Written by Kate Mitchell, Maternal Health Task Force


Ann Blanc, Director of the Maternal Health Task Force, welcomed attendees of the Global Maternal Health Conference to the third and final day of the conference. She recalled the Safe Motherhood Conference held in 1987 in Nairobi–and said, “Experts at the Nairobi meeting did not expect to be here today. They would have thought that by now preventable maternal mortality would be a thing of the past.”

Lynn Freedman, Director of the Averting Maternal Death and Disability program at Columbia University and moderator of the final plenary, opened the session with a statement that she said few could argue with: Many of the pieces are in place to make preventable maternal mortality a thing of the past; technical knowledge, money, political will, and big improvements on the great challenges of implementation. What we need now is accountability. The title of plenary three was Maternal health accountability: successes, failures, and new approaches.

Insights from plenary three panelists:

Sigrun Mogedal, of the Ministry of Foreign Affairs in Norway, discussed bi-lateral and mulit-lateral aid for maternal health. She noted the current momentum around maternal health but reminded conference participants that we have been here before–and asked, “Why should now be different?” She pointed out that consensus in New York is not the same as action on the ground. The missing piece needed for more action on the ground is accountability–and this is a matter of hard domestic policies. She said that bi-lateral and multi-lateral debates “take up too much space.” The global must serve and respond to the local, NOT the other way around.

Helena Hofbauer, Manager of Partnership Development at the International Budget Project, raised questions about aid effectiveness–and discussed national governments’ commitments to spending on maternal health. She described the work of the International Budget Project to use budget analysis to address persistent inequalities in maternal mortality. She said that the budget is a nation’s single most important overarching policy document. Helena asked, “What would happen if people actually asked the government how much and specifically on what they are spending to improve maternal health?” The International Budget Project did ask these questions on behalf of citizens, and the response was “deplorable”. In fact, the reply from Nigeria was that this sort of information is “sensitive and controversial” and from Tajikistan, “Please don’t bother the minister with these sorts of requests.” Helena declared, “This is, in practice, an accountability free zone.”

Nancy Northup, President of the Center for Reproductive Rights, talked about accountability within the context of a human rights and legal framework for improving maternal health. She described a paradigm shift from considering maternal health solely as a public health issue to now understanding it as a human rights issue. Nancy described the legal framework for how and why governments should be held accountable for maternal deaths–citing the right to life, health, equality and non-discrimination, privacy, spacing of children, to be free from cruel, inhumane or degrading treatment, and to education, information and the benefits of scientific progress. She described the process of litigation at the national and international level to demand individual compensation and systemic change–noting that demanding this sort of accountability is the next critical step in improving global maternal health.

Aparajita Gogoi, Executive Director of CEDPA India and the India National Coordinator for the White Ribbon Alliance, commented on accountability through grassroots advocacy. She said that working on the issue of accountability at the grassroots level occurs in three phases: gathering information, spreading awareness, and speaking out. She described a number of tools that can be employed to give local communities a voice including public hearings, check lists, verbal autopsies, and more. Aparajita talked about the importance of providing a safe setting for dialogue—a place where communities can voice concerns and demand action. She pointed out that crucial here, is that people with power are also present, take the concerns seriously, and are held accountable for taking action.

Follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.

For more posts about the Global Maternal Health Conference, click here.

For the live stream schedule, click here.

Check back soon for the archived videos of the conference presentations.

Written by Janna Oberdorf, Women Deliver

Every year, an estimated 20 million unsafe abortions take place. And of all maternal deaths, unsafe abortion accounts for 13%. Imagine if we could change that. Imagine if we could make a serious dent in the deaths and morbidities that are caused from botched abortions, from unhygienic surgeries, and from unskilled providers.

Now, imagine if we could change that with a few simple, low-cost pills. That’s what the drugs mifepristone and misoprostol are doing for women around the world.

