Congo's New Partogram Revolutionizes Maternal Care, Reducing Mortality Rates

At the forefront of this implementation is Brazzaville’s Mère-Enfant Blanche Gomes Hospital, where the updated partogram has been used since 2023.

The Republic of the Congo is significantly advancing its maternal health strategy, focusing on reducing maternal mortality and improving the safety of childbirth. One of the key innovations in this effort is the introduction of the simplified partogram, a labor monitoring tool designed to track the well-being of both mothers and babies during active labor. This tool, known for its ability to guide healthcare workers in identifying potential complications early, has been a game-changer in improving the overall quality of care provided to women giving birth.

The partogram has been in use in the Republic of the Congo since 1993, but it was only in 2022 that a simplified version was introduced across 12 health districts to make it more accessible and easier for maternity staff to use. This new version of the partogram has proven invaluable in improving the overall clinical outcomes for both mothers and babies, while also ensuring a smoother and safer labor process.

At the forefront of this implementation is Brazzaville’s Mère-Enfant Blanche Gomes Hospital, where the updated partogram has been used since 2023. Dr. Frédine Mahoungou, an obstetrician-gynaecologist at the hospital, explains the improvements brought by the new tool. “Previously, the partogram was a complicated chart to complete, which led to low uptake and errors in labor monitoring. This sometimes resulted in rushed deliveries and the overuse of oxytocin, which increased uterine contractions. This raised the risk of tearing and hemorrhage, creating a stressful situation for both staff and the woman in labor.”

To facilitate the effective use of the updated partogram, the World Health Organization (WHO), with support from the Swedish government, provided comprehensive training for 235 health professionals, including midwives and gynaecologists. This training empowered healthcare workers to use the revised partogram to track vital indicators such as cervical dilation, contraction frequency, and the vital signs of both mother and baby. According to Minerve Nsouka, a midwife at Blanche Gomes, the new tool has brought clarity and reduced stress: “With the old partogram, we were very stressed because we didn't know how to use it efficiently. The new version is much easier and helps us better follow the progress of labor.”

The results of the updated partogram's introduction have been impressive. In 2023, the fill rate for the new partogram soared to 99%, up from 74% in 2022. Furthermore, the rate of Cesarean sections dropped from 32% to 21%, while the stillbirth rate decreased from 2% to 1%. The improved monitoring and earlier detection of complications have helped staff make timely interventions, which ultimately improves the likelihood of a positive outcome.

“I can better support women during labor, guiding their breathing, encouraging hydration, and offering reassurance and care,” says Nsouka. The simplified partogram has allowed midwives to offer more personalized and attentive care, creating a more peaceful environment for mothers during labor. This is particularly significant as better maternal care not only impacts clinical outcomes but also contributes to a positive childbirth experience, as seen in the case of Ghislaine, a mother of three. She notes the drastic difference in her most recent birth experience: “When I had my first child in 2016, it was very different. This time, the midwives were holding me, we even danced – I could really feel the difference. I felt safe and fully supported throughout the delivery.”

The introduction of the simplified partogram comes at a crucial time in Congo’s efforts to reduce maternal mortality. WHO estimates that the maternal mortality ratio in Congo dropped significantly, from 710 deaths per 100,000 live births in 2005 to 241 deaths per 100,000 live births in 2023. However, despite these advancements, Congo’s maternal mortality ratio still remains above the global average of 211 deaths per 100,000 live births and far from the WHO target of 70 deaths per 100,000 live births by 2030. This highlights the importance of continuing efforts to improve maternal care, especially in rural and underserved areas.

WHO, along with the Congolese government, has continued to support national efforts through the development of a strategy to promote family planning and emergency obstetric care. This strategy also highlights the need for improved antenatal and delivery monitoring tools to enhance the safety and quality of maternal health services. Dr. Vincent Dossou Sodjinou, Acting WHO Representative in Congo, emphasizes, “WHO continues to support maternal and neonatal health initiatives to ensure that every pregnancy and birth occurs in conditions of safety and well-being. All women must be able to give birth with the support of qualified staff who know how to use these tools.”

The Congolese government, alongside its international partners, is ramping up efforts to ensure better maternal health. The updated partogram is seen as a key tool in this ongoing effort. “Thanks to the new partogram, we are now better equipped to provide optimal conditions, so that childbirth can be a satisfactory experience for mothers and the wider community,” concludes Dr. Mahoungou. “It is essential that women leave the maternity unit safe, well, and feeling cared for.”

In the broader context of maternal health in Africa, the introduction of the simplified partogram is part of a larger initiative aimed at improving outcomes across the WHO African Region. Between 2000 and 2023, the region recorded a nearly 40% decline in maternal mortality, from 727 deaths per 100,000 live births to 442. In Congo, the drop has been even more substantial, with a 50% reduction in maternal mortality between 2005 and 2023.

This remarkable progress in the Republic of the Congo serves as an example of how targeted innovations, like the simplified partogram, can contribute to improving maternal health outcomes and reducing the risks of maternal and neonatal mortality. As more health districts adopt the new partogram and healthcare staff continue to receive training, Congo is well on its way to achieving further improvements in maternal care.