It was an honour to have hosted a seminar co-organised by the Global MDSR Action Network and the London School of Hygiene and Tropical Medicine’s Centre for Maternal, Adolescent, Reproductive, and Child Health and Health in Humanitarian Crises Centre where three speakers shared their experiences working in maternal health during the Ebola outbreak in Sierra Leone: Dr Chris Lewis, a general practitioner by training and Health Advisor with Department for International Development during the outbreak; Laura Sochas, a Global Health Researcher with the London School of Economics formerly with Options; and Dr Benjamin Black, an obstetrician and gynaecologist with vast experience in crises settings, who was working with Médecins Sans Frontières in Sierra Leone at the time of the crisis.
Sierra Leone is estimated to be one of the riskiest places in the world to be pregnant and deliver a baby, where a woman has a 1 in 17 lifetime risk of dying from a pregnancy-related cause. My experience in Sierra Leone working on mother and newborn health programmes since 2012 highlighted some of the challenges in being able to count the real number of maternal and newborn deaths. Through research, I heard health workers explain how the deaths of women occurring outside of health facilities may be undocumented and how the lack of even minimal budgets to hold meetings hampered their ability to conduct reviews of maternal deaths. Interviews with communities revealed how during the Ebola outbreak, women in labour were turned away from or did not attend facilities because they were worried about contracting Ebola.
A key theme in the seminar was data and how the lack of available, open and quality data has implications in responding to the causes of maternal and newborn death. This becomes exacerbated in a crisis. In September 2014, Options started to look at the use of health services – such as antenatal care, facility delivery and postnatal care – and found evidence of a decline in usage. Building on this work, Laura Sochas discussed how she was then able to project the number of maternal deaths. In one year of the epidemic, Laura estimated the number of indirect maternal deaths during the Ebola outbreak was around 4,000 due to reduced uptake of services. This is roughly the same number as those who died directly from maternal deaths before Ebola.
It’s important to pause on this statistic and what it means for women and their families in Sierra Leone. And just as important was the reality – as Dr Benjamin Black explained – that pregnant women during the Ebola outbreak were often dying from the same things women die from in any context.
However, there are opportunities. As Dr Chris Lewis explained we need to be proactive in the disclosure of information, especially as the secondary consequences of a crisis are so important. Data can help build resilience, help us to understand a problem, and justify and plan a response. It’s also important that we look closely at communities’ understanding and their barriers to action. Dr Benjamin Black emphasised in his talk the impact of the lack of trust between the community and health workers before, during and after the crisis and why the causes of this lack of trust need to be addressed to have an adequate response to maternal deaths.
Involving the community is a key aspect of maternal and perinatal death surveillance and response. The ability of communities to contribute to improving maternal and newborn health is immense – we must strive to build maternal and perinatal surveillance and response systems where communities are truly involved. Shocks and crises will happen but what makes a system resilient is being prepared with tools, data, knowledge and information to roll-out an integrated response.
To find out more, click on the links below to read about:
- A presentation by Dr Chris Lewis about the UK Government’s response to Ebola in Sierra Leone and what opportunities there are to strengthen resilience of the health system, available to download here.
- A method to estimate maternal and newborn mortality during a crisis, as presented by Laura Sochas. Click here to download.
- A presentation by Dr Benjamin Black on how MSF’s maternal health programme adapted to respond to Ebola and his reflections on MDSRs, available to download here.
Acknowledgements: This blog was written by Sara Nam, Seminar Moderator, Technical Specialist at Options and Manager of the MDSR Action Network.