At today’s panel session on “Reducing the toll of unsafe abortion using simple medical technology” at the Global Maternal Health Conference in Delhi, panelists laid out the landscape of how introducing and expanding access to medical abortions could save lives and prevent injury:

•    Beverly Winikoff, of Gynuity Health Projects, talked about misoprostol as first-line treatment of incomplete abortion, and about introducing and expanding existing services and implications for training. As she said, misoprostol is low cost, and it can increase women’s choice and reduce the burden on doctors and health facilities.

•    Patricio Sanhueza Smith, from the Secretariat of Health in Mexico City, talked about lessons learned from Mexico City on the potential of misoprostol alone for transitioning services. He said, “Medical abortion with misoprostol alone is not the Gold Standard, but it is a duty to widely disseminate its use, while mifepristone becomes available.”

•    Selma Hajiri, of the Center for Research and Consultancy in Reproductive Health, talked about a randomized controlled trial of medical abortion with misoprostol only versus mifepristone plus misoprostol. She said that although the combination is the gold standard, misoprostol alone should be promoted where mifepristone is not accessible.

•    Kelsey Lynd, of Stanford University, spoke about making outpatient services a reality. She discussed research on administering mifepristone and misoprostol at home, and a pregnancy test that could simplify medical abortion provision.

•    Hillary Bracken, of Gynuity Health Projects, spoke about expanding access late in the first trimester, and the promise of outpatient mifepristone and misoprostol after 63 days.

Though I’m constantly amazed by the possibility and potential of mifepristone and misoprostol for safe abortion, I was even more amazed to hear about Kelsey Lynd’s work on making outpatient services a reality.

Having an abortion is a difficult and traumatic decision, with serious health repercussions. But that decision becomes so much harder when you have to pay for a sonogram to determine gestation period; to attend a clinic to take the mifepristone; to return to the clinic two week later for a follow-up visit and second dose; and to have a second sonogram to ensure the pregnancy was terminated. It’s a time-consuming and costly decision… but every one of those steps also takes an emotional toll.

Lynd presented research that showed that it is safe for women to self-administer mifepristone and misoprostol at home. Though this is great news for time and money saving reasons, it also gives women some control and choice over when to start their abortion.

Lynd also presented findings on a home pregnancy test that determine their pregnancy status after abortion. This semi-quantitative pregnancy test is administered at the health facility while the woman is pregnant to achieve a baseline of her hCG blood level. Then, 1 to 2 weeks after the woman has been administered mifepristone and misoprostol, she can use the test to check if her hCG blood level has decreased, thus confirming termination of pregnancy. In her findings, 98% of women felt they could use the test on their own in the future, and the tests identified ALL ongoing pregnancies.

The implications for this research are mind-boggling. I think it is obvious that cutting down clinic visits and sonograms would save time (for the woman and the provider) and save money. But it is the emotional implications that jump out at me. The ability for women to feel they have some control over their bodies and their abortions is something that is severely needed.

One last note is that although these findings are encouraging in making outpatient services a reality, they must be partnered with education, information, and counseling. Home abortions are a scary thing. Bleeding for days on end is a scary thing. And women need to understand complications that need treatment, and have some emotional support. We need to guide these women with the proper education, counseling, call centers, job-aids, and more, if and when we finally make outpatient services a reality.

Janna Oberdorf is the Communications Manager at Women Deliver.

Follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.

For more posts about the Global Maternal Health Conference, click here.

For the live stream schedule, click here.

Check back soon for the archived videos of today’s presentations.

Written by Saumya RamaRao, Population Council

It is Day 2 at the Global Maternal Health Conference and the energy level has revved up as all participants roll up their sleeves to get down to detailed discussions.  Today I learnt of ongoing innovations in maternal and newborn health from different parts of the world.  As I listened to the presentations, it was indeed learning about “context” and identifying general lessons for application elsewhere.

Here are my picks for the day gleaned from different sessions and conversations over tea with colleagues during breaks.

National programs: India’s National Rural Health Mission (NRHM) is an ambitious government initiative aiming to improve the health and wellbeing of its citizens with an emphasis on reaching the underserved with accessible and good quality services.  The NRHM provides a framework for individual states to experiment with ways to “accelerate the pace of decline in maternal mortality.”  A flagship project of the NRHM is the Janani Suraksha Yojana that provides poor, indigent women with cash incentives to deliver in health facilities.  It will be exciting to see whether the multi-pronged investments in health infrastructure, quality accreditation mechanisms, workforce retention strategies and others will indeed result in demonstrable gains in maternal and newborn health.

