Improving Maternal Health and Family Planning in Jordan

In Jordan, pregnancy-related hypertensive disease is a serious health threat for women of reproductive age. Meanwhile, demand for modern contraception and knowledge of the health benefits of family planning has lagged, and Jordan’s public hospitals still lack the facilities and trained staff needed to provide the highest standard of obstetric and neonatal care.

Two projects led by Abt Global and funded by USAID are working with the government and private sector to change this.

The Strengthening Family Planning project is working with private health care providers and conducting public campaigns in Jordan to address the country’s most pressing family planning challenges, including the use of modern contraceptives, which has not seen growth in 10 years.

“Training hospital staff and putting them in modern medical facilities is essential to reducing maternal deaths and improving the health of unborn children,” says Diana Silimperi, Division Vice President of International Health at Abt.

The Health Systems Strengthening II (HSS II) project has trained health care providers and equipped them to care for pre-eclampsia, eclampsia, and other hypertensive diseases. These treatable conditions, which can lead to seizures and comas, accounted for 20 percent of maternal deaths in Jordan in 2005 – the largest single cause.

Reducing Expectant Mothers’ Health Risks

HSS II worked closely with the Jordan Ministry of Health to identify root causes of deaths due to pre-eclampsia and eclampsia.

The analysis revealed that Jordan lacked standardized clinical guidelines for case management of these conditions and, at most public hospitals, insufficient access to and awareness of the value of the best treatment – magnesium sulfate.

Based on these findings, HSS II initiated a multi-pronged approach to reduce these unnecessary maternal deaths. The team implemented training for obstetricians and midwives at all public hospitals in Jordan plus clinical performance monitoring checklists to help health providers manage pre-eclampsia and eclampsia cases. These and other efforts led to the inclusion of magnesium sulfate on Jordan’s national drug list.

“Jordan is closer to achieving its potential of consistently providing the highest-quality health care possible to expectant mothers,” Silimperi said.

The project also carried out community based interventions that raised awareness of the risk signs of pre-eclampsia and eclampsia during pregnancy, childbirth, and post-partum.

This effort is contributing to reductions in maternal mortality in Jordan: the overall rate is in 2009 is half what it was in the mid-1990s. Similarly, pre-eclampsia/eclampsia is associated with just 6.6 percent of maternal mortalities in Jordan – one-third the pre-intervention rate – according to a national maternal mortality study launched in 2009.

Better Equipped Hospitals Support Better Care

Properly trained doctors, nurses, and other health care providers won’t be truly effective without adequate facilities and equipment. With that in mind, HSS II is renovating the emergency, obstetrics, and neonatal departments of 14 hospitals in Jordan. The work is expected to finish by the end of 2013.

The $6 million in renovations conducted by the HSS II project began in 2011 at Al Bashir Hospital, the largest teaching hospital in Amman, Jordan’s capital. The facility serves more than 2.3 million residents and delivers nearly 20,000 children annually. The hospital’s emergency, obstetric, and neonatal departments serve complex pregnancies referred by other hospitals in other areas. The renovations included the post-partum department, which provides health care for women after delivery and women seeking family planning services.

The renovations enabled health care providers to expand high quality obstetric and neonatal health care services in accordance with international standards. For example, physicians are now able to counsel post-partum and post-abortion clients in new private and designated places. The upgrading also increased the departments’ capacity to 167 obstetric beds – an increase of 22 – and the neonatal department’s number of incubators to 70, an increase of 20.

“I’ve worked in this hospital for 11 years now and the difference is remarkable,” said Khadija Mohammad, the head nurse in the post-partum department. “The environment we now work in keeps us motivated and helps perform our jobs better. There were mothers who delivered here five years ago and came back now to deliver their next babies and they don’t believe that this is the same place.”

Increasing Understanding of and Demand for Contraceptives

Women’s use of modern contraception in Jordan has been stalled at 42 percent for a decade, with 17 percent of women relying on traditional methods and others not using contraception, according to a 2009 demographic survey.

The Strengthening Family Planning project is raising awareness of the value of oral contraception through an ongoing campaign with national TV advertising, radio spots, physician appearances on major TV and radio talk shows, print materials at pharmacies and other locations, extensive community events, and a Facebook page.

The campaign exceeded its goal of convincing 60 percent of married women of reproductive age – its target audience – that oral contraceptive pills are safe. In follow-up surveys, 84 percent of such women said these pills are safe.

The campaign also successfully emphasized the effectiveness of modern contraceptive methods such as oral contraceptive pills over traditional methods such as withdrawal and the rhythm method. Eighty-six percent of married women of productive age now see contraceptive pills as more effective than traditional methods. Also, 22 percent of traditional method users and 30 percent of non-users said they intend to begin relying on pills.

Tracking survey respondents ranked the campaign’s advertising on Jordan Television as the “most remembered” by a two-to-one margin over the next most popular TV ad and as the “most preferred,” a remarkable result for a socially conservative nation, according to respondents to a tracking survey.

The Strengthening Family Planning project also has reached more than 130,000 married women of reproductive age who had never spoken with a counselor. The project oversees an operation with more than 100 community health workers who have conducted more than 180,000 family planning visits in one year. In this ongoing effort, the workers provided referrals to public and private clinics for family planning services and handed out vouchers to low-income women who preferred to visit private clinics with female providers but cannot afford the cost.

“Together, the Strengthening Family Planning project and Health Systems Strengthening II project have created sustainable solutions for Jordan’s maternal and child health and family planning challenges. These projects also work together as much as possible to maximize efficient use of donor resources and provide more value for money,” Silimperi said.