Infant health

INTRODUCTION
In this world, every minute one woman dies of pregnancy or birth related complications. WHO defines maternal death as: death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy from cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. Perinatal death means death of a fetus from 28 weeks of gestation to seven complete days of life including stillbirths. The perinatal mortality; is a sensitive indicator of health status of women, the health of the newborn and quality of health care provided during perinatal period especially delivery and immediate postnatal period. According to TDHS 2004/5,there is high antenatal care coverage- 94% at least one visit; 62% makes four or more visits yet the maternal mortality ratio is still high- 578/100,000 live births and under 5 mortality rate = 112/1000 live births.
Tanzania is amongst countries with very high number of maternal deaths in the world, the high maternal and newborn mortality constitute a silent emergency in Africa, (WHO, 2004) .Two decades after safe motherhood initiative (SMI); the maternal and perinatal mortality levels have sadly continued to rise instead of declining. Health indicators are not improving which may be attributed by poor quality of health services provided (reproductive and child health survey, 1999; TDHS, 2004/5).Poverty, social exclusion, low levels of education and women violence/abuse are amongst the contributing factors.
ANGELS OF CHANGE
Angels of Change is an entry point to prevent maternal deaths using the Positive Deviant/Hearth Approach. Angels of Change is an Idea of intensive behavior change Intervention targeting Mothers of Childbearing age and Pregnant mothers who at risk of maternal complications. It is derived from the fact that despite of all of the above factors contributing to the high Maternal mortality in Tanzania, one thing is evident, that there are a number of women who has never experienced Pre, intra and post delivery complications within our communities under the same resources, these mothers has been able to explore the environment and make use of the available resources while others are not able to do that, these are the one I call the Positive Deviants or The Angels of Change. Through identifying these Positive Deviant Mothers and Using the Community Based Hearth Session Approach, women of Childbearing age and Pregnant women can be brought together to share the Positive Deviant behaviors practiced by Positive Deviant Mothers. Different issues involving locally-discovered positive deviant practices as well as promote other practices essential to healthy living. Hearth sessions incorporate a number of approaches for behavior change including identification of Angels of change in a community, peer to peer support, Mother Dialogues, counseling, negotiation, Adult learning principles, skills building, motivation through visible practices and Women mobilization. Family planning, prevention of unwanted and high risk pregnancies, ensure skilled care during childbirth; ensure access to quality emergency care when a complication arises are among the topics during Hearth sessions.
It involves learning what these Role Models (Angels of Change) has been doing to promote their socially and communally acceptable behaviors and practices promoting good maternal health, HIV/AIDS Prevention and Health care utilization and promoting these practices to be adopted by other mothers. The Hearth part of Angels of Change idea using a PD approach is an intensive behavior change Intervention targeting mothers at risk of maternal Complications.
Sites of implementation including selection of places where majority of Youths are found/lives/work in relatively close proximity, where there are a significant number of risk behaviors.
Angels of Change will be identified though Initial dialogue with respective mother’s groups in a particular community/Institution through peer voting systems especially during antenatal visits. The respective group, guided by Community health workers will anonymously select an Angels of Change with positive deviant behaviors and practices communally acceptable which promotes good maternal health using a special tool. Our Health Volunteer(s) together with the selected Angels of Change will facilitate a mothers Conversation process to discover behaviors and Practices depicted by a selected Role Model and the Group will set up Action Plan. The selected Role Model will trained on facilitation skills and be responsible to conduct Hearth Sessions with Material support provided. She will also be Our contact person in a Particular group observing how peers are adopting her/his practice and behaviors and recommending the way forward. The project will facilitate group meeting at least twice a month and Group learning visits to other successful group with the same socio-economical circumstances. Each group will have a chairperson, Secretary, one Angel of Change and one guardian, teachers/ a community member identified by the group will serve as Guardians. Our Health volunteers will be conducting regular supportive visits to respective group(s) and Provide Monthly report.
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This project aims to improve the health of women and infants through increased awareness and uptake of the hormonal IUD. Hormonal IUDs, which are recommended by the WHO, would have benefits for women such as reduced anemia, increased educational and employment opportunities, better sanitation, and greater control over timing and spacing of births. Reducing anemia in reproductive-age women will also lead to better birth outcomes, including reduced risk of preterm birth and better immune function and developments in neonates. Because IUDs must be inserted in clinics, this also provides an entry point for counseling and testing for other health issues, including other family planning methods and STIs. To advance these goals, this project will build capacity of health clinics and community networks to promote and market the hormonal IUD.