Ideas: An idea that was repeated in different ways at different sessions was that it is not always necessary to follow an “either or” approach whether it is a choice between community based initiatives versus facility based initiatives, oxytocin versus misoprostol for post-partum hemorrhage, or any other such choice.  These tensions can be resolved by “context” specific rationale and solutions too may change and evolve over time with changing circumstances.

Another idea discussed in several sessions was the active role that communities play in the organization of their health care—whether taking on activities such as health promotion and education that are “task-shifted” to them or resource generation to fund volunteers and or services.  In a world of health sector reform, as Zulfiqar Bhutta noted devolution can “create demanding communities” leading to a “democratization of public health”.

Innovations in service delivery: Today there were many opportunities to learn about programming strategies currently being tested in many countries.  I was able to attend a couple of sessions on community-based initiatives for post-partum hemorrhage prevention and control.

Here are my sound-bytes from these sessions:

•    Community-based distribution of misoprostol for PPH is feasible in resource poor settings
•    There is a high degree of correct use by women delivering at home
•    Common side-effects include shivering, nausea, dizziness, and fever which seem to occur at the same rate in both misoprostol and non-misoprostol treated women
•    Misoprosotol is acceptable to women, families, and their communities
•    There has been little misuse noted of the drug whether for labor induction, augmentation or for terminating a pregnancy
•    Women can be trusted to be educated consumers when they are treated as active rather than passive participants of  programs
•    As misoprostol for PPH prevention goes to scale, it will be important to think about ensuring adequate supplies and logistics.

Saumya RamaRao is an economic demographer with research interests in safe motherhood, abortion and postabortion care, and family planning.  She has experience in monitoring and evaluation of reproductive health programs, cost analysis, and the use of data for program design and improvement.

Follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.

For more posts about the Global Maternal Health Conference, click here.

For the live stream schedule, click here.

Check back soon for the archived videos of today’s presentations.

Written by Kate Mitchell, Maternal Health Task Force

Plenary one at the Global Maternal Health Conference in Delhi was about finding common ground amidst two sets of maternal mortality estimates. Much like plenary one, plenary two, Community and facility interventions: reframing the discussion, was also about finding a common ground. It was about closing the divide between those who advocate for community-based care and those who advocate for facility based care–an issue that has caused major debates in the maternal health community for decades. This session was about reframing the discussion from “one or the other” to “both”. Plenary speakers called for an understanding that improving global maternal health must be about striking the right balance–and scaling up evidence-based interventions both at the community level and within facilities.

Brief insights from the second plenary:

Syeda Hameed, Member of the Planning Committee of the Indian government, challenged the nearly 700 conference attendees to think critically about one question: “How do we reach the unreached woman who is grappling with issues of maternal health?” Syeda then asked attendees to consider the woman who died last week on a busy Delhi street after delivering her baby. She asserted that training local women is KEY–and said that illiterate or semi-literate women can be trained and can save lives. She cited projects in Gadchiroli as evidence that this is achievable. Syeda also said that India must spend more not only on health, but also on the social determinants of health.

Zulfiqar A. Bhutta, Head of the Division of Maternal and Child Health at Aga Khan University, asked conference attendees to consider community-based and facility-based interventions as complementary and interconnected. He cited studies that have shown the impact of community-based interventions in improving maternal morbidity as well as increasing institutional deliveries. He characterized the debate around community vs. facility interventions as a confrontation that has unnecessarily split the field of maternal, newborn, and child health. He proposed an approach that focuses on the continuum of care: Where we have no facilities, we must adopt community based interventions. Where we have some access to skilled attendants, we should use incentive systems, like JSY, to encourage facility-based deliveries. And where there are facilities, we should supplement them with community-based services to support antenatal and postnatal care.

