In 1998, recognizing the need to extend the Foundation’s mission internationally, the March of Dimes Board of Trustees approved the establishment of a department of Global Programs. Its purpose was to respond to the high rates of death and disability from birth defects and preterm birth in developing countries.
To focus global attention on the problem of birth defects and preterm birth, Global Programs staff worked with international organizations, academic institutions, government agencies and non-governmental organizations to collect country-level estimates of the number of affected births and newborn deaths associated with these conditions. Global Programs then used these data to produce high-visibility reports that focused global attention on the previously under-counted, under-reported and under-valued problems of birth defects and preterm birth. Examples include: The March of Dimes Global Report on Birth Defects (2006) and . Both reports presented the first ever country-level rates of birth defects and preterm birth and recommended actions to strengthen prevention and care of these conditions. The reports reached millions of households worldwide via radio, TV and print and galvanized international action, including passage in 2010 of a WHO Resolution on birth defects.
To reduce the unacceptably high rates of birth defects and preterm birth in developing countries, Global Programs partners with academic medical centers, international organizations, non-government organizations and other stakeholders in middle- and lower-income countries to implement actions, including those in the above reports. Global Programs has no overseas offices; we do all our work through our partners. Our partnerships have four guiding principles: local ownership of all international activities; cost-sharing; collaboration across the Foundation in informing our partnerships; and a focus on short-term, product-intensive projects.
Examples of partner programs include establishing surveillance systems to improve the quality of country-level data on the incidence of, mortality from and economic costs of birth defects and preterm birth; education of health care providers on best practices in prevention and care; raising public awareness of the steps couples and families can take to improve birth outcomes; and interventions on specific risk factors, including fortification of foods with folic acid to prevent neural tube defects and promoting rubella immunization to prevent congenital rubella syndrome.
To bring additional visibility of the findings of our reports and partnership successes, Global Programs also organizes and co-sponsors international conferences, including the International Conference on the Prevention of Birth Defects and Disabilities in the Developing World, which is held every other year in different regions of the world. These conferences bring together researchers, health care providers, policy makers, donor agencies and community-based organizations like parent/patient groups to share new findings and best practices and strengthen regional and global networks.
The Global Network for Maternal and Infant Health (GNMIH) is a collaboration of Global Programs with three of our strongest partners sited in Peking University, China; the American University of Beirut (Lebanon) and the Institute of Human Genetics of the National Institutes of Health, Philippines. The main aim of the GNMIH is to foster the sharing of expertise, knowledge and experience in research and project implementation strategies across partner sites. Current cross-cutting activities of the GNMIH include surveillance of birth defects and preterm births, education of primary care providers on diagnosis and appropriate referral; and community health education, especially targeting girls and young women. The GNMIH is also developing a global volunteer youth network of students and young professionals to assist its community health education projects.
Global Programs has also carried out a number of projects in Latin America, many of which focus on the promotion of fortification of foods with folic acid. For example, Global Programs partnered with the Pan American Health Organization (PAHO), the U.S. Centers for Disease Control and Prevention (CDC), the Institute of Nutrition of Central America and Panama (INCAP) and the Ministry of Health of Costa Rica to establish uniform norms and standards for fortification of foods with micronutrients across the countries of Central America. It also partnered with the Institute of Human Nutrition in Santiago, Chile, and the CDC to measure the extent of reduction in the rate of neural tube defects (NTDs) following the national implementation of folic acid fortification in Chile in January 2000. The findings of this study, which showed a significant decrease in NTD rates in less than two years, spurred implementation of national fortification programs in more than 10 additional countries in Latin America.
In India, Global Programs worked to reduce maternal and neonatal mortality in partnership with the Jawaharlal Nehru Medical College/KLES Hospital and Medical Research Centre, Belgaum, Karnataka. The program, which began in 2004, provided training to medical officers and auxiliary nurse midwives in rural areas to improve perinatal health care; facilitating the development of a hospital referral system; and educating the community about healthy pregnancy. Additionally two pilot projects were implemented to improve prenatal health and newborn care in a peri-urban area of Belgaum City and to provide health education to adolescent girls in a rural area of Belgaum District.
Global Programs has also carried out a number of partnerships in Central and Eastern Europe. For example, we worked with the Dartmouth Medical School on a project in Kosovo to improve perinatal health surveillance and use of these data to improve care of women and neonates to reduce neonatal deaths. A pilot study of late stillbirths and early neonatal deaths is being carried out under the auspices of the Kosovo-based Foundation for Healthy Mothers and Babies and in collaboration with the University Clinical Center of Kosovo. The study aims to provide data on the incidence and causality of late stillbirth and early neonatal deaths, identify improvements in care to prevent still births and newborn death and raise awareness among health policymakers and funding agencies of the extent of the stillbirth/early neonatal death problem.
Future priorities of Global Programs include the expansion of research networks of professional organizations, governmental and non-governmental organizations and academic centers to identify new prevention strategies that reduce birth defects and preterm birth rates middle- and low-income countries; working with professional organizations to implement strategies to lower rates of elective C-sections conducted before 39 weeks of gestation worldwide; and promoting preconception health and the harmonization of care across the reproductive, maternal, newborn and child health (RMNCH) continuum, with particular emphasis on health of girls and young women.
In pursuing these and other activities, Global Programs remains committed to extending the March of Dimes mission abroad and working with our partners worldwide to ensure a day when all pregnancies are safe and babies everywhere have a healthy start in life.