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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Preventive Dental Visit: Pregnancy.

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Strategy. Midwifery-Initiated Programs (Pregnancy)

Approach. Integrate comprehensive, midwife-initiated oral health screening and priority dental treatment access into routine antenatal care

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Overview. The Midwifery-Initiated Oral Health-Dental Service (MIOH-DS) program is a proven, comprehensive model to address significant gaps in maternal oral health promotion and care utilization during pregnancy. [1] This strategy involves specially trained midwives providing evidence-based oral health education and screening using a validated tool during the first antenatal visit. [1,2] Critically, the intervention successfully links pregnant women to priority access to free or cost-free local dental services for assessment and necessary treatment, which is typically provided during the safe period of the second trimester. [1] A multi-centre randomized controlled trial demonstrated that participants receiving the full MIOH-DS service (Intervention Group 2) had substantially higher rates of dental service uptake (87.2%) compared to the control group (20.2%). The intervention group also showed significant improvements across key oral health indicators, including oral health knowledge, reduced gingival bleeding, and fewer decayed teeth. This integrated approach is essential because pregnant women often have limited knowledge about maternal oral health and rarely seek dental care, while providers often lack training to discuss these issues. [1]

Evidence. Emerging Evidence. Strategies based on emerging evidence show promise but have not undergone extensive testing. While these approaches demonstrate potential, their effectiveness remains unconfirmed. Prioritize rigorous monitoring to ensure they achieve desired outcomes for all MCH populations.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Morbidity Reduction. This strategy addresses factors that can decrease the incidence or prevalence of diseases and illnesses.
  • Quality of Care. This strategy promotes the degree to which healthcare services meet established standards aimed at achieving optimal health outcomes.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Referral and Follow-Up (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of public hospitals or prenatal clinics where midwives have been successfully trained and certified to implement the MIOH screening and referral protocol. (Measures the institutional adoption and workforce readiness of the integrated model)
  • Number of dedicated dental clinics or public dental service pathways established to provide free/priority access treatment slots for referred pregnant women. (Measures the necessary physical infrastructure created to remove access challenges)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of perinatal care providers (e.g., midwives) in participating settings who successfully complete the endorsed oral health education program and demonstrate competence in the MIOH screening tool. (Measures the fidelity and effectiveness of workforce training)
  • Percent of MIOH participants who confirm they received clear, evidence-based oral health educational materials (brochures, web-based info) during their initial antenatal visit. (Measures the quality of information dissemination based on program components)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of pregnant women identified as having an oral health need (e.g., dental problem or high risk) who receive a documented referral for dental assessment and treatment via the MIOH pathway. (Measures the volume of at-risk women successfully channeled into the treatment system)
  • Number of women enrolled in the MIOH program who confirm accessing a dental check-up or necessary treatment during their pregnancy. (Measures the achievement of the primary outcome: increased dental utilization)
  • Number of women who exhibited clinical improvements in oral health status, specifically a reduction in measures like the Sulcus Bleeding Index or Decayed Teeth scores. (Measures the volume of clinically improved health outcomes)
  • Number of partnerships and agreements formalized between maternity care services and dental services to ensure sustained priority access for pregnant women. (Measures the systems change required for program sustainability)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent increase in the uptake of dental services among pregnant women in the MIOH-DS group compared to the standard care group. (Measures the definitive effectiveness of the integrated model in overcoming utilization challenges)
  • Percent of women with untreated dental caries or gingivitis at baseline who complete necessary treatment (e.g., restoration, scaling) during the safe period of the second trimester. (Measures the effectiveness of the intervention in reducing treatable morbidity)
  • Percent of participating pregnant women who report high satisfaction with the oral health education and referral process provided by their midwife. (Measures the improvement in Patient Experience of Care and acceptance of the integrated model)
  • Percent of referred women who demonstrate an increase in oral health knowledge (e.g., safety of dental care, importance of maternal oral health) post-intervention. (Measures the success of the health teaching component of the intervention)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] George, A., Dahlen, H. G., Blinkhorn, A., Ajwani, S., Bhole, S., Ellis, S., Yeo, A., Elcombe, E., & Johnson, M. (2018). Evaluation of a midwifery initiated oral health-dental service program to improve oral health and birth outcomes for pregnant women: A multi-centre randomised controlled trial. International Journal of Nursing Studies, 82, 49–57.
[2] Johnson, M., George, A., Dahlen, H., Ajwani, S., Bhole, S., Blinkhorn, A., Ellis, S., & Yeo, A. (2015). The midwifery initiated oral health-dental service protocol: an intervention to improve oral health outcomes for pregnant women. BMC Oral Health, 15(2), 1–9.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.