JSI RESOURCES: Publications

Madagascar Technical Brief – Strengthening Last-Mile Interventions for Maternal Health


Although important global progress has been made to improve maternal health in the last two decades, an unacceptably high number of women continue to die during and following pregnancy and childbirth, including in Madagascar. The most common causes of maternal injury and death are excessive blood loss, infection, high blood pressure, unsafe abortion, and obstructed labor. The majority of these deaths are preventable with antenatal care (ANC), the presence of a skilled attendant at birth, and access to emergency obstetric care.

Despite the Government of Madagascar’s commitment to improve maternal health, progress toward reducing maternal mortality has been slow over the last two decades. The country’s maternal mortality rate stands at 426 maternal deaths per 100,000 live births, compared to the global average of 211 deaths per 100,000 live births. Although ANC visits help pregnant women prepare for safe delivery while linking them to the formal health system, in 2018, only half of pregnant women in Madagascar completed four visits. This rate is low, especially considering both the World Health Organization (WHO) and Madagascar’s national guidance recommend that pregnant women have eight ANC visits. Furthermore, six of ten deliveries take place at home, and only half of deliveries are assisted by skilled personnel. 

Through its complementary and mutually reinforcing community health interventions, the USAID Community Capacity for Health Program aimed to contribute to the objectives of Madagascar's Ministry of Public Health, which include improving the supply of and demand for health services by the population and reducing maternal and newborn mortality rates.

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