A “complimentary” approach to saving mother’s lives?
campaign, health, maternal survival“The standard recommendation to a woman who needs medical attention is, ‘Go to the hospital’ - but in rural parts of India there are so few doctors that this is like telling her, ‘Do nothing.’ We decided to follow Gandhi’s message to go to the villages. Instead of waiting for people to come to us, we found a way to take the care to the people.“ Abhay Bang, SEARCH
More than 50% of mothers in low-income countries still give birth in the home, far from health facilities, medicines and trained professionals .
Why? These women often live in remote and inaccessible rural areas. And even if health facilities and trained professionals are within reach, many women confront insurmountable cultural and religious obstacles in accessing that healthcare and inevitably give birth at home. Plus, their governments face significant economic challenges, made worse by the exodus of trained medical staff to rich countries.
Given these and other constraints, there is scant hope that enough clinics will be built, medicines provided and skilled medical staff recruited in a 5 to 10 year time-frame to eliminate life-threatening risks faced each day by women in pregnancy and childbirth. It will take many years before 100% of all births in low-income countries take place within facilities attended by skilled professionals. In the meantime one woman will die every minute in childbirth, while millions of others will suffer physical or mental harm.
Maternal health advocacy has been focused on the long-term goals of building and resourcing facilities, as part of strengthening health systems, with some advocates decrying any interim, or ‘in the meantime’ solutions, such as supporting community-based delivery of care. The implication has been that saving lives now, through such solutions, might weaken the political will of governments to embark on the long-term and expensive task of strengthening health systems.
We strongly disagree with that position. There may be an opportunity, by complimenting and augmenting a health systems strategy, to prevent and treat maternal illness in the community. Mothers’ deaths and injuries could be prevented in the home by community or village health workers trained and equipped with life-saving medicines.
NGOs have for many years provided “clean birth kits” to village level health workers consisting of items such as soap, gloves and clean razorblades, but these do not include essential life-saving medicines, and cannot be effective in treating life-threatening conditions, including postpartum hemorrhage and infection. Training for TBAs (Traditional Birth Attendants) has been largely abandoned after maternal survival rates did not significantly improve as a result of these training programmes in the late 1980s and early 1990s, but the TBAs were not equipped with life-saving medicines that can prevent maternal death. There is now a re-evaluation of community-based care underway, driven in large part by physicians and health workers from low-income countries with a “reality-based” approach to saving mothers’ lives in the immediate term. Practical solutions are once again under consideration and development, driven by the emergence of safe, effective and easy-to administer medicines such as misoprostol for postpartum hemorrhage, and compelling data on the community-based delivery of antibiotics.
Life-saving, tried-and-tested medicines administered by community and village-level health workers will help to address the immediate emergency of maternal mortality. Such an approach will also provide a tangible and specific “ask” that the global public can rally and fundraise around, just as in campaigns for vaccination, bed nets and anti-retroviral treatment. Furthermore such a campaign will have the added benefit of raising awareness, building demand from women and generating political will for comprehensive health systems to save mothers’ lives.