Obstetric and Epidemiological Transitions in the Americas Require Complex Interventions to Further Improve Maternal Health: Jamaica's Experience

Jamaica’s epidemiological tradition dates to the 19^th century when vital registration was introduced to monitor survival after the slave trade (1807) and slavery (1838) were abolished.  Health services, introduced by plantation owners and continued by the Colonial government, aimed to keep plantations productive. Community midwives were deployed from 1910-1929 into all 41 health districts to improve maternal and perinatal survival. 

Active maternal mortality surveillance (1998), alongside other public sector research, informed public policy decisions.  Epidemiologists adapted international evidence to Jamaican circumstances, field testing and evaluating them ahead of national implementation.  The World Bank’s reclassification from a lower to upper middle income country has however limited access to international research and development grant financing.

As simple problems were solved with magic shots of penicillin or oxytocin, complex ones persist.  These require carefully orchestrated behaviour change among patients and providers, more efficacious medicine and adaptation to a changing environment, alert to emerging diseases like chikengunya virus, reintroduction of malaria, alongside cardiovascular and sickle cell disease, increasingly impacting women of reproductive age. 

The need for complex interventions create opportunities for North-South and South-South investigators to share alternative approaches to similar problems, enabled by communication technologies accessible to even the peasant farmer, who is often a woman.  The Caribbean provides a well-educated community whose variable social circumstances yield conditions of higher prevalence than the North, allowing better powered investigations, in a more cost-effective work environment.  We look forward to opportunities to exploit our common advantages and interests, while improving global health policy and practice.