Suggestions for improving maternal health practice

In this issue, Anne K. Sebert Kuhlmann and colleagues reviewed literature on the importance of community mobilization interventions to improve reproductive and maternal health. They conclude that although researchers agree with what is needed, what is needed in practice is rarely implemented.

Researchers certainly do many health care studies on existing practices. Often they conclude by presenting recommendations for how to improve practice. Not often enough are these suggestions implemented, or followed by additional studies on whether or not practice has been improved. If these studies are being done, alas they are not being submitted for publication in our journal. In this issue of Health Care for Women International, in addition to the aforementioned review, you will read about the following suggestions for improving maternal health practice:

• Stina Thorstensson and colleagues in Sweden write about the need to build bridges between first-time mothers who wish for more information on childbirth, and practitioners who aren't providing what the first-time mothers want.

• Hatice Yangin and colleagues in Turkey suggest that infertile patients receive proper mental health guidance from professionals.

• Jenny Jean and colleagues in Florida, USA suggest that preconception counseling discussions in HIV care should be initiated frequently by all health care providers, and should include pregnancy risk among other topics.

• Shanti Raman and colleagues suggest a more nuanced understanding of autonomy and agency are needed with regard to the relationship to women's reproductive health, particularly for urban populations in India.

• Jane Namasasu and colleagues, working in rural districts in Malawi, suggest a culturally competent reproductive agenda that focuses on preventive care is needed, to provide information about anatomy and biology and educate men and women throughout their lives.

• Olayide Ogunsiji suggests the following: “With organizational support and thorough understanding of the unique obstetric needs of circumcised women, and adequate follow-up, clinicians can provide the holistic, culturally competent, and sensitive obstetric care for women living with the consequences of FGM,”(p.1166), but then notes there are too few providers with such understanding.

• Finally, Jelena Milosavljevic and colleagues in Serbia suggest that much more training for pharmacists is needed in order for pharmacists to provide emergency contraception.

As I read all of these articles with all of the practice suggestions, I ponder whether it is time to stop discussing just what is missing and speculate additionally on how exactly to implement change. What would a maternal practice look like if such changes were in place? What would the economic and social costs of change be? There have been changes in practice. Why am I not receiving research papers about them? I want to learn whether more practitioners were needed to implement change, or whether practitioners who stopped doing some things in order to take time to do different things have evidence that the changes produced better or worse results. Researchers, help me out, or mine will be just another empty suggestion.

August 30, 2016