Building on momentum from the global campaigns: an exploration of factors that influenced prioritization of stillbirth prevention at the national level in Uganda

Eric Ssegujja,Michelle Andipatin

doi:10.1186/s12992-021-00724-1

Eric Ssegujja, Michelle Andipatin

Open Access

https://doi.org/10.1186/s12992-021-00724-1

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Abstract

BackgroundOf the close to 2.6 million stillbirths that happen annually, most are from low-income countries where until recently policies rarely paid special attention to addressing them. The global campaigns that followed called on countries to implement strategies addressing stillbirths and the adoption of recommendations varied according to contexts. This study explored factors that influenced the prioritization of stillbirth reduction in Uganda.MethodsThe study employed an exploratory qualitative design adopting Shiffman’s framework for political prioritization. Data collection methods included a document review and key informants’ interviews with a purposively selected sample of 20 participants from the policy community. Atlas. Ti software was used for data management while thematic analysis was conducted to analyze the findings.FindingsPolitical prioritization of stillbirth interventions gained momentum following norm promotion from the global campaigns which peaked during the 2011 Lancet stillbirth series. This was followed by funding and technical support of various projects in Uganda. A combination of domestic advocacy factors such as a cohesive policy community converging around the Maternal and Child Health cluster accelerated the process by vetting the evidence and refining recommendations to support the adoption of the policy. The government’s health systems strengthening aspirations and integration of interventions to address stillbirths within the overall Maternal and Child Health programming resonated well.ConclusionsThe transnational influence played a key role during the initial stages of raising attention to the problem and provision of technical and financial support. The success and subsequent processes, however, relied heavily on domestic advocacy and the national political environment, and the cohesive policy community.

Highlights

Up to 2.6 million stillbirths occurred in 2015 with most of the cases from Low and Middle-Income Countries (LMIC), in rural areas, and during the intrapartum period [1,2,3]
International Stillbirth Alliance (ISA) started in the USA in 2003 by three mothers to stillborn babies aimed to push for improvements in bereavement care, prevention research, and clinical care which has grown into a global movement[30]
The key factors for this include the cohesive policy community converging around maternal and child health which was able to embrace the recommendations from the global campaigns into policy priorities

Summary

Introduction

Up to 2.6 million stillbirths occurred in 2015 with most of the cases from Low and Middle-Income Countries (LMIC), in rural areas, and during the intrapartum period [1,2,3]. The potential to save mothers and neonates led to calls for the strengthening of health systems for a triple return on investment[11] Despite this potential, it is not clear why stillbirths did not receive the same rates of reduction as maternal and child health[12]. The campaign postulated that improving care around delivery through offering Emergency Obstetric Care services have the greatest effect with syphilis treatment having a moderate effect while advanced Antenatal Care (ANC) would have the least effect Delivering such services at Universal coverage (99 %) was estimated to lead up to 45 % of third-trimester stillbirths averted on top of 54 % maternal deaths and 43 % neonatal deaths averted per year[9, 10]. This study explored factors that influenced the prioritization of stillbirth reduction in Uganda

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