(9) "Family Planning." Strategy Overview. Bill & Melinda Gates Foundation, Nov. 2009. Web. 9 Sept. 2011.

(10) "Mission: March of Dimes." Pregnancy, Baby, Prematurity, Birth Defects. March of Dimes. Web. 12 Sept. 2011.

(11) "History: Mission: March of Dimes." Pregnancy, Baby, Prematurity, Birth Defects. March of Dimes. Web. 12 Sept. 2011.

(12) "A History of the March of Dimes: Mission: March of Dimes." Pregnancy, Baby, Prematurity, Birth Defects. March of Dimes. Web. 12 Sept. 2011.

(13) Baghdady, Georgette, and Joanne Maddock. "Marching to a Different Mission." Stanford Social Innovation Review. Web. 14 Sept. 2011.

(14) Brown, David. "Rubella Virus Eliminated in the United States." The Washington Post: National, World & D.C. Area News and Headlines. Web. 12 Sept. 2011.

(15) "The NICU Family Support Program: Baby: March of Dimes." Pregnancy, Baby, Prematurity, Birth Defects. March of Dimes. Web. 12 Sept. 2011.

(16) "And Down Will Come Baby". Orange Coast Magazine: 98–112. Nov 1989.

(17) "Expanding Newborn Screening: From Advocacy to Program Implementation." Web. 14 Sept. 2011.

(18) "March of Dimes." Pregnancy, Baby, Prematurity, Birth Defects. March of Dimes. Web. 14 Sept. 2011.

(19) "March of Dimes." Pregnancy, Baby, Prematurity, Birth Defects. March of Dimes. Web. 14 Sept. 2011.

(20) "The Economic and Societal Costs: Mission: March of Dimes." Pregnancy, Baby, Prematurity, Birth Defects. March of Dimes. Web. 14 Sept. 2011.

(21) "Prematurity Campaign: Mission: March of Dimes." Pregnancy, Baby, Prematurity, Birth Defects. March of Dimes. Web. 14 Sept. 2011.

(22) "Most Common Questions Global Programs: Mission: March of Dimes." Pregnancy, Baby, Prematurity, Birth Defects. March of Dimes. Web. 12 Sept. 2011.

(23) "Inside March of Dimes Global Programs: Mission: March of Dimes." Pregnancy, Baby, Prematurity, Birth Defects. March of Dimes. Web. 14 Sept. 2011.

(24) Ibid.

(25) "Global Programs: Mission: March of Dimes." Pregnancy, Baby, Prematurity, Birth Defects. March of Dimes. Web. 12 Sept. 2011.

(26) "UN Secures $40 Billion for Women’s and Children’s Health." United Nations. UN Summit. Web. 8 Sept. 2011.

(27) "Commitments." Every Woman Every Child. Web. 14 Sept. 2011.