Projects Implemented

NCMNH conducted in-depth analysis of the Verbal Autopsy data obtained from Pakistan Maternal Mortality Survey 2019 on deaths of women of reproductive age. The objective was to unpack and disaggregate causes of maternal deaths, and identify specific causes of Direct, Indirect, Coincidental and Late maternal deaths, so as to understand the real issues behind the tragedy. Furthermore, it also unpacked the level of delays leading to maternal deaths.

National Institute of Population studies (NIPs) requested NCMNH for support in the Pakistan Maternal Mortality Survey (PMMS) 2018-19. NCMNH reviewed the Verbal Autopsy forms analyzed and assigned the causes of death according to the World Health Organization’s International Classification of Diseases, ICD 10. NIPS has published the report of Pakistan Maternal Mortality survey 2019.

NCMNH was one of the implementing partners of the consortium formed by Pathfinder to increase Post-Pregnancy Family Planning through expanding public and private sector service with a focus on “Young Women” in Sindh and Punjab.  Instructors of Midwifery and Public Health Schools of selected districts were trained in Teaching methodology, counseling, Post-Partum Family Planning (PPFP) to enable them to teach the subject to student Community Midwives (CMWs) and Lady Health Visitors (LHVs).

NCMNH strengthened PPFP and PAFP services by providing quality trainings to skilled birth attendants, midwifery tutors , technical supervisors of Pathfinder International and trainers of other consortium partners. In addition, NCMNH also developed a family planning skills lab in the OB/ Gyn departments of teaching hospitals of the intervention districts for the  training of post-graduate students on PPFP, Postabortion Care (PAC) and infection prevention. NCMNH believes that this project has contributed to increase in contraceptive uptake during the immediate postpartum and postabortion period.

NCMNH will conduct advocacy activities with policy makers for implementation of already existing policies on PPFP and PAFP.

NCMNH collaborated with Gynuity Health Projects to implement a research project in Badin and Mirpurkhas districts. This was a quasi-experimental project that tested advance distribution of Misoprostol to pregnant women for treatment of postpartum haemorrhage.

NCMNH took an initiative to promote the teaching of family planning as an essential part of nursing and midwifery education in the public and the private sectors. NCMNH built the capacity of 116 tutors from Schools in 29 districts of Sindh. It also ensured that FP becomes a compulsory part of qualifying examination of midwives.

In addition 33 practicing midwives were trained in FP and PPFP in Sindh and Punjab.

Use of Misoprostol for Prevention and treatment of Post PartumHaemorrhage and treatment of Postabortion Complications funded by Gynuity Health Projects

NCMNH held workshops on use of Misoprostol for midwifery tutors in Sindh, Punjab, and Balochistan. More than 120 midwifery tutors were trained.

This advocacy project in collaboration with RAF achieved its objective for inclusion of Misoprostol in the Essential Medicines Lists for Sindh and Punjab in May 2013. Pakistan Nursing Council also included it in its midwifery curriculum.

NCMNH advocated for use of Misoprostol and its availability at all public health facilities to prevent and treat PPH and post abortion complications, where Oxytocin is either not available or a trained provider to administer it is not present. Awareness was also created about the deterioration in efficacy of Oxytocin if the cold chain is not maintained. NCMNH also worked with the Health Departments for advance distribution of Misoprostol by Lady Health Workers to prevent PPH at home births.

Sub-award by Population Council for National Study on Post-Abortion Care in Pakistan

NCMNH partnered with Population Council and Guttmacher Institute to implement National Study on Post Abortion Care (PAC) in Pakistan. NCMNH provided technical assistance in the research design, and several NCMNH members were a part of the Technical Advisory Group for the study. NCMNH ensured communications outreach and advocacy to disseminate the findings of the study through media.

NCMNH in collaboration with Ipas, worked to reduce Maternal Mortality and Morbidity through Post Abortion Care (PAC).  Provider skills were improved through trainings for Manual Vacuum Aspiration (MVA) and Medication Abortion (MA).  Policy makers and service providers were sensitized about the problem of unsafe abortion. After the pilot phase the initiative was scaled up all across Pakistan as Woman Centered-Post abortion Care (WC- PAC)

NCMNH collaborated with the Guttmacher Institute on an Advocacy & Communication project. The primary goal was to increase understanding among the priority audiences about the incidence of unsafe abortion in Pakistan and the consequences and impact of abortion complications on Maternal Mortality and Morbidity.

ENGAGE was an Advocacy & Communication project that NCMNH implemented in partnership with the Population Reference Bureau and the Gapminder Foundation. This was a part of the global initiative, to reduce Maternal Mortality and Morbidity through targeted outreach and the use of innovative communication technologies.

Pakistan Demographic and Health Survey (PDHS) 2006-2007 was carried out by the National Institute of Population Studies (NIPS) with assistance of MACRO, USA. NCMNH was given the task of analyzing the Verbal Autopsy forms and assign a cause for all female deaths, the level of delay and opinion regarding the quality of data. A panel of experts carried out this activity. A medical cause of death was assigned according to the WHO ICD-10.

NCMNH contributed the chapter on maternal mortality PDHS 2006-07

NCMNH conducted a systematic in-depth analysis of the data obtained from PDHS 2006-07 on deaths of women of reproductive age. the psycho socio and cultural factors contributing to adult female deaths were unpacked. Late maternal deaths were also identified.

Case Study for Safe Motherhood- Learning from South Asia: Study in Pakistan

NCMNH collaborated with International Center for Diarrheal Disease Research, Bangladesh (ICDDR, B) on a Study titled “Case Study for Safe Motherhood: Learning from South Asia Programmes.”ICDDR, B was awarded a grant by DFID, UK to work with policy makers and programme managers to determine recommendations and bench marks for programme implementation and strategic policies for improved Safe Motherhood in South Asia.

Technical Assistance to the Ministry of Health for The formulation of a “National Health Policy for Maternal and Neonatal Health” has been one of the most important tasks assigned to NCMNH by the Federal Secretary Health and supported by UNICEF Country Office, Pakistan.

A trio of docudramas “Mamta ki Hifazat” highlighting the socio cultural factors contributing to maternal deaths and disabilities, was produced with support from UNFPA.

In collaboration with UNICEF, Pakistan NCMNH developed user-friendly EmONC Manuals and pocketbooks in English and Urdu. This Manual was designed to encourage team work among Midwives, Obstetricians, Paediatricians& Anesthetists. Posters featuring five major causes of Maternal deaths were also printed.Workshops were held in each province to train key health personnel on EmONC and to promote utilization of these manuals. A second edition was reprinted in 2007.

In collaboration with CIDA this project focused on sensitizing men to the high level of Maternal Mortality and Morbidity and for enlisting their support to promote safe motherhood. The project strategy was to hold one-day seminars for men in rural and urban locations using the existing government and private sector infrastructure.