What if you could reduce maternal deaths in developing countries by bringing women together and getting them talking? According to results published in a special edition of the Lancet, released in conjunction with the 2013 Women Deliver Conference, it is possible.
While there have been significant reductions in maternal mortality in the last 20 years, nearly 275,000 women are still dying annually from complications due to pregnancy and childbirth. Ninety-nine percent of those deaths occur needlessly in developing countries.
It’s important to remember that regardless of where you live, the causes of maternal deaths are the same: hemorrhage, obstructed delivery, unsafe abortion. The difference is that women in developing countries do not receive adequate care in time.
‘In time,’ these researchers realized what they needed to address: when to seek care, how to minimize risks if home deliveries cannot be avoided, and how to best get to a hospital.
According to the findings, seven different interventions set out to address maternal deaths. Instead of addressing access to health care – a top down approach often seen in development – the researchers decided to address this problem from the bottom up. The interventions also sought to reduce mortality among newborn infants.
The concept is such: bring women together as a group to discuss maternal health problems facing their communities. The result: a 37 percent reduction in maternal mortality in rural and urban India, Nepal, Bangladesh and Malawi. And the researchers extrapolate that if scaled-up correctly, this type of intervention could reduce at least 41,100 deaths per year across the 74 Countdown countries.
The numbers, for a concept that seems so logical, are even more impressive when you pool the findings from four evaluations: they found that when at least 30 percent of pregnant women participated in a group, the maternal mortality reduction was a staggering 55 percent. Instead of just telling women to go to the hospital during childbirth, they strengthened their decision-making process about safe pregnancy and childbirth through conversations, role play and story telling,
The intervention described in the article is a four-phase participatory learning and action cycle. First, women identify and prioritize problems during pregnancy, delivery and childbirth. After the issues are selected, they plan and implement strategies to address them and finally, evaluate their activities. Thus, the women ultimately see the results of their own hard work and, as a result, now have an understanding of what causes death and what to do when complications arise. Finally, through community meetings, the women collectively share what they’ve learned and encourage buy-in from their husbands, neighbors and village leaders.
It was activist Paolo Freire who believed that “the oppressed must be their own example in the struggle for their redemption.” These researchers have tapped into an important resource: the women themselves. By working together in a collaborative manner that supports and encourages the ideas and assets of the community, it can lead to great strides in the reduction of maternal mortality, as well as impressive reduction in deaths among newborn infants.
As Will Rogers once said, “Rumor travels faster, but it don’t stay put as long as truth.” In other words, instead of running to an untrained birth attendant when a problem arises and only later looking for a means to reach to a hospital when things get worse, the women and their families are now empowered through knowledge and enhanced decision-making: plans are put in place, support networks are availed, safer practices followed and ultimately, lives are saved.