The Drum Beat 305: MDG #5 - Improving Maternal Health

Millennium Development Goal (MDG) #5 seeks to reduce the maternal mortality ratio, worldwide, by 75% prior to 2015. This issue of The Drum Beat explores just a few of the ways in which communication tools and strategies are being utilised to address life-threatening complications during pregnancy and childbirth - in short, to meet MDG #5 and save women's lives.

Next month we will focus on MDG #6: Combating HIV/AIDS, Malaria and Other Diseases. Please send your projects, articles, events, etc. to Deborah Heimann dheimann@comminit.com

 

CONTEXT

1. Unsafe Motherhood - The Facts
The greatest risks of maternal death are faced by women in sub-Saharan Africa. Worldwide, the World Bank estimates that maternal health services could cost as little as US$2 per person per year in developing countries. [Data is from Dec 2001.]

2. Maternal Mortality
The Maternal Mortality Rate is defined as the number of women who die as a result of pregnancy and childbirth complications per 100,000 live births in a given year. An estimated 585,000 women die each year from these complications; 99% live in developing countries, where they are more likely to be malnourished and suffer from hemorrhage (the leading cause of maternal deaths: 146,000 each year) and infection (causing 87,000 maternal deaths each year). [Data is from 2003.]

3. World Bank Report Warns Many Countries Falling Behind MDG's for Health
At the current pace in the developing world as a whole, 17% are likely to meet MDG #5. [Data is from Jan 2004.]

4. Birth Attendants
According to the United Nations Secretary General, recent data on the proportion of births attended by skilled health personnel indicate significant improvements in northern Africa and Eastern and South-Eastern Asia; the lowest rates are found in South-Central Asia - only 35 attendants per 100 deliveries. [Data is from 2004.]
Source: The Millennium Campaign

MOBILISING COMMUNITIES & CAREGIVERS

5. Impact Data - Engaging Guatemalan Communities to Save Mothers - Guatemala
The major causes of maternal mortality in Guatemala are preventable: hemorrhage (53%), infection (14%), and hypertension (12%). In the western part of the country, 69% to 80% of women deliver at home. In response, the Ministry of Health and Public Assistance and the Maternal and Neonatal Health (MNH) Program used radio and printed materials to improve maternal services and mobilise communities to respond to obstetric emergencies in an appropriate and timely manner. At baseline, 5% of women reported having made a plan for transportation; 37% of women exposed to the programme made a plan (vs. 12% of non-exposed). The percentage of women who reported setting aside money increased in both groups from a baseline of 5%, but to a far higher level among those exposed (74%) than among those not exposed (26%).

6. Impact Data - Participatory Intervention with Women's Groups - Nepal
In rural Nepal, 94% of births occur at home, and 13% are attended by trained health workers. The Mother and Infant Research Activities in Kathmandu undertook a low-cost, community-based participatory intervention to reduce neonatal and maternal mortality. In each intervention cluster (average pop. 7,000), a literate local woman was selected and trained. Guided by these facilitators, women gathered every month for a year to discuss problems related to neonatal and maternal care in their community, and to devise strategies - which were then implemented at the local level. In intervention clusters, 54% of attendants used a boiled blade to cut the cord (vs. 26% in control clusters) and 68% of attendants washed their hands (vs. 33% - control). If ill, 50% of women in intervention clusters visited a health facility (vs. 22% - control). The maternal mortality ratio was about 80% lower in intervention than in control clusters.

7. Training Workshop for Physicians, Nurses, and Midwives - Latin America/Caribbean Region
In 2002, the Maternal and Neonatal Health (MNH) Program organised a weeklong workshop in Baltimore, MD, USA for 16 doctors, nurses, and nurse-midwives from Bolivia, Chile, Guatemala, Haiti, Honduras, Paraguay, Peru, and Uruguay. The aim was to support clinicians by updating their evidence-based maternal and newborn knowledge and skills, enhancing their training skills, and equipping them to be advocates for change. As part of their participation in the initiative, experts committed to an action plan to change selected maternal and newborn healthcare practices at their local institutions.
Contact mnh@jhpiego.net

