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TABLE OF CONTENTS

Overview 3

Section 1: Executive Summary 5

- Key Findings 5

- Messaging Implications 10

- Messaging Platform 11

- Next Steps 14

Section 2: Full Report of Findings 15

- Immersion 15

- Exploratory Research 19

- Workshop and Creative Collective 33

- Validation 41

- Messaging Platform 58

- Conclusions and Opportunities 62

Section 3: Appendix 64

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OVERVIEW

The United Nations Millennial Development Goal (MDG) Five focuses on improving maternal health

with an aim to cut maternal mortality by three-quarters by 2015. For maternal health advocates and

many in the global health and development community, MDG Five is often considered the heart of the

MDGs, because meeting this goal sets the foundation for the success of all of the other MDGs, especially

those related to reducing poverty, improving child health and promoting gender equality. Thus, it is

particularly concerning that MDG 5 is cited as the goal that is consistently off-track, with progress on

maternal health lagging behind most other MDG indicators. Focus and urgent action is needed to

advance progress on maternal health to ensure women not only survive, but thrive and help set a course

for stronger generations to come.

There are a constellation of factors that contribute to improving maternal health, including access to

family planning services, care by skilled birth attendants and antenatal care. However, a consistently

overlooked, but essential, part of the solution is access to maternal health supplies.

Too often, low-cost, effective and simple health supplies -- such as contraceptives, medicines used

during child birth and simple equipment -- do not reach the women who need them. As a result, the UN

Commission on Life-Saving Commodities was created in the Spring of 2012 to identify strategies for

improving the delivery of essential health supplies, including strengthening local production capacities,

promoting new technologies and products, strengthening regulatory frameworks, and enhancing

innovative financing mechanisms at both the global and local levels.

This initiative is an important step forward and it is anticipated the Commission will release a report in

September containing recommendations and a work plan for concrete action on 13 commodities,

including three maternal health medicines. But it will take the collective efforts of maternal health

organizations and advocates to place the need for increased focus and investments in maternal health

supplies higher on the political and policy agenda, ultimately supporting the action and sustained

momentum needed in order to save millions of women's lives.

It is within this landscape that PATH and its partners sought to further define the advocacy case for

improved policies and investments in maternal health supplies throughout the developing world with an

effort to create a clear, compelling and consistent message platform. Weber Shandwick and KRC

Research were commissioned for this project, developing an approach that included:

• Conducting exploratory research with maternal health stakeholders and policy influencers to

gain a deeper understanding of this nascent issue, including current levels of awareness and

perceptions of policy challenges and opportunities

• Seeking input and consensus across multi-sector partners on the strategic framework for

messages, including the identification of audiences, challenges, opportunities, and key themes

• Drafting a message platform, including both the best evidence-based case for maternal health

supplies investments and language that resonates emotionally and inspirationally

• Testing the messages with global policymakers, influencers and their proxies to ensure that they

resonate and most importantly, have the desired outcome

This final report contains the results of this effort. The message platform created through this process is

designed to provide a unified framework for advocates to support the case for policies and investments

that broaden access to life-saving maternal health supplies. This message platform includes themes,

messages and evidence-based proof points—or concrete examples of success-- to be used consistently

across multiple communications channels in advocacy efforts, and wherever possible given the

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emerging nature of the issue. The power of these messages will truly be brought to life through a

targeted and fully-integrated advocacy communications effort. Guided by a strategic communications

plan, these efforts might include presentations at international fora, advocacy materials featuring the

personal perspectives of front-line health care workers delivering life-saving medicines to the women

that need them, compelling story-telling through online video vignettes and through many other

channels that reach global policymakers and influencers.

It is important to note that this platform is not designed as a “one-size-fits-all” script, but a consistent

framework that still allows the flexibility for partner organizations to tailor specific supporting points

and illustrative examples in a way that reflect their unique program or policy perspectives. Additionally,

given the emerging nature of the issue, the message platform is a living document, to be updated as the

Commission shapes its recommendations and as new supporting evidence or refined policy “asks”

emerge from the advocacy community.

Most importantly, these messages ultimately support one unified advocacy goal: demonstrating the

value of investments in maternal health supplies, inspiring action, saving lives, and, ultimately creating a

lasting impact on women, families and communities around the world.

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Section 1: Executive Summary

Key Findings

Our Task

Weber Shandwick and KRC Research’s assignment was to develop and test maternal health supplies

advocacy messages that would elevate the awareness and visibility of the importance of maternal health

supplies, and persuade global policymakers and influencers to fund these supplies. The target audience

was specified as global policymakers, donor partners (e.g. foundations, multi-laterals, and governments)

and other influencers. The messaging objective was also specifically defined as building an advocacy

case for policies and investments that broaden access to life-saving maternal health supplies,

particularly leading up to and following efforts to support the UN Commission on Life-Saving

Commodities recommendations.

Our approach

Developing strong, persuasive messages for advocacy issues are built on three distinct pillars:

• Framing Principle: The first component is the framing principle, which is a basic assertion of

principle that gets heads nodding and our audiences and our spokespeople on common ground.

This is often a statement about what is important, or about the ultimate goal. It’s about

showing the values that guide us and framing the context for communications.

• Relevant Facts: The second component is generally factual, which are things we want our

audiences to know about the situation that will influence their opinions. It’s about making our

case, proving our point. This component generally emphasizes basic facts that are readily

believed and understood.

• Impact and Inspiration: The third component answers the question “so what?” What are the

consequences? It’s about why the issue is relevant to or matters for our audience. It’s about

what’s likely to happen if we do not support or take action to further civility in public discourse.

Combined, these three pillars; framing the issue with widely held values, making the case with

believable facts, and making it relevant to the end audience all lead to powerful and persuasive

messaging. They are not complete, however, without a clear and compelling “ask” or request of the

audience, whether that be too broadly support/oppose or to take a clear and impactful action. This is an

element we will develop with insights from external stakeholders, and provide counsel on how to best

make the “ask” as part of a proposed communications plan.

The most successful communications plans are built on a foundation of clear and actionable research.

Research is a critical component to building solid messages that resonate with target audiences,

allowing us to observe the environment and test ideas, then providing us the opportunity to refine

messages to optimize impact. To that end, we employed a four-part process, rooted in research among

both those who would be communicating these messages, and those who we ultimately hope to

persuade using these messages. The four-part process included: Immersion and exploration, a partner

workshop and creative collective, audience validation, and ultimately culminated with a finalized

message platform.

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Phase 1: Immersion

The process of building a messaging architecture that the maternal health advocacy community could

utilize to persuade global policymakers and influencers to protect and build upon current investments

began with a two part immersion phase.

The first part of the immersion consisted of a materials review of nine current documents germane to

maternal health and supplies. This included “Medicines for Maternal Health,” the report prepared for

the United Nation’s Commission on Life-Saving Commodities for Women and Children. The materials

review showed us that the main themes in maternal health-related messaging include:

• Complications of pregnancy and childbirth are among the leading cause of death and illness for

women in developing nations, especially those who are poor, uneducated, or live in rural areas.

• Over half a million women die each year, and millions more suffer serious injury. [Figure has

since changed]

• Bleeding, infection, unsafe abortion, preeclampsia, and prolonged/obstructed labor are the

major causes of maternal death.

• Aside from gender inequality, cost of health services including drugs, distance from health

facilities, poor infrastructure of and along the supply chain, and other logistics are key factors

that contribute to ill health and death.

Overall, the immersion phase educated the team on current messaging being used, allowing us to

identify strengths, opportunities and gaps for communications purposes. It also informed us of recent

public opinion data on maternal health as well as key thought leadership pieces within the community.

The second part of the immersion process was an exploratory research exercise. Weber Shandwick and

KRC Research conducted telephonic in-depth interviews with 27 individuals identified as representing

key stakeholder audiences, in order to further build understanding on existing perspectives, current

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knowledge and best practices in maternal health as well as quickly identify current stakeholder

priorities, opportunities, resources, competing interests and sensitivities.

The 27 in-depth interviews with key stakeholder audiences including global policymakers/donor,

foundation partners in administrative health and procurement systems, national-level health policy

maker/implementers, peers at other NGO organizations and partners in the private sector corporations

with leadership roles in maternal health issues. The interview was conducted over the phone, led by a

professionally trained moderator, and lasted approximately 30 minutes.

Key findings include:

• Supplies significantly impact maternal health: Target stakeholders were very familiar with

maternal health, meaning supporting a woman’s health before, during and after pregnancy.

Supplies are thought to be a small part of many issues surrounding maternal health, however, it

is a very critical one because of the significant impact that access to available supplies can have

on maternal health. These supplies offer specific improvements to lower maternal mortality,

leading to more family and community stability.

• Medicines are an essential part of supplies: Important supplies included the medicines

oxytocin, misoprostol and magnesium sulfate because those medicines can prevent the two

major causes of maternal death – post-partum hemorrhage and pre-eclampsia/eclampsia. The

effectiveness of these medicines actually gives women a reason to go to the medical facility to

receive treatment. The demand for these medicines also provides the need for medical staff to

be trained and available to dispense the medications appropriately.

• Obstacles surrounding availability of supplies are numerous. There are many obstacles to

having a stocked supply cabinet, beginning with lack of education on the importance of supplies

within national governments. Also posing obstacles are supply chain issues for the delivery of

supplies, quality control issues as well as transportation and other issues that physically prevent

women from getting to the facility.

• Progress, however, is attainable: Through education and increased government buy-in for the

importance of supplies as well as building awareness on the impact that supplies have on

maternal health (leading to increased family and community stability), advocates can work

toward policy changes that will increase availability of supplies.

Phase 2: Messaging Workshop and Creative Collective

Following the immersion, the team (Weber Shandwick and KRC Research) prepared for an interactive

messaging workshop with maternal health advocates from several organizations.

The message workshop began with an introduction and sharing of objectives for the session which

included:

• Sharing insights from review of an issue and message landscape;

• Refining communications goals and target audience priorities;

• Compiling and prioritizing potential messages that convey the key topics, urgency and value of a

maternal health supplies advocacy initiative; and

• An overview of next steps including testing with key external stakeholders.

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The team paid careful attention to the thoughtful input of workshop attendees so that the first draft of

messaging could take into consideration the important themes that emerged from the working group.

The key themes and their implications for messaging included:

• Messages must educate. Audiences must be shown the importance and need for allocating

resources to maternal health supplies, including how supplies connect to the broader issue of

maternal health. However, challenges are significant. There is concern over lack of data and

research that would confirm the impact of maternal health supplies on maternal health overall

and that would provide evidence to prove an unmet need.

• Education is a key short-term goal, as is aligning advocates. In the short term, the maternal

health supplies advocacy community feels it is important to include ensure that the target

audience is educated on the importance and the issues surrounding maternal health supplies.

Education can help secure additional advocates for maternal health supplies that will in-turn

help lead the way for tackling the issue, and ensuring accountability for policymakers and global

funders to show responsibility and ownership regarding this issue as one of their goals.

• Opportunities for increasing focus on supplies are numerous. The most visible opportunity is to

utilize is the UN Commission to help bring a strong voice and a clear set of policy-focused next

steps to the cause. In addition, tools from the reproductive health advocacy community can be

adapted and used for models, secondary research such as case studies and pilot programs can

help illustrate impact and there are numerous gatherings and meetings within the maternal

health advocacy community that can provide a platform to extend the dialogue.

• Making maternal health supplies available will still face challenges. Past experience shows that

it will be difficult to engaged national decision makers into meaningful conversation about

making supplies available, and, getting a commitment that truly translates into stocked supply

cabinets. Availability of supplies will continue to face systematic challenges within the supply

change. Also a challenge is the lack of quantifiable data illustrating the gap in supply and

demand. And, these three items can pose significant obstacles to our end goal.

• Pair the humanistic voice with an economic voice. When it comes to messaging on maternal

health supplies, there’s room for a humanistic voice, as well as an economic voice. The group

would like to enter into the maternal health supplies conversation through the prism of the

larger maternal health issue. The humanistic voice addresses what supplies can do for maternal

health, how they can truly save a life, and that no woman should die while giving life (especially

when a large number of the deaths that occur are from preventable complications).

• Economic angle is attractive and effective. The economic voice addresses how supplies help

bring about a return on investment within other areas of maternal health, although specific

proof points may need further development.

• Women=family=community=nation. Messaging should explore the connection between

maternal health and children’s health, the entire family unit and the community as a whole,

showing the true impact that women can have. This is a claim that feels logical and believable,

but finding data to support could be difficult.

With learnings from the immersion phase and workshop, the team began to draft messages with which

they shared with Weber Shandwick’s own “creative collective” group of global communicators who

work on issues directly or indirectly related to maternal health. This yielded a level of insight and

expertise that aided us in refining words and phrases to increase impact of the statements.

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The Creative Collective is a group of 12 creative directors and global health and social impact leads from

across Weber Shandwick’s global network. The Creative Collective includes branding, consumer

marketing, digital and advertising experts from the US, Canada, UK, Africa, and Europe.

The message brief along with the key messages and proof points were posted in the creative collective

to learn what resonated and what did not across this audience. Respondents engaged in a robust online

discussion during the response period and built on each other’s opinions and the conversation.

Phase 3: Validation

Following a review and refinement of the messaging architecture, the validation process began. It’s

here where Weber Shandwick and KRC Research tested the messaging with the target audience, which

included individuals who work as global policymakers and donor or foundation partners in

administrative health and procurement systems, peers at other NGO organizations and partners in

private sector corporations with leadership roles in maternal health issues.

In total, nine individuals partook in the validation phase. The interview was conducted over the phone,

led by a professionally trained moderator, and lasted approximately 30 minutes. The interview was

blinded, meaning the participant did not know the sponsor of the research.

During the course of the interview, the participant was asked to provide feedback to the overarching

theme guiding advocacy for increased investment in and prioritization of maternal health supplies and

test potential messages that convey the value of investment in priority maternal health supplies.

During this exploratory exercise, the participant was asked to talk about important themes surrounding

maternal health (including maternal health supplies) as well as provide feedback on the various

messages and statements that comprised the draft messaging architecture. (The tested messages are

included in the Appendix D for reference.)

Key findings include:

• Our audiences of global policymakers and influencers need messages that educate on the

importance of supplies illustrate the value of the investment, show commitment and

partnerships globally.

• The short term goal/ask is to elevate the importance of funding supplies. Similarly the long term

goal was to secure funding.

• The overarching theme is accurate, believable, contains powerful word in “essential” but it

needs a more direct or strong statement to engage in what comes next.

• The supporting statements include emotion as well as facts and information. They also educate

on the importance of supplies.

• The themes convey important points, introduce new arguments for supplies, and provide

“something for everyone” in the audience. They need some refined focus to emphasize the

importance of “availability” of supplies, and a more “politically correct” way to discuss

partnerships.

This knowledge led to implications (described in “messaging implications”) for messaging that ultimately

aided the refining and finalizing of the messaging platform.

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Messaging Implications

Education brings clarity. While the value of maternal health supplies is logical for many, it is a newer

focus in maternal health discussions, and there are curiosities surrounding what constitutes maternal

health supplies, what exactly makes them hard to attain, and why they are so critical. Educating on the

importance, the need, and the lack thereof builds impact, because the audience then understands more

about making maternal health supplies available.

Lead with impact. The audience wants (and needs) to feel impact at the onset of the overarching

theme. The audience agrees: supplies save lives. This gives them a reason to focus in on the importance

and need for supplies. They need to hear that explicitly, and immediately. Even though there is no

direct ask, there can still be a call to action and conveyance of impact.

