From Research to Global Impact: Advancing Community MPDSR for Maternal Health

When I started my doctoral studies in maternal health in 2012, research on Maternal and Perinatal Death Surveillance and Response (MPDSR) was emerging as a crucial area of focus. I tried to explore the available literature to understand what existed and what evidence had been generated. My passion was to dedicate my full energy and efforts to community-based MPDSR, which, at that time, I felt was severely undermined.

I remember reading Beyond the Numbers, published in 2004, which was then the most recent piece of evidence focusing on maternal death reviews at the facility level. However, when the first global MPDSR guideline was published in 2013, it was entirely facility-based, with no mention of community MPDSR. This was deeply disappointing. As I looked at global, regional, and country-level data, it became clear that in low- and lower-middle-income countries, a significant number of maternal deaths were occurring at home or before reaching healthcare facilities. I kept asking myself: If we do not operationalize community-based MPDSR, how will we ever achieve the Millennium Development Goals (MDGs)?

With that motivation, I dedicated my hard work, research, and efforts toward advocating for community MPDSR. In the meantime, Bangladesh had also started implementing MPDSR and gradually scaling up. I actively sought to engage myself in the global MPDSR community, raising awareness and advocating for community verbal autopsy and social autopsy as priorities. It was not easy—I had to do a lot to push this agenda forward!

At that time, the MPDSR Action Network was actively publishing country experiences on MPDSR. I was fortunate to contribute several articles, and they provided great support in capturing and disseminating research findings and key results. Later, WHO recognized my work and published one of my articles on their website, highlighting the implementation of MPDSR in Bangladesh.

Then, in 2016, the first global MPDSR report was published, and I had the privilege of providing technical support for drafting the Bangladesh case study on social autopsy. While this was a significant milestone, community MPDSR was still missing from the global framework.

After years of struggle and challenges, I finally completed my PhD, and to my knowledge, I was the first person to conduct a PhD thesis on MPDSR. Shortly after, I had the opportunity to work with UNFPA Bangladesh Country Office, where one of my key roles was to support and strengthen the MPDSR system in Bangladesh. This also led me to become a member of the Global MPDSR Technical Working Group and various sub-working groups, where I was able to take part in several technical discussions and highlight the importance of community MPDSR at the global level.

Through years of collective effort and advocacy, community MPDSR was finally included in the 2nd Global Technical Guidance on MPDSR, published in 2021. Yesterday, the 2nd Global MPDSR Report was released, and this time, it includes Bangladesh’s case study on community MPDSR. I feel incredibly fortunate and privileged to have worked with the team in drafting the Bangladesh chapter.

For me, this is not just a few pages in a report—it is a story of a paradigm shift in MPDSR in Bangladesh. A country that had an MMR of 320 per 100,000 live births in 2001 has now brought it down to 123 per 100,000 live births in 2023, according to UN estimates. While MPDSR may not have directly contributed to this decline, I am confident that the integration of MPDSR into the national health system has created an opportunity for routine death notification and reviews.

MPDSR is an integral part of quality improvement, and I believe this is just the beginning of the journey—there is much more to be done to enhance its effectiveness. Perhaps countries with similar settings can read the Bangladesh case study to understand what factors contributed to improving community MPDSR.

I dream of a day when several African countries, where maternal mortality remains alarmingly high, will significantly reduce maternal deaths. Perhaps, the Bangladesh experience can serve as an example—an opportunity to unfold and explore new solutions!

I am sharing the Global MPDSR Report herewith. Happy reading!

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