8. Initiatives for Social Inclusion Programme - Peru
UNICEF finds that 10% to 20% of births in areas of Peru with a high concentration of indigenous people take place in health centres; maternal death is related to gender inequality, and is connected to increased mortality among small children, reduced school attendance, and family impoverishment. In response, UNICEF-Peru offered culturally sensitive, community-based training sessions tailored to health care workers, traditional birth attendants, women, and men (partners). Campaigns using mass media, cultural animation, and interpersonal communication encouraged the formation of community groups. Meetings were held with local authorities and opinion leaders to raise awareness and urge the development of inter-sectoral local plans to promote safe motherhood. Casas de Espera ("Maternal Homes") were set up close to the health centre, where women from distant rural communities stay during the last month of pregnancy.
Contact Esperanza Vives evives@unicef.org

INFORMATION & ADVOCACY STRATEGIES

9. Mobile Phones for Mother & Child Care
by Patricia N. Mechael
The WHO's World Health Report 2005 cites Egypt as having made significant progress in improving maternal and child health; mobile phones have been central to that progress in indirect - as well as the following direct - ways: reducing response time to obstetric emergencies by enabling contact with formal and informal means of transport, and facilitating consultations between traditional birth attendants and mid-wives, as well as between mid-wives and physicians. Further, "Most women prefer to contact their mothers or sisters when they require health-specific decision-making support....Mobile phones increasingly are facilitating access to this guidance..."

10. Impact Data - Eyi Megh Eyi Roudra - Bangladesh
Viewers of this 26-episode TV drama are more aware of pre-delivery preparations and pre- and post-delivery complications. Viewers are more aware that delivery should be performed either by trained birth attendants or doctors. 70% of viewers had received antenatal care services during their last pregnancy, as compared to 48% of non-viewers. 58% of non-viewers, versus 41% of viewers, said they had taken "no preparations" in advance of their last pregnancy.

11. Sex Positions - United Kingdom
Marie Stopes International and Interact Worldwide collaborated to raise awareness and inspire action around the issue of safe motherhood. UK citizens use their political voice and rights by communicating directly with their Member of Parliament (MP). A boldly coloured printed postcard may be downloaded on the campaign website, which also includes a "take action" page detailing additional strategies. The postcard begins with this message, in all-capital letters: "If you care about reducing global poverty and preventing the unnecessary suffering of hundreds of thousands of women and children each year, then ask yourself this question...Sex: What position should I adopt?" This double entendre is followed by information, statistics, and actions for the MP to carry out. Organisers aim "to put pressure on the UK government to take the lead in ensuring that the international donor community fulfils promises...to support global efforts to achieve sexual and reproductive health and rights for all by 2015."
Contact sexpositions@mariestopes.org.uk

12. LOVE, LABOR, LOSS: A Documentary Film on Obstetric Fistula
In Niger, "women are being forced into marriage at an early age (as young as 9), becoming pregnant shortly after without access to appropriate prenatal and emergency obstetric care....Niger's strong commitment to alleviating women of fistula is met by tremendous social hurdles." This film seeks to "challenge the global apathy towards women's reproductive rights by profiling a special group of women who live with obstetric fistula - the most debilitating and ostracizing childbearing disorder affecting over 2 million women in the developing world". Filmed on location, the documentary follows personal stories and perspectives in an effort to motivate viewers to ask, "Is safe motherhood a human right?"

13. Communicating Safe Motherhood in Morocco
This maternal mortality prevention programme was carried out by the Ministry of Health in collaboration with John Snow, Inc. and the Johns Hopkins University Center for Communication Programs. "The communication strategy has been essential...Through early advocacy activities, maternal mortality became a clear and undeniable priority in Morocco. Through media coverage, it became an increasingly high-visibility issue. Through provider motivation and training in emergency obstetric care, an increasing number of Moroccan women are gaining access to life-saving services. And through public education and outreach, women and their families are learning that an obstetric complication does not ordain death." The latter component featured entertainment-education in the form of a play that toured urban and rural areas and a dramatic video that was shown by mobile health units.

 

PARTNERSHIP STRATEGIES

14. Accelerating Progress towards Achieving the MDG to Improve Maternal Health
by Geeta Nanda, Kimberly Switlick & Elizabeth Lule
This collection of promising approaches that have been designed to meet MDG #5 indicates that "success in addressing maternal health issues and strengthening the supply-demand nexus requires support and involvement from stakeholders at all levels - from women themselves, their families, communities, nongovernmental organizations, governmental organizations, medical institutions, bilateral and multilateral agencies, other development partners, and policymakers".