Bring everyone along. As we observed in the exploratory research, coalition-building with national

governments and international policymakers is essential for truly making maternal health supplies

available. Without these groups taking an interest, and making a commitment to the issue, impact

won’t be long-lasting. To that end, consider wording and phrases that help bring everyone along vs.

isolating.

Let economics support the moral argument. The audience appreciates messaging that speaks to the

moral imperative of caring for women. The economic argument brings a fresh (and welcome)

perspective to the issue that can be a vehicle for conveying the moral argument. These supplies save

women’s lives for small amounts of money, and they provide the tools that health workers/facilities

need to make those investments pay off.

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Messaging Platform

SUMMARY

STATEMENT

Investing in Essential Supplies Saves Lives and Improves Maternal Health

Becoming a mother is usually a special, joyous event. But for many women in developing countries, childbirth can be life-threatening.

Can you imagine a woman in labor arriving at a clinic to deliver her baby only to find that the basic medical equipment, medicines, and

health staff aren’t there? Ensuring access to basic maternal health care will prevent hundreds of thousands of women from dying

during pregnancy and childbirth and ensure they and their children live healthier lives. Access to essential maternal health medicines,

including items such as medicines, contraceptives, and simple equipment used during childbirth are often a hidden part of the

solution.

Having a healthy pregnancy, childbirth and the opportunity to see your children grow up healthy should not be a matter of where you

live or your economic status. It should be a universal right for every woman, everywhere. The good news: this goal is achievable.

Working together, global leaders, national governments and maternal health advocates have the power to elevate the critical role of

maternal health supplies in protecting women’s lives during pregnancy and childbirth. Policy leadership, matched with additional

funding for proven, low-cost maternal health supplies, can improve maternal health and save millions of lives worldwide.

Healthy mothers have a powerful ripple effect. To save a mother is to save a family. And to save a family is to lay the foundation for

stronger communities and more stable nations.

KEY THEMES No Woman Should Die Giving Life Essential Supplies Save Lives

and Improve Maternal

Health

Leadership and Investments in

Maternal Health Supplies Matter

Saving Mothers Means Stronger

Families, Communities and

Nations

SUPPORT The solution to safe pregnancy

and childbirth for women in the

developing world begins with

access to basic health care,

including maternal health

supplies.

Increasing the availability of

supplies is essential to saving

lives and improving maternal

health, especially during

pregnancy and childbirth.

Global leaders and national

governments have the power and

responsibility to protect women’s

lives during pregnancy and

childbirth with greater leadership

and additional funding for

maternal health supplies.

Healthy mothers have a

powerful ripple effect. To save

a mother is to save a family.

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PROOF &

EVIDENCE

• At the heart of good maternal

health care is a set of basic,

low-cost, but essential

supplies that includes items

such as medicines,

contraceptives, and simple

equipment used during

childbirth.

• Each year approximately

287,000 women – 99 percent

of whom live in developing

countries – die from

pregnancy and childbirth-

related complications. That

means one woman dies every

two minutes from pregnancy-

related complications

• Experts estimate that with

access to basic health care

and proven interventions, the

leading causes of maternal

deaths are largely

preventable. These include:

severe bleeding after

childbirth; high-blood

pressure during pregnancy

and infections.

• Having a healthy pregnancy,

childbirth and the opportunity

to see your children grow up

healthy should not be a

matter of where you live or

your economic status. It

should be a universal right for

• The important role of

essential maternal health

supplies and medicines

can be hidden in the face

of larger health system

challenges in low-resource

settings.

• Maternal health supplies

and medicines need to be

stocked in health clinics,

in the hands of trained

health care workers and

ultimately delivered

appropriately to the

women who need them in

order to save lives.

• Three proven, low-cost

medicines – oxytocin,

misoprostol and

magnesium sulfate – have

the potential to save the

lives of mothers

worldwide, making their

accessibility and

availability critical during

pregnancy and childbirth.

Each of these three

medicines costs less than

US$1.00

• Contraceptives are an

essential element of

maternal health.

• Essential, lifesaving

equipment such as

• New global leadership is

highlighting the need to

improve the availability,

quality and impact of proven,

low-cost medicines through

the UN Commission on Life-

Saving Commodities for

Women and Children.

• Coordinated approaches and

increased innovative

partnerships, as exhibited by

the successes of pooled

purchase and delivery of

vaccines and medicines to

prevent HIV, would

dramatically improve the

impact of low-cost supplies

and save more women’s lives.

• Prioritizing funding for

maternal health supplies will

provide a significant return on

the other investments made in

maternal health and

maximizes the potential

impact of health care workers.

• Reliable availability of

maternal health supplies and

medicines will strengthen

health care systems and make

frontline health workers more

effective. There is a powerful

opportunity to save many

more lives and improve

maternal health through

• From the cradle, to the

classroom, to the workplace

and community, a healthy

mother can mean a world of

difference for her child and

her family.

• When women survive and

thrive after childbirth, they

can increasingly impact

change and economic

development in their

communities and ultimately

their nations.

• There are many complex

challenges to improving

maternal health, but policy

leadership, matched with

additional funding for

proven, low-cost maternal

health supplies, can set off a

powerful ripple effect,

saving and improving

millions of lives worldwide.

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every woman, everywhere.

• An essential part of ensuring a

woman survives pregnancy

and childbirth includes access

to maternal health medicines

and other supplies.

catheters and urine bags

needed for women during

childbirth – particularly

difficult labors – cost

approximately US$3

• The solution is within

reach: Delivering a

package of services,

including essential

supplies, is estimated to

cost less than US$1.50 per

person in the 75 countries

where 95% of maternal

mortality occurs

policy leadership matched

with much-needed

investments in supplies.

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Next Steps

A message platform is most effective when providing a unified framework, with themes and messages

to be used consistently across multiple communications channels. Message platforms are always living

documents, but given the emerging nature of the maternal health supplies issue, some specific

opportunities and next steps include:

• Continuing to collect and refine additional proof-points that support each message, and bring

new evidence or examples to strengthen each element of the messaging architecture, including

partner organizations tailoring specific supporting points and illustrative examples in a way that

reflect their unique program or policy perspectives. This effort may also involve identifying and

prioritizing the need to generate new research or supporting data to strengthen the evidence-

based case.

• Refining and tailoring the messaging for specific events, opportunities, or appeals as the policy

and advocacy landscape shifts.

• Similarly, working with the Maternal Health Supplies Working Group and other members of the

advocacy community to clarify both the policy ask and the funding ask, keeping in mind that as

milestones such as the release of the UN Commission’s recommendations in September 2012

are reached, these asks will be further refined.

• Bringing the messages to life through a targeted, strategic communications plan, fully

integrating them into the work of the maternal health advocacy community.

Additionally, given the more technical nature of maternal health supplies policy issues, as well as the

relatively small, but influential, target audience of policymakers and funders who can have the greatest

impact on the issue, a stakeholder mapping exercise would be an effective approach toward developing

a more comprehensive maternal health supplies advocacy strategy for message delivery. This effort

would build on the initial research conducted with policy influencers to inform the message

development process, but focus on how best to reach and have an impact on these audiences.

Stakeholder mapping includes:

• Comprehensively identifying the major stakeholders and influencers (either organizations or

individuals) in civil society, bilateral and multilateral organizations, donors, policy circles, the

philanthropic community and private sector

• Assessing and prioritizing their relative importance/impact

• Providing a strategic road-map for advocacy outreach, including best channels of reaching and

influencing these stakeholders (e.g. conferences, academic gatherings, influential publications)

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Section 2: Full Report of Findings

Immersion

The process of building a messaging architecture that the maternal health advocacy community could

utilize to persuade global policymakers and influencers to protect and build upon current investments

began with an immersion phase. The immersion phase educated the team on current messaging being

used, allowing us to identify strengths, opportunities and gaps for communications purposes. It also

informed us of recent public opinion data on the topic as well as key thought leadership pieces within

the community.

Methodology & Approach

The immersion phase consisted of a top-line review of selected publications and public opinion research

on maternal health-related topics in order to build on our existing knowledge of maternal health

advocacy issues and sector-specific best practices and avoid reinventing the wheel. This phase allowed

us to quickly identify internal priorities, opportunities, resources, competing interests and sensitivities.

In preparation for developing messages for use with advocacy partners, PATH shared nine documents to

aid immersion into the topic. These maternal health topics include information surrounding leading

causes of maternal death due to complications of pregnancy and childbirth including bleeding, infection,

unsafe abortion, preeclampsia and prolonged or obstructed labor, information about how the cost and

distance from health facilities affects mothers as well as information about the drugs oxytocin,

misoprostol and magnesium sulfate. A full list of these materials can be found in Appendix A.

Summary of Learnings

These articles, along with a review of public information on PATH’s website and conversations, are

indeed useful tools for understanding the dynamics of issues surrounding maternal health, maternal

deaths, and maternal health supplies. They have illustrated what is currently known, and what is

essential to learn from stakeholder interviews. The four main “known’s” and “need to knows” are

summarized in the chart below. A larger explanation of the findings follows the chart.

Known: Need to know:

• Issue of maternal postpartum

deaths has grown out of larger

global strategies for women and

children’s health, and has

received additional attention

from advocates and global

health experts recently

• Incidence of maternal deaths

• Is this an issue that warrants broader

attention? What makes it important?

• Is this an issue where the maternal health

advocacy community can make a difference?

What’s considered “success” or a “win?”

• Designated medicines, virtues

and drawbacks of each

• Are these considered the “right drugs” for

reducing maternal postpartum death?

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Known: Need to know:

• Current access to drugs

• What can be done to illustrate the virtues of

these drugs, and that they are the “right

drugs” so that there is a true cause for

increasing access to them?

• What global mechanisms can be leveraged to

increase access to drugs?

• Action items for expanding

access to medicines (as

described in “Medicines for

Maternal Health” report)

• Are these the right action items for moving

down the path?

• Will these conjure support for funding studies

to reduce barriers (below)?

• What does the outcome of these action items

mean for the greater communities within

developing nations?

• Key barriers to success include

lack of research on needs, gaps,

systems and financing for

medicines

• Inconsistent medical care/lack

of skills also a barrier

• To what extent is each of these barriers? How

limiting is not having this type of research?

• What is the community willing to do while

these remain unknowns?

• What elements does messaging need to

include to conjure up support for research to

fill gaps?

Expanded Summary of Learnings

These materials reveal much about the origin of the UN Commission on Life-Saving Commodities for

Women and Children, the progress of the Maternal Health Supplies Working Group, arguments for

maternal health being part of reproductive health, and, ultimately ways in which critical medicines can

be made available to women so as to avoid two major causes of death.

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The immersion materials provide essential documentation of the facts surrounding maternal death:

• Complications of pregnancy and childbirth are among the leading cause of death and illness for

women in developing nations, especially those who are poor, uneducated, or live in rural areas.

• Over half a million die each year, and millions more suffer serious injury. [Figure has since

changed]

• Bleeding, infection, unsafe abortion, preeclampsia, prolonged/obstructed labor are the major

causes of maternal death.

• Aside from gender inequality, cost of health services including medicines, distance from health

facilities and other logistics are key factors that contribute to ill health and death.

They also provide essential background on the three chosen drugs that PATH is looking to build a

stronger advocacy case for in key countries.

• Oxytocin, a medicine for minimizing postpartum hemorrhaging is extremely effective, but must

be stored in specific conditions to preserve its effectiveness. It also requires a health

professional trained and authorized to administer the drug. These two elements make it

difficult for women in rural areas to receive the drug if in need.

• Misoprostol, a medicine that can be a substitute for oxytocin for postpartum hemorrhage, does

not have the same storage or administering requirements, and therefore is an option for women

in rural areas, or when oxytocin is not available. However, it is also associated as an abortion

agent which makes some countries reluctant to recommend its use.

• Magnesium sulfate is a medicine for reducing high blood pressure. High blood pressure can lead

to preeclampsia/eclampsia. The WHO recognizes this drug as the safest, most effective and

cost-efficient way of treating preeclampsia/eclampsia. Each treatment requires multiple vials of

the drug, and is administered via injection.

In looking at case studies from Uganda and Bangladesh, there are country-specific challenges worth

noting:

• In Uganda, availability of supplies truly is limited even though the government is widely viewed

as committed to maternal health. Poor financing is only part of the issue. Supply chain issues

are a reality. Even though country policies address the need to have more deliveries at health

facilities, weak supply chains do not yield the supplies that a facility needs.

• In Bangladesh, a major challenge related to the supplies issue is the low rate of facility delivery

(only 15%) and skilled attendants at birth (18%). While the government is described as

supportive of maternal health, many stakeholders feel that this has not translated into

additional capacity or funding for maternal health supplies. Additionally, the government only

has one procurement cycle per year, leaving many facilities low on supplies at various points

during the year. Supplies for maternal health are also not generally funded by development

partners.

The immersion process clearly illustrates the proposed action items, the challenges that face action, and

background surrounding policy, regulatory, supply chain and manufacturing, and financing issues. All

this information is a strong primer for the key elements:

• Attitudinally, motivationally, emotionally, as well as programmatically, what will bring about

change with regard to access to these medicines and other supplies as a way to reduce maternal

death?

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• Which global mechanisms are best to leverage as conduits for change in this space?

• What levers does messaging have to pull to bring about action within the maternal health

advocacy and broader global health and development community?

• How can success best be defined?

The content of the discussion guide was heavily influenced by the findings of this immersion phase. The

findings will also help interviewers effectively listen for and probe accordingly on specifics related to

maternal deaths, medicines and other supplies, global mechanisms and ways of achieving success while

speaking with stakeholders.

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Exploratory Research

This section summarizes the in-depth interviews conducted among key target audiences in order to

explore the important themes and topics in maternal health. These interviews were used to identify

current stakeholder priorities, opportunities, resources, competing interests and sensitivities, to help

inform the policy and political landscape for the issue and to reveal elements and angles that are

important to capture in messaging on the topic.

Research Objectives & Methodology

KRC Research and Weber Shandwick conducted 27 one-on-one in-depth interviews (IDIs) of the key

target audience between March 12 and March 28, 2012. Our key target audience was defined as

individuals who worked as global policymakers and donor/foundation partners in administrative health

and procurement systems, national policymakers, peers at NGO organizations and partners in private

sector corporations with leadership roles in maternal health issues.1 A more complete listing can be

found in Appendix B and a sample of the pre-notification letter sent to these stakeholders can be found

in Appendix C.

Overview of Findings

Overall, we learned that:

• Maternal health is a topic area with which the targeted stakeholders are very familiar. At its

core, maternal health includes supporting a woman’s health before, during and after pregnancy.

However, there are differing opinions regarding the duration of care and type of care

encompassed.

• Maternal health supplies are perceived to be a small part of many, many issues that constitute

maternal health; however, they can still have a critical impact. In many ways, supplies address

the challenges implicit in issues related to maternal health – keeping women alive and healthy

during and after pregnancy. Supplies such as oxytocin, misoprostol and magnesium sulfate:

o Address two major causes of maternal death, post-partum hemorrhaging and

preeclampsia/eclampsia.

o Give women a reason to seek out medical assistance in labor and delivery, or go to a

medical facility.

o Provide the need for trained health care professionals and/or skilled birth attendants

(medicines to administer, reason to seek out trained assistance).

• Supplies are important because they are specific ways to bring about improvements in maternal

health; subsequently reducing maternal mortality means fewer motherless children, more

family stability, and greater community stability.

• There are a number of obstacles facing access to maternal health supplies themselves, starting

with getting governments to consider these medicines important. Beyond that, there are also

supply chain issues in delivery of the medicines and other supplies, quality control issues, and

struggles with an expectant mother being able to physically get to a health care facility.

