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On Monday, I traveled with my colleague, Anupam Sarkar, a nutrition and newborn health expert and Project Advisor for the Maternal and Newborn Survival Initiative (MANSI), to Hudu, a small, hard-to-reach village amidst forest, steel plants, and roaming wild elephants. It took us nearly 2 hours from Jamshedpur, weaving around and cutting through steel plants and villages along bumpy and muddy roads–the same roads that pregnant women must travel on if they opt for institutional delivery. We were heading to Hudu to observe a Seraikela Chhau peformance.

Seraikela Chhau is a traditional form of dance that originates in the Seraikela block of Jharkhand, part of the eastern steel belt of India. Over the past six months, I have been working as a Clinton Fellow with the Maternal and Newborn Survival Initiative in the Seraikela block. MANSI is a partnership between the American India Foundation, Tata Steel Rural Development Society, and the local government—with technical support from SEARCH. As part of our project activities, our team has recently coordinated a series of Seraikela Chhau performances that will combine the native dance form with key maternal and newborn health messages throughout the 174 villages of our project area.

When Anupam and I arrived in Hudu, we learned that a pair of twins had recently passed away in the village and we decided to visit the family before the performance began. We are conducting similar home visits for every maternal and newborn death that has been reported in our project area (spanning 174 villages) since the baseline survey was completed in 2009. The goal of the home visits is to gain a better understanding of the ground realities and knowledge gaps so that we can shape and inform the messages of the MANSI health communication campaigns in a way that meets the needs of the communities.

The local health worker guided us to the home where the twins had passed away. The parents were not at home–but we were able to meet with the paternal grandparents, Asha and Ganesh Sardar.

 

They shared their story…

The mother of the twins, Vilasi, is 28 years old. She and her husband, Ragdu, already had four children, all girls, and the family was  eager to have a boy. Soon they became pregnant with twins, one girl and one boy. All four of the previous children were delivered at home without complication–and the family assumed that this delivery would also be free of complications. They explained that they were unaware of the benefits of institutional delivery. When the twins were born, they seemed very small. Immediately following delivery, the mother put the babies to her breasts to feed them. They were weak and unable to suckle. Initially the family thought about giving them goat’s milk–but eventually decided to give sugar water (locally called Misri Pani). When it became clear that the babies were extremely weak and in critical condition, the family wanted to take the infants to the hospital but they had not anticipated the emergency. They were not prepared. They did not have a transportation plan or money set aside. One baby died the very same day–and the other died the following day.

We thanked the grandparents for sharing their story and asked them if it would be OK if we also shared their story with other communities. The grandparents agreed and the grandfather said, “After losing the twins, I have come to know about the importance of institutional delivery. Why not share our story and let others also come to know?”

It is tough to know precisely what led to the death of the twins—and if giving birth in a facility would have made a difference. But it is clear that many factors were stacked against them. The family was faced with poor roads, long distances to health centers, limited resources, combined with a lack of information at the community level about birth spacing and planning, care of low birth weight babies, danger signs, institutional delivery, and information on how to tap into government schemes that offer cash incentives for institutional delivery—all potential topics for future Chhau performances.

With the story of the twins on our minds, we returned to the center of the village to observe the performance.

With no electricity in the village, the performers rigged their loud speaker system to their vehicle battery. They began beating their drums and singing loudly, calling on community members to gather in the village center.

It did not take long for community members to gather, all curious to know what the commotion was about. They formed a crowd of boys and girls, and men and women of all ages. Soon the drumming and singing picked up pace, a performer dressed in a traditional colorful costume with a big mask jumped out from behind the vehicle, and the show began!

The performers acted out various situations, using dance and drama to cover several critical maternal and newborn health topics—with a focus on the importance of institutional delivery, birth planning/preparedness, and the five cleans of safe delivery. The audience watched with great enthusiasm.

As we traveled the bumpy roads away from Hudu, a jagged rock punctured our tire–delaying our return to Jamshedpur and reminding me of the numerous barriers that women face in accessing care. While we waited for the tire to get repaired, I thought of the twins and the grandparents who we interviewed. I also thought of the Chhau dance and all of the community members in attendance. That day, I witnessed the consequences of the various factors that were stacked against the twins. I also witnessed one strategy for building community awareness of critical maternal and newborn health information. I left feeling confident that the Chhau performance that we observed will help to equip the community of Hudu with key information about maternal and newborn health—and will serve as one of many important steps toward the overall goal of protecting the health of women and infants in the Seraikela block.

