The Drum BeatA weekly electronic publication exploring initiatives, ideas and trends in communication for development.

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- The Drum Beat - Issue #353 -
"MDG #5 - Improving Maternal Health"
June 26 2006
[Click here for Previous Issues]

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Contact: The Communication Initiative

...global forces...local choices...critical voices...telling stories...

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The push to achieve Millennium Development Goal (MDG) #5 - reduce the maternal mortality ratio (a measure of the risk of death a woman faces every time she becomes pregnant) by 75% prior to 2015 - is taking shape in different ways in communities around the world. This issue of The Drum Beat highlights a few of the communication-focused strategies for saving women's lives through participation and collaboration - that is, involving women, men, community members, health care providers, and researchers in increasing knowledge and communication about, and access to, safe and effective contraceptive and maternal health services.

To view additional materials on components of MDG #5 such as family planning, please use our Custom Search tool and select the keyword for this MDG. Please also visit our MDG Impact section for more examples of the impact of communication on meeting maternal health goals.

Next month we will focus on MDG #6: Combating HIV/AIDS, Malaria and Other Diseases. Please send your projects, articles, events, etc. to Deborah Heimann dheimann@comminit.com

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1. Department for International Development (DFID) Factsheet - September 2005 [PDF]
Every year more than 500,000 women die due to complications of pregnancy and childbirth; all but 2500 of these deaths occur in developing countries. The chances of suffering a maternal death over a woman's lifetime are as high as 1 in 16 in some countries in sub-Saharan Africa. Maternal death is the leading cause of death for girls between the ages of 15 to 19 in the developing world - they are twice as likely to die in childbirth as women in their twenties. Every minute 190 women face unwanted or unplanned pregnancies. Every year 20 million risk unsafe abortion and 70,000 die from complications of unsafe abortion. 200 million women have an unmet need for safe, effective contraceptive services.

2. United Nations Association (UNA) of the United States of America (USA) Fact Sheet - February 2006
"Despite positive efforts by a number of countries in improving the health and well-being of mothers and babies...the countries that started off with the highest burdens of mortality made least progress during the 1990s, and in some countries the situation has actually worsened....Of all the countries that have reported more than 1,000 deaths per 100,000 births, all but one, Afghanistan, are found in Africa. Sierra Leone has the highest prevalence with 2,000 deaths per 100,000 births reported."

3. Saving the Lives of Mothers and Newborns
According to Save the Children's State of the World's Mothers 2006, every year 60 million women give birth at home, without the help of professional birth attendants. Nearly all (98%) maternal deaths occur in developing countries where pregnant women lack access to basic health care services - before, during and after delivery.

4. Monitoring and Evaluation (MAE) Skilled Attendant at Birth - 2006 Updates (April 3 2006) - Department of Reproductive Health and Research (RHR), World Health Organization
Worldwide, 61.5% of births are attended by a skilled health worker. Although virtually all births are attended by skilled health personnel in more developed countries, this proportion is 57.4% in less developed countries and 33.7% in the least developed countries.

5. Female Genital Mutilation Harmful For Mothers And Babies
"In the latest study [The Lancet, June 2 2006] the World Health Organization (WHO) study group on female genital mutilation [FGM] and obstetric outcome analysed data from 28,373 women giving birth to a single baby between November 2001 to March 2003 at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan. The researchers found that FGM caused one to two extra perinatal deaths per 100 deliveries, in relation to a background risk of 4-6 perinatal deaths per 100 deliveries. Women with FGM were also more likely to have deliveries complicated by caesarean section, haemorrhage, surgical intervention to enlarge the vagina and assist birth, and extended hospital stays."