Stakeholders highlighted the multiple actions that need to be taken to minimize these

1 Interviews included: 7 bilaterals/multilaterals, 2 foundations, 6 government donor country influencers, 10 NGO/policy centers and 2

private sector

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challenges, and most start in the same place— getting the right people to fully understand the

impact that maternal health supplies has on women’s health.

• When governments know and care about the impact maternal health supplies can have on

maternal health, and see the bigger picture—what maternal health means for the family and

community, putting in to place policy to make supplies a reality becomes more obtainable.

• Along that path, however, maternal health supplies will incur the same challenges that other

supplies and medicines incur. In-country supply chains are limited and do not support the

needs of the community. There are issues that span from transportation of medicines, supply

chain management, to knowing how to monitor the supply cabinet and when to place orders.

• PATH and members of the Maternal Health Supplies Working Group bring an advantage to this

space. Their technical expertise in other areas can greatly benefit its work on maternal health

supplies.

Definition of Maternal Health and Key Issues in Space

Issues and challenges surrounding maternal health are numerous. Some are more tactical, related to

access and availability of supplies as well as medical professionals. Others pertain more toward current

mindset, or more system-wide issues.

At its core, maternal health refers to providing care to support a woman’s health before, during and

after pregnancy. Stakeholders also attach additional meanings to the term, in addition to the core

understanding.

• Some stakeholders also include the health of women in their childbearing years, from age 15 to

49. Others shared that maternal health spans from conception through six weeks after birth, or

until the mother is no longer carrying primary responsibility for the health of her children.

• For some, maternal health also includes safe abortion where legal, contraception, reducing or

preventing maternal death and morbidity, or even ensuring the newborn survives delivery.

• Preventing and/or managing preeclampsia and post-partum hemorrhage is frequently

referenced with supporting maternal health.

• Nearly all think of maternal health as specific to giving or providing care. A select few held the

perspective that maternal health is a

state of being.

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There are a myriad of issues within the maternal health space, but one clear theme emerged: providing

access to quality care is a big challenge.

• The lack of access to quality care spans many different avenues including having health

professionals to provide care, physically being able to access the services, and having supplies

necessary, including blood, medicines, and commodities.

• Stakeholders talk of a shortage of trained workers such as nurses and midwives. They also talk

of cultural or physical obstacles that prevent access to care, especially when it is most needed

during pregnancy and within the first 24 hours after birth. These barriers include being in a

remote location and having to travel far distances with a lack of good, reliable transportation.

Some mentioned the need to bring their own supplies to the clinic for labor and delivery.

• It’s here, when discussing access to care, that many include supplies associated with maternal

health. Supplies include medicines, equipment, blood, and even consumables such as gloves,

gowns, syringes, wound dressings, etc.

Underlying these issues are larger ones. Maternal health has been overlooked until recently. Funding is

also a struggle, as is infrastructure (having hospitals, care centers, warehouses for storing supplies) and

having a framework and system in place to incorporate pilot programs into a standard medical regime.

• Stakeholders share that global attention is on HIV/AIDS and malaria, not on maternal, child and

newborn health. Also, many countries themselves do not prioritize maternal health. Some share

that the attention should be placed more on family planning vs. maternal health.

• A few stakeholders that worked on pilot programs shared successes of the actual program itself,

but said that the country/region was not equipped to take over the program and therefore

there was no lasting impact of the program.

Maternal Health Supplies Awareness, Importance, and Major Players

Stakeholders themselves admit to lacking the most current information on maternal health supplies, and

many profess to not being experts. This later inhibits stakeholders from offering up more tactical or

policy-related solutions, and suggests that stakeholder education is an important component in building

support for this issue.

Without having as much knowledge as they would like, stakeholders still immediately see the critical

importance of maternal health supplies, indicating that little convincing has to be done as to why

supplies should be part of the conversation within maternal health.

Familiarity with maternal health supplies ranges from vague to more comprehensive. Many, despite

familiarity, profess they are not an “expert” in this area.

• Those less familiar recognize the reference, and know that supplies are an important part of the

larger issue.

• Those somewhat more familiar offer up commentary about what makes them important, and

challenges associated with providing supplies.

• Those with the most familiarity tend to heavily stress the importance of supplies within

maternal health. Without the supplies there can’t be a service.

• Many, across familiarity, feel they are not as “up-to-date” on what’s going on specifically with

supplies, yet they understand the importance and need of commodities being at the right place,

at the right time. And too, stakeholders were willing to share that they are not experts on this

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topic, meaning they do not know enough about the nature of the problem or potential

solutions.

Maternal health supplies are an integral part of

maternal health.

• Supplies are a small piece of a larger

issue; however the “small piece” is a

critical component that holds potential

to impact the issue in a much larger

proportion.

• More specifically, three medicines,

oxytocin, misoprostol, and magnesium

sulfate, are critical for addressing two

major issues within maternal health,

post-partum hemorrhaging and pre-

eclampsia/eclampsia. Stakeholders did

not refute or take issue with any of

these three medicines being important

supplies.

• Not only do these medicines provide a

solution to major medical issues, their availability gives women a reason to seek out medical

attention. They also provide a reason for there to be trained health professionals to administer.

• Remembering that access to care is a top issue for getting women medical attention, some

explain that the three areas for improving access are training professionals, providing supplies

such as medicines, and getting women to a health facility. There are models in place for training

professionals, and therefore the next item on the list is to make supplies more available, which

holds the potential to justify a trip to a health facility.

USAID, UNFPA, and the UN Commission on Life-Saving Commodities for Women and Children top the list

of key players in the maternal health supply space, according to the survey participants.

• USAID was listed by a quarter of stakeholders, followed closely by the UN (and more specifically,

the UN Commission on Life-Saving Commodities for Women and Children), WHO and UNFPA.

• JHPIEGO and the Partnership for Maternal, Child and Newborn Health also received multiple

mentions.

Challenges Facing Maternal Health Supplies (MHS)

Challenges begin with getting the appropriate people to understand and care about providing maternal

health supplies, and drawing the connection between that and a positive impact on community. Then,

more tactical challenges can be addressed.

It is also important to be mindful of those barriers that are not specific to maternal health. Maternal

health supplies will encounter the same system-wide availability complications that other drugs

encounter that stem from poor supply chain management.

There are two types of challenges facing maternal health supplies; those specific to maternal health

supplies and those more system-wide. The system-wide issues appear to be the more challenging,

harder to overcome issues.

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• Top on the list of challenges specific to maternal health supplies is making this topic visible and

relevant to national governments. Ministers of Health and other leaders need to be educated

on the need for these supplies and the impact they can have. The challenge is showing the

impact that fostering maternal health can have on the family, the children, and the community.

Maternal survival means children grow up with their mother, leading to greater family stability,

and greater community stability.

• Some also share that supplies aren’t as

“sexy” as other topics.

• Other challenges include the proper

storage and administration of oxytocin,

the misuse of misoprostol, and

bureaucratic hurdles surrounding the use

of misoprostol in countries where it is

currently illegal (most African countries).

• Procurement of medicines and lack of

training for administrating medicines is

also mentioned, though much less so than

other challenges.

• Maternal health supplies are also subject

to system-wide issues which stakeholders

describe as hard to overcome. Countries

are ill-equipped to manage an effective supply chain and monitoring usage to predict need. And

too, transport of medicines from warehouses to medical facilities is also a threat to the supply

chain, as distances can be long and roads unsuited for travel in poor weather.

Methods for Addressing Challenges to Providing Maternal Health Supplies (MHS)

Unaided, stakeholders most frequently offer up advocacy as the main method for addressing challenges

in providing maternal health supplies. In their minds, making this an issue of importance is the first step

to getting these supplies in medical centers

or with skilled birth attendants.

Stakeholders struggle to offer up specific

policy implications or global mechanisms

for addressing challenges unaided. They

tell us that the first step really is advocacy,

or, that they are just unsure as to next

steps.

Aided, stakeholders find value in the

specific policy implications and global

mechanisms that we tested. Cost-wise,

increasing funds by national governments

and donor organizations is highly

important, and a reason to advocate for

the medicines being placed on the

“essential medicines” list in countries.

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There are a number of ways that stakeholders felt the issues surrounding maternal health supplies could

be addressed, but the foundation of each of these suggestions lie in providing an increased

understanding and a hook to ensure support from key groups.

• The need for collaboration among multilaterals, donor government entities, national

government entities and advocacy groups was a strong theme across the interviews. Partnering

together can actually make changes and advocacy groups that can help work toward change.

• In order for national governments to take this charge as seriously as they should, they need an

increased understanding of why this is important and how this will impact communities. One

stakeholder mentioned that advocacy to maternal health needs to be “unpackaged.” All the

various aspects of maternal health need to be individually understood – the need for skilled

birth attendants, the need for updated facilities, the need for proper equipment and supplies,

everything needs to be thoroughly explained in a way that makes the key groups (government

and the like) understand how it will impact their agenda and why it is important for it to be a

priority.

• A few stakeholders cited the need for a commission to take charge and lead the way on the

initiatives to help focus on which specific needs need to be tackled first and then provide some

accountability on the back end to make sure that those needs are actually addressed. There

currently is no ownership of all the various elements that are connected to maternal health

supplies.

• In a similar vein, channels of communication need to be very open between the advocacy

groups and the people that are more involved in the day-to-day operations on the ground,

including implementing partners, program drivers and provider networks in developing

countries to make sure that advocacy groups have a clear picture of what is actually taking

place.

• Other ways to address challenges include, providing training for medical staff on supply chain

and inventory management as well as medical training, conducting more research on

commodities, investing in health systems and providing funding for medicines.

• Stakeholders struggle to offer up more specifics, unprompted, surrounding policy implications or

global mechanisms for increasing support for supplies. Their current knowledge, coupled with

their belief that others need to care more about this topic, seems to limit their assertions as to

what else needs to be done.

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Stakeholders heard up to four of eight potential methods for addressing challenges related to the availability of maternal health supplies (two

availability-related, two cost-related).

Availability-Related Challenges

Potential Method Relevance Challenges/Limitations

Providing data on both

the unmet need for

maternal health

supplies as well as

available financing for

supplies.

• Relevant, though very few were aware of a lack of

data in this area.

• Some organizations that have developed a list of

essential supplies and equipment that should be

available at health facilities depending on the level

of care that they provide.

• One stakeholder recommended that you start with

a commitment to creating budgetary line items at

the country level, based upon research

surrounding unmet need.

• Others mentioned demographic surveys, gap

analysis further down the road.

• Figuring out how to get the people

and products together at a place that

women are coming to is the big issue.

Data must capture that.

• While some stakeholders indicate

that not enough data exists, one

stakeholder addressed a concern that

there comes a time where we need to

do the best with the data that we

currently have to then spend the

money on solving the issue rather

than collecting more and more data.

Accelerating adoption

and scale up of

maternal health

supplies.

(note, fewer

participants

asked/able to address

this item)

• Relevant, but not a first step. This comes after

advocacy, perhaps providing data and even after

quality assurance.

• Countries need to ensure the safety of the

medicines, ensure they are registered.

• It is suggested that cues be taken from other

efforts when it comes to accelerating adoption and

scale up of maternal health supplies, look to

malaria or child vaccines in order to prevent

‘reinventing the wheel.’

• Many steps come before this step.

• Need a model that works and takes

into consideration data showing

unmet need in supply and financing.

• Need to generate credibility within

country before.

Ensuring quality • Relevant, but not a first step. • Expense – National lab and quality

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Availability-Related Challenges

formulations of the

medicines are widely

available and used.

• Explore problems not just in manufacturing but

along the supply chain and facility storage

(especially given what a challenge supply chain

poses).

• FDA is a player.

• Drug Regulatory Authorities in individual countries

are also players.

assurance is very expensive.

• WHO’s prequalification process is too

slow.

• Drug regulatory authorities can have

problems with funding, being

understaffed and under-skilled.

Regulating the quality

and usage of

medicines across

countries for quality

assurance purposes at

a national level, yet

with global

accountability.

• Relevant, but not a first step.

• Come up with policies to regulate the import of

medicines within individual countries. Then work

to monitor the implementation of policies.

• Global accountability.

• Association of Physicians or Pharmacists and

Ministries of Health, and country presidents can

implement policies and monitor the

implementation of these policies in the areas of

importing, training and dumping.

• Alliances such as: African Alliance for Malaria also

can advocate for the value in regulating the quality

and usage of medicines across countries.

• Right now very weak as a community.

• Need to understand needs to come

up with policies.

• Needs to be addressed at the national

level, yet at higher political level as

well.

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Cost-Related Challenges

Potential Method Relevance Challenges/Limitations

Increasing funds

contributed by

national

governments for

maternal health

supplies.

• Highly relevant, and enabled by showing the value of

investing in MHS.

• Should document the gap that exists in each country and

show the impact that it creates, including the number of

women who are dying each year because of it.

• Need to ring-fence (protect) funding around commodities.

• Generally, make sure medicines are a part of the essential

medicines list because government can distribute more

funds to it.

• Getting governments to care about

maternal health supplies, showing

their relevance

Increasing funds

contributed by

global donors for

maternal health

supplies.

• Relevant, and can have impact.

• Increased advocacy by implementers and individual

countries.

• Showcasing what Millennium Development Goals provide.

• One stakeholder said that maternal health supplies is

somewhat of a late-comer so focusing on this now is very

positive.

• Individual countries still need to

acknowledge maternal health

supplies as an issue; otherwise

donor contributions won’t have a

lasting impact. While it’s OK to

have funding globally, it can’t be in

place of a government taking

responsibility and deeming this an

important area.

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Cost-Related Challenges

Ensuring larger

purchase volume

and more

consistent quality.

• Relevant. Important to have the capacity to distribute and

meet need.

• Need more bilateral and multilateral donors & discussions

with manufacturers.

• One stakeholder reported trying

this but that the long-term

contracts that came with bulk

procurement did not work.

• Another mentioned that while

there is a need to have more

discussions with manufacturers,

ensuring larger purchase volumes

is difficult due to skills in predicting

and planning for need.

Pooled-

procurement at

global/regional

and/or national

level.

• Feels relevant, but many could not speak to this.

• Different strategies have already been defined.

• One stakeholder commented that

trying to pool and hold until you

can negotiate is wrong because

there is a disconnect between

consumption and demand.

• There are different mechanisms for

financing. Examples already in

place include: take another issue,

pool other mechanisms,

government funding or specific

funding for the drugs and supply

management at the country level.

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The WHO’s role in Maternal Health

The WHO is seen as an organization that can help amplify the message to national governments (a key element in addressing challenges on this

issue) and can provide the necessary accountability for moving forward with policy implementation.

Stakeholders’ sentiments about the WHO largely echoed what they suggested to be done to overcome hurdles and barriers to increasing

support for maternal health.

• The WHO should help provide crucial understanding to national governments and other organizations to ensure that maternal health is

a priority by utilizing policies that are in place, such as the essential medicines list and continue their work by monitoring the roadmap to

maternal health that has been created, bringing much needed accountability to the space.

• Stakeholders felt that policies were already in place but that it is important to bring continued understanding to national governments

and other organizations such as UNFPA, UNICEF, WHO, and UNAIDS who have influence on policymakers and implementers. One

stakeholder mentioned that it would be beneficial if staff from this organization had specific direction and authorization from their

headquarters to make the conversations about maternal health and maternal health supplies a high priority.

• Several stakeholders mentioned WHO’s role in putting out the essential medicines list and the importance of this list. While this list

exists, one stakeholder mentioned the importance of WHO to clearly articulate what the important medicines are for this. Another also

mentions the need for WHO to work closely with drug manufacturers to leave no stone left unturned in search for cheaper, generic

drugs.

