Guest post by Lauren Herzer, Wilson Center
This blog post is cross-posted on the New Security Beat.
Photo Credit: Water point in Ethiopia, courtesy of Pablo Tasco/Oxfam International.
Does access to quality water and sanitation have an effect on maternal health outcomes? That was a surprising topic of discussion on day one of the second-ever Global Maternal Health Conference hosted this week in Arusha, Tanzania.
Surprising because, to be honest, I did not think there would be strong disagreements over the relationship between water and sanitation (WASH) and maternal health. In my work with the Comparative Urban Studies Project, the two seem to be clearly linked.
Hosted by the Maternal Health Task Force, the 2013 Global Maternal Health Conference brings together researchers, scientists, policymakers, donors, and practitioners to network, exchange knowledge, and engage in discussions on how to improve the quality of maternal health care around the world. My colleague, Sandeep Bathala, and I have been here all week and are reporting back on discussions and developments.
Linkages Found in the Field
There have been 100 panel discussions over the course of the 3-day conference on everything from HIV/AIDS to malaria during pregnancy. The water and sanitation event I attended was about how WASH efforts might help better enable maternal health goals to be met.
The effect of quality water and sanitation on maternal health is “one of our blind spots around maternal health…it’s an issue that hasn’t featured dominantly,” said Wendy Graham of the University of Aberdeenand the U.K. Department of International Development in her opening of the discussion.
But Oliver Cumming, of the London School of Hygiene and Tropical Medicine, suggested that maternal health and water and sanitation can be linked in many places. In a study, he found that 81 percent of home births in Bangladesh took place in homes that lacked improved water and/or sanitation; 90 percent in India; 98.5 percent in Tanzania; and 97 percent in Malawi. Looking closer, he found that homes deemed “WASH-unsafe” (lacking improved water and/or sanitation) most often lacked improved sanitation versus improved water. For example, of the 90 percent of homes considered WASH unsafe in India, 82.1 percent had water but no sanitation and just 0.8 percent had improved sanitation but lacked access to safe water.
Addressing the two together, via the UN’s Millennium Development Goals framework for example, might therefore make sense.
Millennium Development Goal 5 calls for an improvement of maternal health; MDG 7c calls for improved water and sanitation. The first target of MDG 5 is to “reduce by three quarters, between 1990 and 2015, the maternal mortality ratio.” The United Nations reports that, while progress is being made, the rate of reduction is well below the rate needed for success. And while the world is “on track to reach the drinking water target”, the sanitation target is “out of reach.” Two-and-a-half billion people still lack access to safe sanitation, and even with the water target nearing completion, 780 million people are still without access to safe drinking water.
“When I was first approached to look at the links between water, sanitation, and Millennium Development Goal 5, I thought it was silly,” said Oona Campbell, also of the London School of Hygiene and Tropical Medicine. But, like Cumming, she soon found there was a connection in the field.
In an examination of three studies that looked at sanitation and the association of maternal mortality, Campbell found that women who lived in households with poor sanitation were more than three times more likely to die. The statistical correlation with water was less significant, yet still evident, at 1.5 times more likely to die.
Incentives for Collaboration
Despite the clear challenges to maternal health posed by poor water and sanitation, both Campbell and Cumming added asterisks to their conclusions. Campbell called for more systematic reviews and primary research; Cummings self-deprecatingly remarked that his expertise was in WASH, not maternal health.
A woman in the audience challenged the panelists’ reluctance to advocate their findings. “Why are you being so cautious?” she prodded. An epidemiologist herself, she argued that if she and her colleagues had run a study that had found such statistical significance as those that Campbell found hers, they would have been confident in their findings. Campbell and Cummings attributed their hesitation to some of the initial responses they had received from stakeholders and the fact that their studies were high level and lacked primary research.
Certainly further research is always helpful, but, regardless, the evidence presented during the session made it clear that there could be real value in the WASH and maternal health sectors adjusting their approaches to harness potential synergies.
“At a policy level, there is definitely sufficient data here…to issue that call for policy coherence,” Cumming said. “Specifically, what we’re seeing here is potential incentives for collaboration between the maternal health community and WASH community.”
Check out the conference website to access archived videos of conference sessions.
Join the conversation on Twitter: #GMHC2013.
Communities, activists, researchers, policymakers and politicians: Unite for maternal health!
Posted on January 18, 2013 by Kate Mitchell
Guest post by Dr. Nosa Orobaton, Chief of Party, Nigeria Targeted States High Impact Project (TSHIP), JSI Research & Training Institute, Inc.
There is a sense of timelessness in resplendent Arusha, Tanzania, the venue of the second Global Maternal Health Conference. Not so in the hallways of the conference meeting where there is a palpable sense of urgency to do more for maternal health.
During my time at the conference, I have been struck by four main impressions:
First, there is a sense that progress has been made. Globally, maternal mortality has dropped by roughly 50 percent between 1990 through to 2010. While this is good news, there is also a clear sense that we, maternal health professionals, are not moving as quickly as we expected.
Second, conference delegates are already thinking about the post Millennium Development Goals era. There is a sense of apprehension that maternal health will not receive the support it truly needs in the post MDG era. Humanity cannot afford any loss of momentum for this critical issue. The halls are buzzing with ideas about what a post-MDG agenda might look like—and the attention maternal health may or may not receive.
Third, there is a sense that much more needs to be done to improve quality throughout the continuum of care to increase and sustain the utilization of maternal services. Big questions are being raised: How can we improve quality of care? What needs to be done to be sure that respect for women is incorporated into these improvements at every stage? How might we take into consideration the preferences of women, families and culture? Improving quality of care is an area that clearly needs much more attention and investment.
Fourth, many people are talking about the need to apply the evidence generated from research more sensibly and proactively. Context by context, we must do more, and do better to figure out what works, why, how, and at what scale. Above all, we must then act on it—translating what we know into measurable results for the health of women around the world.
These are some of the key themes that I have heard at the conference here in Arusha, Tanzania, one of humanity’s earliest dwelling places. Tanzania was one of the first places on earth that our ancestors were first confronted and affronted by the tragedy of maternal mortality. And here we are today, still struggling to eradicate preventable maternal mortality.
The time is now to maintain and build on the momentum for improving global maternal health. Communities, activists, researchers, policymakers and politicians, unite!
Check out the conference website to access archived videos of conference sessions.
Join the conference conversation on Twitter: #GMHC2013.
Visit JSI’s blog, The Pump, here. Follow JSI on Twitter: @JSIHealth.
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