The overall expected impact of the MOMI project is a contribution to new knowledge about maternal and newborn health, which will be used to generate evidence-based strategies, especially relevant to the primary health care approach to integrated services in the postpartum and to support continuity of care. In particular, new evidence will demonstrate the value of taking advantage of potential synergies between maternal and newborn health.

Focused postpartum services addressing maternal and newborn health is expected to result in:

1. Better access to community- and facility-based postpartum and newborn services.
2. Validation of the proposed strategy of developing context-specific solutions to the "know-do" gap.
3. Evidence to inform decisions about the optimal configuration and schedule of postpartum visits.
Evidence of the effectiveness of a locally-adapted package of postpartum services.

Findings of the study will also impact future decisions about the optimal visit schedule of postpartum visits. Unlike with antenatal care, little evidence is currently available to inform decisions about the optimal timing and number of postpartum visits. Two or more postpartum visits have been suggested by WHO, depending on whether maternal complications are present. A more detailed understanding of the optimal schedule and setting for postpartum visits which will result from this study will inform such considerations.

This study will provide new evidence about the effectiveness and safety of interventions such as community-level distribution of misoprostol and antibiotics, among other interventions. This will impact on future decisions at a global level about the inclusion of such interventions in a package of postpartum care.

Beside obstetric emergencies such as haemorrhage and sepsis, are underlying maternal morbidities placing women at risk by for severe illness or making them less resilient when such illnesses occur. New evidence about how best to address these more routine - but no less important - conditions will also constitute an important study impact.

Information is also needed on the optimal means of delivering family planning counselling and contraception in the postnatal period. Contraception undoubtedly impacts on child survival. For example, research in the Matlab district in Bangladesh showed that longer intervals between two pregnancies could significantly reduce infant and child mortality rates. Apart from these benefits, increased access to family planning services and birth spacing can contribute substantially to the achievement of a number of Millennium Development Goals including: reduction of poverty and hunger, women's empowerment, and long-term environmental sustainability. As with all impacts, it is important to consider the costs incurred and potential savings.

The importance of the postpartum period is finally gaining prominence in programmes to prevent mother-to-child transmission of HIV, against a backdrop of complex controversies around provision of safe infant feeding in HIV-infected women. Recent findings (that giving antiretroviral drugs to breastfeeding infants reduces transmission through breast-milk) have led to increased global focus on the postpartum period in high HIV burden countries. Given the recent WHO recommendations about the services necessary to reduce HIV transmission through breastfeeding, it is likely that the policy importance and prominence of the postpartum period will increase across Africa as postpartum HIV services scale up. The MOMI project is thus timely in providing evidence to what newborn and maternal interventions are needed in the postpartum, which will complement and enhance the effects of postpartum antiretroviral drugs for breastfeeding infants.

Though much of the above could be considered self-evident, without specific projects demonstrating the impact of postpartum projects on maternal and newborn health, these apparently obvious concepts may remain unrecognized and peripheral, and missed opportunities to improve maternal and newborn care may continue to be overlooked.