• Accountability is another theme that stakeholders mentioned. There is a need to monitor the policies for the governments and other

stakeholders to ensure that commitments that have been made are being honored. One stakeholder mentioned that if the existing

commitments were monitored and implemented then a large part of the problem would be addressed. One of the barriers to keeping

everyone accountable is that prioritizing has to occur and that is very difficult when dealing with competing priorities in health and

limited resources. Some also mentioned the need for more integrated medicine policies.

• Showing support for the issue is also seen as a theme. Some stakeholders believe that this support should be shown at the country and

even the community level, through work with organizations of influence, as stated above, while others believe it should be at the UN

level. Making sure that everyone is committed should be a priority, through increased budget, and increased training.

Types of Innovations: Focus for Future R&D

Aside from advocacy, it’s the supply chain that is most commonly mentioned as an area to address, including innovation. And, supply chain is an

issue that plagues not just maternal health supplies. Potentially, there are innovations and/or solutions for providing maternal health supplies

that can then apply to other types of medicines and other supplies.

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Getting stakeholders to set aside advocacy as a focus is difficult, and it even surfaced when asked what types of innovations relative to maternal

health supplies development and delivery should be a focus.

• Many stakeholders struggled to answer questions surrounding innovation, largely due to not having the knowledge to support foresight

into what innovations could be worthwhile. Some who found this difficult to answer shared examples from other health sectors that

they felt could be relevant here.

• Ultimately, suggested innovations that would aid in the development and delivery included:

o Packaging. A stakeholder cited a “little ketchup pouch” as a way to deliver medicine to infants with little waste (calling this

“low-tech” technology). Another mentioned micro needle pouches. These examples of packaging from other health sectors felt

like relevant ways of thinking for maternal health supplies (even if the actual package recalled was not relevant).

o Supply chain innovations. Any innovations that can improve the supply chain through reducing travel to hospital, increasing

transportation and accessibility, moving regional warehouses closer to a district, management of supply closet, inventory

management, supplies management, and qualified staff to manage supply chain tasks. Operations research, and community-

based distribution were also mentioned in tandem with supply chain innovations.

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Number in parenthesis indicates the total stakeholders interviewed in that sector *Note: one representative from this group only participated in half of an interview

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Workshop and Creative Collective Summary

This section summarizes the discussion from the PATH Maternal Health Supplies Advocacy Message

Workshop held on Wednesday, April 11 at the PAI offices in Washington DC, outlining the goals, target

audiences, strengths, opportunities and challenges in messaging related to maternal health supplies

advocacy. Attending the session were fellow maternal health advocates from several organizations2.

Overview of Session and Key Outcomes

The message workshop began with an introduction and sharing of objectives for the session which

included:

• Sharing insights from review of an issue and message landscape;

• Refining communications goals and target audience priorities;

• Compiling and prioritizing potential messages that convey the key topics, urgency and value of a

maternal health supplies advocacy initiative; and

• An overview of next steps including testing with key external stakeholders.

Six main themes emerged as a result of the workshop, all of which have implications for messaging.

• There’s synergy between learnings from stakeholder interviews and the dialogue between

workshop participants. Stakeholder interviews showed us that maternal health supplies were a

critical component for making an impact on maternal health, but the challenges facing them

were significant. Much work is to be done to get policymakers to understand the importance of

supplies, how these supplies connect to broader maternal health needs and to better

understand how key policy issues (e.g., supporting supply chain system improvements)

contribute to achieving maternal health goals. Workshop participants echoed these sentiments,

and shared their concerns over lack of data and research that would confirm the impact and

need for supplies and clarify key policy issues. They also shared that the advocacy community

needs to become engaged and recognize its role in emphasizing the importance of supplies.

Many of the participants may identify elsewhere in maternal health, but not in supplies.

• The main overarching goal that brings advocates to the table to talk about maternal health

supplies is simple. The goal is to ensure that low cost and high quality maternal health supplies

are available for women who need them, when women need them. That goal then supports the

group’s larger goal, which is to minimize maternal death. No mother should die giving life.

• There are shorter term goals and objectives of importance. These include ensuring that the

target audience is educated on the importance and the issues surrounding maternal health

supplies, securing advocates for maternal health supplies that will help lead the way for tackling

2 Attendees included: Janna Oberdorf- Women Deliver, Rachel Wilson-PATH, Kristy Kade-PATH, Abi Weaver-PATH, Dilly Severin-PAI, Elisha Dunn-Georgiou-PAI, Allie Doody-PAI, Elizabeth Leonard-PAI, Bonnie Keith-RHSC, Shafia Rashid-FCI, Crystal Lander-MSH, Bridget McHenry-White Ribbon Alliance.

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the issue, and ensuring accountability for policymakers and global funders to show responsibility

and ownership regarding this issue as one of their goals.

• Opportunities are numerous. The most visible opportunity to utilize is the UN Commission to

help bring a strong voice and a clear set of policy-focused recommendations to the cause. In

addition, tools from the reproductive health community can be adapted and used for models.

Secondary research such as case studies and pilot programs can help illustrate impact and there

are numerous gatherings and meetings within the maternal health community that can provide

a platform to extend the dialogue.

• Challenges are also significant. The most discussed challenge, and the perceived biggest road

block by the workshop group, is lack of data and evidence showing the impact of maternal

health supplies on maternal health overall, as well as lack of evidence to prove an unmet need.

Another significant challenge is the monitoring and accountability in terms of follow-through of

policies prioritizing maternal health supplies in countries where they exist.

• When it comes to messaging on maternal health supplies, there’s room for a humanistic voice,

as well as an economic voice. The group would like to enter into the MHS conversation through

the prism of the larger maternal health issue. The humanistic voice addresses what supplies can

do for maternal health, how they can truly save a life, and that no woman should die while

giving life (especially when a large number of the deaths that occur are from preventable

complications). The economic voice addresses how supplies help bring about a return on

investment within other areas of maternal health, although specific proof points may need

further development. Lastly, messaging should explore the connection between maternal

health and children’s health, the entire family unit and the community as a whole.

Goals, Defining Progress, and Success

Successful communications and advocacy campaigns are rooted in shared goals and indicators of

success. Therefore the interactive portion of the messaging workshop began by establishing

communications goals, both short term and long term.

Short term goals can fall in to three categories:

• Providing a clear understanding of the issues and policy next steps surrounding maternal

health supplies. There is a need to affirm what maternal health supplies are, and why they are

important, especially as it relates to access to care and safe childbirth.

Lack of awareness and education on the importance of maternal health supplies is an issue,

even within the community which works on maternal health and therefore raising awareness

and defining maternal health supplies as an issue is critical. Crucial to building awareness is

identifying clear next steps with respect to specific policy needs (e.g., quality issues, supply

chain, and regulatory needs) and community responsibilities.

• Connecting maternal health supplies to maternal health, positioning it as a lynchpin for

addressing the larger issues surrounding maternal health. Maternal health supplies are

absolutely essential to maternal health, and therefore to women. Without supplies, you cannot

save lives.

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• Establishing champions for the cause of maternal health supplies. Maternal health supplies

needs to have champions that will help coordinate all partners and advocates by way of

resources, policies, and donors and would serve as a resource for where medicines and other

supplies are available and accessible. Coordination with these champions of sorts could help

bridge the gap between the private and public sectors to ensure that everyone is on the same

page and working together as well as possible.

• Ensuring that national governments and global funders are accountable and show

responsibility and ownership of providing maternal health supplies. In countries where

policies have been established to provide supplies or to fund maternal health, there needs to be

monitoring of implementation to ensure that these policies are being enforced. In countries

that have not adopted policies that include supplies, work must be done to bring supplies into

the fold.

To measure progress toward near term goals, advocates identified the following methods as beneficial

in taking the pulse as to where they are:

• A greater understanding of maternal health and maternal health supplies among the advocacy

community and key stakeholders

• Build the connection between supplies and broader maternal health outcomes

• Building the case for maternal health supplies, and inspiring policymakers/influencers to action

• Building partnerships and engaging advocates

• Monitor message pick up in the media

• Oversight to make sure that policies exist and are being implemented

• Engaging national governments so that they care about the issue

Long term goals center around deepening some of the short term goals, such as educating and engaging

additional audiences, creating more partnerships spurring accountability and measurement.

The long term goals included:

• Building an infrastructure to support the necessary supply chain for quality maternal health

supplies

• A reduction in maternal death and an improvement of maternal health through access to

essential supplies that are where they are needed when they are needed made possible through

donors and the maternal health community striking an important partnership

For the long term, success will be defined mostly by a reduction in maternal death, and existence of an

infrastructure to support the supply chain and other delivery issues. However, measuring the reduction

in maternal death is challenging given the lack of data quantifying death due to inability to access

supplies.

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Targeted Audience

The ultimate audience is global policymakers,

national governments and influencers. However,

there are audiences surrounding that group that

can be conduits for influencing and reaching that

group.

The group discussed how maternal health

advocates in the room held the ability to

influence the working group and community of

maternal health advocates as well as the UN

Commission Thereby both parties could

influence donors. And, all three then play a role

in influencing governments, as well as global

policymakers and influencers.

Strengths and Weaknesses

Strengths, assets and opportunities

Perhaps the most visible and immediate strength, opportunity and asset is the UN Commission. This is

seen as a group that can bring a voice to the issue, clarify key policy issues and can use its influence to

build accountability and drive change.

Additionally, the following elements were mentioned as beneficial for maternal health supplies:

• Tools from the reproductive health community can be adapted and used as models for supplies

when building systems to track usage and build accountability. This may also help quantify need

and unmet need;

• There are case studies and pilot programs in providing supplies that can be useful for illustrating

impact;

• Solutions are known, and low cost;

• There are various convening and meetings within the maternal health community that could

support extended dialogue on supplies;

• The request is not just monetarily based; and

• Supplies can be linked to ROI on other investments. A skilled health worker is not effective if

there are no medicines available. Healthcare clinics and community health workers aren’t

nearly as useful if they don’t have medicines to dispense as needed. Supplies can be positioned

as the element that makes the rest of these areas have the most impact.

Challenges, weaknesses and liabilities

Strengths outnumbered the challenges identified by the group, however some challenges are

considered significant.

The group largely focused on the lack of data and evidence to show the impact of maternal health

supplies and the unmet need. With that, there is also a lack of collected data surrounding usage and

outcomes.

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While it is commonly understood that the presence of supplies enables healthcare workers to treat a

woman who is hemorrhaging or has pre-eclampsia/eclampsia, and ultimately saves her life, there is a

lack of hard proof for quantifying usage and unmet need. That makes it hard to show the severity of the

situation, the opportunity of impact and to then show progress toward a goal. It should be noted that

this is an issue that was perceived to be a much greater challenge among workshop attendees than it

was among target stakeholders interviewed during the landscape assessment. This could in part be due

to the intuitive nature of the need and some stakeholders’ belief that research and data already exist.

Other challenges cited by the group included:

• The lack of a clear “ask” or monetary commitment. Part of this ties back to lack of research and

evidence in quantifying an unmet need

• The politics surrounding misoprostol and its use as an abortion agent

• It is challenging to make a case for global production when medicines are already low-cost

• Getting on meeting agendas

• To date, most spokespersons on maternal health supplies are technical experts not advocates,

and therefore messaging to date has been very technical vs. advocacy-oriented. While the

technical expertise is critical, sometimes it is the emotional or personal angle that gets targeted

audiences to connect and feel committed to the issue

• Affirming what maternal health supplies are, and why they are important, especially as it

relates to access to care and safe childbirth. As stated previously, there is a lack of awareness

and education on the importance of MHS as an issue, even within the community who work on

maternal health

Top Strengths

UN Commission

Tools from RHSC

Case studies and pilot programs showing success

Convenings

Known , low-cost supplies

Top Challenges

Lack of data to quantify unmet need and impact

Politics surrounding misoprostol

Justifying need for global production

Spokespersons need to be less technical

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Message Platform Development

Each workshop participant was asked to complete their own messaging platform, listing the objectives,

principles, facts, impact and inspiration from which the messages should be built. The target audience

for this exercise was global policymakers and influencers.

The sections and the grid below summarize themes shared by the group, and also provides

representative examples of responses from the worksheets.

It should be noted here that the group did not come to consensus on how to go about obtaining the

research that they felt was lacking for effectively bringing policymakers and influencers along on seeing

the importance of maternal health supplies.

Principles

Advocates were asked what some of the basic beliefs or values that they and the audience (global

policymakers and influencers) could take on faith are true. There was one main theme that emerged

from this discussion.

Every woman has the right to survive - there are no good reasons why deaths should NOT be prevented.

• Many advocates mentioned that safe motherhood should be universal, that every woman

deserves to live, especially when the price of “saving her life” amounts to a solution that already

exists, and is cost-effective.

A couple advocates mention the importance and feasibility of a flourishing supply chain.

• A well-stocked, well -run supply chain is essential to building a strong health system.

• Managing this supply chain is something that should be achievable.

Supporting Themes

Advocates were asked what facts or supporting ideas would most likely be relevant and persuasive in

making the case for increased support for and investment in maternal health supplies. Most found facts

that centered around the following themes to be most important to convey in messaging.

Facts illustrating known solutions to problems plaguing maternal health in general, and supplies.

• Right now, the solution is at hand, not something that needs to be thoroughly researched to

determine how to keep women from dying during and after childbirth.

• The facts about the true problems that are plaguing women in developing countries, that

pregnancy-related deaths cause so many women to die, is something that needs to be exposed

to ensure that everyone is on the same page about how huge of an issue this is.

Facts showing that the solution is low cost and effective.

• Advocates believe that the facts need to be displayed in black and white. Numbers need to be

put down that show just how many lives are saved when a certain amount of money is spent on

this cause.

• The economic impact that women have is also something that needs to be explored, as when a

woman’s life is cut short, all other investments in her life were in vain and her future

contributions are lost forever.

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Outcomes-oriented facts, showing the full value of a mother to both her family and the larger

community.

• Tying the health of the mother to the health of the child is very important. Showing facts that

bring to light the number of children that live to the age of 5 after the mother has died

during/after childbirth would help to show how essential that mother’s life is to that child.

Supplies are essential for administering care.

• Just like you can’t drive a car without gas, you cannot provide care to pregnant women or

women who just gave birth without the essential supplies. Without supplies, healthcare

workers, hospitals and care facilities are handicapped in what they can do.

Impact & Inspiration

Advocates were also asked why the world or audience would be better off if the goals were achieved.

Feedback included:

• Humanistic/mother focused:

• Imagine a world where more mothers would be able to come to expect to survive the

birth of their children and also have a healthy child.

• With mothers in this world, their children, their family and their communities are better

off.

• The impact that mothers have on their children, family and communities is something

not to be discounted.

• Financial/ROI focused:

• Financial goals would be realized for donors who would receive the return on

investment that they expected or higher than they expected.

• Other goals would be met, like the Millennium Development Goals (MDGs).

• Health-system and health worker focused:

• Health systems and facilities would be operating more to their potential, leading health

workers to be more at their potential.

The chart below reflects the notes that workshop participants made in drafting their own platform.

These will serve as a reference and source material as our team constructs the draft message platform.

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Participant

Notes Audience Objective Principles Facts Impact and Inspiration

Themes of

responses

Global

policymakers

and

influencers

MHS are the lynchpin for

problems plaguing maternal

health; increase in support

for funding, policies and

access to essential supplies.

Every woman has the right to

survive; no good reasons why

deaths are NOT be prevented;

having a well-stocked, well

run supply chain is doable and

essential to building strong

health system.

