Tabassum Firoz is an obstetric physician and global maternal health researcher. Tatenda Makanga is a doctoral student in Geography. They are the principal investigators for MOM.
Maternal health is a global responsibility and it begins with a woman’s local community. This Mother’s Day, we reflect on the potential to improve the health of mothers by building that local community. In the medical literature, maternal health has been confined to a woman’s clinical characteristics, such as her age, weight, ethnicity and medical conditions. While these are important for her overall health and prognosis in pregnancy, the broader context that she lives in is just as critical. Mapping Outcomes for Mothers (MOM) is an innovative project that is supported through the Stars in Global Health program of Grand Challenges Canada. It can provide insight into local challenges and empower the community to take targeted action. By learning from resilient communities, successful strategies can be implemented to promote healthy pregnancies.
The influence of the broader context is especially important in low- and middle-income countries, where 99% of maternal complications and deaths occur. Socio-economic factors (such as poverty and gender inequality) impact health-seeking behaviour, while environmental factors (such as natural disasters, lack of transport or poor road conditions) can be a barrier to accessing care. The political situation influences the function of the healthcare system, development and infrastructure, which in turn impacts maternal health.
The MOM project will develop an integrated model of local community-level maternal risk by exploring the interactions between these determinants. Set in Maputo and Gaza provinces in Mozambique, MOM uses geo-spatial mapping to produce a picture of the determinants, overlaid on maternal outcomes. This will allow front-line workers to understand how a woman’s local community influences her pregnancy risk. Therefore, MOM is a point-of-care tool that will allow the community health worker to make decisions and plan ahead. MOM will also identify resilient communities – populations that have good maternal outcomes in the face of adversity – so that other communities can learn from them and develop successful strategies.
The formative phase of the project has just wrapped up. For this phase of the project, we conducted focus groups with key stakeholders: reproductive-age women, matriarchs, male partners, community leaders and community health workers. The purpose of the focus groups was to determine relevant social, economic and environmental factors, as identified by the local community. Women have cited lack of finances and access to finances as a key reason for poor maternal health in their local settings. We also interviewed the heads of the administrative posts to better understand the historical and political context of the areas where MOM is being developed. Discussion, thus far, has focused on how civil war and floods have influenced development and infrastructure.
Based on this information, we are currently collecting household level data on the factors (as identified by the local community) as well as associated maternal outcomes. Concurrently, we are mapping the areas and the relevant environmental determinants. These data will be integrated with the historical and political context of the region to develop the model. Following model development, we will translate it to a mobile platform and pilot test it with community health workers in Mozambique.
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