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Maternal and perinatal death surveillance and response (MPDSR) is an approach promoted by the World Health Organization (WHO) and partners to reduce maternal and perinatal mortality. MPDSR involves stakeholders in the processes of identifying and reporting maternal and newborn deaths and stillbirths, understanding why the deaths occurred, taking actions to prevent similar deaths occurring in the future, monitoring implementation of actions and resulting changes, and promoting accountability for maternal and perinatal deaths.

The aim of this report is to describe progress on strengthening MPDSR over the last 10 years, as a follow up to the WHO and UNFPA Time to respond: a report on the global implementation of maternal death surveillance and response, published in 2016. The report describes improvements in policies, implementation and tracking of MPDSR implementation, and highlights how MPDSR can be successful in various contexts, such as humanitarian and fragile settings. Eight country case studies highlight examples of addressing barriers to MPDSR implementation by using the MPDSR approach to reduce maternal and perinatal mortality and increase accountability for maternal and perinatal deaths. Finally, the report outlines progress on MPDSR implementation since 2016, improvements in barriers to implementation, and highlights focus areas to further strengthen to 2030.

This report takes a systematic approach investigating in-depth the practice of using MPDSR in eight countries around the world with more than 160 semi-structured interviews. Through case studies from countries at different levels of progress in MPDSR implementation, it also reports on gaps and challenges in MPDSR implementation and shares experiences from countries on how these have been addressed. It is expected that this report will encourage the global health community of policy-makers, programme managers, health workers, civil society organizations (CSOs), professional societies, academic institutions, bilateral and multilateral agencies and foundations working in maternal, perinatal and newborn health to continue to strengthen MPDSR implementation and mobilize efforts and funding to overcome gaps and challenges that adversely affect maternal and perinatal survival.

NEST360 is an international alliance united to end preventable newborn deaths in African hospitals. The alliance works to deliver a package of technologies and services that enable local governments to save newborn lives, improve newborn outcomes, and empower the medical workforce for the future. There are a number of resources available to support clinicians, engineers and administrators to implement an evidence-based model for sustainable, high-quality hospital-based newborn care in limited resource settings, including clinical and technical resources, technology resources, implementation resources, and COVID-19 related resources.

Strong and integrated surveillance and response systems for both maternal and perinatal mortality can help countries obtain accurate cause of death information and use it to take action to improve health and reduce deaths. To support linkages between maternal and perinatal death surveillance systems and to update global resources, MOMENTUM Country and Global Leadership and multiple UN agencies — the World Health Organization, UNFPA, and UNICEF — have developed an integrated Maternal and Perinatal Death Surveillance and Response (MPDSR) Capacity Building Package that can be used to support country capacity for MPDSR through virtual means. For the first time, capacity building materials for both maternal and perinatal mortality surveillance have been combined into one package, which also includes updated guidance and COVID-19 modules. These combined materials can be used by countries to help build capacity for implementing MPDSR at the facility level. You can learn more about MPDSR through this WHO operational guide and WHO knowledge brief on MPDSR and quality of care.

In 2015 over 2,060,000 babies were born in Tanzania but 38,600 of these newborns died in their first month of life. In addition, there were nearly 47,100 stillbirths and 8,200 maternal deaths (UNICEF 2016). According to WHO & UNICEF (2019), the maternal mortality ratio in Tanzania is 524 deaths/100,000 live births over the past decade. The United Nations’ Sustainable Development Goals (SDGs) include reducing the global maternal mortality rate to less than 70/100,000 live births by 2030. Maternal and perinatal death surveillance and response is widely recommended as an intervention to reduce maternal and perinatal mortality and to improve quality of care and could be key to attaining SDGs. Given this context, efforts to eliminate preventable maternal and newborn deaths in Tanzania need to include strong accountability processes, such as the MPDSR, that contribute to improving the quality of maternal and newborn health care and identifying challenges leading to maternal and newborn deaths head-on.

The purpose of these implementation tools is to provide a roadmap for conducting Maternal and Perinatal Death Surveillance and Response (MPDSR) in clinical and policy settings, as described in the two World Health Organization (WHO) guides entitled Maternal death surveillance and response (MDSR): technical guidance information for action to prevent maternal death (2013) and Making every baby count: audit and review of stillbirths and neonatal deaths (2016).

These two guides provide approaches to respond to maternal and perinatal death cases to help end preventable maternal deaths, stillbirths and newborn deaths. Bringing the death review process together has the potential to promote successful partnerships at different levels that can lead to real change for communities and nations.

MPDSR involves qualitative, in-depth investigations of the causes and circumstances surrounding maternal and perinatal deaths. This process is an integral part of quality of care improvement efforts to reduce maternal deaths, as well as preventable stillbirths and neonatal deaths.

The MPDSR process relies on the effective identification of reporting and assigning causes of deaths, identifying actions that may contribute to the prevention of further deaths, assigning those actions to particular groups or individuals, designating time frames for completion of those actions, and following up to ensure that those actions have been taken.

Maternal and perinatal death surveillance and response (MPDSR), or any form of maternal and/or perinatal death review or audit, aims to improve health services and pre-empt future maternal and perinatal deaths. With expansion of MPDSR across low- and middle-income countries (LMIC), we conducted a scoping review to identify and describe implementation factors and their interactions. The review adapted an implementation framework with four domains (intervention, individual, inner and outer settings) and three cross-cutting health systems lenses (service delivery, societal and systems).

Most maternal deaths are preventable. In order to end preventable maternal deaths, accurate information on how many women died, where they died and how they died is essential, but is currently inadequate. Maternal death surveillance and response (MDSR) contributes to better information for action by promoting routine identification and timely notification of maternal deaths, review of maternal deaths, implementation and monitoring of steps to prevent similar deaths in the future.

This document provides technical guidance to health care professionals, health care planners and managers working towards improving maternal health, and complements WHO’s 2004 publication “Beyond the Numbers”.

Personal testimonies discussing the experience of stillbirth can be found on the Healthy Newborn Network blog series on stillbirth here. These testimonies offer an important perspective of the human cost of stillbirth and support advocacy efforts.