Proven solutions are cost

effective, available and they

exist TODAY; how many deaths

could be prevented spending x

number of dollars on medical

supplies; women’s impact on

family and communities.

Impact women have on

children, family and

communities; goals being

reached (MDGs); financial

goals are met and have better

ROI, improvements to health

system.

Example of

responses

Global

policymakers

and

influencers

Mothers and women are

essential for the economy of a

country & you can't support

child survival w/o maternal

health.

Every woman deserves access to

skilled health provider and the

necessary medicines to save her

life during delivery.

Proven, effective medicines exist

that could prevent the majority of

maternal deaths.

Saving women's lives has a ripple

effect - her children are

healthier, her communities are

stronger, and economies can

benefit for her inputs.

Maternal health supplies are the

lynchpin to solving this maternal

mortality challenge that they

(the global policymakers &

influencers) have committed to

fix.

A healthy happy mom is better

able to raise healthy kids and is a

force for positive change in her

community. Imagine life without

a mother. Why wouldn't you do

everything to prevent any child

from going through that?

Lifesaving technologies and

supplies EXIST TODAY.

More mothers will live and more

children will have mothers.

Increase support for and

funding to both increasing

maternal health supplies and

improving access.

Access to quality MHS are

important for saving women's

lives.

MHS gives women a reason to go

to facilities for labor/delivery.

MHS gives governments/donors a

reason to build and expand trained

health worker base.

With access to medicines and

skilled health care providers,

most women across the world

can expect a successful delivery

and a healthy newborn.

MH supplies are essential to the

global health and development

agenda.

Maternal health leads to

family/community stability.

MHS are a cost-effective

investment. X # of maternal

deaths could be prevented

through X investment in X # of

oxytocin, magnesium sulfate,

misoprostol.

Women healthier. Women not

dying.

Understanding that commodity

security for MHS is integral to

quality provision of maternal

health care.

Death from preventable

causes/lack of supplies to treat

conditions is unacceptable.

Managing a supply chain is

possible.

MHS are low cost. MHS are proven

to improve maternal health, save

women's lives, and help achieve

MDG 5.

Healthy moms lead to healthy

families and communities.

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Validation

This section of the report will outline the results of the validation research message testing

among key external stakeholders.

Research Objectives and Methodology

KRC Research conducted nine 30-40 minute, one-on-one in-depth interviews (IDIs) with the key

target audience between May 24 and June 12, 2012. Our target audience was comprised of

individuals who work as global policymakers and donor or foundation partners in administrative

health and procurement systems, peers at other NGO organizations and partners in private

sector corporations with leadership roles in maternal health issues.

Participants were recruited to partake in the interview by a recruiting team, and the sponsor of

the research was not disclosed during the recruit process, or at any time during the interview.

The objective of this research was to explore thoughts, opinions and reactions to the

overarching theme guiding advocacy for increased investment in and prioritization of maternal

health supplies and test potential messages that convey the value of investment in priority

maternal health supplies.

To that end, the conversation followed a custom-designed discussion guide that addressed the

three purposes of the research.

Overview of Findings

Our audience of global policymakers and influencers needs messages that educate on the

importance of supplies, illustrate the value of the investment, show commitment and

partnerships globally.

The short-term goal/ “ask” is to elevate the importance of funding supplies. Similarly the long-

term goal was to secure funding.

The overarching theme is accurate, believable, contains powerful word in “essential” but it

needs a more direct or strong statement to engage in what comes next.

The supporting statements include emotion as well as facts and information. They also educate

on the importance of supplies.

The themes convey important points, introduce new arguments for supplies and provide

“something for everyone” in the audience. They need some refined focus to emphasize

importance of “availability” of supplies, and a more “politically correct” way to discuss

partnerships.

Messaging Needs of the Audience

The audience is global policymakers and influencers. They therefore need messages that:

• Educate on the importance and need for supplies

• Can be applied and used across the broad community

• Show partnerships, working together to improve maternal health

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• Show the economics of the issue, the investment, the ROI of investing in supplies

This initiative is asking both

donors and stakeholders for

increased funding for services

and resources and increased

political attention – but that

policy is a secondary "ask" to

funding ( not a lot of points

specifically focusing on policy).

Global heath leaders and

organizations such as: UN

Commission, UNFPA,

Reproductive Health Supplies

Coalition, Bill and Melinda Gates Foundation, CARE, Save the Children, Every Mother Counts,

PATH and Family Care International would be the voices behind this message, according to the

survey participants.

In order to increase support among this audience it is recommended the messages connect to

specific evidence, using a ROI model. Also, partnering with other advocates in reproductive

health, abortion, family planning etc., to ensure everyone is on same page and increase support

for messaging will ultimately increase support for needed policy changes and funding.

Overarching Theme: Health Supplies: Essential to Protecting Mothers Before, During

and After Childbirth, Improving Maternal Health

The statement is found to be accurate according to those in the target audience, yet it lacks an

exciting call to action needed to emphasize the importance of supplies and the life-saving

potential they carry.

• As a statement, it is accurate and

believable and it includes an

important reference to stages

associated with maternal health.

The word “essential” was found

to be very important and

influential, but the statement

overall lacks excitement or a call

to action.

• As a theme, it should more

specifically connect “essential”

with “women’s health” so that it

carries more interest and it should emphasize the life-saving potential of supplies.

In their own words:

“One thing I think commodities have going for them in the

broader discussions is that you can actually count them

and talk about them as defined things.”

“We need to move a little bit further away from these

general statements of ‘no woman should die giving birth,’

to’ this is what your money buys - this is what your

policies will achieve.’”

In their own words:

“If the mother doesn’t survive, it obviously has

very negative impacts on the wellbeing of

children… but it’s a little detached from the

wider ramifications of maternal survival.”

“It’s generic. It doesn’t sound like people have

strong information and it’s not powerful

enough. It’s right, but it’s what you can read in

any paper on maternal health. ”

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• The audience expects to hear a clear “ask” – a statement of the impact it will have on

women’s lives as a result of the funding and clear data-based evidence that supports the

follow-up statements in terms of the impact it has.

• In order to improve, more closely associate “essential” with “improving women’s lives.”

“Supplies: Essential for improving women’s lives throughout stages….” brings impact

while preserving the message. “Essential for improving lives” gives people a reason to

listen.

Respondents felt the use of imagery was very compelling. The overall message is a familiar topic

of discussion in the area of maternal health, allowing it to correspond well with the current

maternal health initiative.

Supporting Statement Why it works

“Can you imagine a woman in

labor arriving at a clinic to deliver

her baby only to find that the

basic medical equipment,

medicines, and health staff aren’t

there?”

The imagery of a woman coming to an ill-equipped center

was very compelling, memorable and well liked.

Vagueness piques curiosity a bit: What are these medical

centers lacking in exactly? But the knowledge gap means

that messaging must answer that question.

“But for many women in

developing countries, childbirth

can be life-threatening.”

The fact that childbirth is still life threatening for women is

unacceptable. The audience can tolerate this element

being so direct without being bothered by the content.

Begs the question: how many actually are at risk or do die

during childbirth?

“Ensuring access to basic

maternal health care will prevent

hundreds of thousands of women

from dying during pregnancy and

childbirth and ensure that they

and their children live healthier

lives.”

Very appropriate for the maternal health movement and its

current goals. Women need to and should be able to reach

these supplies with ease—but it is as much if not more

about availability vs. just access.

Reference to “basic maternal health care” feels inclusive.

Reference to “healthy lives” and “children” help establish

the value of a woman, as well as her connection to a child.

While respondents felt positively about the imagery in statements, they disliked statements that

did not clearly define the roles and actions of government and other influential figures, or why

there is a lack of supplies.

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Supporting Statement Why it needs strengthening

“Policy leadership matched with

much-needed investments…”

The specificity on how the entities involved are going to

solve the problem is compelling, but the statement could

be strengthened with exactly what investments can be

made by these global leaders, national governments and

maternal health advocates.

It was also mentioned that these entities need to make

commitments, not investments, to maternal health

improvement.

“…will provide women with

access to proven, low-cost

maternal health supplies needed

to save millions of lives

worldwide.”

Economic argument is important, and a welcomed

addition to the typical moral arguments in maternal

health.

Lacks call to action without more data about need or

impact.

Begs the question- if low cost, why isn’t there more

access?

“Working together, global

leaders, national governments

and maternal health advocates

have the power to elevate the

critical role of maternal health

supplies…”

The idea of “working together” resonates well, and the

merger of the entities that have the ability to resolve the

situation is powerful.

Starts people thinking about the role of each entity, and

how they actually do work together.

Sensitivities surrounding the use of “power” as it feels like

a strong, almost threatening word. It’s more about

opportunity, ability, and authority to make a change.

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Themes

After the statement, a series of themes was read to participants. Again, respondents felt

positively about the use of imagery and economic ROI reasoning. Respondents did, however,

express a desire for more specificity and details in each statement.

Theme Text

Theme 1: No woman should die giving life “The solution to safe pregnancy and childbirth for

women in the developing world starts with access to basic health care, including maternal

health supplies.”

Theme 2: Access to overlooked supplies saves lives and improves maternal health “Supplies

are an essential solution to improving maternal health, especially during pregnancy and

childbirth. Maternal health supplies need to be available at the health clinics and in the

hands of trained health care workers to save women’s lives.”

Theme 3: Leadership and investments in maternal health supplies matter “Global leaders

and national governments have the power and responsibility to protect women’s lives during

pregnancy and childbirth with greater investments in maternal health medicines and other

supplies.”

Theme 4: Saving mothers means stronger families, communities and nations “Healthy

mothers have a powerful ripple effect. To save a mother is to save a family. And to save a

family is to lay the foundation for stronger communities and more stable nations.”

On the whole, the impact of all four themes can increase by using more examples, evidence,

and specifics to back up the statements:

Theme What does it Communicate How to Increase its Impact

“No woman

should die

giving life”

Moral argument that basic care

and supplies are the solution to

maternal health.

• Allow for customization that

includes specific supplies.

Because the focus is on

supplies being part of the

solution, naming them

becomes more important

• Consider reference to

economic impact along with

moral argument

“Access to

overlooked

supplies saves

lives and

improves

maternal

Access to supplies, saving lives,

improving maternal health, and

the connection to health care

workers.

• Reduce length and complexity

• Re-focus on “availability of

supplies.” Having available

supplies means health care

workers have something to

administer, women have a

Page 45

Theme What does it Communicate How to Increase its Impact

health” reason to go to the facility,

and the medicines for saving

lives are literally within arms’

reach.

“Leadership

and

investments in

maternal health

supplies

matter”

Brings national governments and

global leaders along as partners in

improving maternal health.

• Focus on the authority and

ability that governments have

to make a difference, in place

of “power” and

“responsibility” which feels

obligatory and forceful. The

value in this message is that

governments are partners,

and forceful words counteract

that.

• Give examples of investments

that have been done in the

past (perhaps as proof points).

“Saving mothers

means stronger

families”

Importance of mother’s health to

her family and community.

• Build evidence reference into

theme, so that this is less

philosophical. “In countries

where… in communities

where…”

• Use available data to build the

proof step-by-step, even if

proof of the direct connection

doesn’t exist.

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Theme 1: No woman should die giving life

No woman should die giving life “The solution to safe pregnancy and childbirth for women in

the developing world starts with access to basic health care, including maternal health

supplies.”

Overall Observations:

Even though “No woman should die giving life” is a common phrase – most see it as a positive,

compelling statement. Adding examples of supplies will avoid the question “what supplies,”

even if it is a broad range. Some suggest this statement needs to be strengthened, referencing

the value of the investment in maternal health. The expectation is that data on maternal deaths

and cost of supplies will be used to support the statement. Some note that family planning is

missing.

Positive Elements

Those portions of the theme that were well received included:

Phrase It’s impactful because…

No woman should die giving life Phrase is powerful and repeatable

The solution to safe pregnancy

and childbirth for women

Showing stages of pregnancy and childbirth is a positive

Areas for Improvement:

Those portions of the theme that could benefit from improvement included:

Phrase Improve because

Including maternal health

supplies

Desire to see illustrative examples of supplies because the

message is so focused on supplies being the solution

Recommendations for this theme:

In order to be more impactful for the target audience, the theme needs to allow flexibility in

naming the specific supplies needed. Also, while the moral argument is very impactful, this

theme could do more to reference the equally impactful economic argument for increasing

maternal health supplies.

In their own words:

• “I think that the no women should die giving life is a very powerful phrase that we

use often in this field.”

• “It’s short, it’s compelling, no woman should die from things that are preventable

and especially when giving birth.”

• “I liked it, it does point out or highlight the fact that these are preventable deaths

and there’s something that can be done, and that something starts with essential

supplies.”

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Theme 2: Access to overlooked supplies saves lives and improves maternal health

Access to overlooked supplies saves lives and improves maternal health “Supplies are an

essential solution to improving maternal health, especially during pregnancy and childbirth.

Maternal health supplies need to be available at the health clinics and in the hands of trained

health care workers to save women’s lives.”

Overall Observations:

The link to health care workers makes this a valuable and powerful message. However, it feels

confusing and complex, referencing access, supplies, workers, when this really feels like

“availability.” Additional statements provide much needed clarity around theme. Some say this

has a less emotional pull than others tested, focus on availability could amplify. Leverage proof

points that show outages, supply, deaths and costs to work in an economic angle.

Positive Elements

Those portions of the theme that were well received included:

Phrase It’s impactful because…

Maternal health supplies need to

be available at the health clinics

Brings availability of supplies into the conversation (not just

access)

and in the hands of trained

health care workers to save

women’s lives.

Good duality of end-user need and health care worker

need

Areas for Improvement:

Those portions of the theme that could benefit from improvement included:

Phrase Improve because

Access to overlooked supplies

save lives and improves maternal

health

Feels less about “access” more about “availability.”

Recommendations for this theme:

This theme needs to focus more on the availability of supplies, rather than access, using

language that stresses the importance of having these supplies continuously and readily

available to health care workers. Also, reducing the length and complexity of the message would

make its goal clearer for the intended audience, and, therefore, more likely to incite action.

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In their own words:

• “It’s good because it brings in the skilled workers aspect, because without

skilled workers the supplies can’t be delivered effectively… that linkage is

critical in this message.”

• “You want short statements that convey as much in the statement without

being too wordy, so it’s access to essential maternal health supplies.”

• “This message was pretty clear. It addresses the issues of supplies as well as a

trained provider, that’s important and I think taken together this is a more

powerful message.”

• “I think it’s important to be more specific on supplies as we possibly can be. But

when this is such a high-level advocacy statement, it might be a bit difficult to

be more specific. I think the contexts are pretty different, depending on the

region or the country.”

Additional Statements:

Additional statements were similarly presented to participants, which were found to have a

positive impact on the original theme.

Theme What does it Communicate How to Increase its Impact

“At the heart of good maternal

health care is a set of basic,

low-cost, but essential supplies

which include contraceptives,

medicines, and simple

equipment (e.g. manual

vacuum aspiration), among

others.”

Addresses curiosities in

theme & strengthens

argument.

Fear over MVA being off-

putting

“Women everywhere depend

on a stocked supply cabinet.”

Good imagery, speaks to

availability.

Feared that reference is more

for “Westerners.”

In their own words:

• “It basically shows you are not just asking for pregnancy and childbirth you are

asking for the whole reproductive span of a women’s life from planning a

pregnancy to having a pregnancy and childbirth to choosing not to have or

terminating a pregnancy. That is a much wider scope of a women’s

reproductive span than just the childbirth which is what normally I think of

when I think of maternal health supplies.”

