142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

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Towards Better Solutions for Reducing Maternal Mortality

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 10:42 AM - 10:54 AM

Susan Aradeon, MA Columbia U.; Phd Ahmadu Bello U, Nigeria , Mannion Daniels Ltd.,UK; matthew.wiltcher@manniondaniels.com, Partnership for Transforming Health Systems, Phase 2 (PATHS2), a United Kingdom Department for International Development programme, Aventura, FL
Amina Aminu , ABT Associates, PATHS2, Abuja
Henry Doctor, PhD University of Pennsylvania; MA University of Pennsylvania. , United Nations Office on Drugs and Crime
Yes, TBAs can’t save lives but the international community insistence that every woman deliver with a skilled birth attendant (SBA) is a specious solution for environments with high rates of home delivery and maternal mortality. The majority of women are too disbursed in rural areas for governments to realistically post 24/7 SBAs at accessible facilities in the foreseeable future.

To save rural women's lives, we introduced an intensive, innovative social mobilisation intervention that transformed rural apathy into social responsibility and maximized the lifesaving scope of the SBAs.  Within 2.5 years, rural communities that participated in the PATHS2 programme in northern Nigeria arranged timely emergency obstetric care referrals for 5,634 women from virtually zero. The prevailing MDG5 approach would have required the SBAs in programme clusters to deliver about 31,000 births to ensure survival of these women.

PRRINN-MNCH survey data for a northern Nigerian programme with the same intervention show a strong correlation requiring further research between knowledge of four maternal danger signs (a proxy for preparing for emergency care) and an impressive 16.7% reduction in maternal mortality within four years from a very high MMR.  From a low baseline, women’s knowledge increased 300% in the intervention sites versus 50% in the control sites where the MMR baseline (1271/100,000) remained high and virtually unchanged. The increased number of SBAs cannot explain the significant difference between the endline intervention and control site MMRs; the number of SBA births doubled from 11.2% in both the intervention sites (26.8%) and the control sites (23.6%).

Learning Areas:

Advocacy for health and health education
Implementation of health education strategies, interventions and programs
Program planning

Learning Objectives:
Demonstrate that the worldwide campaign to reduce maternal mortality through skilled birth attendance unnecessarily discriminates against rural women in poor health system environments with high home deliveries, the Nigerian example

Keyword(s): Community Health Workers and Promoters, Women's Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was BCC resident adviser for two DfID health systems strengthening programs:Johns Hopkins University Senior Program Officer,PRRINN-MNCH, Kano, Nigeria (January 2007 - March 2011) and Mannion Daniels Ltd Consultant Technical Lead for Informed Citizens Output, Abuja, Nigeria (October 2011 - September 2013), continuing as non-resident adviser through July 31, 2014. My focus is on promoting normative change by empowering community volunteers and members to communicate, reflect together and decide to act on health information.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.