Benefits of IUDs

There are several reasons why this method of contraception would be beneficial for young Indian women. According to the 2006 National Family Health Survey (NFHS) report, the vast majority of Indians do not use modern methods of birth control until the desired number of children is achieved. The most common method is female sterilization. Delaying first births and spacing subsequent births is important to the health of both mother and child, especially with the young age of marriage. Delay of initial childbearing after marriage would increase educational and employment opportunities for women. This time also allows for further maturation of girls who are married in their teens, which decreases risk to both mother and baby during pregnancy and birth.

Out of the 3 spacing methods currently promoted by the Indian government (oral contraceptives, condoms, and IUDs), the hormonal IUD is the most effective, longest lasting, and easiest to use, since it only requires 3 medical visits during 5 years of use. As a long-term method, the IUD is also highly cost-effective for both patients and the medical system. These characteristics make IUDs the most commonly used reversible contraception method worldwide.

Hormonal IUDs have other non-contraceptive benefits. In 90% of women, hormonal IUDs reduce the amount of blood lost in menstruation; for about 20% menstruation ceases altogether. Menstruation is a major cause of anemia in women of reproductive age. Women that are anemic before pregnancy are usually anemic during pregnancy, which can lead to postpartum hemorrhage and other complications. Additional benefits included possible reduced risk of endometrial hyperplasia, endometrial cancer, and pelvic inflammatory disease, which can all cause infertility.

Current Status of IUDs in India

According to the 2006 NFHS, 68.8% of Indian women have knowledge of IUDs, compared to 85% for oral contraceptives and 96.6% for female sterilization; furthermore, only 51% of men have knowledge of IUDs. Only 0.4% of married 15-19 year olds have ever used an IUD, compared to 1.1% who have been sterilized. IUD use is 3.6% among married 20-24 year olds. The IUD is the least known and least used method of the 3 spacing methods available, and it is also the only of these methods that is not socially marketed.

My project

While pills and condoms are socially marketed for birth spacing and limiting, their usage rates are also low -- 11.1% and 13.9%, respectively. To improve community attitudes about IUDs, I propose to market them not solely on their benefits as contraception, but as a method of improving preconception or intraconception health. First, project staff will identify women who have had IUDs to learn from their experiences. Project staff will then hold focus groups with young women to determine the acceptability of amenorrhea, which previous studies in India suggest is culturally acceptable. We will also have focus groups of men and older women, possibly members of the local panchayats, who are influential in family planning decisions, to determine the effectiveness of the message that hormonal IUDs should be used to improve birth outcomes for both mother and child in the future.

The project will use information from the focus groups to develop a social marketing plan to promote awareness and uptake of IUDs. The plan will include recommendations on how best to transmit messages, including through informal networks and peer to peer education. Engaging peers in education is a highly effective and sustainable practice for health programs. To ensure this method is successful, project staff will provide a train-the-trainer session for the peer education coordinator in our project area.

Project staff will also meet with health professionals responsible for inserting IUDs to ensure they are providing adequate family planning counseling, including both the positive and negative side effects of hormonal IUDs, since these are the most common reason for IUD discontinuation. Also, testing facilities for STIs will be evaluated and a risk assessment algorithm, based on the USAID model, will be recommended if facilities are inadequate. Since many young women are illiterate, we will assess the availability of visual aids used in education and counseling on IUDs and create materials if needed.

