Maternal Health Platform

In the maternal care platform, ASSET research focuses on the continuity of care throughout pregnancy, the timeliness and effectiveness of emergency care, and the integration of psychosocial support into maternal care services.

Maternal mortality remains unacceptably high in Sub-Saharan Africa (SSA). In 2015 over 303,000 women died from preventable causes related to pregnancy and childbirth, more than half of these deaths occurring in SSA. The UN Sustainable Development Goal (SDG) 3 calls for a reduction in the global maternal mortality ratio to fewer than 70 per 100,000 live births by 2030 with no country exceeding 140 per 100,000.

In 2015, a further 1.1 million babies were stillborn in SSA (42% of global stillbirths), the region with the slowest rate of decline worldwide1. The leading causes of maternal death are haemorrhage, sepsis, and hypertensive disorders of pregnancy (pre-eclampsia and eclampsia). Earlier detection, timely care escalation and evidence-based treatments for these conditions have the potential to reduce maternal mortality. The low autonomy of women, and geographic and economic barriers to accessing routine antenatal, and routine and emergency obstetric and neonatal care are all important factors. Alongside these there are low levels of birth preparedness, a lack of knowledge and recognition of danger signs, and limited awareness of what to do when they occur (complication readiness). Most critically, there are significant concerns regarding the quality of maternal health services; the continuity and consistency of healthcare from conception, through the antenatal, intrapartum and postpartum periods, and the integration between community, primary, secondary and emergency care services.

The psychosocial aspect of maternal healthcare has been neglected in low- and middle-income countries (LMICs)2, despite evidence of high levels of maternal depression and anxiety3 and exposure to intimate partner violence4. Independent of its influence on mental health, intimate partner violence (IPV) is acknowledged by the World Health Organization to be a key social determinant of physical health5. Women experiencing IPV are 1.5 times more likely to acquire HIV, and other sexually transmitted diseases and 16% more likely to have a low birthweight baby. 42% of women subject to intimate partner violence are injured, and 38% of homicides against women are committed by their intimate partner. A recent systematic review has highlighted the impact on birth outcomes with increased risk of premature birth, small for gestational age babies and low birthweight6. WHO guidance highlights the importance of identifying IPV in maternity settings internationally7.

We are researching HSSS within maternal health care in Ethiopia (work package 2) and South Africa (work package 6).


  1. Blencowe, H. et al., 2016. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. The Lancet Global Health, 4(2), pp.e98–e108. Available at:
  2. Hanlon, C., 2012. Maternal depression in low- and middle-income countries. International Health, 5(1), pp.4–5. Available at:
  3. Fisher J, Cabral de Mello M, Patel V, et al. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ 2012;90:139G-149G. doi:10.2471/BLT.11.091850
  4. Garcia-Moreno C, Jansen HAFM, Ellsberg M, et al. Prevalence of intimate partner violence: findings from the WHO multi-country study on women’s health and domestic violence. Lancet Lond Engl 2006;368:1260–9. doi:10.1016/S0140-6736(06)69523-8
  5. Garcia-Moreno C, Jansen HAFM, Ellsberg M, et al. WHO multi-country study on women’s health and domestic violence against women. Initial results on prevalence, health outcomes and women’s responses. Geneva, Switzerland: : World Health Organization 2005.
  6. Donovan BM, Spracklen CN, Schweizer ML, et al. Intimate partner violence during pregnancy and the risk for adverse infant outcomes: a systematic review and meta-analysis. BJOG Int J Obstet Gynaecol 2016;123:1289–99. doi:10.1111/1471-0528.13928
  7. World Health Organization. World Health Organization. Responding to intimate partner violence and sexual violence against women. WHO clinical and policy guidelines. Geneva, Switzerland: : World Health Organization 2013.