• “Yeah, I mean again I think it depends on who the audience is. I think for a U.S.

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government type of audience it could be somewhat off-putting if people know

what that is, but if it’s outside the maternal healthcare family planning, they

might not.”

• “If you need to mention MVA, you might wish to mention it as part of a longer

list, rather than singling it out. Because I think you’re just looking for trouble.”

• “A stocked supply cabinet is something we can visualize.”

• “It’s effective if its high income audience and if it’s in an environment where

there are very many stock outages but that having a healthy stocked cabinet is

something but that it may be foreign to most people.”

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Theme 3: Leadership and investments in maternal health supplies matter

Leadership and investments in maternal health supplies matter “Global leaders and national

governments have the power and responsibility to protect women’s lives during pregnancy

and childbirth with greater investments in maternal health medicines and other supplies.”

Overall Observations:

The economic angle in this message is important, and new to the issue. Sensitivity exists

regarding wording choice. While some like the call out to leadership/governments , others do

not like the word “responsibility.” This is about persuading leaders to leverage their authority

and ability to bring about change. They have the opportunity to make a difference. Examples of

investments will help add clarity surrounding what leaders can/should do

Positive Elements

Those portions of the theme that were well received included:

Phrase It’s impactful because…

Leadership and investments in

maternal health supplies matter

Including leadership as a partner in making maternal health

supplies available is necessary and important.

Economic angle is a new, and welcome argument alongside

the moral position.

Areas for Improvement:

Those portions of the theme that could benefit from improvement included:

Phrase Improve because

Global leaders and national

governments have the power and

responsibility

The words “power” and “responsibility” can feel

uncomfortable and cause resistance in using for some.

with greater investments in

maternal health medicines

Desire for specificity on the type of investments

Recommendations for this theme:

While it was seen as beneficial to call out specific entities who play a role in improving maternal

health, the forceful language used such as “power” and “responsibility” didn’t fit with the

overarching theme of a need for shared and voluntary efforts among government powers.

Continuing the specificity with examples of what has been done in the past would also help to

make this theme more impactful.

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In their own words:

• “I think it’s good to call on governments to say that you have both the

opportunity and the responsibility to impact maternal mortality. I think if you

could follow it up with a strong concrete ask with how much you are looking for

people to invest or what kinds of programs you are looking for them to invest in

supplies, etc.”

• “The word power seems strange. We have the power to, I don’t know what. Is

that money or something else? Influence? What is it?”

Theme 4: Saving mothers means stronger families, communities and nations

Saving mothers means stronger families, communities and nation.

“Healthy mothers have a powerful ripple effect. To save a mother is to save a family. And to

save a family is to lay the foundation for stronger communities and more stable nations.”

Overall Observations:

This theme was well received by most. It resonates with many because of the link to the bigger

picture. It clearly shows the link between a mother and nations, which logically makes sense. In

order to strengthen the statement, consider alluding to where this is evident. Utilize the proof

points to build the case off of incremental data that currently exists.

Positive Elements

Those portions of the theme that were well received included:

Phrase It’s impactful because…

Saving mothers means stronger

families, communities and

nations

“Ripple effect” resonates with many.

Areas for Improvement:

Those portions of the theme that could benefit from improvement included:

Phrase Improve because

Healthy mothers have a powerful

ripple effect

Desire to allude to where this is evident, so it is less

philosophical and more actual.

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Recommendations for this theme:

As in other themes, this could be improved with more specificity and detail. Having examples or

statistics of how mothers impact their community could support the statement, and in turn

make it more impactful among those in the target audience.

In their own words:

• “I think it is the evolution of the statement is quite good, stronger woman,

stronger health that makes stronger family and I think it’s a good point.”

• “I always think that is a good message but it would have to come after you’ve

explained with that problem is, why do you need to save mothers, I mean not why

do you need to save mothers but what’s the problem, that women are dying in

childbirth.”

• “That one is very believable because its set in a wider context about why does this

matter, I mean ultimately this is about peace and security, apart from the

happiness of an individual and individual family unit.”

• “It’s a big jump between women, between saving women’s lives and laying the

foundations for stronger countries or nations.”

Additional Statement:

Phrase It’s impactful because…

Tell me more about what type of

proof we need here to show long-

lasting impact through funding

maternal health supplies.

“Show countries where this is effective. Show data that

builds the case (in stages – helps mothers – helps families,

etc.)

In their own words:

• “There is a lot of follow up facts that even exist today that you could add to that,

the ripple effect so that sort of effect it has on children, the effect it has on families

and communities, the effect it has on economies… Additionally it would be great if,

again, we could have a cost on the other side of how much it would cost to save

these women’s lives.”

• “I always like those kinds of things, you know, those more general things followed

up by some facts. Like, the risk of a newborn dying is twice as high, or 10 times as

high, if their mother dies. Or, things like that, that support the statement that, in

fact, saving a mother’s life saves, improves their children’s life chances, supports

their family’s economic wellbeing and helps build the community.”

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Priorities for Proof Points

One of the key ways that the messages will become more effective is by adding specificity and

reliability through proof-points. The most important ones include:

• The overarching theme is the scope of the issue – how many women is this affecting?

How many women are dying in childbirth? What percent of women are denied this

access of care? Where do these women live? What supplies are lacking? How much do

those supplies cost?

• “No woman should die giving life…” Provide illustrative examples of what supplies are

and the number of maternal deaths in developing world.

• “Access to overlooked supplies…” Provide illustrative examples of what supplies are and

the number of maternal deaths in developing world.

• “Leadership and investments in maternal health supplies matter” Needs an explanation

as to if it is so easy, why isn’t it happening? What are the barriers getting in the way?

Show concrete examples of how responsibility and partnership between entities have

made a difference.

• “Saving mothers means stronger families” Show reduced mortality in countries where

maternal health improved. Statistics on how saving mothers helps children( what

percent will live to fifth birthday, relationship between living mother and

education/nutrition of child, etc.)

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In Summary: Maximizing Impact

Theme: This theme is about: To increase impact:

No woman

should die giving

life

• Moral argument that

basic care and supplies

are the solution to

maternal health

• Allow for customization that includes specific supplies. Because the focus is

on supplies being part of the solution, naming them becomes more

important.

• Consider reference economic impact along with moral argument.

Access to

overlooked

supplies saves

lives and

improves

maternal health

• Access to supplies,

saving lives, improving

maternal health, and the

connection to health

care workers.

• Reduce length and complexity.

• Re-focus on “availability of supplies.” Having available supplies means

health care workers have something to administer, women have a reason to

go to the facility, and the medicines for saving lives are literally within arms’

reach.

Leadership

and investments

in maternal

health supplies

matter

• Brings national

governments and global

leaders along as

partners in improving

maternal health.

• Focus on the authority and ability that governments have to make a

difference, in place of “power” and “responsibility” which feels obligatory

and forceful. The value in this message is that governments are partners,

and forceful words counteract that.

• Give examples of investments that have been done in the past (perhaps as

proof points).

Saving mothers

means stronger

families

• Importance of mother’s

health to her family and

community

• Build evidence reference into theme, so that this is less philosophical. “In

countries where… in communities where…”

• Use available data to build the proof step-by-step, even if proof of the direct

connection doesn’t exist.

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Implications

The core goal of this process was to create a jointly emotional and economically motivated

theme that encompasses the reasons why maternal health specifically is so important and how

access to health supplies is the key to improvement. The theme needs to be not only concise but

also specific, providing evidence and examples in order to better educate the audience and call

them to action. To that end, there are four implications for themes when it comes to obtaining

funding for maternal health supplies.

Education brings clarity. While the value of maternal health supplies is logical for many, it is a

newer focus in maternal health discussions, and there are curiosities surrounding what

constitutes maternal health supplies, what exactly makes them hard to attain, and why they are

so critical. Educating on the importance, the need, and the lack thereof builds impact, because

the audience then understands more about making maternal health supplies available.

Lead with impact. The audience wants (and needs) to feel impact at the onset of the

overarching theme. And, they agree, supplies save lives. This gives them a reason to focus in on

the importance and need for supplies. They need to hear that explicitly, and immediately. Even

though there is no direct ask, there can still be a call to action and conveyance of impact.

Bring everyone along. As we observed in the exploratory research, coalition-building with

national governments and international policymakers is essential for truly making maternal

health supplies available. Without these groups taking an interest, and making a commitment

to the issue, impact won’t be long-lasting. To that end, consider wording and phrases that help

bring everyone along rather than isolating any group.

Let economics support the moral argument. The audience appreciates messaging that speaks

to the moral imperative of caring for women. The economic argument brings a fresh (and

welcome) perspective to the issue that can be a vehicle for conveying the moral argument.

These supplies save women’s lives for small amounts of money, and they provide the tools that

health workers/facilities need to make those investments pay off.

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Final Messaging Platform

SUMMARY - Investing in Essential Supplies Saves Lives and Improves Maternal

Health

Becoming a mother is usually a special, joyous event. But for many women in developing countries, childbirth can be life-threatening. Can you imagine a woman in labor arriving at a clinic to deliver her baby only to find that the basic medical equipment, medicines, and health staff aren’t there? Ensuring access to basic maternal health care will prevent hundreds of thousands of women from dying during pregnancy and childbirth and ensure they and their children live healthier lives. Access to essential maternal health medicines, including items such as contraceptives, medicines, and simple equipment used during childbirth are often a hidden part of the solution. Having a healthy pregnancy, childbirth and the opportunity to see your children grow up healthy should not be a matter of where you live or your economic status. It should be an universal right for every woman, everywhere. The good news: this goal is achievable. Working together, global leaders, national governments and maternal health advocates have the power to elevate the critical role of maternal health supplies in protecting women’s lives during pregnancy and childbirth. Policy leadership, matched with additional funding for proven, low-cost maternal health supplies, can improve maternal health and save millions of lives worldwide. Healthy mothers have a powerful ripple effect. To save a mother is to save a family. And to save a family is to lay the foundation for stronger communities and more stable nations. Themes:

No Woman Should Die

Giving Life

Essential Supplies Save Lives and

Improve Maternal Health

Leadership and Investments in

Maternal Health Supplies Matter

Saving Mothers Means Stronger

Families, Communities and

Nations

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THEME 1: No Woman Should Die Giving Life

MESSAGE The solution to safe pregnancy and childbirth for women in the developing world

begins with access to basic health care, including maternal health supplies.

PROOF

• At the heart of good maternal health care is a set of basic, low-cost, but

essential supplies that includes items such as medicines, contraceptives, and simple equipment used during childbirth.

• Each year approximately 287,000 women – 99 percent of whom live in developing countries – die from pregnancy and childbirth-related complications. That means one woman dies every two minutes from pregnancy-related complications.i

• Experts estimate that with access to basic health care and proven interventions, the leading causes of maternal deaths are largely preventable. These include: severe bleeding after childbirth, high-blood pressure during pregnancy and infections.

o Proven, low-cost medicines such as oxytocin and misoprostol prevent and treat severe bleeding, and magnesium sulfate can prevent seizures caused be high-blood pressure during pregnancy.

o Examples of low-cost, but essential health equipment include blades, plastic sheets, clean thread, needles and clamps for the umbilical cord.

• Having a healthy pregnancy, childbirth and the opportunity to see your children grow up healthy should not be a matter of where you live or your economic status. It should be a universal right for every woman, everywhere.

o In the United States where education, family planning, and health care services and supplies are widely available to all, one out of 4,800 women dies from complications of pregnancy and childbirth. The rate is even lower in the United Kingdom, where one out of every 8,200 women dies. Contrast that to Niger, where poverty and a shattered health care system mean pregnancy-related causes will kill one out of every seven women. ii

• An essential part of ensuring a woman survives pregnancy and childbirth includes access to maternal health medicines and other supplies.

THEME 2: Essential Supplies Save Lives and Improve Maternal Health

MESSAGE Increasing the availability of supplies is essential to saving lives and improving maternal health, especially during pregnancy and childbirth.

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• The important role of essential maternal health supplies and medicines can be hidden in the face of larger health system challenges in low-resource settings. o Access to these essential supplies in developing countries is limited due to

supply chain management challenges, regulatory hurdles, and funding gaps.

• Maternal health supplies and medicines need to be stocked in health clinics, in the hands of trained health care workers and ultimately appropriately delivered to the women who need them in order to save lives. o A supply shortage in hospitals can become a patient’s responsibility; those

seeking care are often required to pay for all their medications, blood and even surgery when supplies are scarce. This can add up to $200 to $300, which is several months' wages for many.iii

• Three proven, low-cost medicines – oxytocin, misoprostol and magnesium sulfate – have the potential to save the lives of mothers worldwide, making their accessibility and availability critical during pregnancy and childbirth. Each of these three medicines costs less than US$1.00. o Oxytocin, used to prevent and treat severe bleeding after childbirth, costs

roughly between US$0.18 and US$.72 per dose and is given by injections [difference based on doses for prevention (10 IU) and treatment (40 IU)].

o Misoprostol, also used to prevent severe bleeding after childbirth – especially in settings where oxytocin is not available – costs between approximately US$0.15 and US$.60 per dose [difference based on doses for prevention (3 tablets) and treatment (4 tablets)]. � In a ten year period, it is estimated that 41 million cases of severe

bleeding would be prevented and 1.4 million lives would be saved if oxytocin and misoprostol were available to all women giving birthiv

� Up to 50 percent of all maternal deaths take place during the first 48 hours after delivery, a time when every minute counts. The presence of oxytocin and misoprostol can mean the difference between life or death.v

o Magnesium sulfate, is recognized by the WHO as the safest, most effective and economical medication for preventing and treating deadly seizures caused by high blood pressure during pregnancy, at a cost of approximately US$1.00 per dose.vi

• Contraceptives are an essential element of maternal health. o More than 215 million women worldwide lack access to modern

contraceptives.

• Experts estimate that by providing women wider access to modern contraceptives and family planning services, maternal deaths would reduce by a third. This is a highly cost-effective public health strategy.vii

• Essential, lifesaving equipment such as catheters and urine bags needed for women during childbirth – particularly difficult labors – cost approximately US$3.viii

• The solution is within reach: Delivering a package of services, including essential supplies, is estimated to cost less than US$1.50 per person in the 75 countries where 95 percent of maternal mortality occurs. ix

o A package includes costs for medicines, other supplies, and lab tests; the service of health care workers; and investments in the health

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system such as training, transport, infrastructure updates and community program costs.x

• By prioritizing the availability and delivery of maternal health supplies, many more women’s lives will be saved and women will be healthier.

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THEME 3: Leadership and Investments in Maternal Health Supplies Matter

MESSAGE Global leaders and national governments have the power and responsibility to protect women’s lives during pregnancy and childbirth with greater leadership and

additional funding for maternal health supplies.

PROOF • New global leadership is highlighting the need to improve the availability, quality and impact of proven, low-cost medicines through the UN Commission on Life-Saving Commodities for Women and Children. o The UN Commission will identify strategies to improve the delivery of a range of

essential health supplies by recommending ways to streamline the regulatory environment, explore supply chain improvements, examine innovations and best practices and identify market shaping opportunities, all with the aim to improve women and children’s health.

o An example of national leadership includes the government of Tanzania prioritizing access to maternal health. Over the past 15 years, Tanzania has made steady progress toward ensuring that family planning and maternal health supplies are available throughout health systems, effectively putting them closer to accomplishing the Millennium Development Goal 5 target of reducing maternal mortality by three-quarters.xi

• Coordinated approaches and increased innovative partnerships, as exhibited by the successes of pooled purchase and delivery of vaccines and medicines to prevent HIV, would dramatically improve the impact of maternal health supplies, and save more women’s lives.

