Every two minutes, a woman dies from complications related to pregnancy or childbirth. This means that by the time you reach the end of this blog post, four women have died giving birth.
Additionally, for every woman who dies in childbirth, around 20 more suffer injury, infection or disease – approximately 10 million women each year. That’s not all, 99% of these deaths are in low- and middle-income countries where it is often a leading cause of death in women of reproductive age. The sad record holder is sub-Saharan Africa, where the highest maternal mortality rates exist.
These numbers are staggering, to say the least. That’s why maternal health, together with newborn and child health, remains Canada’s top development priority. Global action was ignited by the launch of the Canadian–led Muskoka Initiative, and with Canada’s leadership, maternal mortality rates are declining. But there’s a lot of work still to do.
Grand Challenges Canada (which is funded by the Government of Canada) supports over 70 projects (a total investment of $39 million) that aim to eliminate preventable deaths among women in developing nations. On Mother’s Day (May 10), we want to highlight just a few of these Bold Ideas with Big Impact that are rendering results.
Through our Stars in Global Health Program, we are supporting an innovation in Uganda addressing maternal mortality. Uganda’s maternal mortality has hardly changed over the past ten years, with a rate of 438 deaths per 100,000 births. This translates into over 6,000 women dying every year.
A major factor responsible for this high mortality rate is the fact that many women in Uganda are still giving birth at home, although there have been many efforts to encourage facility delivery. More specifically, the lack of participation of the male partners in birth preparation seems an issue. In many households, men tend to be responsible for important decisions such as finances, transportation and the choice of facilities. However, most maternal and child health programs focus solely on the health needs of women and children, ignoring men.
Innovators from Makerere University in Uganda developed a male-integrated approach to provide antenatal care services and health education to male spouses, with the goal of positively increasing birth preparedness and after-birth outcomes for the mother and baby. 670 couples who were 2 to 6 months into the pregnancy were enrolled in the study. Results showed a positive correlation between educating men and increased birth preparedness, as well as better health outcomes. It also helped these families to save money for transport, purchase appropriate supplies and seek skilled delivery.
Most maternal deaths are avoidable as they are due to modifiable factors that may have simple solutions like mHealth. The University of British Columbia is leading project implemented in Mozambique, called MOM (Mapping Outcomes for Mothers), an mHealth application that integrates geographic mapping methods to create a picture of maternal health in the context of local social and physical environments. MOM generates a risk profile for the individual woman and her community. MOM is unique because it looks at pregnancy risk in four dimensions: 1) social environment; 2) physical environment; 3) health care system; and 4) the woman’s individual characteristics. MOM identifies the positive and negative influences and how they interact to create risk.
The project managed to operationalize a framework using Geographic Information System (GIS) to map maternal outcomes and these determinants. A total of 80,506 women of reproductive age were surveyed to determine five key variables that were associated with maternal outcomes: household head availability, private transport availability, marital status, driving time to the nearest major road, and driving time to the nearest primary health care centre. The MOM mhealth app will be used to present community health workers with a list of these risk factors as well as community specific recommendations.
Finding groundbreaking, scalable solutions to maternal mortality around the time of birth in poor, hard-to-reach communities is one of the goals of the Saving Lives at Birth Partnership, bringing together Grand Challenges Canada, the U.S. Agency for International Development (USAID), the Government of Norway, the Bill & Melinda Gates Foundation, and the UK’s Department for International Development (DFID).
With the help of these partners, Jacaranda Health tested a Postpartum Home Follow-Up Checklist in Kenya. The checklist consisted of a series of screening questions that Community Health Workers (CHWs) asked moms by phone or in person, two 2 days after giving birth, ensuring a safe transition from hospital to home. The checklist guided CHWs to identify and refer danger signs early. Supervised by Nurses, CHWs also counselled the new mothers on the importance of seeking timely care and troubleshoot common barriers low-income women face when seeking care, such as lack of transport, hospital fees, and decision-making with their husband after birth.
Results show that when health workers detected potential risks, mothers were almost twice as likely to return to the clinic for care in comparison to those who did not. Jacaranda was able to reduce health risks, promote healthy behaviour postpartum and ensure a safe transition home in these critical few days after delivery, including the use of postpartum family planning. Women who received a call or visit by a CHW were 86% more likely to use a family planning method of their choice at 9 weeks after birth compared to those who did not receive any follow-up.
In Nigeria, with the help of a Saving Lives at Birth award, The Development Research Projects Centre engaged influential conservative Islamic opinion leaders in the northern parts of the country in scholastic debates aimed to challenge their perceptions on vaccination and child spacing that spread discouraging messages to their followers. A total of 28 scholars and 100 apprentices participated, leading to a shift in their perceptions and pronouncements on maternal and child health issues that now promote vaccination and child space. The scholars organized radio shows and participated in vaccine drives, in addition to their regular sermons, which exposed 8 million people to their messages of health promotion. dRPC is now focused on training Islamic scholars and health providers side by side to increase quality of care and information received by families towards the increase in immunization and family planning practices in the region.
In Indigenous districts in Central Guatemala, home births are still the norm, where 60 to 90% of births take place at home. Despite the existence of 24-hour care facilities in the region, indigenous women ignore the clinics because care is often of poor quali
ty and insensitive to their cultural values. Based on positive results of a cluster randomized trial that showed a significant gain (10% relative increase) in birth volume, the teams at CIESAR Guatemala and PRONTO International are scaling a package of interventions to 33 communities. This work will see full coverage of this package in two departments in Guatemala, which aims to promote institutional births through a tried and tested social marketing campaign, and when women arrive in facility, they will be cared by for traditional and formal birth providers who have been trained in emergency obstetric care that takes into account the wants and needs of indigenous women. This program is currently being rolled out.
As maternal mortality is caused by unavailable, inaccessible, unaffordable, or poor quality care, Grand Challenges Canada is helping to reduce maternal mortality by supporting many other innovations through more programs and partnerships. Our Saving Brains Initiative supports bold ideas to improve early brain and child development in low- and middle-income countries. The portfolio includes innovations, offering peer support to mothers, and improve caregiver wellbeing. The Global Mental Health Program assists with projects managing maternal depression, trying to eliminate all forms of violence against women and girls and creating a safe and healthy environment to give birth.
Maternal mortality rates have both dropped dramatically. Ending preventable child and maternal death in a generation is now within reach, with developing countries increasingly taking the lead. However, despite progress, more remains to be done. With the support of the Government of Canada, Grand Challenges Canada continues to identify and nurture innovations across our programs and partnerships.
Read our other blog post for Mother’s Day 2015: “Mother’s Day story of Kristen (Canada) and Christian (Colombia)“.