Maternal health's ascent on the global policy agenda: How the Millennium Development Goals & a continuum of care framework changed an initiative's fortunes

An emergent policy network first drew attention to maternal mortality, a global health problem disproportionately affecting vulnerable populations in the developing world, in the mid-1980s. The initiative failed to acquire high-level political attention for two decades. This changed circa 2005-2007. A movement to link maternal, newborn and child health in a continuum of care framework emerged with powerful backing from donors, leading to a merging of three secretariats that housed separate initiatives on behalf of the issues. This convergence linked the interrelated issues and provided a platform for their joint ascendance on the global policy agenda. Driven by politics and strategic advocacy surrounding the health-related United Nations Millennium Development Goals, maternal health began to attract attention from high-level policymakers, followed by significant resource commitments from donors and developing countries and culminating in the UN Secretary-General's Global Strategy for Women's and Children's Health – a multisector global initiative launched in 2010 with $40 billion in commitments. We draw upon constructivist international relations theory and scholarship on policy networks to uncover factors affecting agenda status. We use a comparative case study methodology to capture initiative evolution and impacts. Data include in-depth interviews with 60 actors involved in the global health policy networks, and analysis of archival data. Results suggest that the normative influence of the Millennium Development Goals and continuum of care framework changed the initiative's fortunes in the international policy arena, but success may be short-lived due to limited engagement at the country level and the short term Millennium Goals timeframe.