• Prioritizing funding for maternal health supplies will provide a significant return on the other investments made in maternal health and maximizes the potential impact of health care workers. o All the skilled health care workers in the world can’t deliver the care women

need if a clinic’s supply cabinet is bare and the next round of supplies is weeks away.

o Nepal – a county of the world’s poorest, with a GDP per capita income of $438.00 – has well-established cadre of 50,000 frontline health volunteers, mainly women, who provide a wide range of maternal and child health services throughout the country. These health workers have been a bridge between the formal health system and the communities they serve. These health workers:

� Carry out home visits before and after birth and have been trained in essential newborn care. They counsel women about contraception and link them to needed supplies.

� Augment a system of care that has developed since 1990, cutting Nepal’s maternal mortality rate nearly in half. And, its under-5 mortality rate fell 64 percent between 1990 and 2008.

• Reliable availability of maternal health supplies and medicines will strengthen health care systems and make frontline health workers more effective. There is a powerful opportunity to save many more lives and improve maternal health through policy leadership matched with much-needed investments in supplies.

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THEME 4: Saving Mothers Means Stronger Families, Communities and Nations

MESSAGE Healthy mothers have a powerful ripple effect. To save a mother is to save a family. And to save a family is to lay the foundation for stronger communities and more

stable nations.

PROOF • From the cradle, to the classroom, to the workplace and community, a healthy mother can mean a world of difference for her child and her family.

o Babies who lose their mothers are five times more likely to die in infancy than those who do not.xii

o Motherless children face consequences of family impoverishment (diminished resources for the children in particular), malnutrition, and decreased educational opportunities as older children leave school to earn money or care for their homes and younger siblings.xiii

• When women survive and thrive after childbirth, they can increasingly impact change and economic development in their communities and ultimately their nations.

o The death or illness of a mother also leads to a reduction in income given the important economic role of women, such as in agricultural production and trade. xiv

o The U.S. Agency for International Development (USAID) estimated the global economic impact of maternal and newborn mortality at US$15 billion in lost productivity every year.xv

o When women and girls earn income, they reinvest 90 percent of it into their families.xvi

• There are many complex challenges to improving maternal health, but policy leadership, matched with additional funding for proven, low-cost maternal health supplies, can set off a powerful ripple effect, saving and improving millions of lives worldwide.

THE ASK

Support polices and investments that broaden access to life-saving maternal

health supplies.

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Conclusions and Opportunities

While supplies and medicines may be an essential, but currently comparatively hidden part of

the solution to improving maternal health and meeting MDG 5, the path ahead is filled with

great promise to make a lasting impact on this issue.

The research insights in this report provide a clearer picture of the policy and stakeholder

landscape on this emerging issue. This includes the pressing need to further educate target

audiences about the role of supplies. Most importantly, it demonstrates how supplies may be a

relatively small element in the broader context of maternal health, but they hold the potential

to make a much larger impact on women’s health. The research also reaffirms the importance

of advocacy efforts that lead with the moral imperative of saving women’s lives and success

stories, while providing a compelling new way to view the issue by way of emerging economic

arguments, hence the connection is made to the ripple effect on families and communities.

The message platform created as a result provides a unified framework for advocates to support

the case for policies and investments that broaden access to life-saving maternal health

supplies.

This message platform includes themes, messages, evidence-based proof points and concrete

examples of success to be used consistently across multiple communications channels in

advocacy effort. Message platforms are always living documents, but given the emerging nature

of the maternal health supplies issue, some opportunities ahead include:

• Continuing to collect and refine additional proof-points that support each message, and

bringing new evidence or examples to strengthen each element of the messaging

architecture, including partner organizations tailoring specific supporting points and

illustrative examples in a way that reflect their unique program or policy perspectives.

This effort may also involve identifying and prioritizing the need to generate new

research or supporting data to strengthen the evidence-based case.

• Refining and tailoring the messaging for specific events, opportunities, or appeals as the

policy and advocacy landscape shifts.

• Similarly, working with the Maternal Health Supplies Working Group and other

members of the advocacy community to clarify both the policy ask and the funding ask,

keeping in mind that as milestones, such as the release of the UN Commission

recommendations in September are reached, these asks will be further refined.

• Given the more technical nature of maternal health supplies policy issues, as well as the

relatively small but influential target audience of policymakers and funders who can

have the greatest impact on the issue, a stakeholder mapping exercise would be an

effective approach toward developing a more comprehensive maternal health supplies

advocacy strategy for message delivery. This effort would build on the initial research

conducted with policy influencers to inform the message development process, but

focus on how best to reach and have an impact on these especially targeted audiences.

Ultimately, the power of these messages will truly be brought to life through a targeted and

fully-integrated advocacy communications effort. Guided by a strategic communications plan,

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these efforts might include presentations at international fora, advocacy materials featuring the

personal perspectives of front-line health care workers delivering life-saving medicines to the

women that need them, compelling story-telling through online video vignettes and through

many other channels that reach global policymakers and influencers.

Most importantly, these messages ultimately support one unified advocacy goal: demonstrating

the value of investments in maternal health supplies, inspiring action, saving lives, and,

ultimately creating a lasting impact on women, families and communities around the world.

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Section 3: Appendix

Appendix A: Immersion Materials

•Delivering on the Promise

•Maternal Health Working Meeting notes; April 2011, September 2011, January 2012

•Family Health: Communication and Message Research

•Draft Call to Action for Access for All: Supplying a new decade for reproductive health

•Postpartum Hemorrhage: A Challenge for Safe Motherhood

•Misoprostol for Postpartum Hemorrhage

•Maternal Health Supplies in Uganda

•Maternal Health Supplies in Bangladesh

•Medicines for Maternal Health

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Appendix B: Exploratory Interviews List

Message testing with key external stakeholders consisted of 27, 30-40 minute one-on-one in-

depth interviews (IDI’s) that included:

Interviewee Organization Sector

Luc de Bernis UNFPA Bilaterals/Multilaterals

Julia Babinard World Bank Bilaterals/Multilaterals

Aron Betru UN Foundation Bilaterals/Multilaterals

Dr. Yves Bergevin UNFPA Bilaterals/Multilaterals

Shannon Marsh USAID Zambia Bilaterals/Multilaterals

Joar Svanemyr NORAD Norway Bilaterals/Multilaterals

Renee Vander Weerdt UNICEF Bilaterals/Multilaterals

Judith Helzner and Erin Sines MacArthur Foundation Foundations

France Donnay Gates Foundations

Michelle Wallon

JHPIEGO Government, Donor country

influences

Walter Proper

JSI Government, Donor country

influences

Dr. Bonface Fundafunda

Zambia Ministry of Health Government, Donor country

influences

Abraham Chingalika

MOH Zambia Government, Donor country

influences

Lynn Adrian

USAID/Kenya Government, Donor country

influences

Dr. Kwame Asiedu

JHPIEGO Government, Donor country

influences

Andrienne Germain International Women's

Health Coalition

NGO/Policy Centers

John Townsend Population Council NGO/Policy Centers

Ann Starrs Family Care International NGO/Policy Centers

Pape Gaye IntraHealth NGO/Policy Centers

Elisha Dunn-Georgiou

Population Action

International NGO/Policy Centers

Frances Ganges White Ribbon Alliance NGO/Policy Centers

Karl Hofman PSI NGO/Policy Centers

Meg Greene

Woodrow Wilson Center –

GHI NGO/Policy Centers

John Skibiak RHSC NGO/Policy Centers Barbara Crane IPAS NGO/Policy Centers Scott Ratzan Johnson & Johnson Private sector

Maria Schneider Merck for Mothers Private sector

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Appendix C: Exploratory Stakeholder Audience Pre-notification

Letter

Dear {Sample field: Fname}{Sample field: Lname},

PATH is currently working to better understand approaches for improving access to maternal

health supplies in low-resource setting. To that end, we are reaching out to our peers, including

institutional donors, national and international policy influencers, international development

NGOs, and some private sector organizations with whom we interact with or collaborate on this

topic.

We are writing to you because we feel we would benefit from your perspective, and would like

for you to take part in a research interview. We have engaged KRC Research, an independent,

third party research firm, to conduct in-depth interviews. The interview would take

approximately 30-45 minutes.

The results of the interviews will be analyzed and reported in a policy landscape assessment that

PATH is planning to publish. If you choose to partake in an interview, you will be listed as a

participant in the landscape assessment, however no quotes, ideas or positions will be

attributed to you. You may also request an advanced copy of the report to review prior to it

being published.

Your participation in an in-depth telephone interview would be greatly appreciated, as your

unique perspective will provide invaluable insight that will help guide us in the future. In

consideration of your time, we will make a contribution to a charity of your choice.

A representative from KRC Research, Kim deBelle, will contact you in the next two weeks to

follow-up on this letter. In the meantime, if you have any questions please feel free to contact

me or Colleen Learch, KRC Research (clearch@krcresearch.com).

Thank you for your consideration.

Sincerely,

PATH Signature

Colleen Learch

KRC Research

clearch@krcresearch.com

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Appendix D: PATH Maternal Health Supplies Stakeholder

Exploratory Interview Discussion Guide

• My name is _____ and I am calling from KRC Research, an independent research

firm.

• As (recruiter) mentioned, we have been engaged by PATH to conduct a research

study among select individuals who work on topics within the larger issue of

maternal health in low resources settings. We know how busy your day is, and

we appreciate you taking the time to participate in this research. Your opinions

are very important to us, and to PATH.

• There are a few things I’d like to tell you before we get started with the

interview.

– I am an independent researcher, and as such, I am not vested in any

particular viewpoint or policy. I am looking to learn from you and your

experiences. Your candidness in responses is very useful to me in

learning about the topics in this interview.

– The results of the interviews will be analyzed and reported in a policy

landscape assessment that PATH is planning to publish. You will be listed

as a participant in the landscape assessment, however no quotes, ideas

or positions will be attributed to you. Responses will be summarized in

aggregate only. At the end of the interview, you may also request an

advanced copy of the report to review prior to it being published if you so

choose.

– The interview will take 30-40 minutes of your time. With your

permission, I’d like to record the interview so that I don’t need to slow

down to take notes.

• For my own background, could you tell me a little bit about yourself and your

role at (organization)?

I. Context- Maternal Health Topics 5 minutes

(Purpose: Warm-up section before delving into the heavier, more detailed aspects of the

topic. This section will be short, but will also help us understand what is top of mind for

these individuals when it comes to maternal health. Our interview team is prepared to

curtail conversation in this section so that it is productive, but does not dominate the

interview).

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• As I mentioned, I am an independent researcher, not an expert on maternal health

specifically. How do you, personally, define “maternal health?”

• Are there variations in how this is defined within the community? How so?

• How would you describe the political landscape in relation to maternal health right

now?

• What are the two or three most important topics within the larger maternal

health space today? How do you see this changing over the next 5 to 10 years?

- Who are the biggest players in this space? Who can really make a

difference in this area?

- Does the issue have opponents or people or organizations that are

obstacles?

• Are there elements that make issues related to maternal health different from

other global health issues with which you are familiar?

- Does this pose a greater challenge?

- Is this difference advantageous at all?

- How much attention does Maternal Health get vs. the others?

• What are some of the reasons these topics get more/less? How

much of an issue is the amount of attention paid to maternal

health?

• If not already discussed: Tell me more about the political landscape regarding

this issue at the national level? What about internationally?

• If not already discussed: What about improving access to maternal health supplies in

low-resource setting? What’s the political landscape like when it comes to maternal

health supplies?

• Are you familiar with it at all? What have you heard?

II. Maternal Health Supplies Challenges and Opportunities 15 minutes

(Purpose: Probe deeper into the topics that fall under maternal health, including

availability of supplies, knowledge of work being done to date, what makes it important,

who can make a difference and how).

• For the rest of our time together today, we’re going to be talking about maternal health

supplies. Specifically, the issue of making available specific medicines that can help

minimize maternal death following labor and delivery. How large a factor in maternal

health do you think this issue is?

• Who currently works on that topic?

• What makes it important? Who or what is driving the discussion on maternal

health? Or, who or what is driving progress on maternal health?

• Are supplies currently a robust part of the conversation within maternal health?

How come?

• Is this an area where a difference can be made?

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• Medicines that are part of maternal health supplies include Oxytocin, Misoprostol, and

Magnesium Sulfate available.

• How does that match up with your understanding of issues in Maternal Health?

• What do you think about the inclusion of those three medicines?

• What are the challenges for making supplies more readily available?

- Moderator listen for and probe accordingly on:

- Making this issue a priority

- Quality of the drugs

- Cost for user

- Cost for government

- Access

- Ability to administer the drugs

- Packaging

- No research/proof that this works/lack of data

• Based upon your knowledge and experience, how do we best address these challenges?

(listen first before probing on questions below)

- What policies or actions are necessary for: (NOTE: EACH RESPONDENT WILL BE

ASKED AT LEAST FOUR OF THE ACTIONS/POLICIES BELOW, TIME PERMITTING)

Availability-related

• Providing data on both the unmet need for maternal health supplies as well

as available financing for supplies.

• Accelerating adoption and scale up of administration of maternal health

supplies?

• Ensuring quality formulations of the drug are widely available and used?

• Regulating the quality and usage of medicines across countries for quality

assurance purposes?

FOR EACH OF THESE ABOVE ASK:

- How important is this?

- Who is best positioned to lead this type of action?

- How could this action occur?

- Are there specific road blocks for this action? How can they be

overcome?

Cost-related

• Increasing funds contributed by national governments for maternal health

supplies

• Increasing funds contributed by global donors for maternal health supplies

• Ensuring larger purchase volume and more consistent quality

• Pooled-procurement at global/regional and/or national level?

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FOR EACH OF THESE ABOVE ASK:

- How important is this?

- Who is best positioned to lead this type of action?

- How could this action occur? What strategies or mechanisms could

help this?

- Are there specific road blocks for this action? How can they be

overcome?

- Pooled-procurement: What form would this take?

• In your opinion, what WHO and/or other global policies or actions are needed to propel

national agendas and actions related to increasing access and availability of

maternal health supplies? - What are the roadblocks to creating these policies? How can they be overcome?

[Probe on Misoprostol specifically and data, information, and logistics

management information systems and health management information systems

need]

• What types of innovations relative to maternal health supplies development and

delivery should be a focus for future research and development?

- What makes this important?

- How does one build interest and investment in this area?

• IF NOT ALREADY COVERED: What else has to happen so that these challenges to

maternal health supplies do not stand in the way of the work?

- Listen for and probe accordingly on:

• Politically/Advocacy-related-?

• Policy-related?

• Regulatory-related?

• Programmatic-related

• Supply chain-related?

III. Importance of Maternal Health Supplies and Outcomes 12 minutes

(Purpose: Exploration of what makes this important, and the desired and/or potential

outcome of working on the issue).

• In your opinion, who knows what Maternal Health Supplies are?

• Who doesn’t know what Maternal Health Supplies are?

• Who needs to know, and doesn’t currently?

- What specifically do those parties need to know?

• I understand all that you’ve told me so far, but I really want to understand what makes

the overall maternal health supplies so critical.

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• Let’s start with your organization. What makes it important for your

organization?

• What about your peers, peer organizations? What makes it important for

them?

• Who else is this work important for? (PROBE ON: WOMEN, MOTHERS,

CHILDREN, COMMUNITIES, ETC). How does this impact those?

• What is it that makes it important?

• Does advocacy for maternal health supplies alter the maternal health policy

landscape at all?

• You’ve just shared the impact that work on maternal health supplies can have, but

what’s the outcome of working on this issue? What results from organizations or

people caring about maternal health?

