Indicator menus: Intentional reorientation in global maternal and neonatal health measurement

There is strong impetus for internationally standardized measurement for maternal and neonatal health (MNH) to facilitate global benchmarking and accountability. Recent funding cuts have sharpened debates about whose priorities should guide measurement and what role international-level actors should play. This qualitative study combined observations and 24 semi-structured interviews in 2023-2025 with experts across multilateral agencies, bilateral donors, academia, and philanthropic organizations to explore how global-level MNH measurement actors understand challenges of indicator standardization and prioritization amid shifting funding and governance dynamics. Our findings show a field grappling with an appetite for increasingly comprehensive measurement which has outpaced feasibility and local relevance. The expansion from mortality and coverage indicators to quality-of-care measurement represents progress to many, but has also generated indicator proliferation and 'overloaded plates'. Underlying this are deeper questions of purpose and power: global MNH measurement was widely perceived as designed primarily to serve upward accountability rather than local decision-making. Interviewees proposed indicator menu approaches - curated but selectable sets of indicators from which countries choose based on their own priorities and capacities - as a meaningful step towards contextualisation and flexibility, while acknowledging that menus alone do not alter the accountability architecture within which measurement operates. Funding disruptions exposed the structural fragility of donor-dependent measurement systems and were viewed with cautious optimism as a potential catalyst for reorientation. Substantive change, however, was seen as demanding more than redesigning indicator lists. It requires building local measurement capacity and centering people who produce and use data closest to the point of care.