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Several leading media outlets are covering the news of dramatic global declines in maternal deaths–and raising questions about why a group of women’s health advocates pressured the Lancet to delay publishing the findings…

The New York Times

“…The study cited a number of reasons for the improvement: lower pregnancy rates in some countries; higher income, which improves nutrition and access to health care; more education for women; and the increasing availability of “skilled attendants” — people with some medical training — to help women give birth. Improvements in large countries like India and China helped to drive down the overall death rates.

But some advocates for women’s health tried to pressure The Lancet into delaying publication of the new findings, fearing that good news would detract from the urgency of their cause, Dr. Horton said in a telephone interview…”

Read the full story, Maternal Deaths Decline Sharply Across the Globe, on NYTimes.com.

The New York Times Freakonomics Blog

The New York Times Freakonomics Blog also had something to say about this story and provided some background information on the history of maternal mortality–including a reference to the contributions to maternal health of Ignatz Semmelweis, the Hungarian physician who discovered that the incidence of puerperal fever could be drastically reduced with basic hand washing (ie. Medical students needed to wash their hands between cutting open cadavers and delivering babies!!).

Read the full post, Who’s Not Happy About a Falling Maternal Death Rate?, on the New York Times Freakonomics Blog.

Also see stories from the Associated Press, Lancet reports drops in maternal childbirth deaths, says it was pressured not to publish story; and from the Washington Post, Fewer Women Dying in Childbirth, Study Says.

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The Maternal Health Task Force and the Public Health Foundation of India announced today that the website for the Global Maternal Health Conference 2010 launched today–and abstract submissions are now open!

Maternal Health Task Force

“Check out our new Conference website www.gmhconference2010.com!  All the news and information currently available about the Global Maternal Health Conference 2010 is now online.  This is where you’ll learn about registration, abstract submission, the conference program, and all the logistics you’ll need to attend the first ever global conference devoted exclusively to maternal health. Be sure to bookmark this site and visit it often – it will be continually updated as the conference nears.

Submit your abstract for a poster or a presentation at the Global Maternal Health Conference 2010 now!  The deadline is April 30th and all the details are available here.

A 20-person Conference steering committee has been hard at work identifying the themes and sub-themes that will by the focus of the 3-day conference. The themes are Maternal Health Interventions and Programs, Underlying Factors Affecting Maternal Health, Measurement–Trends and Methods, Reproductive Health,  Health Systems, and Policy and Advocacy.

More information about the themes and subthemes is available here.

The Steering Committee is looking for abstracts that fall within the three organizing parameters of the Maternal Health Task Force: Evidence, Programs, and Policies and that are germane to the themes outlined above.

Submissions will be accepted for single abstracts and pre-formed panels.  Scholarships are available for participants from developing countries whose abstracts are accepted. To submit an abstract click here…”

For more information on the conference, click here.

For information on other conferences with a focus on maternal health, click here.

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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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I recently rediscovered this Oxfam International video of  pregnant women* breakdancing and raising awareness of the risks associated with childbirth in developing countries. I first saw it a couple years ago—and loved it! When I came across it again on Every 8 Minutes, a blog focused entirely on the issue of maternal health in India, I enjoyed it all over again. 

*The women in this video are not really pregnant. They are professional dancers wearing pregnancy suits. 

Let me know what you think of the video! 

Also, be sure to check out Every 8 Minutes for information on the state of maternal health in India. 

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Screenshot from Women Deliver conference website.

 

Women Deliver 

Volunteer at the conference and receive free registration for the conference, including three days of panel presentations and breakout sessions; access to Tuesday’s Technology Symposium and to the Exhibition Hall; and a Women Deliver volunteer t-shirt.

The conference will be held at the Walter E. Washington Convention Center in Washington DC from June 7th to the 9th, 2010. The deadline to apply to volunteer is March 31st, 2010.

For details on eligibility and information on the various volunteer assignments, click here!

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Lisa Russell and IPAS invite you to an evening of film and music for women’s health.

Click here to learn about MDGfive.com, a new project that Lisa and Maya are working on. They are calling on creative communities to use their artistic skills to raise awareness for the issue of maternal health.

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