INVOLVING WOMEN

6. Effect of a Participatory Intervention with Women's Groups on Birth Outcomes in Nepal: Cluster-randomised Controlled Trial
by Dharma S Manandhar, David Osrin, Bhim Prasad Shrestha, Natasha Mesko, Joanna Morrison, Kirti Man Tumbahangphe, Suresh Tamang, Sushma Thapa, Dej Shrestha, Bidur Thapa, Jyoti Raj Shrestha, Angie Wade, Josephine Borghi, Hilary Standing, Madan Manandhar, Anthony M de L Costello & members of the MIRA Makwanpur trial team
A team from Mother and Infant Research Activities (MIRA) in Kathmandu, Nepal undertook a low-cost, community-based participatory intervention with women's groups to test the impact of peer education on birth outcomes in an economically poor rural population. In each intervention cluster, a literate locally resident woman convened 9 monthly group meetings with women of reproductive age; the emphasis was on participatory learning. This strategy was found to be effective: Women sought more information about perinatal health, which was provided through the iterative design and playing of a picture card game. The intervention (which was coupled with action by the MIRA team to remedy weaknesses in the provision of antenatal, delivery, and newborn care) reduced maternal mortality by 78%.

7. Grandmothers Promote Maternal and Child Health: The Role of Indigenous Knowledge Systems' Managers
by Judi Aubel
This article describes a 5-step methodology for working with grandmother networks in Africa and Asia in order to strengthen their role and knowledge in promoting optimal practices related to maternal and children health and well-being. In each setting where the methodology was used, communities strongly supported the idea of grandmother inclusion, and most grandmothers participated actively, acquired new knowledge, and agreed to combine new ideas with traditional knowledge. Grandmothers were found to have considerable influence on all matters related to women and children's well-being and on other household members' attitudes and practices in this regard. Another finding is that the majority of grandmothers, including illiterate ones, are capable of (and open to) learning new things when the paedagogical approach is based on respect and dialogue.

8. Determining an Effective and Replicable Communication-Based Mechanism for Improving Young Couples' Access To and Use of Reproductive Health Information and Services in Nepal - An Operations Research Study
This study explored the impact of 2 models - the Youth Communication Action Group (YCAG) and the Mother's Group (MG) - which were implemented in the Udaypur district of Nepal as part of the Nepal Red Cross Society's Reaching and Enabling Women to Act on Reproductive Health Decision (REWARD) project. For instance, members of YCAGs (mostly spouses of migrant men) are empowered with information, education, and communication (IEC) materials and skills to negotiate condom use and to openly discuss the role of condoms in birth spacing and HIV/AIDS prevention. The groups "facilitate youth-to-youth communication through an entertainment and education approach." The proportion of respondents who knew that a pregnant woman should have at least 4 antenatal care visits increased in the experimental sites (YCAG and MG) only. The proportion who were able to cite at least 3 danger signs during pregnancy, labour, and delivery also increased significantly in those sites. The increase in safe motherhood practices was greater in the YCAG area than in the MG site or the control site. The proportion of deliveries assisted by trained birth attendants rose from 14% to 43% in the YCAG area while remaining modest in the other sites.

9. The Woman Tour - United States
Film screenings, music performances, and panel discussions were part of a 3-week, 16-date tour designed to help raise USA residents' awareness of women's health in the developing world, and to advocate for increased attention to (and funding for) the maternal health condition of obstetric fistula. Conducted at select universities and involving global women's health experts and public figures, the initiative also drew on information and communication technologies (ICTs) to stimulate awareness and action: A blog documented the tour's course and an interactive website offered information about fistula; featured journal entries from musicians, filmmakers, and public health specialists; and shared action ideas for influencing U.S. legislation that would help fund fistula programmes.
Contact Lisa Russell lisa@governessfilms.com

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Please participate in our PULSE POLL

Listening to parents is the most important thing communities can do to better support early child development.

Do you agree or disagree?