Harshad Sanghvi, Vice President and Medical Director of Jhpiego, said that striking the right balance between community-based and facility-based interventions is going to involve task-sharing. He said that one problem with solely advocating for facility-based care is that what often happens is that we go from poor access to low quality services to improved access to crowded and lower quality services. “We need to figure out logistical support to improve quality within facilities and use task-sharing to improve access to quality care at the community level.” Harshad discussed his experience with community-based distribution of misoprostol in Indonesia, Nepal, and Afghanistan which was safe, feasible, and programatically effective. He also raised transport and referral issues, stating that improving the capacity of communities to administer life-saving drugs will help to reduce the need for emergency transport. He also noted maternity waiting homes as a good option to consider.

P. Padmanabhan, Director of Public Health in Tamil Nadu, Ministry of Health and Family Welfare, India, expressed the importance of considering context when implementing maternal health interventions in India. He described numerous context driven maternal health intervention strategies throughout many regions of India–illustrating why some projects work better in certain regions that others. He concluded by saying that we must improve service delivery at both the community and facility level, always taking local context into account.

For more brief insights from our conference presenters, follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.

For more posts about the Global Maternal Health Conference, click here.

For the live stream schedule, click here.

Check back soon for the archived videos of the conference presentations.

Written by Lorraine Thompson, Ashoka

On August 30 at 8:00am, the air was already hot and sticky as Ashoka’s Young Champions and Changemakers boarded an air-conditioned bus. After careening across Delhi’s bumpy streets, the young social entrepreneurs stepped into the bright light of downtown Delhi for their first day at the Global Maternal Health Conference (GMHC).

In the morning they attended the Conference’s inaugural ceremonies. After lunch they absorbed new facts, figures and findings at special conference sessions. Later that evening, I caught up with two Young Champions and a Changemaker to ask a question:

What was your most important takeaway from today’s GMHC sessions? How will it impact your work?

Onikepe Owolabi

“At the first presentation today, I was struck by the obstetric epidemiologist from Aberdeen (Wendy J. Graham from Immpact at the Univeristy of Aberdeen). She kept mentioning context of research. And it struck me that when we look at studies to influence what we do, we should always try to find out about the culture of the people there. And the other things was her idea of ‘failing forward’: learning to maximize our failures—to make them into successes and leverage them for future successes.”

“In the afternoon, I attended a session on the social and economic impacts on maternal health. There was a young man who spoke about a qualitative study done in Nepal. Because of what I heard in the morning, I was a lot more open to qualitative research. Sometimes people think it’s not as scientific as quantitative data collection. He spoke about the cultural things that stopped women from accessing healthcare. He kind of sparked a thought in my heart—that culture is an integral part of people’s lives.”

“I think the aim of our Young Champion projects should be to eliminate the harmful practices of culture. But maybe we will get women to access healthcare better if we can incorporate some good parts of culture. From my cultural context, many people use traditional birth attendants because they want the love, the prayers and the social support. So maybe if we could somehow incorporate those spiritual rituals into hospital birthing and institutional deliveries, women would be more open to using them—as against just insisting that they come to the hospital.”

Seth Cochran

“The partner I work with in Uganda uses these birth kits. She goes around to different women in the villages and shows them a little backpack filled with things that will make a pregnancy safer. Really basic stuff. Like soap to wash your hands. A razor to cut the cord—a sterile razor. A clean blanket.”

“Originally I thought, it was a great idea. But it turns out it’s a pretty controversial idea. A lot of people worry that if you give a woman this kit of clean stuff, it’s going to tell her it’s okay to give birth at home. And that’s not what the institutional players want. They want the women having their babies in hospitals. Which I think is ideal—but in a lot of cases not realistic.”

“Since the Women Deliver Conference, I’ve been thinking I need to better understand this discussion. So today I went to a session on birth kits. It was structured almost like a debate. Like, Here are some of the facts: What do you think?”

“And it became very clear to me what I want to do. With these birth kits, there are all these possibilities, right? It doesn’t have to be a facility birth. If you manage it properly, not only can it make a woman want to go to the hospital, it can help the hospital more effectively treat her. It’s a packaged set of commodities—and the facility may be short of commodities.”

