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Posts Tagged ‘maternal mortality’

The Safe Motherhood Program at UCSF is looking for interns to work in the Copperbelt of Zambia from August – October, 2011.

Interested? Check out the details below!

This internship is based in the Copperbelt Region of Zambia.  The intern will work on a study which aims to reduce maternal mortality and morbidities in Zambia and Zimbabwe caused by obstetric hemorrhage.  This is a cluster randomized control study which compares outcomes based on evidence from intervention and control clinics.  The intervention clinics in this study are the clinics that are using the NASG (Non-pneumatic Anti-Shock Garment) as a first aid device for patients suffering from hypovolemic shock caused by bleeding during pregnancy.

Some of the duties of the intern are:

  • Providing logistic support for the local Zambian team – distributing supplies, copies
  • Reviewing data collection forms
  • Encouraging protocol adherence
  • Conducting training with local hospital and clinic staff
  • Visiting the study clinics
  • Following up on cases
  • Liaising with the San Francisco office and the in-country staff

Desired qualifications:  Experience in international settings, interest in maternal health, research experience, familiarity with clinical environments.  Must be highly detail- oriented, be well-organized and have excellent follow-through skills.

Note: This internship is unpaid. Intern must provide their own airfare and living expenses.

To apply, send cover letter and cv to:

Elizabeth Butrick

NASG Project Director

ebutrick@globalhealth.ucsf.edu

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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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On May 27th, Sarah Boseley reported on her Global Health Blog that the families of two women who died in childbirth have taken legal action against the Ugandan government, asserting that the women’s rights to life and health were violated.

Sarah Boseley’s Global Health Blog, The Guardian

“…The case is unprecedented in Uganda. Aid agencies and medical charities and donor governments can condemn the death toll in pregnancy and childbirth, but the most powerful argument is the devastating testimony of those who suffer.

Sylvia Nalubowa died in Mityana hospital on 10 August 2009 from the complications of obstructed labour. She was carrying twins, one of whom was delivered. The second died with her. Jennifer Anguko died in Arua regional referral hospital on 10 December 2010 when her uterus finally ruptured after 15 hours of obstructed labour. Her status as a district councillor brought her no favours – she was said to be the fourth woman to die in that hospital that day…”

Read the full story here.

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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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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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In April, the Lancet published new maternal mortality estimates (out of the Institute for Health Metrics and Evaluation) that showed a significant reduction in global maternal deaths, shaking up the global health community’s understanding of the global burden of the issue–and providing new hope. The report also illustrated the important links between HIV/AIDS and maternal mortality.

In the wake of the Lancet report, maternal health professionals from various organizations engaged in robust dialogue (like this one) about measurement methodologies–and raised questions about when the World Health Organization would release their estimates and how they might differ from the IHME estimates.

On September 15th, WHO, UNICEF, UNFPA, and the World Bank released their new maternal mortality estimates in a report, Trends in maternal mortality. Their report also showed a significant drop in maternal deaths—a 34% decrease between 1990 and 2008.

Excerpt from the WHO press release:

“The new estimates show that it is possible to prevent many more women from dying. Countries need to invest in their health systems and in the quality of care.

‘Every birth should be safe and every pregnancy wanted,’ says Thoraya Ahmed Obaid, the Executive Director of UNFPA. ‘The lack of maternal health care violates women’s rights to life, health, equality, and non-discrimination. MDG5 can be achieved,’ she adds, ‘but we urgently need to address the shortage of health workers and step up funding for reproductive health services’…”

More highlights from the report:

  • Ten out of 87 countries with maternal mortality ratios equal to or over 100 in 1990, are on track with an annual decline of 5.5% between 1990 and 2008. At the other extreme, 30 made insufficient or no progress since 1990.
  • The study shows progress in sub-Saharan Africa where maternal mortality decreased by 26%.
  • In Asia, the number of maternal deaths is estimated to have dropped from 315 000 to 139 000 between 1990 and 2008, a 52% decrease.
  • 99% of all maternal deaths in 2008 occurred in developing regions, with sub-Saharan Africa and South Asia accounting for 57% and 30% of all deaths respectively.

Click here to read the press release and here to read the full report.

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In my last few weeks at the Maternal Health Task Force, I have been working with Raji Mohanam, Knowledge Management Specialist at the MHTF, Matthew Meschery, Director of Digital Initiatives at ITVS, and Lisa Russell, Filmmaker and Co-Founder of MDGFive.com, and an incredible team of presenters, to coordinate a panel presentation on digital tools for maternal health for the Global Maternal Health Conference in Delhi. Take a look below for a post I wrote for the MHTF Blog about the upcoming panel session–with info on how to participate remotely.

I am off to India tomorrow! Check back next week for posts from the conference.

The upcoming Global Maternal Health Conference in Delhi (August 30th-September 1st) will focus on lessons learned, neglected issues, and innovative approaches to reducing maternal mortality and morbidity. The anticipated outcome of the conference is increased consensus around the evidence, programs and advocacy needed to reduce preventable maternal mortality and morbidity.

One session, Maternal Health Digital, will showcase a number of digital communication tools being applied to maternal health. Matthew Meschery, Director of Digital Initiatives at the Independent Television Service, will moderate the session—and will guide panelists and participants through a lively discussion that will explore the potential of digital tools to improve the health of women around the world. Panelists will also address questions about how to measure the impact of such projects.

Throughout the session, conference participants will learn about an email help desk that is aiming to increase access to misoprostol and mifepristine, a mobile phone and radio initiative that is aiming to improve delivery of maternal and neonatal health services, an online media “mash-up” tool that is enabling users to make their own advocacy videos, a crowd-sourcing project that is tapping into the knowledge of front-line maternal health care providers in 9 languages, and more.

This exciting session will include presentations from Google.orgWomen on WebZMQ Software SystemsHealth ChildMDGFive.com, the Social Media Research Foundation, the Pulitzer Center for Crisis ReportingUniversity of Oxford, the Maternal Health Task Force, and the Independent Television Service.

Take a look at the session summary:

In recent years, the health, technology, and communication sectors have come together to innovate health communications through the use of digital media. Advances in tools for cross-media storytelling, social networking, digital games, real-time messaging, and mobile and location-aware technologies are being adapted to fit the needs of the maternal health community—and are helping to fuel the increased momentum around the issue. In this interactive session, conference participants will learn about a diverse range of innovative projects that are aiming to identify challenges and solutions for providing care to pregnant women, build stronger connections among maternal health organizations, create new ways to collect and use data, foster increased collaboration through engaging communities, and continue to drive attention toward the issue. As well as highlighting the promise of these new tools, we will also look at some specific challenges such as measuring impact, working in areas with limited connectivity, and merging online and offline strategies. There will be a series of mini-presentations on crowd-sourcing, interactive mapping, a media mash-up tool, an online reporting hub, mobile health campaigns, and more. Participants will not only get an over-view of a wide variety of strategies and recent developments in digital health communications—but they will also learn tips for applying many of these new tools to their own work and engage in a dialogue around how to maximize the utility of these technologies in order to significantly improve the health of women around the world.

This session will be live streamed! Click here for the live stream schedule.

Join the discussion via Twitter! Conference hashtag: #GMHC2010, Session hashtag: #GMHC2010Digital


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