• Who benefits?

• What can we expect/what is the result of the work?

• What’s the outcome of access to supplies? What results from that?

• What does success in maternal health supplies look like?

• What drivers do you see in evolving the discussion or issue to achieve this

success (if needed, give timeframe: over the next decade, beyond the next 10

years)

• Are there barriers that you see in evolving this discussion or issue? (if needed,

give timeframe: over the next decade, beyond the next 10 years)

• If not already covered: Let’s take a step back for a moment, and I want to understand

more about how Maternal Health Supplies ties in to the overall topic of Maternal

Health. Can you explain that to me?

• What is the role that Maternal Health Supplies plays within Maternal Health?

• How much of a factor in Maternal Health is it?

• Do you feel that you have a role in increasing access to maternal health? How so?

• What about in making supplies available?

• What do you need to see, or have, before you/your organization can act?

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IV. PATH’s Role in Maternal Health 5 minutes

(Purpose: Gauge knowledge and reactions of PATH’s work in this area, the anticipated or

potential outcomes/impact, as well as identification of opportunities and challenges)

• As you may know/as you described, PATH is working alongside other advocates to

improve access to maternal health supplies in a low-resource setting, focusing on three

medicines; Oxytocin, Misoprostol, and Magnesium Sulfate

• How does that sound to you? Listen for references to past work by PATH, UN

report, other reports issued

• Does making medicines such as those named available for purposes of saving

lives align with your thinking about what you’d expect from advocates for

maternal health?

• Are you familiar at all with this type of work?

• Does that align with your thinking about what you’d expect from PATH within

the maternal health community?

• What does PATH have to offer in working to improve access to maternal health

supplies?

– What should PATH be considering as they work on this topic?

– What are their biggest strengths in working on this topic?

– What are their biggest challenges?

– Are there any big roadblocks or obstacles that they should foresee?

– What should their role be in improving access to maternal health supplies?

Listen for and probe accordingly:

� Advocacy

� Implementation

� Research

� OTHER

• In thinking about all the advocates working on this issue, including PATH, how do those

advocates best capture attention for this issue?

• Are there things that PATH specifically can do to or offer, or prove to prompt

attention?

- What story should they tell?

- Who should it matter most too?

- What audiences do they most directly target? Indirectly target?

• What’s the desired outcome/win for advocates?

• What do advocates need to do to gain your support and involvement?

V. Wrap Up 2 minutes

• Last question before we wrap up: What does PATH need to most keep in mind as they

work on this issue?

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• Thank you very much for your time and feedback. Would you be willing to be contacted

further by PATH in relation to the report of findings that will be generated from these

interviews? You are not obligated in any way to say yes.

• Would you like to receive an advance copy of the policy landscape report?

• Any final thoughts or questions for me?

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Appendix E: Workshop Agenda

I. Welcome & Introductions (continental breakfast served) ......................................1:00

- Overview of PATH’s maternal health supplies advocacy message

development goals

II. Objectives for Session .................................................................................. 1:15

- Share key insights from policy landscape interviews

- Determine communications goals and target audience priorities

- Compile and prioritize potential messages that convey the

urgency and value of a maternal health supplies initiative

- Overview next steps including creative process and testing

III. Key Findings from Policy Landscape Interviews ......................................... 1:30

IV. Defining Communications Success .............................................................. 2:15

- What does success or the “win” look like for messaging outreach?

- What is the long-term goal? What are the short-term milestones?

V. Target Audiences ......................................................................................... 2:45

- Given our goals, who or what audiences must we reach and persuade?

- What is the desired outcome of the communication to this audience(s)?

VI. Situational Assessment ................................................................................ 3:15

- What are our strengths, assets and opportunities in the

maternal health supplies arena?

- What are the challenges, weaknesses and liabilities we face?

VII. Message Platform Development ................................................................ 3:45

- What are the most important principles or values that we want our target

audiences to share and believe? What are we for?

- What are the themes or facts that are most likely to be relevant and

persuasive?

- Ultimately, what the consequences to our target audience? Why should

they care about maternal health supplies?

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VIII. Final Comments & Adjourn .......................................................................... 4:45

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Appendix F: PATH Maternal Health Supplies Stakeholder

Validation Interview Discussion Guide

• My name is _____ and I am calling from KRC Research, an independent research

firm.

• As (recruiter) mentioned, we have been engaged by a community of maternal

health advocates to conduct a research study to better understand approaches

for addressing maternal health challenges overseas. We know how busy your

day is, and we appreciate you taking the time to participate in this research.

Your opinions are very important to us, and to the maternal health advocates.

o MODERATOR TO ACKNOWLEDGE THAT THIS IS “PART TWO” FOR THOSE

INDIVIDUALS WHO PARTICIPATED IN THE FIRST PHASE.

• There are a few things I’d like to tell you before we get started with the

interview.

– I am an independent researcher, and as such, I am not vested in any

particular viewpoint or policy. I am looking to learn from you and your

experiences. Your candidness in responses is very useful to me in

learning about the topics in this interview.

– Your participation in this interview is anonymous and your feedback will

remain confidential.

– The interview will take 30-40 minutes of your time. With your

permission, I’d like to record the interview so that I don’t need to slow

down to take notes.

• For my own background, could you tell me a little bit about yourself and your

role at (organization) and your current or past work on maternal health issues in

low resource settings?

I. Context – Maternal Health Supplies 5 minutes

(Purpose: Warm-up section before delving into the messages that we want to test about

the topic. This section will be short, but will also help us understand what is top of mind

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for these individuals when it comes to maternal health issues. Our interview team is

prepared to curtail conversation in this section so that it is productive, but does not

dominate the interview.)

• As I mentioned, I am an independent researcher, and I only know what I learn

from these types of interviews. There are no wrong answers, I’m just looking for

your experiences and perspectives.

• We are going to be focusing on maternal health supplies today. What are

the two or three most talked-about topics when it comes to making

available maternal health supplies in low resource settings?

• What are some of the reasons that it is important to support policies and

increased investments in maternal health supplies?

• In your experience, are there any particularly good ways to illustrate the

importance or impact of increased investments in maternal health supplies?

• Who or what entities do you think could be the most effective champions or

advocates in increasing support and investments in maternal health supplies?

II. Overarching Theme 8 minutes

• I’m going to read you a statement that could be used to help increase support

for and investment in maternal health supplies among global policymakers and

influencers. I’d like to know what you think of when you hear it.

The statement is: Health Supplies: Essential to Protecting Mothers Before, During and

After Childbirth, Improving Maternal Health

o What do you think of when you hear this?

o Who do you feel would say this? What type of group?

o What questions or curiosities do you have about this statement?

o Does this at all feel relevant to increasing support and investments in

maternal health supplies in developing countries?

o Does this feel like something that would get the attention of global

policymakers and influencers?

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NOTE: IF PARTICIPANT ASKS FOR CLARIFICATION ON “GLOBAL POLICY MAKERS,” FIRST

ASK WHO THEY PERCEIVE TO BE GLOBAL POLICY MAKERS.

• I’ve got a few sentences to read to you now that might be used with this overall

theme. I’d like to get your reaction on each. The first/next is:

o Becoming a mother is usually a special, joyous event. But for many women in

developing countries, childbirth can be life-threatening. Can you imagine a

woman in labor arriving at a clinic to deliver her baby only to find that the

basic medical equipment, medicines, and health staff aren’t there? Ensuring

access to basic maternal health care will prevent hundreds of thousands of

women from dying during pregnancy and childbirth and ensure they and

their children live healthier lives. However, access to essential maternal

health medicines and other supplies are an often overlooked part of the

solution.

o Working together, global leaders, national governments and maternal health

advocates have the power to elevate the critical role of maternal health

supplies in protecting women’s lives during pregnancy and childbirth. Policy

leadership matched with much-needed investments will provide women with

access to the proven, low-cost maternal health supplies needed to save

millions of lives worldwide.

After each, ask:

• What are your initial reactions?

• Do you find this particular phrase accurate and believable?

• Do you find this particular phrase to be compelling? Something that you would

want to take action on?

• If you were to hear this, what type of evidence or follow-up statements would

you expect to also hear to make it more believable?

MODERATOR TO LISTEN FOR AND PROBE ACCORDINGLY ON:

o Economic ROI

o Scope of the problem

o Impact data

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o Examples of solutions

o Costs of solutions

o Firsthand experience or accounts

o Anecdotal stories from mothers

o Attitudinal data

• AFTER ALL: What words or phrases do you feel really resonate with you from

what I read to you?

o Is there anything with which you disagree? Or that you would change?

• AFTER ALL: Are there any elements in here that you feel particularly speak to an

increased investment in maternal health supplies?

• Does this feel like something that would get the attention of global policymakers

and influencers?

III. Messages 10 minutes

• I’m going to read you some additional themes or ideas that might be used to

support policies and increased investments in maternal health supplies, and I’d

like to get your reaction on each. The first/next is:

o No woman should die giving life: The solution to safe pregnancy and childbirth

for women in the developing world starts with access to basic health care,

including maternal health supplies.

o Access to Overlooked Supplies Saves Lives and Improves Maternal Health:

Supplies are an essential solution to improving maternal health, especially during

pregnancy and childbirth. Maternal health supplies need to be available at the

health clinics and in the hands of trained health care workers to save women’s

lives.

o Leadership and investments in maternal health supplies matter: Global leaders

and national governments have the power and responsibility to protect women’s

lives during pregnancy and childbirth with greater investments in maternal

health medicines and other supplies.

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o Saving mothers means stronger families, communities and nations: Healthy

mothers have a powerful ripple effect. To save a mother is to save a family. And

to save a family is to lay the foundation for stronger communities and more

stable nations.

FOR EACH, READ TEXT FIRST, THEN ASK:

• In the context of increasing support for and investments in maternal health

supplies, what does that statement say to you?

• Do you find it believable?

• Do you find it compelling?

• Would it get your attention?

• IF STATEMENT IS NOT WELL-RECEIVED, ASK: Is there a part of this statement that

is just not working for you? Let’s break it down.

• If you were to hear this, what type of evidence or follow-up statements would

you expect to also hear to make it more believable?

MODERATOR TO LISTEN FOR AND PROBE ACCORDINGLY ON:

o Economic ROI

o Scope of the problem

o Impact data

o Examples of solutions

o Costs of solutions

� Probe: Does knowing that each of the three medicines costs less

than $1 USD lend support for the message?

o Cost per person

� Probe: does knowing that delivering a package of services,

including supplies necessary for improving maternal health is

estimated to cost less than $1.50 USD?

o Firsthand experience or accounts

o Anecdotal stories from mothers or fathers

o Attitudinal data

• Should these be focused on specific supplies? Which ones?

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• Does this feel like something that would get the attention of global policymakers

and influencers?

• For Theme 2: I’m going to read you a few more sentences and I’d like your

thoughts on them:

o At the heart of good maternal health care is a set of basic, low-cost, but

essential supplies that includes contraceptives, medicines, and simple

equipment ( e.g. manual vacuum aspiration), among others.

o Women everywhere depend on a stocked supply cabinet

After each, ask:

o Do you find it compelling?

o Would it get your attention?

• For Theme 4: Tell me more about what type of proof we need here to show

long-lasting impact through funding maternal health supplies

o IF NEEDED: What proof points or evidence does the community have to

offer, or need to find, to support this?

• AFTER ALL MESSAGES: Of those that I’ve read, are there one or two messages

that you think speaks to the need for increasing supportive policies and

increased investments in maternal health supplies particularly well?

• AFTER ALL: Are there one or two that are less compelling to you?

IV. The Ask and Messengers 5 minutes

• In thinking about these messages, in your own words, how would you describe

what the community of maternal health advocates is asking for?

• Would the messages that you heard today support the community of maternal

health advocates asking for increase support for polices that broaden access to

life-saving maternal health supplies?

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o What about increased investments that broaden access to life-saving

maternal health supplies?

• Who would you expect to be asking for this?

o Are there other voices that you could see asking for increased support:

Moms, nurses, a celebrity, corporate CEO, a scientist or a non-profit

organization that works on this issue?

o Are there organizations that you find are well-suited to ask for this? How

so?

o Are there organizations that you think would be better received among

your peers?

V. Wrap Up 2 minutes

• To wrap up, what have you heard during our conversation that you feel is the

most compelling reason to increase the investment in maternal health supplies

in developing countries?

o What is the single best example of why it is important to increase the

investment?

o If you had to choose between moral and economic reasons for increasing

the investment, which argument would you be drawn toward most?

• Do you have any advice for the community of maternal health advocates on how

to make a targeted investment for maternal health supplies a reality?

• Thank you very much for your time and feedback. Any final thoughts or

questions for me?

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Appendix E: Messaging Key Phrases, Words, and Jargon

KEY PHRASES and WORDS (working list)

Essential maternal medicines and supplies save lives. Healthier moms, healthier babies, healthier communities. Proven, cost effective medicines prevent a majority of maternal deaths. Healthy women and mothers are good for everyone. Maternal supplies must be in-stock. Mothers should be able to count on maternal medicines and supplies.

JARGON TO CONSIDER RETIRING (FOR MESSAGE PURPOSES ) (working list):

Commodities Supplies (without an example or context) Maternal mortality and morbidity-MMR

i USAID, Saving the Lives of Women and Children, retrieved from: http://www.usaid.gov/our_work/global_health/mch/mh/index.html ii Every Mother Counts, Country Statistics, retrieved from: http://everymothercounts.org/issue iii Washington Post, A Mother's Final Look at Life (2008), retrieved from: http://www.washingtonpost.com/wp-dyn/content/article/2008/10/11/AR2008101102165.html?sid=ST2008101201887&s_pos iv United Nations Commission on Life-Saving Commodities for Women and Children (Prepared for), Medicines for Maternal Health, retrieved from: http://bit.ly/IryoJY v The World Health Report (2005), Make Every Mother and Child Count, retrieved from: http://www.who.int/whr/2005/whr2005_en.pdf vi United Nations Commission on Life-Saving Commodities for Women and Children (Prepared for), Medicines for Maternal Health, retrieved from: http://bit.ly/IryoJY vii John Hopkins Study – find link viii UNFPA ix Women Deliver, Focus on 5: Women’s Health & the MDGs, retrieved from: http://www.womendeliver.org/assets/Focus-on-5.pdf x The World Health Report (2005), Make Every Mother and Child Count, retrieved from: (http://www.who.int/whr/2005/whr2005_en.pdf xi Maternal Health Task Force, U.N. Commission on Life Saving Commodities for Women and Children:

Country Case Studies(2012), retrieved from: http://maternalhealthtaskforce.org/components/com_wpmu/wp-content/uploads/blogs.dir/1/files/2012/06/UN-Commission-for-Lifesaving-Commodities_Country-Case-Studies_June-2012-clean.pdf xii Brown. UNICEF. “Working Together for Maternal and Newborn Health,” retrieved from :http://www.unicef.org/sowc09/docs/SOWC09-Panel-5.1-EN.pdf

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xiii USAID, Two Decades of Progress: USAID’S Child Survival and Maternal Health Program, retrieved from: http://pdf.usaid.gov/pdf_docs/PDACN044.pdf xiv The World Health Organization, Maternal Health: Investing in the Lifeline of Healthy Societies &

Economies, retrieved from: http://www.who.int/pmnch/topics/maternal/app_maternal_health_english.pdf xv Women Deliver, Focus on 5: Women’s Health & the MDGs, retrieved from: http://www.womendeliver.org/assets/Focus-on-5.pdf xvi ONE, Africa’s Future is Female, retrieved from: http://one.org/c/international/hottopic/3806/