December 15, 2011
5th floor, Woodrow Wilson Center
“Throughout the 2009-2011 Advancing Dialogue on Maternal Health lecture series, we always heard the same good news: we know how to save the lives of women and girls. But more political will is needed,” said Calyn Ostrowksi, program associate for the Wilson Center’s Global Health Initiative on December 15 for the launch of the series’ culminating report, Delivering Solutions: Advancing Dialogue To Improve Maternal Health.
Joining Ostrowski were co-author Margaret Greene, director of GreeneWorks; Luc de Bernis, senior advisor on maternal health at the UN Population Fund; Tim Thomas, interim director for the Maternal Health Task Force; and Chaacha Mwita, director of communications at the African Population and Health Research Center.
One of the few forums dedicated to maternal health, the series brought together senior-level policymakers, academic researchers, members of the media, and NGO workers from the United States and abroad. The series consisted of 21 separate events, with hundreds of experts sharing their experiences and thousands of participants and stakeholders providing their expertise. The final report captures, analyzes, and synthesizes the strategies and recommendations that emerged from the series.
Promoting Social Change
Unlike other health issues, said Green during her presentation on the findings of Delivering Solutions, the field of maternal health requires a holistic and multi-faceted approach; that is, an approach that looks not only at health systems, but also at underlying social factors. The report divides maternal health into three broad categories: social, economic, and cultural factors; health systems factors; and research/data demands.
Looking first at the social, cultural, and economic issues, Greene highlighted the need to improve nutrition and educational opportunities for young women in developing countries. Policymakers must be convinced that investing in women is not just good for women but good for families and children, she said. The participation of male partners and other male family members is also needed to increase access to maternal health services, such as family planning, and promote gender equality. The report pointed to a number of recommendations to promote male engagement:
- Target interventions that educate men about danger signs and pregnancy complications.
- Address pressures that many young married men feel to prove their fertility.
- Inform men about sexual rights and how they relate to the health and wellbeing of their partners.
Technology Solutions and Priority Areas
Health systems and medical resources play an equally pivotal role in reducing maternal mortality as social factors. The report highlights several key areas for strengthening the health system including the expansion of healthcare workers, health finance schemes, technology, and commodity distribution.
One key recommendation is to integrate reproductive health and maternal health supply chains. Four key medicines, oxytocin misoprostol, magnesium sulfate, and manual vacuum aspirators, target the three leading causes of maternal mortality (post-partum hemorrhage, obstructed labor, and unsafe abortion). Efforts to improve the distribution of these commodities should be more widely dispersed in developing countries and supported by community-based interventions. Women in urban slums, for example, face unique challenges that are not being adequately addressed.
Additionally, new technologies should be more creatively and effectively used, in particular the use of mobile phones in rural communities.
Many of the policy recommendations offered by the report, as Greene pointed out, are low-cost and highly effective. Yet three significant challenges remain for the field in general:
- Six countries – Afghanistan, Democratic Republic of Congo, Ethiopia, India, Nigeria, and Pakistan – account for over half of the maternal deaths worldwide. The unique problems of each of these countries must be addressed and solved.
- Integration of maternal health with existing health services along with an over-reliance on community health workers can overburden weak infrastructure.
- Unnecessary cesarean births are on the rise as more women deliver in private sector facilities. These births cost 2 to 18 times as much as vaginal births and create unnecessary risks for mothers.
Lessons From The Ground
Chaacha Mwita of the African Population and Health Research Center (APHRC), located in Nairobi has seen firsthand the result of an overburdened and inadequate maternal health system in both his personal and professional life. Mwita endorsed the findings of the series report, emphasizing in particular the focus on transportation systems, male involvement, stakeholder dialogue, and education.
Mwita said that collaboration at all levels is the key to improving maternal health. Policymakers must communicate with researchers, who, in turn, must communicate with doctors, nurses, and hospital administrators in the field. The collaborative in-country dialogue series between the Wilson Center and APHRC, he believes, was a highly useful and easily replicable way of encouraging dialogue among relevant stakeholders in the field.
The Big Picture
“Our hope is that we’ve been able to seed discussions,” said Tim Thomas of the Maternal Health Task Force, one of the co-sponsors of the maternal health series. “We hope those seeds will take root and flourish.” Luc de Bernis, senior maternal health advisor of UNFPA, echoed Thomas’ sentiments, emphasizing the need for continued dialogue.
While maternal health has drawn increased international attention, creating political agreement among policymakers is a complex and often difficult process. There has been marked, though uneven, progress in improving maternal health across the globe, but more must be done. The Delivering Solutions report provides a state of the field assessment as well recommendations for existing, easy-to-implement solutions.