At the hospital, they know, if they’ve been trained, how to receive this woman: The woman comes with a little package, they can immediately take every thing out, do the job quicker, more effectively, make sure everything’s there.”

“Today the debate made it very clear in my mind that I’m going to do this as a fundamental part of my program. The specifics of how—I’m not quite sure about yet. But my mind was boiling with possibilities: You could sell these things. You could sell vouchers for additional care. You could give them vouchers for local transport—negotiate with taxis. It’s a physical good, a package that’s not only sellable to the woman in Africa—or donate-able—but it’s also saleable to the donating public. Because it’s tangible. And it’s low cost—probably less than $10 or $15.”

Dr. Minal Singh

“I liked meeting people from the same field, with a similar cause. The best part was I’m coming away with the feeling that I’m not alone—I’m not facing different values in the field of maternal health. The values are shared by people all over the world. So it gives me lots of inspiration to work with new energy when I get back.”

“There are so many synergies. Though we had little time to connect with all the partners, I’m sure we have their contact details and their organization names. Thanks to the World Wide Web, we’ll be able to connect again. I can see much potential—people from whom I can learn and partner.”

“In the afternoon I attended a session on the social and economic and cultural implications of maternal health. It was a very nice talk. And this is actually the problem we are facing—the gap in India between the rural and the urban and also the economic gap. So I hope this will help me implement better.”

Lorraine Thompson is the winner of the Ashoka’s Maternal Health Blogging Contest and is live blogging for the Change Summit and the Global Maternal health Conference.

Stay up to date with the conference happenings! Follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.

For more posts about the Global Maternal Health Conference, click here.

For the live stream schedule, click here.

Check back soon for the archived videos of the conference presentations.

By Sara Stratton, IntraHealth International

This post was originally published on IntraHealth’s Global Health Blog.

To the business world, it’s location, location, location. Here in Delhi, though, at the Global Maternal Health Conference, the mantra is context, context, context. There are many ways to improve and save women’s lives, but the success of any given intervention depends on local context. What works in one country or one community may not work in another. Many people here are talking about the importance and value of understanding how and why an intervention succeeds or fails at the local level. This means investigating and evaluating not just how widely an intervention reaches or the quality of the services, but also the specific, local factors that play into its uptake and impact. How do these realities affect whether an intervention that saved lives in one place would work equally well somewhere else?

This idea of the importance of the local context became woven into presentations on the first day of this groundbreaking conference. In one session, a representative of the SEWA Rural Society for Education, Welfare and Action, Rural (SEWA Rural) talked about how they had found that in Gujarat, India, a woman’s decision to deliver at home or in a hospital in her last pregnancy often influences where she delivered in a subsequent pregnancy. The question for us all to ponder was raised: is the key to saving women’s lives to encourage them all to deliver in hospitals? If so, how much would this cost? Can governments really afford this now? How far would women have to travel to a hospital? The reality, though, is that for some communities, encouraging hospital- or health facility-based delivery may be part of the answer, but in others it may still be an impractical approach. This question led to a discussion about home delivery versus institution-based delivery—as well as the value of traditional and trained birth attendants.

Whether we are talking about where women deliver, how they deliver, who helps them deliver, what we are really talking about is how we evaluate and minimize a woman’s risk during pregnancy and childbirth. Where distance and a lack of health facilities make facility-based delivery improbable, a community may need programs that improve the quality of care offered by trained birth attendants during a home delivery even though in an ideal world there would be another option. What I’m hearing in Delhi is, in some ways, what I already know. There are no easy answers. We must support communities to succeed within the context of their own limitations in terms of the availability of and access to health facilities and health workers. At the same time, we have to remain committed to helping communities to change these limitations.

Sara Stratton is the director of MNCH/FP programs at IntraHealth International.

Stay up to date with the conference happenings! Follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.

For more posts about the Global Maternal Health Conference, click here.

For the live stream schedule, click here.

Check back soon for the archived videos of today’s presentations.

