According to the World Health Organization, almost all (99%) of maternal deaths occur in developing countries, and 68% occur in sub-Saharan Africa alone. An estimated 5.2 million children under 5 years died globally mostly from preventable and treatable causes in 2019. Sub-Saharan Africa remains the region with the highest under-5 mortality rate in the world, with one in 13 children dying before turning the age of 5.
Zeroing in on sub-Saharan Africa, even on account of increasing improvements in maternal and child health over the past two decades, mortality is still phenomenally common. About 800 women die in Africa every day, mostly from preventable causes related to pregnancy complications and childbirth. Despite a 39% decline in maternal mortality between 2000-2017, this rate is still one of the largest in the world. While almost all maternal and child deaths are preventable, why is maternal and child mortality still an unpredictable persisting challenge in this region?
There are many existing yet removable barriers to healthcare and sometimes more than one barrier affects access to quality care for women and children at the same time. The United Nation’s (U.N.) third Sustainable Development Goal aims to ensure healthy lives and promote well-being for all at all ages. The first two targets of this goal aim specifically to improve maternal and child health, but to achieve this, existing gaps need to be closed.
Indicator 3.1.1: Maternal mortality ratio. The maternal mortality ratio refers to the number of women who die from pregnancy-related causes while pregnant or within 42 days of pregnancy termination per 100,000 live births.
Indicator 3.1.2: Percentage of births attended by personnel trained to give the necessary supervision, care, and advice to women during pregnancy, labor, and the postpartum period; to conduct deliveries on their own; and to care for newborns.
Indicator 3.2.1: Under-5 mortality rate. The under-5 mortality rate measures the number of children per 1,000 live births who die before their 5th birthday.
Indicator 3.2.2:Neonatal mortality rate. The neonatal mortality rate is defined as the share of newborns per 1,000 live births in a given year who die before reaching 28 days of age.
Source: World Health Organization
Some of the barriers preventing successful achievements of these targets include:
Due to aforementioned barriers, multiple tech solutions targeted at tackling the causes of sub-Saharan Africa’s maternal and child mortality have surfaced in recent years, each intending to help as many women and children as possible. Some become successful while others collapsed before they could meet their purpose.
When developing solutions, innovators should put in mind factors that will help make them a success. In this context, let us look at innovation the same way Abraham Lincoln looks at democracy: of the people, for the people and by the people.
Local partnerships are crucial in enabling a comprehensive approach for access to care. By building and strengthening partnerships between different expertise levels, we create room for an extensive solution covering multiple corners of barriers to health. For example, a health information innovator can partner up with a digital referral platform and a telemedicine expert. This partnership can offer mothers solutions, information, and connect them to a referral system and a healthcare provider at the same time. Local partnerships are key to strengthening health systems because they are made up of the local people who understand the needs of the local population.
Additionally, innovators—both local and foreign—are dealing with the fact that they need the support of the government. Digital health innovators should not just focus on the central government, but also approach states, local governments and district leaders that often have autonomous healthcare frameworks to integrate innovative solutions into their maternal and child care processes.
Solutions must be developed with the target group in mind. Perceptions, attitudes and behaviors often affect how people seek healthcare. It is imperative for innovators to design and develop culturally sensitive solutions as deviation from this can cause rigidity in adapting the solution within the targeted populace. Furthermore, gender sensitive solutions are also more acceptable. Women are a vulnerable group in most societies, therefore, creating solutions that take into account their physical, mental and social well-being should be the cornerstone to any innovation targeting them.
One of the key strategies for meeting the U.N.’s third Sustainable Development Goal will be to reduce adolescent pregnancy as maternal health conditions are also the leading cause of death among girls aged 15-19. However there is a lot of stigma around teenage pregnancy prevention interventions. In some countries in sub-Saharan Africa, it is a taboo to discuss sexual and reproductive health to adolescents. Such cultural differences influence the health seeking behaviors of these young girls and women. Irrefutably, innovators should develop solutions that are adolescent-friendly, addressing stigma and health as a human right, while providing better data and information for all women—including systems to access pregnancy prevention tools and achieve universal coverage of skilled birth attendants.
One of my favorite innovation approaches is Tim Brown’s human-centered approach to solving problems. Before developing tech solutions for maternal and child health, one needs to understand the environment and needs of the target group. This involves engaging experts to find out more about the area of concern through observing, engaging and empathizing with the women to understand their experiences and needs, along with dipping into their physical environment to gain a deeper personal understanding of the issues involved.
As maternal and child health innovators develop their solutions and set out their rollout plans, they must include them in defining the problem (need assessment) and designing the solution. This helps to prioritize their needs and learn where solutions can be synchronized. However, inclusion of the target group does not end here, it is crucial that they test the solution at every stage of development keeping the women in the front and center of the solution.
Conclusively, the lack of quality maternal and child care has a devastating health, social and economic impact in developing countries. In sub-Saharan Africa, inadequate numbers of doctors and the relative lack of quality-standard healthcare have contributed to extremely high maternal and child mortality rates. Such a persistent and important problem naturally draws the attention of innovators who want to bring new effective solutions of reaching pregnant women in Africa to provide them with the information and access required to have a healthy pregnancy and delivery course. Most maternal and child deaths in developing countries are preventable through access to quality primary healthcare, adequate nutrition and birth by a skilled birth attendant. In today’s world, tech solutions play a big role in filling such gaps, but it is crucial to keep a human-centered approach—inclusive and fitting to the local context.
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Maternal health is a critical issue faced by millions of women every day. And this is not just a women's issue, it's a human issue. In this episode of the Accelerate Health podcast, Ellen Seely, MD, director of clinical research for Brigham and Women's Hospital, talks about her research as the lead for Heart Health 4 Moms, a study of women who have experienced pregnancies complicated by preeclampsia and questions to ask that could determine risk level associated with other pregnancy complications.