For too many women around the world, the most dangerous time in their lives is the day they give birth. Almost 800 women died every day from preventable causes linked to pregnancy and childbirth in 2020, the most recent year with available data. Nearly half of maternal deaths occur on the first day after childbirth, while 25% occur in the first week. And the vast majority — 95% — happen in low- and lower middle-income countries. The good news is innovators and global health organizations are always working on ways to make pregnancy and childbirth safer for women.
To mark International Women’s Day we were fortunate to speak to three experts about some of the most significant maternal health innovations in recent years and how they are helping more mothers get equitable access to healthcare.
A Kit to Let Mothers Take Control of Their Health
Stephanie Suhowatsky, Project Director of the Antenatal and Postnatal Care Research Collective (ARC) project under Jhpiego: “Self-care is a growing area in healthcare, helping empower people to take control of their own health. Family-led postnatal care (FPNC) is a relatively new intervention to address one of the persistent problems in maternal healthcare: the lack of postnatal care for both mothers and babies. The global target is for 80% of mothers and newborns to receive a checkup within two days of the birth. But in places such as Nigeria and Ethiopia, very few get this care due to factors such as lack of access to transportation or cultural reasons — in some places, families traditionally stay home for the first six weeks after a baby is born.
With FPNC, after a woman gives birth, her family collects a home-care kit to use for a week. It contains a blood pressure machine, an infrared thermometer, a pictorial health education booklet designed for both literate and non-literate users, and a checklist for guiding daily self-care tasks and recording results. Every day, with the support of her family, the mother can use the kit to see if she or her baby is experiencing any of the most common postnatal problems. If they find something of concern, they can seek care at the health center. Our small study found that 96% of the mothers and newborns who received the kit had a postnatal check in the first three days after birth, compared to around 10% of women surveyed before FPNC was introduced. Three times as many mothers detected a health danger sign during the intervention period, giving them the chance to catch it before it became more serious. The kit can be used in every community, including underserved communities, such as those far from health facilities — rural villages, nomadic tribes — or in humanitarian settings. It also improves the pre-discharge care in health centers and strengthens families’ trust in the health system.”
Bundling Treatment to Tackle Postpartum Bleeding
Dr. Femi Oladapo, Head of WHO’s Maternal and Perinatal Health Unit: “Postpartum hemorrhage (PPH), severe bleeding after childbirth, is the leading cause of maternal death, especially in low- and middle-income countries. Each year about 14 million women experience PPH and about 70,000 cases end in death. We define postpartum hemorrhage as the loss of more than 500 milliliters (about one pint) of blood within 24 hours of birth, but many times nobody is measuring how much blood a woman loses. Also, historically, healthcare workers use a sequential approach to treat postpartum hemorrhage. Before delivery, women are given a preventative drug, such as oxytocin, to contract the uterus and minimize bleeding. Then, if they start to bleed, you give another drug, then you wait and see if it works before doing the next treatment, and so on. But PPH is a rapidly evolving and dangerous situation — often, within 15 minutes it is too late to save a woman’s life.
So, WHO and the University of Birmingham came up with the E-MOTIVE model, a bonded approach to the treatment of PPH. As soon as a woman delivers her baby, a calibrated bag or “drape” is attached underneath her to accurately measure her blood loss. The moment it hits 500 milliliters, you administer all of the recommended treatments at the same time. Our study involving more than 200,000 women showed that this approach reduced severe bleeding — when a woman loses more than a liter of blood after birth — by 60%, dramatically cutting the likelihood of her dying. When I was working in Nigeria, I saw women bleed to death after giving birth because they did not get the right treatment quickly enough. That image sticks with you. Women in low- and middle-income countries are dying from the same conditions that women in high-income countries usually survive. By simply measuring blood loss accurately and then giving women all the treatments you have as soon as the situation becomes urgent, you give those women close to the same outcome as they would get in a richer country.”
Better Data for Healthier Mothers
Senthilkumar Murugesan, CEO Co-Founder of Savemom (JioVio) Limited:“Wearable technology is still evolving, but it already allows women to get fast, accurate information about their pregnancies, helping doctors track their health and quickly respond to any complications. The devices can collect physiological information such as heart rate, blood pressure, glucose, temperature and sleep cycles. That data is tracked in real time and stored in the cloud, not on paper records that are updated only during the few times a pregnant woman visits her doctor. Whenever a woman does go in for a checkup, the data is already summarized and analyzed by artificial intelligence, ready for her doctor to look at. For example, the AI can look at her blood pressure over the past month and if it has increased at any point, it can check if there is a correlation with anything else. For example, maybe her blood pressure is elevated because she hasn’t slept properly for the past four days. The technology can also help prevent pregnant women from missing their antenatal checkups. When women skip these checkups, it is easier to miss potentially dangerous health issues, which can contribute to higher maternal death rates, especially in rural areas.
In India, a woman might have to be at the clinic or hospital for five or six hours to see her doctor, and that could be after traveling one or two hours to get there. In villages, it is mostly the women who cook and care for the family. If they leave home for a checkup, that is a whole day when the family isn’t being fed. So, many choose not to. Those long wait times inspired me to create the Savemom system of maternal healthcare solutions. It’s now used in five Indian states, where battery-run wearable devices, designed to look like beaded bracelets, are handed out for free to women in areas where maternal death rates are highest. With all of their health data digitally stored in a wearable device and easily accessed by their doctor, women can be in and out of their antenatal checkups in an hour. That makes it possible for many more women to attend. If a mother still isn’t visiting the hospital or clinic, the system can trigger an automated call to remind her. Or we can send a health worker to do a checkup themselves or connect the mother to her doctor over video call. And if a woman moves from one area to another, the system can alert her doctor to move her records over to her new local health clinic. Our system has supported almost 36,000 successful deliveries to date, which shows the potential for wearable tech to greatly improve women’s lives. Recently, when I was visiting one of the villages where the program is being implemented, I was invited to join the celebrations for a new birth. The villagers were passing the baby around between them. When it came to me, the baby’s grandmother told me this was the first time in the village that a baby had been born a healthy weight.
I spend all day at my computer, figuring out how to make mothers and babies safer through tech — this was the first time I saw the proof smiling up at me.”
Interviews by Jumana Farouky.
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