Russia Maternal and Child Health Initiative (MCHI)

Various communication tools and approaches were used in this effort to stimulate the creation of an empowered Russian organisation responsible for providing MCH innovations in Russia. Specifically, the Institute for Family Health (IFH) focuses on capacity building and policy reform designed to reduce abortion rates, increase use of contraceptives, and improve youth-friendly services. Throughout this work, the project reflected a commitment to a humane approach toward providing healthcare services, making the interests of the patient and his or her satisfaction with the provided care a priority. A simple illustration of this strategy is as follows: At maternity hospitals and children's hospitals, conditions were created for the mother and the baby to be together all the time, and to enable the father and the family members to take an active part during pregnancy, delivery, and the postpartum period.

Interventions are designed in collaboration with the participating regions and institutions to meet their particular needs and priorities, but here is a general picture of some of the methods IFH developed to foster this vision:

• Integrated training for physicians (obstetricians-gynaecologists, neonatologists, paediatricians, anesthesiologists) and mid-level health care providers (midwives, nurses) in modern methods of quality hospital and outpatient health care services, as well as prevention of infections.
• Regular follow-up and support visits by the project experts to the regions, and "reinforcing" seminars conducted at the workplace in order to provide practical assistance in implementing new approaches.
• Evaluation of the changes in the activity of the institutions which take part in the project, based on the analysis of the data from official medical statistics and research studies which then provide the basis for decision making to further improve outcomes and services.
• Information support, which means providing healthcare professionals and the population with educational materials (publicised in the media and disseminated in hospitals and medical colleges and universities) and conducting campaigns in the mass media that promote breastfeeding and reproductive health. In addition to providing basic information, one specific aim of these campaigns was to help both providers and the population understand that the psychological climate created in the maternity room environment directly relates to the success of the labour and the future of the newborn and mother.
• Organisation of work groups for specialists (obstetricians, neonatologists, and paediatricians) and coordination of their work aimed at developing clinical protocols and putting them into practice.
• Continued education for health care providers. Eight training courses were developed (on family-centred maternity care, breastfeeding, care in the antenatal period, family planning, etc.), resulting in over 150 seminars conducted for 7,000 healthcare providers (administrators and practicing specialists) from more than 200 healthcare institutions which provide care for approximately 10 million people.
• Development of guidelines, recommendations, clinical protocols (12), educational videos (e.g., "Psychological Basis of Counseling", which educates medical providers by offering basic recommendations and rules to connect with a client/patient, using role plays) and commercials on family-centred maternity care, HIV testing, handwashing, etc.

Maternal and Child Health.

An MCHI survey of medical providers conducted in spring 2004 found that many health practitioners did not provide their clients with accurate information about various contraceptive methods. This helps explain why approximately 42% of women arrived at clinics for abortions telling their doctors that they had become pregnant despite proper use of contraceptives - or so they thought.

MCHI's accomplishments include "dramatic increases in breastfeeding, childbirth with fewer medically unnecessary interventions, rooming-in after birth, and contraceptive use. The initiative also helped form multisectoral working groups on youth reproductive health and develop PMTCT Guidelines that were adopted nationwide by the Russian government." According to organisers, "[b]y 2004, approximately 30% of deliveries in MCHI pilot facilities in Murmansk included participation of family members, usually fathers. The family members arrive at the maternity hospitals equipped with childbirth information gathered from newspaper articles and television news stories. No longer afraid or mystified by labor, these family members are prepared to help the mothers during delivery as equal participants. Husbands, parents, and sometimes elder children accompany women through this most difficult and happiest of life's milestones."

In short, "[t]he new approaches to the implementation of perinatal care facilitated the decrease of maternal and infant morbidity and mortality. De-medicalization and regionalization of the care, the interdisciplinary and team approaches turned out to be sufficiently simple, efficient and cost-effective methods as well as dramatically increased the satisfaction of both clients and providers in the care." For example, the percentage of deliveries classified by the World Health Organization (WHO) as normal increased to 50-60%; the number of interventions and medications prescribed during pregnancy, delivery, and in the postpartum period decreased by 2 or 3 times. The percent of antenatal clients who reported that their provider discussed breastfeeding increased from 59.1% in 2004 to 74.5% in 2006. In the same time period, the percent of postpartum clients who reported that they were counselled on HIV and sexually transmitted infection (STI) prevention increased from 34.1% to 46.8%, and the percent of postpartum clients reporting that their provider discussed contraception prior to discharge rose from 44.1% to 73.2%.