By Divya Ramamurthy, Research Analyst – ICTPH
There is a growing need for attention towards the health of newborn infants and their mothers. Neonatal mortality now accounts for about two-thirds of global infant mortality and about 3.8 million of the 8.8 million annual deaths of children under 5. It is not surprising that 98% of these deaths occur in low and middle income countries, of which India is a major concern where neonatal mortality is 56 per 1,000 in the poorest quintile of the population. Considering the fact that maternal health is a major factor that is inextricably linked to the health of the newborn, it is important to consider interventions that target maternal health with positive outcomes for both mother and child.
Maternity is a life event that contains within it several stages, spanning from adolescence to reproductive years, to pregnancy, antenatal and postnatal care. In Thanjavur, although antenatal and postnatal care are provided by the PHC to some extent, there is inadequate focus on nutrition and provision of education to women of reproductive age, before the period of pregnancy. This period is a crucial one where preventable measures can be taken to improve both maternal as well as neonatal outcomes with long-term impact. There is no doubt that community mobilisation will be a key factor in designing any intervention that targets a healthy baby, healthy mother – and it is imperative that this be thought of as a comprehensive one that takes into consideration an integration of factors such as maternal, newborn, adolescent health care as well as a consideration of the health system and local conditions. There is no doubt that community interventions work; however the key is to recognise that effective interventions are an ideal balance of community mobilisation as well as involvement of community health workers.
Literature reveals that truly effective MNCH interventions require a combination of factors which are integral to the success of the intervention out on the field. The first is an agreed minimum set of interventions that integrate both maternal and child health, and are delivered through an effective channel. This is important because maternal health at the primary level offers many areas of potential interventions but it is important for research to be carried out so as to identify the existing set of problems, and where there is a real lack of care. In our case, we identified this to be in the early stages of pregnancy as well as pre-pregnancy, which are both crucial periods of fetal development.
A second factor that we see as imperative for an effective MNCH intervention is attention to demand-creation among the community and building strategies to promote care seeking and behaviour change. In order to establish long-term effects of the intervention, it is important to mobilise the community and encourage them to actively take initiative in seeking health care. The intervention itself will not be a success if people are not motivated enough to seek it out, and for this reason, the usage of behaviour change communication messages to dispense information to educate populations is a key part of any MNCH intervention to be effective in the long term.
Trained human resources are the third and most important factor, which is of particular relevance to rural communities in India. The community health workers that we utilise in our interventions are an integral part – the Iron supplements interventions that we are designing is one such area where even though iron is freely available at the PHC, the compliance to this is very poor. Such an intervention will have to make use of health workers who educate mothers on the importance of iron not just for them but for the health of their child. It is important to note that compliance issues often arise from a lack of understanding of the situation, and health workers will fill this gap in knowledge that currently exists.
Preventive interventions are the new frontier in maternal and child health care, as these are shown to be truly effective in the long term. Integrated interventions that take into consideration the health linkages between maternal and newborn health, are the interventions that are most likely to succeed. Additionally, addressing key health concerns at the crucial period of time is an important part of preventive interventions. For example, providing women with iron folic acid before pregnancy is an intervention that is shown to reduce neural tube defects by two thirds as well as potentially prevent low birth weight babies, which is a significant problem in our populations. The challenge in such an intervention will be in reaching out to the target populations, but we are confident that with the aid of our health workers, this will soon be made a reality on the field.