Written by Janna Oberdorf, Women Deliver

These are two things I’m very proud of. I’m proud to be young (or at least young-ish) and passionate about women and mothers. I’m proud that when I see images of women giving birth in low-quality health facilities, I want to yell at the world. I’m proud that the first time I learned what fistula is, I wanted to smash my computer screen and say, “Why didn’t I even know about this before?” This is a fight that I’m ready and willing to take – the fight for mothers around the world.

But why are there so few young people involved in maternal health, at the research level, at the advocacy level, and at the policy level?

Today, at the Global Maternal Health Conference I got to watch five Young Champions of Maternal Health speak with the same passion that I feel.

I watched:

·      Hellen Kotlolo talk about her project to send SMS text messages to pregnant women and new mothers that give them both health advice, but also loving, empowering messages that increase their self-esteem;

·      Zubaida Bai talk (via a video recording) about her project to distribute clean birth kits to communities;

·      Egwaoje Ifeyinwa Madu talk about using SisterFriends, a trusted network of women in communities, to share information on maternal health and act as a safe and compassionate resource;

·      Carolina Araujo Damasio Santos talk about her project The Art of Being Born which uses music, poetry, and other art forms to humanize the process of pregnancy and birth in Brazil;

·      and Seth Cochran talk about Operation OF, a project to reintegrate fistula survivors into communities who have shunned them for their injuries.

I couldn’t have been more inspired. But I had to ask the question: How do we get more young people on board? It seems that when it comes to maternal health, it’s hard to reach young people in a way that make them understand this is an issue that affects them. Many young people care about sexual and reproductive health – they want safe sex, contraception, safe abortions. But when you mention maternal health, they think about their mothers.

Sitting in front of five Young Champions who certainly inspired this conference of almost 700 people, I hope that one day maternal health will resonate with young people on a bigger, broader level. I hope that one day when we mention maternal health, young people will think of themselves and not just their mothers. And I hope that organizations like the Maternal Health Task Force, Ashoka, and more continue to respect young people’s opinions and innovative ideas, and properly support them with information, guidance, mentoring and funding.

Learn more about the Young Champions of Maternal Health program, a partnership between the Maternal Health Task Force and Ashoka.

Janna Oberdorf is the Communications Manager at Women Deliver.

Stay up to date with the conference happenings! Follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.

For more posts about the Global Maternal Health Conference, click here.

For the live stream schedule, click here.

Check back soon for the archived videos of today’s presentations.

Written by Calyn Ostrowski, Woodrow Wilson Center for Scholars

Four days ago a young woman died giving birth in a bustling marketplace in New Delhi. Just steps away from Parliament, this woman was left to die and no emergency care was sent to her–no midwives, nurses, or doctors; just people walking around her accepting the situation as normal and an uncontrollable way of life. But this is Delhi…not a remote tribal village where the nearest health clinic is hours away (on foot).

This juxtaposition lingers on in me as I sit in the plenary session of day two at the Global Maternal Health Conference and listen to Syeda Hameed, member of the Indian Parliament Planning Commission, discuss her recent visit to a remote village where every house has 10 children living in filth, flies, and emptiness.

Although I have been working on such development issues for the last five years I do not work in the field, nor do I visit the developing world on a regular basis. Hearing these stories, coupled with my firsthand experience of witnessing poverty here in Delhi reminds me of the daily reality of those 342,900 women who die every year. This is their way of life and I think it’s poignant that today’s sessions emphasize community based care, family planning, accountability, behavior change, and culture.

“Context, context, context,” said Wendy Graham of IMMPACT at yesterday’s plenary session. I agree, the context of social and cultural norms is an underlying factor that must be taken into consideration when implementing maternal and child health (MNCH) programs. With a background in psychology, I appreciated when Dr. Zulfiqar Bhutta, of Aga Khan University, recognized the toll of poverty on the imagination and the mentality of fatalism.

That is why it is so essential to “ask the people how they feel and bring their voices into the forums where policy decisions are made,” said Hameed. It is also important to hold key players accountable and include men in MNCH activities.