[For context, please see The Drum Beat #350]

VOTE and COMMENT

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INVOLVING MEN & OTHER COMMUNITY MEMBERS

10. Cultivating Men's Interest in Family Planning in Rural El Salvador
by Rebecka I. Lundgren, James N. Gribble, Margaret E. Greene & Gail E. Emrick
This report from the Institute for Reproductive Health describes a project in rural El Salvador that tested the integration of family planning into a water and sanitation programme as a strategy for increasing male involvement by linking the already-valued concept of protecting natural resources with the concept of protecting family health by means of spacing births. Population Concern International (PCI) wove family planning topics into ongoing educational activities conducted during the process of community mobilisation and construction of water systems and latrines. People began discussing family planning issues even when they themselves were not directly exposed to a group talk or home visit from a PCI facilitator or community volunteer.

11. Services to the People - Kazakhstan, Kyrgyzstan & Tajikistan
The Netherlands School of Public & Occupational Health launched a safe motherhood project in collaboration with the PRO Foundation in Amsterdam and family planning associations in Kazakhstan, Kyrgyzstan and Tajikistan. While a core component is increasing access to quality services (in part by training obstetricians for home deliveries and emergency management), the project also seeks to enlarge male involvement by offering birth preparation courses and taking steps to enable men to accompany their partners to clinics and deliveries. Research is also a strategy; organisers feel that surveillance and maternal-perinatal death audits, at the local level, allow families and communities to learn about the conditions which contribute to mortality and then to discuss appropriate actions.
Contact Olga de Haan o.dehaanol@nspoh.nl OR Nico Brinkman n.brinkman@nspoh.nl OR info@nspoh.nl OR Galina Chirkina rhak@infotel.kg OR Ravshan Tohirov tajik-fpa@rambler.ru

12. Impact Data - Promoting Change in Reproductive Behavior in Bihar (PRACHAR) - Bihar, India
In Bihar, India, 9% of women giving birth receive assistance from a formal provider; 10% of pregnant women receive 3 or more antenatal check-ups. Pathfinder's broad-based community approach included street plays, adolescent training programmes, home visits, group meetings, and basic training for 1,398 traditional birth attendants (dais) and 447 rural medical practitioners. Among the results: The interval between marriage and first birth for newlyweds increased from 21.3 months to 24 months; the percentage who use contraceptives to delay their first child jumped from 5.3% to 19.9%; the contraceptive use rate among young married women increased from 9.7% to 38.1%; pregnancy rates in newlyweds declined from 24.3% at the start of the intervention to a 6-month average of 21.6%; and fertility rates fell by 14.3% in the age group 15-19 years and by 12.8% in the age group 20-24 years.

13. Replication of the TOSTAN Programme in Burkina Faso: How 23 Villages Participated in a Human Rights-based Education Programme and Abandoned the Practice of Female Genital Cutting in Burkina Faso
by Dr. Nafissatou J. Diop, Edmond Badge, Djingri Ouoba & Molly Melching
This paper examines a community-based initiative carried out in 23 villages in the Zoundwéogo Province, Burkina Faso to address female genital cutting (FGC). As the culmination of a series of discussions among local men and women, participants "made a public declaration for the abandonment of the practice of FGC in front of 5,000 villagers, religious, traditional and political leaders, the media and programme managers from government, NGOs and international organizations....They made the historic decision to end the ancestral practice and to promote the health and human rights of women and young girls....The media greatly contributed to spreading the important messages of the declaration throughout the nation. This act...became a model for other communities in Burkina Faso who are seeking to end FGC."

14. Institutional Support for a Program of Activities with the West Bank/Gaza
This report describes a project which aimed to improve the health status of Palestinian women and their children in the West Bank and Gaza, where cultural norms favour early marriage, a preference for sons, and large family size. One of the 3 studies examined here highlights male participants' suggestions for changes at the clinic level; one idea was to hire male health providers to make it easier for men to ask sensitive questions. Suggestions for increasing men's knowledge about reproductive health (RH) include: distributing RH brochures for couples to read together; holding gender-specific seminars at the clinics or other public places; incorporating RH information into the school curricula; and broadcasting RH information on TV so couples can watch together (preferred formats were soap operas, plays or panel discussions). But "women should always have complete and voluntary choice as to when and how to involve their husbands."

