Research and Learning Priorities for a Surgical Obstetrics and Family Planning Project Implementing in Low- and...

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 (LMICs). 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.Methods: Between January and February 2022, a safe surgery project addressing family planning and obstetrics used a 2-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, consisting of 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. Through an online survey, the experts rated the 63 topics on a 5-point scale based on 4 criteria-feasibility, technical importance, level of saturation, and potential for impact-and average ratings were calculated for each criterion and topic. The expert panel then reconvened virtually to rank and refine highly rated topics.Results: A total of 39 people participated in the expert panel, representing multilateral, academic, and funding organizations, implementing partners, and professional associations active in LMICs. Fifteen topics were prioritized across the 4 technical areas. Prioritized topics covered themes of prevention (e.g., intrapartum/midwifery practices to prevent unnecessary cesarean delivery), care-seeking (e.g., social and behavior change strategies for fistula prevention), perioperative care (e.g., use of quality improvement tools including checklists and audits), and postoperative care (e.g., effective measurement approaches for monitoring outcomes).Conclusion: 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.