Assessing the Global Advocacy, Accountability, and Political commitment landscape for Pre Eclampsia and Eclampsia: Identifying opportunities for prioritization and action

Global maternal mortality has declined over the past two decades, yet the pace of progress has slowed and remains insufficient to meet global targets. In 2023, an estimated 260,000 women died from pregnancy related causes.1 More than 90% of these deaths occurred in low and lower middle income countries (LMICs).1 Although the global Maternal Mortality Ration (MMR) has fallen from 328/100,000 deliveries in 2000 to 197/100,000 deliveries in 2023, the rate of decline has decelerated, from an average annual rate reduction (ARR) of 2.5% during the Millennium Development Goal era to 1.6% during the Sustainable Development Goal era.1 If this trajectory continues, the global MMR by 2030 is projected to be 177/100, 000; far above the SDG target of 70/100,000. Achieving SDG target 3.1 would require an average ARR of approximately 14.8% between 2024 and 2030, indicating the need for a substantial acceleration in efforts to reduce preventable maternal deaths.1 Pre-eclampsia and eclampsia are major causes of maternal mortality and morbidity worldwide, and only second to postpartum hemorrhage (PPH) as a direct cause of maternal deaths in LMICs. Despite being predictable and preventable as obstetric conditions, progress in reducing deaths and morbidities is slow due to inadequate health system responses, low awareness among all stakeholders, and lack of prioritization in government and international development policy documents. In contrast, obstetric and medical conditions that impact maternal and child health to a lesser degree have received disproportionally bigger attention. While clinical research on pre-eclampsia/eclampsia is extensive, there is limited synthesis of the advocacy efforts aimed at holding governments accountable and the political commitments made to translate guidelines into practice. Community stakeholders have also not been mobilized and informed sufficiently for any meaningful progress to be realized in reducing the burden of pre-eclampsia/eclampsia in the maternity population world-wide but most especially in LMICs. To address these gaps, there is a need for a comprehensive assessment of the global, regional, and national landscape for advocacy, accountability, financing, and political commitment related to pre eclampsia and eclampsia. Such an assessment requires multiple complementary methods, including review of published and grey literature, stakeholder surveys, key informant interviews, stakeholder mapping, political economy analysis, and country case studies. This protocol therefore outlines our methodological approach to conducting a scoping review as the first step in this formative process. This study is part of a larger World Health Organization-commissioned initiative on preeclampsia, and constitutes one of the five workstreams. The other workstreams are Research Prioritization, Norms and Standards, Access to Health Products, Implementation