Developing a Measurement Framework for Social, Political and Economic Determinants of Maternal Health

A new paper in BMC Pregnancy and Childbirth presents the results of the second phase of a collaborative process to develop a comprehensive monitoring framework for the “Strategies towards ending preventable maternal mortality (EPMM)” (EPMM Strategies report). This framework presents a set of indicators for measuring progress towards ending preventable maternal mortality by addressing the distal determinants of maternal health and survival. The paper, from Jolivet, et al., describes the highly consultative, multi-round process that was used to identify the strongest indicators related to each of the 11 key themes outlined in the EPMM Strategies report.

The process to develop a monitoring framework for the EPMM Strategies report consisted of two phases: while Phase I resulted in a set of indicators focused on the proximal (e.g. facility-based) determinants of maternal health and survival, Phase II—described in this new paper—addressed the more distal determinants, i.e. the social, political, and economic factors that affect women’s and girls’ well-being.

The Phase II process was designed to engage stakeholders worldwide in order to reach consensus on the most important, relevant, and useful indicators for monitoring national and global progress related to the distal determinants of maternal health. Through a series of 12 webinars, a public comment period, and a final expert meeting, more than 150 experts discussed and debated, ultimately agreeing on a set of 25 indicators and six stratifiers that correspond to each of the 11 key themes outlined in the EPMM Strategies report. The Phase II paper describes this process in detail.

Together with the outcomes of Phase I, this paper lays the foundation on which the Improving Maternal Health Measurement (IMHM) project will build. Through a number of different activities, including stakeholder consultations and validation research, the IMHM project will develop and/or test indicators from the Phase II set to ensure that they are ready for collection by—and useful to—countries. The project will engage in-country researchers and partners from the EPMM Working Group to provide technical assistance and develop resources to encourage adoption of EPMM indicators.

The Phase II paper will be instrumental in the effort to encourage stakeholders at all levels to recognize the importance of both proximal and distal factors when working to improve maternal health. Given the adage that “what gets measured, gets done,” the indicators outlined in the Phase II paper direct countries’ attention to the full spectrum of social, political, and economic determinants of maternal health that enable the creation and maintenance of high-performing health systems and supportive societies for every woman and girl.