Policymaking to Improve Maternal Health

We read with interest the article by Behague and Storeng titled Collapsing the Vertical-Horizontal Divide: An Ethnographic Study of Evidence-Based Policymaking in Maternal Health.1 The authors should be applauded for their efforts to analyze the complicated and competing factors that have limited advances in policy and programs that improve the health and survival of women in developing countries. The authors address a number of important points in their article. Here we would like to comment on three: (1) the methods used (2) how policymakers choose the evidence that determines how programs are designed and (3) the use of randomized controlled trials in generating data to use for new maternal health programs. The first comment is how the data were gathered. In the Methods section the authors reported that they interviewed 67 professionals identified opportunistically through professional networking publications and conference proceedings.1(p644) The authors did not report that they used a systematic process to generate the list of people interviewed for their study nor did they report whether they gave different weight to responses from interviewees from different groups such as advocates or researchers. Thus the methods used-which may be primarily from key informants in a limited circle of maternal health advocates and researchers-may generate results that are biased or limited in views regarding maternal health research and policy. The second comment is in regards to the authors observation that some advocacy efforts for maternal health would benefit from additional evidence to guide programs and policy that they might advocate.2 We agree. In a perfect world policymaker decisions should be based on an appropriate balance of advocacy and sound evidence and policymakers would support the attainment of evidence to try to achieve this ideal balance. Our final comment is about the authors observation that randomized controlled trials are not necessarily the final gold standard when it comes to developing evidence to be used to design the most effective maternal health programs. As the authors point out randomized controlled trials can only be planned to address the most focused of questions. Although this experimental approach represents a standard to attain they are often not well suited to the messy reality of realworld service-delivery programs in developing countries. Therefore we concur with the authors call for alternate models to generate evidence useful in devising better health care programs. These models include approaches such as nonequivalent control group designs (quasi-experimental designs) and rigorous program evaluation approaches. (full-text)

Environmental health · Political science · Public health · Global Maternal and Child Health · Health Policy Implementation Science · Medicine · Nursing · Primary Care and Health Outcomes

• Collapsing the Vertical–Horizontal Divide

  Dominque P Behague, Dominique P Behague et al.•American Journal of Public Health•2008

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• Generating Political Priority for Maternal Mortality Reduction in 5 Developing Countries

  Joseph Shiffman, Jeremy Shiffman•American Journal of Public Health•2007

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• Infant feeding policies in maternity wards and their effect on breast-feeding success

  R Pérez-Escamilla, Ernesto Pollitt et al.•American Journal of Public Health•1994

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• Collapsing the Vertical–Horizontal Divide

  Dominque P Behague, Dominique P Behague et al.•American Journal of Public Health•2008

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