Inside March of Dimes Global Programs
In 1998, recognizing the need to extend the March of Dimes mission internationally, the Board of Trustees approved the establishment of an international program. This decision was made in response to the clear international policy vacuum that existed at that time with respect to the prevention and treatment of birth defects and preterm birth. In addition, there were few reliable measures of the extent of the problem. Reports from lower and middle income countries were largely anecdotal, whereas evidence from industrialized nations showed a high toll of birth defects and preterm birth.
The first step for Global Programs was to partner with developing country experts to implement evidence-based interventions in-country. Interventions aimed to strengthen capacity for surveillance of birth defects and preterm birth; improve perinatal health care delivery through provider training; and offer opportunities for women and their families to learn about healthy pregnancy. In tandem with these efforts, which continue today, Global Programs has focused on collection, publication and broad dissemination of data that raise the visibility of the problem of birth defects and preterm birth and make the case to policy makers and donor organizations for implementing programs of care and prevention.
How we work
Global Programs carries out its work by partnering with academic medical centers, international organizations and non-government organizations in middle- and lower-income countries that share the goals of the March of Dimes Foundation. Global Programs has no overseas offices; our partners carry out all in-country programs. Global Programs partnerships have four guiding principles: local ownership; cost-sharing; synergy between March of Dimes technical expertise and those of our partners and a focus on short-term, product-intensive projects.
In the decade since its establishment, Global Programs has developed partnerships focused on perinatal health education and training, genetics education, birth defects and perinatal health surveillance, and interventions for specific risk factors –– including fortification of foods with folic acid to prevent neural tube defects and rubella immunization to prevent congenital rubella syndrome. See the interactive map and a description of our partnership projects by region for further details). In addition to mission alliance activities, Global Programs has had a major role in organization and sponsorship of international conferences, including the International Conferences on the Prevention of Birth Defects and Disabilities in the Developing World, which is held every other year. Global Programs has also produced reports – The March of Dimes Global Report on Birth Defects (2006) and the white paper, (2012). The reports have had significant impact. They are the first publications ever to present rates of birth defects and preterm birth worldwide, by region and, in the case of the global birth defects report, by country. The global birth defects report findings alone reached more than 800 million households worldwide via radio, TV and print. This media response stirred international action, including passage of a WHO resolution on birth defects.
In 2008, March of Dimes Global Programs took the innovative step of building a network of partner institutions with the aim of sharing expertise, project implementation strategies and products across partner sites. Members of the March of Dimes Global Network for Maternal and Infant Health (GNMIH) include Prof. Roberto Giugliani, MD, PhD, Hospital de Clinicas de Porto Alegre, Brazil; Prof. Nanbert Zhong, MD, Department of Medical Genetics, Peking University, China; Prof. Khalid Yunis, American University of Beirut, Lebanon and Prof. Carmencita Padilla, MD, MAHPS, Institute of Human Genetics, National Institutes of Health, Philippines. The network approach has several advantages, including enhanced consistency in definitions, data collection and study methods and strengthened capacity for complementary activities. Currently, cross-cutting activities are focused on improving surveillance of birth defects and preterm births, education of primary care providers on the diagnosis of common birth defects and appropriate referral; and community education on steps couples can take to help ensure a healthy baby, including preconception (pre-pregnancy) care. The GNMIH is also working to develop a global volunteer youth network of students and young professionals.
The March of Dimes Global Network has a number of U.S.-based organizations as technical partners. These include the American Academy of Obstetrics and Gynecology (ACOG), the American Academy of Pediatrics (AAP), the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the World Health Organization and representation from the European Union.
While developing the Global Network, Global Programs has continued its focus on partnerships with one or more institutions in other countries. Current mission alliances outside of the Global Network include activities in Central America, Central Europe and India.
In Central America, Global Programs is partnering with the Pan American Health Organization (PAHO), the U.S. CDC, the Institute of Nutrition of Central America and Panama (INCAP) and the Ministry of Health of Costa Rica to establish uniform norms and standards for fortification of foods with micronutrients across the countries of Central America. This is a five-year Inter-American Development Bank funded initiative which commenced in 2007. Since 2000, March of Dimes has carried out a number of projects in Latin America, many of which focus on the promotion of fortification of foods with folic acid.
In India, Global Programs is working to reduce maternal and neonatal mortality in partnership with the Jawaharlal Nehru Medical College/KLES Hospital and Medical Research Centre, Belgaum, Karnataka. The program, which began in 2004, is providing training to medical officers and auxiliary nurse midwives in rural areas to improve perinatal health care; facilitating the development of a hospital referral system; and educating the community about healthy pregnancy. Additionally two pilot projects are underway: one to improve prenatal health and newborn care in a peri-urban area of Belgaum City and a second to provide education in health and basic hygiene, as well as primary health care, to adolescent girls in a rural area of Belgaum District.
Global Programs has also carried out a number of partnerships in Central and Eastern Europe. At present, we are working with the Dartmouth Medical School on a project in Kosovo to improve perinatal health surveillance and use of these data to improve care of women and neonates. We are also conducting a pilot study of late stillbirths and early neonatal deaths occurring in a hospital setting. The study, which aims to identify quality of care improvement measures, is being carried out under the auspices of the Kosovo-based Foundation for Healthy Mothers and Babies and in collaboration with the University Clinical Center of Kosovo.
Global Programs will continue its engagement with world-class partners in lower-income countries to reduce the toll of adverse pregnancy outcomes, including birth defects and preterm birth. Our program focus is expanding to include the promotion of preconception health and the harmonization of care across the reproductive, maternal, newborn and child health (RMNCH) continuum. We will continue to marshal data for research, intervention and policy by issuing a Global Preterm Birth Report with country estimates in 2011. In addition, Global Programs will continue to support and extend the work of the March of Dimes by maintaining an active, visionary and leadership role in the fight to reduce the harsh global toll of birth defects and preterm birth and ensure a day when all babies everywhere have a healthy start in life.