15. Household-to-Hospital Continuum of Maternal and Newborn Care
Offered by the Access to Clinical and Community Maternal, Neonatal and Women's Health Services (ACCESS) Program, this policy brief outlines an approach to essential maternal and newborn care (EMNC). The household-to-hospital continuum of care strategy begins with the development of a community-based care component, a process that includes the full range of community leaders as well as caregivers and non-governmental organisation partners. Together, participants identify evidence-based best practices for maternal and newborn health and develop a plan - starting at the household level, where behaviour change communication (BCC) strategies can be used to introduce EMNC practices. Community mobilisation and social mobilisation are also used to foster community ownership. One strategy in linking the community to the facility is the development of multisectoral partnerships at the district, provincial, and national levels.

16. Involving Men in Maternity Care in India
by Leila Caleb Varkey, Anurag Mishra, Anjana Das, Emma Ottolenghi, Dale Huntington, Susan Adamchak & M.E. Khan
This report shares strategies and data from the Men in Maternity project, which tested the feasibility, acceptability and cost of a model that encouraged husbands' participation in their wives' antenatal and postpartum care in New Delhi, India; one activity included sessions to strengthen health practitioners' counselling skills. Among the findings: Husbands were significantly more likely to attend information sessions at experimental clinics than at control clinics (28% vs. 13%). Couples in the experimental sites reported more communication on family planning than control couples (84% vs. 64%) and more joint decision-making on the issue (91% vs. 71%). Use of family planning by women 6 months postpartum was 14 percentage points higher for women and 17 points higher for men in the intervention sites as compared to the control sites.

INVOLVING HEALTH CARE PROVIDERS

17. Improving Postpartum Care Among Low-parity Mothers in Palestine
As part of this project of the United States Department for International Development (USAID), the Palestinian Ministry of Health (MOH) and the Center for Development in Primary Health Care (CDPHC), a second home visit was provided to consenting women of low parity 30-38 days after delivery. During the second visit, the community health worker (CHW) reminded the women about their day 40 clinic visit for postpartum care and highlighted the importance and benefits of that visit. The CHW also provided counselling and health education specific to low parity women and their husbands. The second visit was associated with a substantial increase in the likelihood of visiting the clinic on day 40, increased support by the husband, and increased likelihood of husband-wife communication about timing of next pregnancy.

18. Reducing Maternal Mortality among Repatriated Refugee Populations - Huehuetenango, Guatemala
In Guatemala, the maternal mortality ratio for indigenous women is 3 times higher (211 per 100,000 live births) than for the non-indigenous group. A team from Marie Stopes Mexico provided cross-border services to 22 communities in the state of Huehuetenango using locally appropriate materials such as a blanket which shows the menstrual cycle and the fertility period, drawings illustrating signs of high-risk pregnancies and labour, posters detailing an "Emergency Plan for Labour Complications", and dolls, cloth placentas, and umbilical cords. Community meetings and gatherings were used as a venue for participatory educational talks on safe motherhood and related issues; the talks were directly translated by a traditional midwife into the local language. With an eye toward project sustainability, weekly interactive and participatory training workshops were conducted for health promoters and traditional midwives.
Contact Sally Hughes sally.hughes@mariestopes.org.uk

19. Expansion of Postpartum/Postabortion Contraceptive Services in Honduras
by Ruth Medina, Ricardo Vernon, Irma Mendoza & Claudia Aguilar
In an effort to prevent maternal deaths by eliminating unwanted pregnancies, the Ministry of Health (MOH) of Honduras, Population Council/FRONTIERS, and Hospital Escuela teamed up to train physicians, nurses, nurse auxiliaries, social workers, and educators in Ob/Gyn wards to use interpersonal communication as well as information, education, and communication (IEC) materials to increase knowledge and motivation for use of family planning methods. Among women who had been treated for an incomplete abortion (close to 10% of those who had delivered), the proportion who received information about contraception and/or a contraceptive method during their hospital stay increased from 17% to 85%; acceptance of methods increased from 13% to 54%; and the proportion who had delivered and wanted a method before leaving the hospital but did not receive it decreased from 48% to 21%.

