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Posts Tagged ‘newborn mortality’

This post is the first in a series on maternal health in the Seraikela block of Jharkhand, India. 

In 2009, Sarah Blake and I worked together at the Maternal Health Task Force, a Gates Foundation funded maternal health initiative based at EngenderHealth in New York City. Since then, Sarah went on to work as a consultant with several non-profit organizations, including UNFPA and Women Deliver.  I took off for India as a Clinton Fellow with the American India Foundation where I have been working for the past nine months on a maternal and newborn health project in Jharkhand, a state with high levels of maternal and newborn deaths.

A new mom holds her newborn in a small community called Sini, in the Seraikela block, as community members look on.

Sarah and I recently teamed up again (this time, in India) to explore our common interest in maternal health. Over the past two weeks, we have visited hospitals, health centers, government offices, rural villages, and homes in the Seraikela block, a rural area with rugged terrain and limited infrastructure outside the industrial city of Jamshedpur, in the state of Jharkhand.  We conducted a series of interviews with women, families, health workers, and government health officials. We asked questions about pregnancy, childbirth and the postpartum period. We learned about the women’s experiences with home and institutional deliveries–and the factors that influence their decision to deliver at home or in an institution. We explored the implementation of and attitudes toward Janani Suraksha Yojana, a conditional cash transfer program that aims to increase institutional deliveries across India.

A collapsed road on the way from Jamshedpur to the Seraikela Block of Jharkhand.

Conditional cash transfers are trendy. Various governments, non-governmental organizations, and private enterprises across the globe are supporting cash transfer initiatives in efforts to improve school attendance, reduce child under-nutrition, improve maternal and newborn health, and to address other development goals.

What is a conditional cash transfer program? According to the World Bank, “conditional cash transfer programs provide cash payments to poor households that meet certain behavioral requirements, generally related to children’s health care and education”.

Janani Suraksha Yojana (JSY) is a widely discussed (mostly within the global health community but to some extent in mainstream media) and frequently praised cash transfer program. JSY was launched by the Indian government as part of the National Rural Health Mission in 2005, in an effort to reduce maternal and newborn deaths by increasing institutional deliveries.

JSY provides cash incentives to women who deliver in government health institutions as well as accredited private health centers. The program also provides a cash incentive to the health worker who supports the woman throughout her pregnancy and accompanies her to the facility. (For details and FAQs on JSY, click here.)

A community health worker accompanies a pregnant woman to Mahatma Gandhi Memorial Hospital in Jamshedpur, the main referral hospital for the surrounding rural communities.

Maternal and newborn death rates have gradually been declining across India (and the world), but the problem has yet to be resolved. Both maternal and newborn deaths in India continue to make up an extremely large percentage of the overall global burden. According to a study published in the Lancet last year, 20% of global maternal deaths and 31% of global newborn deaths in 2005 occurred in India.

JSY is a big program (the biggest of its kind in the world) that aims to deal with a big problem. The lessons that are drawn from it have the potential to influence global health policy in a big way. The 2010 evaluation of JSY published in the Lancet suggested that the program is having a significant impact on perinatal and neonatal health, but the paper asserted that the verdict was still out in terms of any impact on maternal mortality.

The lesson that has emerged from JSY for newborn health is that giving women money increases institutional deliveries and reduces perinatal and neonatal mortality.  It is likely that the same message will emerge in terms of reducing maternal mortality—and there is a good chance that this approach will be picked up in national health programs in numerous other countries that also have high levels of maternal and newborn mortality.

Our concern is that JSY is far more complex than providing women with money—and reducing maternal mortality is far more complex than increasing institutional delivery.

Given the scope, cost, and potential of JSY; it is incredibly important that we ask questions about the nuances of JSY—the role of money as an incentive for women, families and health workers; the readiness of institutions;  the challenges with transportation; the human rights implications of the program; and a variety of other related factors.

Over the next week (or couple of weeks), Sarah and I will share our experiences and insights from our time with the women, families, health workers, and government health officials of the Seraikela block of Jharkhand, a focus state for JSY. We will highlight stories from the people most impacted by and involved in Janani Suraksha Yojana.

We believe that we have scratched the surface of some interesting issues related to JSY, but our time in Seraikela certainly left us with more questions than answers, and we will be sharing those questions in upcoming posts.

