Evolution

Overview

Since its founding in 1999, AMDD has continuously evolved to address key causes of maternal and newborn death and disability.

We draw upon the expertise found at Columbia University’s Mailman School of Public Health, and United Nations, non-governmental, and government partners to innovate and advance evidence-based action that saves lives.

Below is a summary of our evolution. 

 

Phase One: 1999 through 2005

In 1999, Dr. Deborah Maine and Dr. Allan Rosenfield founded AMDD in the Department of Population & Family Health in the Mailman School of Public Health at Columbia University with support from the Bill & Melinda Gates Foundation.

AMDD was conceived to work with low and middle income countries to improve emergency obstetric care (EmOC) services for women. The basic premise of AMDD still holds true: Most obstetric complications that lead to maternal death cannot be predicted or prevented, but the vast majority of women can be saved through prompt emergency treatment of adequate quality.

Through advocacy and research, AMDD worked to promote EmOC as a critical solution to saving women’s lives. We sought changes in policy and practical approaches to reducing maternal mortality. Through field projects in 18 low and middle income countries that covered a total population of over 270 million, we helped build evidence to support EmOC as a critical intervention.

In just three to four years, EmOC facilities in project areas doubled the number of obstetric complications treated and cut in half the chances of dying from them.

By 2005, the global and maternal health fields reached consensus that EmOC was essential to reducing maternal mortality, as well as newborn mortality and stillbirths. AMDD’s work evolved to include healthcare for newborns, as we view maternal and newborn care as inextricably linked.

Lynn Freedman, JD, MPH became AMDD's Director in 2005 to lead AMDD into the next phase of its work.

 

Phase Two: 2006 through 2010

In 2006, AMDD was among the growing number of voices in the global community calling for a major shift in thinking to significantly reduce maternal and newborn mortality and to meet Millennium Development Goals 4 and 5, which related to maternal and child health. Recognizing the critical role of health systems to achieve large-scale reduction in mortality, AMDD began to focus more intensively on the health systems barriers to equitable access to emergency obstetric and newborn care (EmONC).

Over the next several years AMDD repositioned to give new attention to the role of health systems and to addressing EmONC as a crucial part of the home-to-hospital continuum of care for women and newborns. We have since focused on research, advocacy, and provision of technical support on strengthening the many parts of the health system needed to deliver EmONC equitably and country-wide, such as emergency referral, health systems governance, and robust program implementation. We have also continued to develop tools and strategies that countries rely on to improve access to EmONC.

 

Phase Three: 2010 through Today

AMDD continues to address health system barriers to EmONC. In the Millennium Development Goal era, however, it became clear that access to EmONC was not sufficient; to significantly reduce maternal mortality and morbidity to meet international targets, women also need high quality, respectful maternity care. Developing health systems to provide high quality respectful care requires understanding implementation, accountability, and the social dynamics of respect in health systems.

We are now giving systematic attention to "implementation science," as we examine the process of introducing, institutionalizing, and sustaining policies, programs, and activities in complex settings so that  quality care is accessible to all women and newborns. We continue to work with a variety of longstanding and new partners to better understand how to translate policies and strategies into sound action on the ground.

Available research shows that social accountability efforts can lead to improvements in health care at the local level, including in respectful care. AMDD is committed to advancing social accountability, and partners with international and grassroots NGOs to understand how and in what contexts health systems become more accountable in response to citizen demands.

For years, there has been anecdotal evidence of poor treatment of women in reproductive and maternal health services, but it was not until 2007 that human rights organizations began to formally document incidents of this “disrespect and abuse” (D&A) by healthcare providers during childbirth. In light of the growing body of evidence, a global respectful maternity care (RMC) movement has emerged. Since 2010, AMDD has been a leader in this global movement, collaborating with others around the world – in high and low income countries alike – to document, measure, and build awareness of mistreatment of women during childbirth. AMDD also works with partners to identify solutions to reduce mistreatment in maternity care. Ensuring respectful maternity care is a central tenet of AMDD’s recent work.

 

Looking to the Future

AMDD’s focus continues to progress as we research health systems and learn more about what it takes to achieve universal access to appropriate, high quality maternity care.

While we explore new themes and new approaches, AMDD’s niche remains the same: ensuring that health systems work at every step of the way to provide seamless, respectful care to all women.