During the side session Male Involvement in Reproductive and Maternal and Newborn Health six field experts (in which half the panelists and audience members were men!) discussed effective methods for increasing male participation in family planning, vasectomies, gender equality, and hospital care.

The key findings from this discussion include:

•    Targeted interventions that educate men about danger signs and pregnancy complications correlates with behavior change and increased facility births.
•    Many young married men feel pressured to prove their fertility. A sample of men was evaluated and those who had increased education and income were more likely to delay first pregnancy.
•    Vasectomy is not something men want to talk about with family planning fieldworkers; however, official recognition of the vasectomy benefits by the government did increase referrals.
•    Puppet and theater shows that demonstrate gender equity behaviors provide an opportunity for dialogue. Women in this study reported increased gender equity in family planning decision-making.

There are so many variables that exacerbate the maternal mortality cycle, but evidence presented here provides REAL solutions.  It is time to scale up these solutions and political willpower will be essential.

Calyn Ostrowski is the Coordinator of the Maternal Health Dialogue Series in partnership with the Maternal Health Task Force and UNFPA at the Woodrow Wilson International Center for Scholars.

Stay up to date with the conference happenings! Follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.

For more posts about the Global Maternal Health Conference, click here.

For the live stream schedule, click here.

Check back soon for the archived videos of today’s presentations.

Written by Janna Oberdorf, Women Deliver

Clean Birth Kits. It seems like a no-brainer. And, as one audience member at the Global Maternal Health Conference said, “There’s no doubt these would work.”

But, there is doubt, as I learned at today’s session, “Clean birth kits: do we need them?”. There’s serious speculation on what impact and effect clean birth kits (CBKs) would have on saving lives. The session panelists presented a review of the existing evidence on clean birth practices and the potential role for CBKs in supporting these preventive practices, and they found serious gaps in knowledge and research.

One thing that all panelists agreed on is that clean births are necessary to reduce maternal mortality – each year around 1 million newborns and mothers die from infections soon after birth, and this burden is highest for the poorest families. Of the world’s 60 million home births each year, many occur without adequate hygiene, and some facility births also lack basic hygienic care. There are “six cleans” that make up a clean birth: clean hands, clean perineum, clean delivery surface, clean cord cutting implement, clean cord tying, and clean cord care.

But CBKs are not a new idea. They have been around for decades… centuries. The problem is that little research exists that shows how these kits are used, and more importantly, what effect they have on women and providers.

Wendy J. Graham, from Immpact and University of Aberdeen, used this panel to discuss the Birth Kit Working Group, a compilation of health experts who are assessing existing research on CBKs, and considering the development of a decision guide to assist in the planning of overall strategies relating to the use of CBKs. Their key focus has been on CBKs for use in facilities, and trying to determine whether these kits are a help or a hindrance.

“The fact is: We don’t know,” said Graham, who highlighted the gaps in knowledge and research around CBKs effects. “We’ve heard so much about poor quality of care, and we need to identify catalysts for change.”

Though, as Graham and her colleagues Bilal Avan and Vanora Hundley discussed, the CBKs could work as a catalyst for change in a positive way, or a negative way. The presenters and the participants had a heated debate on how the kits could be distributed: would it be more effective if they are housed at health facilities and used when pregnant women arrive for delivery, or should they be given to pregnant women at antenatal visits. Giving women CBKs might actually deter them from having facility births, thinking that they can use the kit at home. Or, it might empower and enable them to return to the facility for their birth. On the other hand, housing the kits at facilities might create dependence from health providers that would be problematic when supplies run out. Or, the kits could sit on a shelf and never be used.

“This is not black or white; not positive or negative,” said Graham. “It depends on where we’re talking about. And it’s hard to really find out about adverse effects when studies don’t talk about failures.”

In the a community that likes to so often stress, “There’s no magic bullet for maternal health,” the CBKs offer the possible potential of what the bed net has done to curb malaria. Moderator, Ann Starrs of Family Care International, put the CBK issues into a broader global advocacy perspective. “Kits are being looked at and promoted almost as an advocacy tool, and as a way to sell this issue to a broad range of audiences as a problem for which there are quick and easy solutions,” said Starrs.