Healthy Mothers, Strong World: the next generation of ideas for maternal health.
This is an entry for becoming a Young Champion of Maternal Health

Birth is a universal language. It is something all of us can share. This is the strength in it. We must learn to use this to its full potential.
Using this idea, I have often thought that song, is a way to share this.

My idea: To use songs of motherhood to start forums of communication. Firstly, going into a local community to welcome women and men () to come and form a group. Using song as a way to unite. The songs should be focussed on birth, the experience of motherhood to bring the group to a goal. This is a way of allowing song to empower women and birth, to bring it to the forefront. The group can choose a song, and if they do not know one the leader can encourage or help them to learn one. This will beocme the united voice. The idea is to use it as a kind of metaphor which helps women to find their voice.

Then, in these groups, a time to share stories, bad outcomes/ experiences and good experiences of the childbirth continuum , so the group can hear and learn.
Then as these forums gain momentum and trust. The leader can introduce a simple Birth First Aid Kit. Providing ideas and tools using pictures, diagrams, mneumonics (similar to HELPERS for shoulder dystocia) and skill drills. This should take a practical theme, getting women doing role plays and using examples from stories to emphasise how if this was to happen again the family, communtiy could act, and imporove the outcome. (EG learn from their experiences of post partum heamorrhage, preterm labour etc).
These groups should also definatly include local healers/ birth attendants who will have a huge array of expertise to share too. They may also have a lot of clout so getting them on side is very important. As the group develops form important to name a leader (local person) who can continue to initiate these groups in the future(sustainability). The groups should continue to learn lessons from experiences of birth in the community- each time reviewing what happened, why it happened and how outcome can be improved next time. Ideas on how to do this should be collated and pooled back to central source- who can analyse and initiate training/tools as to specific locality.

Then, this person (leader) and yourself (facilitator) as part of the first aid Birth kit need to connect with local land owners/ transport owners/ mayor/ politicians and make a Local Protocol of Action. So, from the family to the village transport there is a clear action pathway- which depicts how the woman who is in need of emergency care could get to a hospital.
It is important that this is again run through, so a skill drill type exercise should be done regulalry, so each person knows what they need to do in the event of an emergency.
This will not be easy especially in very rural areas where there may be no transport. BUT, bringing awareness to the need for a 'commmunity action plan' and lobbying local politicians may help to raise the plight of the need to have a clear protocol of action, and referral pathway. It also gives people a sense of action, responsibility- which is clear and practised, and therefore more likely to happen.
This idea then goes further. I believe it could be taken anywhere, to neighbouring villages, but also other countries and into the West. Using the song theme, creating songs of birth, recording them (later playing them to other groups- so they know this is a universal song, a universal movement to bring awareness to womens birth journeys).Anyway, in other places, the same would apply- but of course making it relevant to local area.
In the future, i would hope to bring the leaders (and maybe small group of women) to come and meet other womens groups, so their stories and lessons and ideas could be shared.
Creating the universal language. Using their songs, stories and lessons, a global network of story telling could be created. All aimed to develop skills, awareness and local problem solving on how to reduce poor outcome to mothers and babies in childbirth.
I believe it is important to start at grass root, making it relevant to local areas. But, also utilising the strength of the universal applicability of birth. To inspire change by empowering women to find their voice.

The central source (facilitator) could pool examples from groups, ideas, songs and tools (utilising the groups ideas but also collating other NGO tool kits eg WHO) into one area. This would become a database to continue to develop expertise and support to groups in the future.

São encontros periódicos e gratuitos às gestantes da comunidade, para difundir idéias, discutir temas e divulgar informações de boa fonte, sobre gravidez, parto e pós-parto. Baseamo-nos no livre acesso à informação e nosso foco são: gestação consciente, parto natural e amamentação exclusiva.