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Refocus on Local Needs in Maternal Health » Women's Courage

Refocus on Local Needs in Maternal Health

March 3rd, 2011 by klstaves Leave a reply »

To: The MacArthur Foundation.

Title: Refocus on local needs and distribution challenges in order to magnify impact of existing tools to combat maternal mortality

The persistence of high rates of maternal mortality despite considerable technological advancements underscores the need for a shift in policy focus away from developing new technologies to improving the distribution and implementation of existing tools. While new technologies will undoubtedly continue to offer new life-saving possibilities in the field of maternal health, our current systems for identifying where and how to leverage these technologies is failing. Addressing these implementation challenges represents the most pressing need in maternal mortality reduction efforts today.

Although the proximal causes of maternal death – factors like postpartum hemorrhage and eclampsia – are similarly across most regions, the underlying barriers to life-saving care are extremely varied.  Because of this reality, there is no one-size-fits-all solution for reducing maternal mortality.  In some regions, such as in parts of rural Bangladesh, cultural beliefs regarding the cause of postpartum bleeding play a significant role in preventing women from seeking emergency obstetric care[i]. In such situations, community education programs that take up the issue of cultural beliefs may be crucially important. Elsewhere however, cultural beliefs do not pose a significant challenge to maternal care, but financial or transportation barriers are substantial.  Such differences in local contexts imply the need for diverse plans and tools to reduce maternal mortality.

Importantly, efforts to develop new technologies and systems for reducing maternal mortality have succeeded in developing strategies to address a tremendous diversity of factors related to maternal mortality. Tested tools in maternal health span a broad spectrum, ranging from community financing schemes to modified partograms[ii] to pharmaceutical interventions such as misoprostol. Still other strategies respond to more unique needs, leveraging dance and song to offer educational messages. The global attention focused around maternal health has contributed to a wealth of options for tackling the challenges of labor and delivery in the developing world. Enacted with local support, in areas where they address a defined need, these tools have the potential to effect significant reductions in the maternal mortality rate.

Unfortunately, while many effective technologies and systems to reduce maternal mortality have been identified, most of these tools remain dramatically underleveraged. For example, despite being demonstrated highly effective at halting postpartum hemorrhage, misoprostol is not widely approved for obstetric and gynecological purposes. Furthermore, even in countries where misoprostol is approved, it is often not available in the rural settings where it is most needed. Similarly disappointing distribution patterns are seen with a number of other tools for reducing maternal mortality, including financing schemes and community education programs. Until better systems are developed to increase the use of these effective tools, their potential will remain unrealized and maternal mortality will remain a significant problem.

In devising strategies to expand the distribution of tools for reducing maternal deaths, developing an understanding of local needs is critical. In order to maximize the impact of dollars directed towards improving maternal health, efforts to improve distribution of critical tools must focus on improving access to the tools capable of making the largest difference. To do this, organizations like the MacArthur Foundation need to focus their attention on developing local contacts capable of indentifying which tools would be best suited to different local contexts.

Fortunately, many areas already have local authorities on obstetric needs who could serve as valuable partners for international development organizations. Community midwives, traditional birth attendants, and local medical professions offer crucial sources of untapped knowledge and potential. While many programs offer obstetric training to these individuals, few actively solicit their input on the types of tools and systems that are needed where they work. New efforts are needed in order to make sure that community health workers are aware of different possible strategies for reducing maternal mortality and have a forum in which they can push for implementation of the tools most appropriate to their region.

The benefits of investing in partnerships with local birth attendants extend beyond new opportunities to identify local needs. These individuals offer an important source of man power that can be used to implement new tools. Efforts to make misoprostol available at the community-level, while still in their infancy, have found that community health workers, including midwives and traditional birth attendants, are capable of safely administering life-saving therapy using this drug[iii]. Efforts to task shift to para-medical health workers expands the network of individuals capable of assisting in efforts to distribute needed technologies, and can as a result significantly impact health outcomes.

While much is known about the potential impact of community health workers, new programs and research initiative are needed to better understand how to develop effective partnerships with these individuals. This is an area in which the MacArthur foundation could make a significant contribution to efforts to reduce maternal mortality. To date, programs working with community health workers have largely focuses on providing training to these individuals. While our knowledge of effective training tools has grown significantly over the past decade, our ability to develop effective two-way communication with these individuals lags behind. Our failure to establish this communication limits our ability to provide targeted solutions, designed with the needs of the communities in mind.

Technological deficits are no longer the primary obstacles to improving maternal health. The technology to save the lives of millions of women exists. What remains unknown is how the necessary tools and ideas can be delivered to the women who need it most. In light of this pressing need, the MacArthur foundation should redirect the focus of its maternal health programs to focus on promoting innovative strategies for developing strong local partnerships.

[i] Sibley et al. “Cultural Theories of Postpartum Bleeding in Matlab, Bangladesh: Implications for Community Health

Intervention.” Journal of Health, Population and Nutrition. June 2009. pp 379-390

[ii] See: “The Paperless Partogram: A simplified tool to prevent prolonged labor.” Maternova. <<http://maternova.net/blog/paperless-partogram-simplified-tool-prevent-prolonged-labor>>

[iii] Barnet et al. “Community Interventions for maternal and perinatal health.” BJOG. Vol 112. Sepember 2005. pp. 1170-1173.



  1. kjewett says:

    You bring to light an important issue here. It’s not that we are uninformed on what technologies are necessary to make a difference. The problem lies in access, and how we can effectively disseminate the information and technologies to the populations who need it most. Perhaps what’s needed is more targeted funding. Foundations need to be more specific about where the money is allocated, rather than handing over large sums. I believe the most difficult component is figuring out how to leverage the people who need these interventions with funding. Like you pointed out, how do we connect grassroots individuals with funding? How do we develop effective community-based programs that empower the people entrenched in these issues with the tools to defend against them? I agree that research into these strategies is of utmost importance so that we can understand how to get more bang for our buck, so to speak. Great job on this! Strong, compelling argument, and well-supported!

  2. csendax says:

    The focus of this memo policy on switching focus to the application of technologies rather than the discovery and marketing of new technologies is a necessity in the area of maternal health, as well as, almost all societal sectors. For, in this highly innovative and fast-paced society that we live in, we often fall victim to thinking that our work is done once solutions have been created. But, clearly, as you note that is not true at all. We need to think critically and comprehensively about how we launch new technologies and the scope of their application. I think you did a terrific job of emphasizing how misuse of technologies can actual harm rather than help the rate of maternal mortality. Thus, new health technologies are somewhat of a trojan horse. Unless used properly, they can cause more harm than benefit.

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