Welcome to this week’s Charity Spotlight Interview. This week we are talking with Maternity Worldwide, an organisation working towards safer birth outcomes in low-income countries. If you have further suggestions for charities you would like to be featured, do get in touch with us at firstname.lastname@example.org
What do you feel are the greatest barriers which currently hold back progress towards safer birth outcomes?
At Maternity Worldwide, we recognise the greatest barriers of safe birth outcomes as The Three Delays Model advocated by Thaddeus and Maine (1994). The first major obstacle women may face in accessing safe and appropriate childbirth is the delay in deciding to seek maternal care in the first place. This can be attributed to the low status of women, poor understanding of complications and risk factors in pregnancy and when to seek medical help, previous poor experience of health care, acceptance of maternal death or financial implications. Secondly, accessing care presents barriers which often hold back progress towards safe birth outcomes. For example, dangerous terrain, long distances to hospitals and health centres, and a lack of affordable transport my prevent women from being able to access the care they need. Lastly, the quality of maternal care itself largely influences birth outcomes. This includes poor facilities, a lack of medical supplies, inadequately trained and poorly motivated medical staff and inadequate referral systems act as the biggest barrier to safe birth outcomes. However, it is imperative to remember that often these barriers do not influence birth outcomes exclusively, but are often present in conjunction together.
Please could you describe the issues of maternal morbidity and mortality worldwide, and explain the work that you do to improve outcomes?
Sadly, every day across the world, 800 women die in pregnancy and childbirth. This equates to 289,000 women annually, and each death is a tragedy which often can trigger devastating effects on the family. 99% of these deaths occur in developing countries and 62% of these in Sub-Saharan Africa where we work (in Malawi, Uganda and Ethiopia). Most of these lives could in fact be saved by relatively simple, inexpensive measures, and that is where we come in.
Here at Maternity Worldwide, we have a vision of a world in which all women and their babies can access safe and appropriate childbirth without fear, regardless of where they live, and to achieve this, we address each the barriers described above, to address both the supply and demand side of maternal health.
To combat the delay in the decision to reach care, we provide communities (both men and women) with information on pregnancy, childbirth and newborn healthcare so they know when to seek medical help. We also facilitate income generation schemes for women to enable them to become financially independent and empowered to make decisions about their own sexual and reproductive health and to become future leaders.
To combat the delay in accessing care, we provide transport solutions to particularly rural areas with bicycle ambulances and motorbike ambulances. We also build waiting houses next to health centres for expectant mothers to stay in before their due date so when they go into labour assistance is on site.
In addressing the biggest barrier to safe birth outcomes, the availability of adequate and safe childbirth and maternal care, we train local midwives who will remain in rural areas when qualified, training nurses, doctors and healthcare professionals to provide safe births now and for future generations. Ensuring health centres are suitably equipped to provide safe deliveries and improving referral systems between health centres and hospitals.
What is the influence of factors such as race, class, education or location (rural/urban) on birth outcomes?
At Maternity Worldwide, we recognise the importance of context, and therefore the influence of all those factors listed above as contributing to birth outcomes worldwide. Where we work in Uganda, Ethiopia and Malawi, the biggest influences on birth outcomes are in the form of location, education, and the quality of health care available. This again mirrors the ‘three delays model’ and our integrated programmes approach, and why we adopt it in the first place. Location can have a huge effect on birth outcomes, for many women in rural areas may live several hours away from the nearest health center and transport may be limited or costly. There may be few roads or other barriers such as mountain ranges and rivers which make it very difficult to reach care. This delay, made of obstructions to reaching care due to location, can have tragic consequences for women, particularly those in need of emergency care.
Furthermore, education can have a huge influence on birth outcomes. This has been shown by our work; from our community maternal health education groups, many women have told us of how they are now far more aware of pregnancy danger signs and to consequently seek professional help, whereas before, they may not have done. Maternal health awareness education is paramount to a woman’s decision to seek care, which may ultimately prove fundamental to her birth outcome. Unfortunately, the delay in decision to access care may also stem from the low status of women (in some areas) which becomes intertwined with lack of women’s education and ultimate decision to reach care, as well as not having a source of their own income; introducing gender inequality as a potential influencer on birth outcomes.
In the countries you work in, how would you describe the quality of the existing health systems for maternal health?
Unfortunately, 62% of global maternal deaths take part in Sub-Saharan African, where our work in centred. In Ethiopia, the Maternal Mortality rate stands at 335 per 100,000 births. In Uganda the figure is 343, and Malawi holds MMR at 643. Unfortunately, all three delays from the model described above are shown to amalgamate themselves in our beneficiary countries, which sadly does not fare well for healthy birth outcomes, and for these countries to ultimately fulfil Millennium Development Goal 5, whereby maternal mortality is reduced by three quarters and universal access to healthcare is ensured. Economic infrastructure can place a huge strain on the quality of health care, particularly maternal, as well as providing transport for women to appropriate health care.
There has been friction between the model of home births with traditional birth attendants, compared to more medicalised facility births. Based on your experience, where do you stand on this debate?
We recognise both the importance of skilled maternal care as imperative to saving lives in childbirth whilst also recognising the cultural and contextual importance Tradition Birth Attendants often hold, particularly in Malawi, one of our beneficiary countries.
We were involved in a research project on this very issue in July, which was titled ‘Birth and Culture: The Nexus of Women’s Perceptions of Maternal Rights and Care-Seeking Behavioural Patterns in the Zomba District, Malawi’ (Weekley, 2018). The study highlighted cultural shifts to placing emphasis on women’s maternal rights which many participants equated to skilled maternal care in conjunction with their bodily autonomy and individual choice to access this care.
There are many historical factors that may have influenced this shift, such as turbulent laws on traditional birth attendants and the role village headmen play in how a women chooses her care, but here at Maternity Worldwide, we are a very beneficiary-led charity, who places women and their needs, and what they classify as their needs, at the forefront in order to ensure sustainable progress in saving lives in childbirth.
Find out more at https://www.maternityworldwide.org/
This blog post was a collaboration between Serena Bailey, Director of Engagement for CORBIS and Amelia Weekley at Maternity Worldwide. If you are a student at the University of Sussex, Brighton and Sussex Medical School or Institute of Development Studies and would be interested in getting involved with our work, get in touch with us at email@example.com
Thaddeus, S. and Maine, D. (1994) Too far to walk: maternal mortality in context. Social science & medicine, 38(8), pp.1091-1110.
Weekley, A. (2018) ‘Birth and Culture: The Nexus of Women’s Perceptions of Maternal Rights and Care-Seeking Behavioural Patterns in the Zomba District, Malawi’ Masters Dissertation, Sussex University