EA - Maternal Health Initiative is Shutting Down by Ben Williamson

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Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Maternal Health Initiative is Shutting Down, published by Ben Williamson on March 15, 2024 on The Effective Altruism Forum.Maternal Health Initiative (MHI) was founded out of Charity Entrepreneurship (AIM)'s 2022 Incubation Program and has since piloted two interventions integrating postpartum (post-birth) contraceptive counselling into routine care appointments in Ghana. We concluded this pilot work in December 2023.A stronger understanding of the context and impact of postpartum family planning work, on the back of our pilot results, has led us to conclude that our intervention is not among the most cost-effective interventions available. We've therefore decided to shut down and redirect our funding to other organisations.This article summarises MHI's work, our assessment of the value of postpartum family planning programming, and our decision to shut down MHI as an organisation in light of our results. We also share some lessons learned. An in-depth report expanding on the same themesis available on our website.We encourage you to skip to the sections that are of greatest interest:For people interested in the practicalities of development work, we recommend 'MHI: An Overview of Our Work'.For those interested in family planning programming, we recommend 'Pilot: Results', 'Why We No Longer Believe Postpartum Family Planning Is Among The Most Cost-Effective Interventions', and 'Broader Thoughts on Family Planning'.Finally, for those interested in broader lessons around entrepreneurship and organisation-building, we recommend 'Choosing to Shut Down' and 'Lessons'.Why we chose to pursue postpartum family planningWhy family planning?Pregnancy-related health outcomes are a leading cause of preventable death among both mothers and children. In 2017, almost 300,000 women and girls died due to either pregnancy or childbirth (WHO, 2017). Cleland et al. (2006) estimate that comprehensive access to contraception could avert more than 30% of maternal deaths and 10% of child mortality globally.Contraceptive access provides a wide range of other potential benefits, the most significant of which may be increasing reproductive autonomy for women who want to space or limit births and currently have limited options for doing so.Why postpartum (post-birth)?Postpartum family planning (PPFP) - that is, integrating family planning guidance into postnatal care and/or child immunisation appointments- has been identified as an effective way of increasing contraceptive uptake and reducing unmet need (Wayessa et al. (2020);Saeed et al. (2008);Tran et al. (2020);Tran et al. (2019);Pearson et al. (2020);Dulli et al. (2016).The maternal and infant mortality risks from short birth spacing make the postpartum period a potential point of particular value from increased contraceptive access. Demographic Health Survey (DHS) analysis suggests an 18% increase in neonatal mortality, 21% increase in child mortality, and 32% increase in mortality risk from births that occur within two years of a prior pregnancy (Kozuki and Walker's2013; Conde-Agudelo et al.2007).While it is often an official policy that family planning counselling should be included in postnatal care (Ghana Health Service,2014), the consistency and quality of family planning services in the postpartum period vary in practice (Morhe et al. 2017).MHI: An overview of our workCharity Entrepreneurship (AIM) recommended postpartum family planning as part of the 2022 Incubation Program through which MHI was founded. As such, MHI has had an explicit focus on postpartum family planning work since its beginning. We spent our first few months interviewing a few dozen experts, getting up to speed with research in the field, and selecting priority target countries. Based on this work, we visited Sierra Leone and Ghana in...