We will also be asking our colleagues working in maternal and newborn health to share their thoughts through guest blog posts. If you are interested in submitting a guest post, contact us at katemitch@gmail.com and sarahcblake@gmail.com.

Tata Steel Rural Development Society, my host organization for my fellowship, provided us with transportation and interpreter services. Many thanks to Shabnam Khaled for her help with translation. 

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I am back to blogging after a few weeks break to get settled in India!

I arrived in Jharkhand, India  just over a month ago. I am here as a William J. Clinton Fellow with the American India Foundation. I transitioned out of my previous role at the Maternal Health Task Force at EngenderHealth just after the Global Maternal Health Conference in Delhi. (Click here to view archived videos of the conference sessions.)  I was craving on-the-ground experience in program implementation and I was looking forward to working at the community level—to put to action the knowledge I gained during my time at the MHTF as well as the program planning skills I learned while completing my MPH in International Health at Boston University.

Mother and Baby, Jharkhand, India--Photo by Kate Mitchell

The people of India face some of the highest levels of maternal and newborn mortality and morbidity in the world.  Jharkhand, a newly formed state in India, faces higher maternal and newborn mortality ratios than India as a whole. And the villages of the Seraikela block, a region of Jharkhand with difficult geographic terrain and low levels of literacy, experience even higher ratios than the state.

My fellowship placement has already offered me some remarkable experiences (I’ll be writing about those experiences in upcoming posts)–and mentors who are working together to improve maternal and newborn health in Seraikela from a number of different angles and organizations.

My assignment is with a new public-private partnership that aims to improve maternal and newborn health in Seraikela at the community and facility level. (Click here to read about recent conversations at the Global Maternal Health Conference focused around striking the right balance between community and facility based interventions.)  MANSI, the Maternal and Newborn Survival Initiative, is being implemented by Tata Steel Rural Development Society, a division of Tata Steel’s corporate social responsibility wing, and the American India Foundation in partnership with the local government. (Click here for a recent post by Alanna Shaikh on corporate players getting involved in global health.) 



MANSI is a replication of the Home Based Newborn Care (HBNC) project that was originally (and very successfully) implemented by SEARCH in Gadchiroli, Maharashtra, India. The MANSI team is working closely with SEARCH to train community health workers from 174 villages within the Seraikela block on the HBNC curriculum, a set of modules that prepares community health workers to address the leading causes of newborn mortality and morbidity in India.  The team will also be training the health workers on a number of interventions that will target the health of the mother–as well as upgrading several sub-centers within the Seraikela block to be equipped to handle normal deliveries and improving referral systems for complicated deliveries.

Mother and Infant Wait to be Seen at a MNCH Clinic Under A Banyan Tree, Jharkhand, India---Photo by Kate Mitchell

Much of what I will be doing over the next ten months is helping to develop training modules for the maternal health interventions that will be added onto the HBNC model–as well as helping to conduct the training. 

I am really excited to be a part of the MANSI team.  It is going to be an exciting and challenging ten months–and I promise to keep you posted:)

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Join Dr. Harry Strulovici, Founder and President of Life for Mothers, Director of  the International Maternal Health Initiative within the Division of Reproductive Global Health and  Clinical Assistant Professor in the Department of Obstetrics & Gynaecology at NYU School of Medicine; Julie McLaughlin, the Sector Manager for Health, Nutrition and Population in the South Asia Region of the World Bank; and Samuel Mills MD DrPH, a consultant in the Health, Nutrition and Population Unit of the Human Development Network for a presentation and Q&A  at the World Bank on reducing maternal and neonatal mortality in Uganda through a holistic approach.

Life for Mothers

When: Jun 15, 2010, 12:30-2pm

Where: World Bank: 1818 H Street NW, Washington, DC 20433

What : Presentation on a Holistic Strategy To Reduce Maternal/Neonatal Mortality in Uganda

Who:

  • Dr. Harry Strulovici, director of  the International Maternal Health Initiative within the Division of Reproductive Global Health and  Clinical Assistant Professor in the Department of Obstetrics & Gynaecology at NYU School of Medicine
  • Julie McLaughlin,the Sector Manager for Health, Nutrition and Population in the South Asia Region of the World Bank
  • Samuel Mills MD DrPH, a consultant in the Health, Nutrition and Population Unit of the Human Development Network at the World Bank

Schedule of events: Lecture with Q&A

RSVP: Contact Victor Arias at varias@worldbank.org

Click here for more details.

