“Triggers and chain of events leading to maternal deaths vary greatly according to contexts in humanitarian settings. We really need to dig up the issues. A systematic review of individual events is essential to take appropriate, life-saving corrective measures. You just need a few reports to understand what is happening, and you can do a lot to change the situation” – Nadine Cornier.
Every maternal death has a story to tell and should be counted, so that appropriate responses can be developed to prevent similar deaths. But how do we do so effectively and in a timely manner in settings where health systems are disrupted and populations are displaced?
In the seminar “Applying maternal death surveillance and response systems in crisis settings”, three speakers shared their perspectives and experiences on the use of maternal death surveillance and response (MDSR) data in refugee or conflict-affected settings:
- Rajat Khosla, Human Rights Adviser for the World Health Organisation;
- Nadine Cornier, Humanitarian Adviser with UNFPA, Turkey;
- and Eleanor Brown, Technical Specialist at Options, London.
This was the second seminar in the Innovations in Maternal and Perinatal Health in Humanitarian Settings series.
Rajat Khosla set the scene: globally, the population of forcibly displaced people equals the size of France. According to UNFPA, 26 million women in humanitarian settings need sexual and reproductive health (SRH) services. These are difficult to prioritise because humanitarian responses tend to focus on basic needs first. [I pause and reflect. What does it say about gender equality, that food and water be more basic than surviving the birth of a baby?].
Rajat explained that, when provided, SRH services are generally based on expert opinion, because in these circumstances, we often lack the epidemiological data or the understanding of women’s SRH needs to make more informed decisions. MDSR is a relatively novel approach, and can potentially provide accurate information on the number and causes of death. But is it feasible? Can it work in humanitarian settings?
Nadine Cornier’s presentation was inspirational in providing examples of how maternal death reviews findings have shaped SRH services in crisis settings.
Drawing from a study on refugee maternal mortality in 10 countries, she challenged the notion that because global causes of maternal deaths are known, the same would apply in humanitarian settings. Care-seeking decisions and quality of care may be affected in many different ways, and factors contributing to maternal deaths will vary.
For example, Nadine described how in Syria MDR findings suggested that the high rate of caesarean (C)sections, followed by rapid discharges from hospitals due to fear of a prolonged stay where health facilities are felt to be unsafe, was a key factor contributing to maternal deaths. Based on these findings, UNFPA is focusing on up-skilling a cadre of midwives, which is crucial to minimise the risk of unnecessary c-sections, for mothers with no other complications. In Kenya, a simple intervention, such as providing screens to ensure mothers’ privacy, originated from a better understanding of women’s perceptions of services in refugee populations, and made a huge difference in service uptake and mortality.
Eleanor Brown also stressed the thirst for evidence on factors affecting decision making and maternal deaths at community level. She presented an innovative method to complement MDSR data, the Participatory Ethnographic Evaluation and Research (PEER) approach, designed to generate rich ethnographic insights that can inform social change programmes.
Describing a PEER study in South Sudan, led by Dr. Elmushafar from the University of Limerick, she discussed how the PEER findings had informed the design of user-focused services, by shedding light on their perceptions of care, barriers to access, and care-seeking processes. Crucially, PEER did do so rapidly, and is therefore a valuable tool in crisis settings.
Watch the recording of the seminar here.
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