The main takeaway seems to be clean births are essential, and there is serious potential for CBKs to have an impact on maternal health and maternal mortality. The problem is: We have no idea what that impact will be. And before we roll out (and massively fund) the creation of distribution of CBKs, we need to be clear on what the likely outcomes will be.

MORE QUESTIONS TO CONSIDER:

1. What are the most important contextual factors to consider regarding introducing CBKs into facilities? How do we address equity and ensure that poor women and women most in-need receive them?
2. What should a kit include? What’s the criteria?
3. What are the potential uses for CBKs, specifically in conflict or disaster situations?
4. Are birth kits just an expensive diversion? Read a post on this issue by Ann Blanc, Director of the Maternal Health Task Force.

Stay up to date with the conference happenings! Follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.

For more posts about the Global Maternal Health Conference, click here.

For the live stream schedule, click here.

Check back soon for the archived videos of today’s presentations.

Written by Maria M. Pawlowska, Cambridge University Gates Scholar

The Global Maternal Health Conference 2010 is underway! Unfortunately, I’m not there in New Delhi to witness it all first-hand but the organisers are kindly live streaming some of the sessions so I can still feel like I’m participating in this extraordinary event, while sitting in my office in Cambridge, UK.

The theme of the live streamed afternoon session (which took place in the early morning UK time yesterday) was “Strengthening access to maternal health” and I tuned in to listen about the importance of human resources.

The White Ribbon Alliance has been doing an amazing job the past months and spreading the word about the importance of skilled birth attendants and campaigning for funds to train health workers. The presentations in this session further stressed the importance of training staff who are not necessarily obstetricians and gynaecologists, available to help and treat birthing women.

Helen de Pinho from AMDD talked about the changing situation in Africa, where increasing numbers of non-physician clinicians (NPC) are broadening the scope of health services they provide. NPCs already provide emergency obstetric care in 6 countries and this number is bound to increase in the near future. De Pinho stressed task-shifting as the key – it’s been proven that NPCs can provide, regular and emergency obstetric care with equal success to doctors. Importantly, their training is shorter, quicker and cheaper with no loss in the quality of services they provide to their patients.

In keeping with the theme, Jeffrey Smith, Jhpiego regional director in Asia spoke about the advantages of midwifery services and what it takes to educate a midwife in the developing world. He argued that the aim of a midwife’s education should be to produce a “health worker [who] is competent, employed and able to work effectively”. Thus, it’s important to focus midwives’ education on clinical practice and continually assess the learning process. Students must be given the permission to provide care, obviously under supervision at least at first, and not just watch others providing it. In order to really gain the skills they require to effectively treat their patients they must have the hands-on clinical experience. Once their education is done, the key is to make sure the midwife is employed and her skills are properly taken advantage of – therefore she must have access to at least basic drugs and a space where she can safely see her patients. A “clinic” without a roof and no medical supplies just won’t do it! It’s also important to remember that both the midwives themselves, and communities tend to benefit most from medical training if the midwife is allowed to return to practice in her home village/town after graduation.

The role of training health workers is hard to overestimate and it will take time to train the health professionals we are currently lacking. In the mean time it should be remembered that there are other very cheap and highly effective methods of combating maternal mortality in the short run. Ndola Prata, and colleagues, from the University of California, Berkeley, School of Public Health have very recently published an analysis showing that the cheapest and most effective way of preventing maternal deaths is investing in family planning and misoprostol (a drug for stomach ulcers turned haemorrhage prevention and treatment “miracle” pill). Misoprostol has recently been gaining mainstream media attention for how incredibly cheap, safe and effective it is at saving lives.

Stay up to date with the conference happenings! Follow the Maternal Health Task Force and EngenderHealth on Twitter: @MHTF and @EngenderHealth. The conference hashtag is #GMHC2010.

For more posts about the Global Maternal Health Conference, click here.

For the live stream schedule, click here.

Check back soon for the archived videos of today’s presentations.