Research and learning priorities for a surgical obstetrics and family planning project implementing in low- and middle-income countries: results of an expert consultation

Introduction Cesarean delivery, peripartum hysterectomy, female genital fistula treatment, and long acting and permanent contraceptive method provision comprise an important set of surgical procedures in reproductive and maternal health. The volume of these procedures is growing in low- and middle-income countries (LMIC). Establishing research priorities in a learning agenda for surgical obstetrics and family planning represents a key step in generating and using evidence to improve health outcomes associated with these surgeries.

A safe surgery project addressing family planning and obstetrics used a two-stage rating and ranking consultation process to prioritize topics in its learning agenda, focusing on LMIC needs. A list of research and learning topics spanning the project’s technical areas (surgical obstetric care [cesarean delivery and peripartum hysterectomy], fistula prevention and treatment, family planning, and cross-cutting safe surgery) was curated by searching the literature, conducting project-related surveys of experts and partners, and soliciting an expert panel via virtual consultation. Topics were rated through an online survey of the experts on four criteria: feasibility, technical importance, level of saturation, and potential for impact. The expert panel then reconvened to rank and refine highly rated topics.

A total of 39 people participated in the expert panel, representing multilateral, academic, and funding organizations, implementing partners, and professional associations active in LMIC. Fifteen topics were prioritized across the four technical areas. Prioritized topics cover themes of prevention (e.g., intrapartum/midwifery practices to prevent unnecessary cesarean), care-seeking (e.g., social behavior change strategies for fistula prevention), peri-operative care (e.g., use of quality improvement tools including checklists and audits), and post-operative care (e.g., effective measurement approaches for monitoring outcomes).

This agenda guides clinical and programmatic learning across the safe surgery ecosystem. Collaborative action across program initiatives and clinical and community settings may contribute to significant evidence building in these priority topics. Teaser Key Message We identified research and learning priorities on surgical obstetrics and family planning for a project’s research and learning agenda. Practitioners, program implementers, donors and researchers involved in global safe surgery, maternal health, and family planning can apply these priorities toward guiding their evidence generation and translation efforts. Key Findings Safe surgery is essential for reducing maternal morbidity and mortality; this consultation represents one instance in which preventative, care-seeking, perioperative, and postoperative priorities were collaboratively identified to strengthen surgical maternal health and family planning services in LMIC. Key Implications Although the topics prioritized in this agenda were developed in the context of a project, they provide donors interested in maternal health and family planning with lines of inquiry to target investments in research and learning. Practitioners, program implementers, and researchers in surgical maternal health and family planning care can fill evidence gaps by applying these lines of inquiry within their interventions and sharing learning across programs and settings. This agenda, in focusing on cross-cutting knowledge gaps related to safe surgery, can complement priority learning questions in national strategic plans for surgery, family planning, and/or maternal health; priorities for policy research; and broader maternal health and family planning research agendas. Competing Interest Statement The authors have declared no competing interest. Funding Statement The work described in this paper was originally funded by the United States Agency for International Development (USAID) through the MOMENTUM Safe Surgery in Family Planning and Obstetrics award (cooperative agreement no. 7200AA20CA00011). This paper was subsequently completed independently by the authors. The contents do not necessarily reflect the views of USAID or the United States government. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Role of authors FAK, KL, RS, and VT designed and implemented the consultation. FAK, KL, RS, and VT developed the data collection instrument. FAK and VT planned data analysis. FAK oversaw data collection and analysis. FAK, KL, RS, and VT prepared the first draft of this manuscript. All authors reviewed and edited drafts of this manuscript and approved this version for submission. Data Availability All data produced in the present study are available upon reasonable request to the authors