15. Access to Clinical and Community Maternal, Neonatal and Women's Health Services (ACCESS) Program - Global
Launching in 2005, ACCESS works with USAID missions, governments, local communities, and partner agencies in developing countries to engage policymakers, providers, and other key stakeholders in an effort to ensure that integrated, high-quality services reach women, families, and communities (particularly marginalised and vulnerable populations). Partnership and participation characterise the ACCESS approach; for example, mobilisation strategies are designed to involve communities in planning and implementing services and in improving birth preparation (e.g., through self-care, identification of a skilled attendant, and planning for emergency transport and care). ACCESS is a follow-up programme to the Maternal and Neonatal Health (MNH) Program, which educated in-country experts to practice, teach, and advocate for communities, patients, and families - and which worked to mobilise communities to demand more and higher-quality health care, seeking to raise awareness of the importance of integrating care for mothers and newborns.
Contact info@jhpiego.net (through July 2005), info@accesstohealth.org (after July 2005)

16. Awareness, Mobilization and Action for Safe Motherhood: A Field Guide
"This Field Guide is intended to provide organizations working in developing countries with practical guidance on how they can be active and involved in the Safe Motherhood Initiative and participate in the White Ribbon Alliance. Both international NGOs with worldwide affiliates and indigenous NGOs in developing countries will find information on how they can contribute to this global effort on the national and local levels. Readers are encouraged to obtain and read the Safe Motherhood Fact Sheets to learn more about safe motherhood issues. The Field Guide...offer[s] suggestions for bringing a wide range of people and organizations together for awareness and action around the theme of safe motherhood."

RESEARCH STRATEGIES

17. Making Motherhood Safer in Egypt
by Karima Khalil & Farzaneh Roudi-Fahimi
"Every year about 1,400 Egyptian women and half of their newborns die from complications related to pregnancy and childbirth. Although this level of maternal mortality...is relatively high by international standards, recent evidence suggests that a woman's lifetime risk of dying from maternal causes in Egypt has dropped dramatically, from 1 in 120 to 1 in 250 during the 1990s." This policy brief asserts that Egypt's success was primarily due to 2 nationally representative studies. Based on these reports, the Ministry of Health and Population was better able to understand the factors affecting maternal mortality and, subsequently, to change community health behaviour through mass media campaigns, the development of national standards for obstetric and neonatal care, and revisions to the medical school curriculum.

18. Maternal and Newborn Standards and Indicators Compendium
This compendium seeks to help programme designers select essential components, actions and appropriate indicators for interventions in maternal and newborn care. It is designed to provide non-government organisations with a single source of information to: 1) determine recommended practices and standards of care at the household, community, and health care facility levels, and 2) identify which indicators are appropriate to use with the different interventions.

19. Afghanistan National Health Resources Assessment (ANHRA) - Afghanistan
To address Afghanistan's maternal mortality rate (1,600 per 100,000 live births), Management Sciences for Health trained 160 male Afghan nationals to survey 1,038 health facilities, 2,915 community health workers, and 1,445 pharmaceutical outlets in all 32 provinces. Among the findings: 70% of primary care clinics cannot provide basic mother and child services; 90% of hospitals do not have equipment to perform C-sections; and 40% of all basic health facilities do not have female staff. Armed with the database created through this research process, the central government traveled to provincial- and district-level health authorities to share these and other results; central ministry staff could see local problems with their own eyes. Provincial health directors were invited to help lead a national workshop in Kabul to examine the results, to plan a future course of action, and to train attendees to run a participatory workshop. The Deputy Minister of Public Health discussed results with Congressional staff, government officials, and the public at a briefing on Capitol Hill in Washington, DC, USA, urging them to help reconstruct the Afghan health system.
Contact Gretchen Hurley ghurley@msh.org OR Paul L. Ickx, MD pickx@msh.org OR Ryoko Yokoyama ryokojh@yahoo.co.jp, ryokoyama@msh.org

 

This issue was written by Kier Olsen DeVries.

 

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