Towards Better Solutions for Reducing Maternal Mortality

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%).