The Maternal Health Task Force (MHTF)’s Kayla McGowan recently had the pleasure of interviewing Jocelyn Finlay, a Research Scientist in the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health. Finlay is the principal investigator of a project based in Burundi working on empowering young women in their reproductive health, using a mixed methods approach to create youth-made and youth-targeted interventions. With support from the MHTF, Finlay is also investigating the provision and use of maternal health services in an urban setting and within refugee camps in Burundi.
KM: Describe your work in maternal health. Could you talk a bit about your collaboration with research partners?
JF: We are looking at maternal health service provision and use within humanitarian crisis settings, specifically looking at refugees that migrate from the Democratic Republic of Congo (DRC) to Burundi. It is a unique setting because Burundi has its own humanitarian crisis at the moment. We see a lot of outflow of refugees from Burundi because of their own political crisis. Its neighbor, DRC, has about half a million refugees, and it has really accelerated. We are working within refugee camps which tend to be very remote.
Given this unusual migration from one conflict setting to another we wanted to look into the maternal health services that are provided and what is used. We are using a mixed methods approach, so the qualitative work is helping us see whether we are asking the right questions in the first place. An initial question was: Is there a gap between provision and use? We wanted to hear about the maternal health services offered, and used, and see if the gap is generated by lack of supply or lack of demand.
KM: What have you learned so far?
JF: Having the qualitative research component has meant that we are better able to shape the research question, to make sure we ask the most important question. We have conducted two types of qualitative interviews. One is on the supply side, interviewing key informants about what kind of maternal health services are offered, whether people use them and what they think are the limitations. We are always asking about both problems and solutions.
The second type is community participatory work with refugees. We use a technique called concept mapping, a workshop where people are grouped by age and interviewed. We are interviewing women between the ages of 15-49, divided into five- or 10-year age groups. The women get to talk about problems and solutions associated with provision and use of maternal health care services. Both the providers and the women get to discuss their thoughts about problems and solutions.
We’ve conducted the qualitative work in an urban setting and in refugee camps.
Two shortfalls that were cited as particularly acute for those in the camps were that there is some basic antenatal care, but there is not really any postnatal care. As my colleague says, “Women who give birth or miscarry are largely left to cure on their own.”
There are doctors within the camps, but they are completely overwhelmed. If there are complications and women have to travel outside the camps, it is a very difficult journey since the camps are often very isolated. Again, to quote my colleague, “Imagine a three-kilometer [or much longer] journey in rough terrain for a mother experiencing labor complications.”
Based on previous conversations, another point that emerged is that the needs within maternal health reflect broader health systems issues. Sanitation issues, such as not having enough soap, are really important to the refugee women. During delivery, sometimes there is not even soap for providers to wash their hands. Another issue is access to prescription medication—for maternal health purposes, newborn care and other issues. They are not confident about the quality of the drugs they are receiving, if they are the right quantity and there are also concerns about prescription medication cost and antibiotic resistance.
KM: What is the biggest takeaway regarding maternal health in this setting?
JF: A key takeaway that has emerged is that there are not enough maternal health guidelines for emergency situations in humanitarian crisis settings. For example, there is the Minimum Initial Service Package as well as guidelines for gender-based violence by the Inter-Agency Standing Committee. However, there is little available for maternal health in refugee settings specifically. There is a need for a short document containing lifesaving guidelines or step-by-step instructions for addressing emergency obstetric care in these settings. The World Health Organization has a “Key Steps” document, but it is not clear if these guidelines should be applied within the camps.
KM: Could you talk a bit about the impact of your work on a global scale?
JF: I hope that we shed light on a refugee situation in such a complex humanitarian situation of Congolese refugees in Burundi. We hope to bring voice to Burundi as a host community, and Congolese refugees.
KM: If you had an unlimited budget, how would you invest in maternal health?
JF: I would say strengthening the health care system within Burundi more broadly. Doing this would then translate to a strengthened health care system for refugees.
Read our series profiling maternal and newborn health in humanitarian settings: