High rates of maternal and newborn mortality and infirmity in developing countries can be reduced if mothers and their newborns are referred with sufficient time to government or private health services in cases of complications during delivery or shortly after childbirth. This fact has led national and international health agencies to advocate for all pregnancies to be closely monitored by medical personnel and all births supervised by “skilled birth attendants” with at least a secondary school education and several years of specialized training.

But in many parts of the world such solutions are unrealistic and may even be harmful:

It is in the most remote areas, where service provision is most difficult and most expensive that obstetric problems are most likely to occur and Western-trained skilled birth attendants are least likely to be found.

It is in these areas that the quality of the services that are available tends to be the poorest. Many women have shied away from government health facilities for a number of valid reasons. Ill treatment, poor and irregular services, disregard for their traditions and fear of unnecessary episiotomies and c-sections.

In some places pressure on local health authorities to reduce maternal deaths has led to coercive policies combining intensive health surveillance with the threat of withdrawing financial incentives offered by popular poverty alleviation programs. These approaches discourage long-held practices, like giving birth at home, with little regard for people’s own customs, cultural stability and mental health.

In the short video below, Dr. Neil Andersson elaborates on these issues.

In both Nigeria and Mexico, CIET is contributing to the search for solutions that will assure safe birth in cultural safety.

A pilot randomised controlled trial in Mexico is aimed at improving maternal and newborn health in indigenous communities in a way that respects and strengthens local cultures and traditional midwifery. 

In Nigeria, CIET is testing a health information system that links skilled obstetric services directly to households by electronically-monitored health worker visits to pregnant women and their husbands where they live. This is part of the larger NEHSI project that is also emphasising primary prevention, seeking to prevent some risks before they become problems that require obstetric services. The NEHSI baseline identified intimate partner violence, heavy work in pregnancy, ignorance of danger signs and failure to discuss pregnancy with the spouse as strongly associated with health complications during pregnancy and childbirth. These results have been published in Biomed Central Health Services Research.