20. Kaisay Kahoon (How Shall I Say It) - Pakistan
In October 2005, an entertainment-education drama premiered in Pakistan to coincide with the launch of a clinic-based programme that counsels newlyweds on a range of health topics, including reproductive and maternal health. 500 doctors were trained to offer young men and women advice on reproductive and maternal health, family planning, infertility, and the importance of spousal communication; a client brochure and client/provider cue card were developed for reference during the sessions. In addition to the 11-episode television serial ("an upbeat, romantic comedy"), 2 music videos based on the drama's theme songs were released, and TV and radio spots promoting the new counselling services were aired.
Contact Shana Yansen syansen@jhuccp.org

INVOLVING RESEARCHERS

21. Towards 4+5 - Global
This research consortium is working to manage projects in Burkina Faso, Ghana, Nepal, Malawi and Bangladesh with the aim of improving maternal and infant health by integrating disparate evidence, generating new knowledge, and communicating findings. Plans include informing the development, by 2010, of a communication strategy that supports evidence-based policy and management decision-making on large-scale programmes for maternal and infant mortality reduction, and increasing capacity in partner countries for knowledge generation and policy influence. The consortium plans to communicate its research through peer-reviewed journals, international conferences, workshops, websites, leaflets, policy briefs, manuals, radio interviews, and meetings with stakeholders.
Contact Sarah Ball ipu@ich.ucl.ac.uk

22. Assessment of USAID Reproductive Health and Family Planning Activities in the Eastern European and Eurasian Region with Special Reference to Armenia, Kazakhstan, and Romania
This paper shares the results of research that examined the extent to which the US Agency for International Development (USAID)'s reproductive health (RH) and family planning (FP) programming/assistance over the past decade in the Eastern European and Eurasian (E&E) region has been effective in addressing major RH/FP needs such as high levels of unintended pregnancy and heavy reliance on abortion. evaluating agency found that "the E&E countries that have been most successful in providing quality RH/FP care have also had rapidly growing economies, higher levels of government commitment to RH/FP programming, greater USAID Mission support for RH/FP activities, more involvement of the commercial and nongovernmental organization (NGO) sectors, and a greater willingness to integrate RH/FP care into primary and family-centered maternity care."

23. SID-SAN Strategy on Maternal Mortality in South Asia
The Society for International Development (SID)-South Asia Network (SAN) is looking at how the MDGs can be met through partnership and research. Among the key areas of concern: the need to find more appropriate and accurate ways to measure the maternal mortality ratio, redefine maternal mortality to include morbidity and non-medical indicators, and uncover and learn from successful strategies. Planned outputs include an advocacy resource book, a set of media advocacy tools, and a report of guidelines and recommendations from a February 2006 meeting in Lahore. The expectation was that these materials would be taken back to national constituencies, form the basis of a media campaign, and be linked to global processes around the MDGs, Cairo +10 and Beijing +10 processes.

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This issue was written by Kier Olsen DeVries.

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The Drum Beat is from the email and web network of THE COMMUNICATION INITIATIVE partnership: ANDI, BBC World Service Trust, Bernard van Leer Foundation, Calandria, CFSC Consortium, The CHANGE Project, CIDA, DFID, FAO, Fundacion Nuevo Periodismo, Ford Foundation, Healthlink Worldwide, Inter-American Development Bank, Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, MISA, OneWorld, PAHO, The Panos Institute, The Rockefeller Foundation, SAfAIDS, Sesame Workshop, Soul City, UNAIDS, UNDP, UNICEF, USAID, WHO, W.K. Kellogg Foundation.

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The Drum Beat seeks to cover the full range of communication for development activities. Inclusion of an item does not imply endorsement or support by The Partners.

Please send material for The Drum Beat to the Editor - Deborah Heimann dheimann@comminit.com