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Posts Tagged ‘perinatal 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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Cross-posted from the MHTF Blog.

The World Health Organization (WHO) invites you to join the WHO Guidance Global Discussion Forum on Prevention of Maternal and Perinatal Mortality and Morbidity.

The online forum will be held from July 26th – August 6th, 2010.

The 2 week virtual discussion forum is designed to provide an opportunity for people to share their ideas, experience and opinions about the type of evidence-based guidance WHO should produce in order to support the reduction of maternal and perinatal mortality and morbidity.

Over the two-week forum participants will receive one to two emails per day: one email to introduce the day’s questions, and one daily digest of the contributions. Five questions will be addressed, and each discussed over two consecutive days. All contributions received will be acknowledged.

For any questions on this Virtual Global Discussion Forum please contact the forum facilitator: Cordelia Coltart at coltartc@who.int.

Click here for official announcement and invitation to the discussion forum.

REGISTER NOW!

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A recent study in the Lancet took a close look at a conditional cash transfer scheme to entice women to deliver in health facilities. The scheme, Janani Suraksha Yojana (JSY), aims to reduce maternal, perinatal, and neonatal mortality.

Published along side the study was a commentary by Vinod K. Paul that summarizes several of the key findings of the study–pointing out successes and challenges with the scheme.

“…In just 4 years, its beneficiaries multiplied 11-fold, from 0·74 million in 2005—06 to 8·43 million in 2008—09 (thus covering nearly a third of the 26 million women who deliver in the country annually). Budgetary allocation for the JSY increased from a mere US$8·5 million to $275 million in the same period. Surely, it is time to ask the question about what health outcomes are achieved by this massive and expensive investment and effort. On the face of it, by promoting a strategy of deliveries in the facilities, attended by skilled providers, JSY should lead to a reduction of maternal, perinatal, and neonatal mortality…”

Click here to read the full commentary. You will need to register (free) with the Lancet to access this article.

Excerpt from a Washington Post story on the study:

“…The payment program seems to be working, according to Indian health workers and researchers who conducted the study for the Lancet.

‘The cash payments mean that India is really starting to invest in women. That trickles out to the rest of the family and the rest of society,’ said Marie-Claire Mutanda, a health specialist with UNICEF, which is supporting the program.

In two of the poorest states in India — Bihar and Uttar Pradesh — the number of women giving birth in medical facilities soared from less than 20 percent in 2005 to nearly 50 percent in 2008, according to the most recent data available.

Doctors here attribute that to the payment program, whose Hindi name translates to ‘women protection scheme’…”

Click here to read the full story in the Washington Post.

Click here to read the study, India’s Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation, in the Lancet. You will need to register (free) with the Lancet to access this article.

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