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There was a one-day consultative meeting held in Bangladesh on August 31, 2006 to discuss the Minimum Activities for Mothers and Newborns (MAMAN) tool developed by CSTS+, USAID and other partners. The Objectives of the meeting were:

• To share the draft MAMAN Package
• To learn about current maternal newborn activities in Bangladesh
• discuss potential for MAMAN Package implementation in Bangladesh
• To obtain feedback and recommendations on the MAMAN

The following is a summary of key points that came out of the discussion throughout the day.

1. Importance of community mobilization / BCC for MAMAN implementation
   
   
2. Referrals to facility services are critical and programs must take into consideration the continuum of care, availability and quality of facility services, might include mapping and grading services.
   
   
3. Where there are no services to refer to, home care services must be expanded and increased
   
   
4. Programs should use communities to influence service delivery
   
   
5. Selection of monitoring indicators at community level may complement other indicators
   
   
6. Definition of skilled birth attendant was discussed. The recommendation was that an indicator for deliveries by a skilled birth attendant should be reported separately from deliveries conducted by a trained TBA
   
   
7. There are health volunteers trained by the Lamb Project and others for 6 months that are being called a skilled birth attendant. The meeting participants felt this needed to be discussed further and that they should probably be placed in a different category from skilled birth attendant as well. MOH policy is that if these volunteers are trained following the government curriculum, they are called a skilled birth attendant. They are not trained or allowed to do manual removal of the placenta.
   
   
8. Some projects are promoting at least one post partum visit by the seventh day post partum. The MAMAN package recommends a post partum visit during the first 24 hours and the second should be sometime during days 3 to 6 post partum. Cultural taboos prevent some women from leaving the home during the first 7 days post partum. The epidemiology of neonatal and maternal deaths must be taken into consideration when determining the recommended timing of post partum visits. Most maternal and newborn deaths occur during the first 24 hours and then during the first 7 days postpartum. There was a question of who should conduct the post partum visits, where they should be conducted and what message should be given regarding timing of the post partum visits. ICDDRB is conducting research on the impact of earlier post partum visits on maternal and newborn health using Projonmo Data. . Findings from this research should be available in about three months and will be shared with the partners at this meeting. In general, post partum and post natal care are low everywhere.
   
   
9. EngenderHealth works in collaboration with the DGHS on prevention of post partum hemorrhage and with the DGFP on promotion of permanent long-term methods of FP. Additionally, they are working on infection prevention (cross cutting intervention) and AMTSL. Partners might work with the DGHS and EngenderHealth to obtain training for their clinical staff in AMTSL. The POPPHI meeting is discussing this issue today. What level of providers may provide AMTSL? Integration of AMSTL into MNC interventions is just starting in Bangladesh.
   
   
10. Verbal autopsies, maternal death audits were discussed as useful programming tools; however, they are not useful for monitoring impact of interventions. "Near miss" investigations may also be useful for programming.
    
    
11. The MAMAN package indicators are few in order to reduce the monitoring burden but it is assumed that if women are receiving tetanus injections and have birth plans, the other basic interventions for ANC are also included.
    
    
12. Discussion regarding pros and cons of high risk pregnancy identification during antenatal care. Based upon the epidemiology, this is no longer recommended. All pregnant women should be considered as having the potential for developing a complication. Recommendations are for programs to ensure communities know the danger signs and what to do. Referral systems and services capable of providing emergency obstetric care are critical to reducing maternal and neonatal mortality.
    
    
13. The GOB has a maternal health strategy document that covers 2001 to 2010 that is currently being implemented.
    
    

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