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The official launch of the Countdown to 2015 Decade Report (2000-2010) will be at the Women Deliver and Countdown to 2015 for Maternal, Newborn and Child Survival conferences next week (the Countdown meeting is being held in conjunction with Women Deliver) –but the report is now available to download on the Countdown to 2015 website.

Countdown to 2015-Maternal, Newborn, and Child Survival

From the report:

“The Countdown report for 2010 contains good news–many countries are making progress, reducing mortality and increasing coverage of effective health interventions at an accelerating pace. But the news is not all good. Many Countdown countries are still off track for achieving Millennium Development Goals 4 (reduce child mortality) and 5 (improve maternal health) and are not increasing coverage of key health interventions quickly enough…”

Click here to download the report and/or the brochure with highlights from the report.

Click here for a press release on the new report.

Click here for a special message from Countdown for conference participants about the special track at Women Deliver for Countdown to 2015 sessions.

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Ray Suarez of PBS, travels to Peru to investigate how health officials, obstetricians, nurses and activists are making better use of existing resources and linking pregnant women to those resources—all in hopes of seeing a reduction in maternal deaths. In this article and video, Suarez reports on a system of maternity homes, homes where pregnant women from remote areas can stay in the final stages of their pregnancies in order to be closer to emergency obstetric care, in the event of an emergency.

PBS NEWSHOUR/The Rundown

“…The NewsHour team headed out to the remote rural town of Vilcashuaman, high in the Andes mountains, to see the new approach at work. We visited a Casa Materna, a mother’s house, where three women from communities far away waited to deliver. In a nurse’s office was a felt bullseye map, with the name and due date of all the women in the region known to be pregnant, along with the approximate distances and travel times to their homes…

…Once ready to deliver, a woman can choose a conventional Western delivery table with an elevated bed and leg stirrups, and as part of the new approach traditional birthing chairs are also available. Women who use the chairs do not have to completely undress, very important in a culture in which modesty is prized…”

Read the full story, In Peru: Life for the Life-Givers—and watch the video.

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The Seattle Times reports on a rise in Gates Foundation funding for programs that aim to improve maternal and newborn health–and according to Melinda Gates, investing in the health of moms and babies saves lives at a far lower cost than treating diseases later on.

The Seattle Times

“…Gates talked about teaching a method known as “Kangaroo Mother Care,” which encourages mothers to wrap and hold their babies until they can maintain their own body temperature. (In fact a study published this week found that “kangaroo mother care” cut newborn deaths by more than 50 percent and was more effective than incubators). Inexpensive drugs can also prevent mothers from hemorrhaging in childbirth.

Such a comprehensive program, together with contraception, could cut maternal deaths by 75 percent and reduce newborn deaths by 44 percent, she said…”

Read the full article, Melinda Gates: Foundation Investing More in Mothers and Newborns.

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Last week, Dr. Blanc, Director of the Maternal Health Task Force, attended a workshop on the evidence base for clean birth kits in London–and this week, she blogs about it on the MHTF Blog.   

MHTF Blog

“…Many questions were raised by participants about whether clean birth kits represent a good investment for maternal and newborn health. There was some concern expressed about the potential for birth kits to be an ‘expensive diversion’ away from much needed work on strengthening health systems, although some could also imagine ways in which birth kits could be used as a strategy for improving the quality of care in health facilities…”

Read the full post, A Good Idea or an Expensive Diversion? Workshop on the Evidence Base for Clean Birth Kits.

The workshop was organized by Immpact/University of Aberdeen and Saving Newborn Lives/Save the Children.

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AllAfrica.com reports that the Nutrition Society of Nigeria is calling for a review of the current national food and nutrition policy—stating that malnutrition accounts for 60% of avoidable maternal, child and infant mortality in Nigeria

allAfrica.com

President of the Nutrition Society of Nigeria, Professor Ignatius Onimawo spoke at the opening ceremony of the 21st anniversary of the Food Basket Foundation International Initiative at the University of Ibadan. He described malnutrition as a major silent killer in Nigeria and said, “It is instructive to know that of the over 100 universities currently operating in Nigeria only five run degree courses in nutrition and yet nutrition holds the key for the reversal of the vicious attack of these deadly diseases.”

Read the full story here

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