Maternal mortality is the second leading cause of death, after HIV/AIDS, among women of reproductive age in low-income countries. One thousand women die every day due to complications of pregnancy and childbirth. In low-income countries, a woman’s lifetime risk of dying of childbirth is 1 in 120; in high-income countries, it’s 1 in 44,300.
Frightening, isn’t it? But there is hope: 70 percent of maternal deaths are preventable.
The alarm bells have been ringing for decades, and the international community has been trying to tackle this issue for decades. The prevention formula has already been deconstructed and may seem straightforward: give pregnant women comprehensive antenatal care and have a skilled birth attendant deliver her child. But the challenge lies not in the what needs to be done to stop maternal mortality, rather, it lies in the how.
How do we recruit health professionals to work in low-resource areas, where pay is traditionally extremely low? How do we communicate with women so they understand the importance of antenatal care and delivering their child in the hands of skilled birth attendant? How do we address deeply embedded cultural and social norms that prevent women from making their own decisions? How does a woman access a health facility when faced with bad roads, no or expensive transportation, and her only option is to walk for 10 miles?
These are the question Reboot is tackling with Concern Worldwide, an international humanitarian organization. Concern’s Innovations project started in 2009 to find bold, new ideas to address gaps in delivery of maternal, newborn and child health services (MNCH), with an initial focus on Sierra Leone, Malawi, and the Orissa State of India. The process began with extensive local consultations and participatory research to reveal what communities perceived as their barriers to accessing health and how they might overcome these barriers.
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The main challenges identified were lack of drugs and effective health equipment; severe shortage of human resources in the health sector; great physical distances to reach health facilities; the gatekeepers to health (husbands, mothers-in-law, etc) having beliefs and adopting practices that often are at odds with modern medicine; and the gaping chasm between the formal and informal health sector.
Using these community-identified barriers, Concern now seeks to redefine existing solutions by adapting well-known best practices in MNCH to reflect localized interpretations of how things might be changed. We have been traveling with Concern for the past two weeks in Sierra Leone and Malawi, and we are working closely with their team to further develop new interventions rooted in community ideas; solicit expert advice on innovative solutions; conduct field analysis and feasibility assessments of proposed concepts; and illustrate how each intervention can be tailored to each context.
We are excited to be expanding boundaries of current public health approaches and supporting Concern Worldwide in their drive to bring cutting-edge solutions to reducing maternal mortality and improving child health. In being one-of-its-kind to truly engage in a community process, to actively seek and hear local experiences, and to validate their voices through co-designed solutions, the Innovations project has already proven to be a powerful catalyst for social change.
