You have a really sound proposal for identifying a broad range of barriers to maternal health and leading causes of maternal death in a very underserved area. I am curious to know about initial ideas you have for indicators to measure how the information from the research impacts maternal health outcomes in the area. I am also curious to know about how you envision this model being replicated in other areas in terms of how you intend on conducting outreach to what types of organizations to replicate it elsewhere. I really like how much detail and thought you've put into your plan.
Hey Jessica, thanks so much for your comment. I think you really put your finger on it -- it is a real challenge to develop sound indicators for programs which address attitude and behavior change, such as my maternal health ethnography idea. In general I think the indicators I develop will have to be cross-cutting, mixing quantitative and qualitative, and there will need to an ongoing meta-monitoring -- that is, a reassessment as to whether the initial indicators still fit/work as the project develops. I also think a strong baseline is a really important place to start.
But here are a couple of initial thoughts I've had about qualitative indicators/measures throughout the project: 1.) by following a woman who was a near-miss through her subsequent births, we can measure whether there has been any change in approach or behavior to ensuring safe delivery, and ask her why/how; 2) we can do the same with family members, friends, and other close individuals to the woman; 3.) after undertaking each ethnography, it would be important to note the several important factors in a maternal death in the conclusion, develop recommendations for how these factors might have been addressed or assuaged, and ensure that the recommendations are disseminated to the right individuals in these sectors (whether it's road infrastructure, agriculture, medical care, etc.) -- then we can measure whether there has been an increase in awareness of how these factors impact maternal health, or whether there have been any changes in guidelines with regards to that.
As for replicating this model -- I think there are a number of ways this can happen, and to varying degrees. One way is to integrate a more anthropological approach to understanding maternal health when training health workers -- that is, include information about the impact of other factors on maternal health and death, besides simply reproductive health. I think another great way to replicate would be to link ethnographers and anthropologists working in the field in that area with maternal and reproductive health professionals in the area. I think we are already seeing a seachange in how maternal and reproductive health is being understood as integrally connected to myriad other factors and outcomes. I think that with enough publication and awareness about the importance of maternal health ethnography/the use of WHO's "Behind the Numbers," we'll see a tipping point where even just aspects of this model can be integrated seamlessly into current program models. For instance, the increased use of maternal death inquest, verbal autopsy, etc. -- that the current information we have been gathering simply isn't enough, and doesn't address the complexity of this issue. I suppose I'm suggesting that end-user demand can help facilitate replication of this model.
Hope that answers some of your questions, but certainly let me know if you have other thoughts!
Dear Jessica, I would love to know more about your research. Have you already completed it ? My organisation has maternal health projects in Ladakh and the information on background causes of mortality would be very useful.
Many thanks
Miren
Comentários
Hi Jessica,
You have a really sound proposal for identifying a broad range of barriers to maternal health and leading causes of maternal death in a very underserved area. I am curious to know about initial ideas you have for indicators to measure how the information from the research impacts maternal health outcomes in the area. I am also curious to know about how you envision this model being replicated in other areas in terms of how you intend on conducting outreach to what types of organizations to replicate it elsewhere. I really like how much detail and thought you've put into your plan.
Hey Jessica, thanks so much for your comment. I think you really put your finger on it -- it is a real challenge to develop sound indicators for programs which address attitude and behavior change, such as my maternal health ethnography idea. In general I think the indicators I develop will have to be cross-cutting, mixing quantitative and qualitative, and there will need to an ongoing meta-monitoring -- that is, a reassessment as to whether the initial indicators still fit/work as the project develops. I also think a strong baseline is a really important place to start.
But here are a couple of initial thoughts I've had about qualitative indicators/measures throughout the project: 1.) by following a woman who was a near-miss through her subsequent births, we can measure whether there has been any change in approach or behavior to ensuring safe delivery, and ask her why/how; 2) we can do the same with family members, friends, and other close individuals to the woman; 3.) after undertaking each ethnography, it would be important to note the several important factors in a maternal death in the conclusion, develop recommendations for how these factors might have been addressed or assuaged, and ensure that the recommendations are disseminated to the right individuals in these sectors (whether it's road infrastructure, agriculture, medical care, etc.) -- then we can measure whether there has been an increase in awareness of how these factors impact maternal health, or whether there have been any changes in guidelines with regards to that.
As for replicating this model -- I think there are a number of ways this can happen, and to varying degrees. One way is to integrate a more anthropological approach to understanding maternal health when training health workers -- that is, include information about the impact of other factors on maternal health and death, besides simply reproductive health. I think another great way to replicate would be to link ethnographers and anthropologists working in the field in that area with maternal and reproductive health professionals in the area. I think we are already seeing a seachange in how maternal and reproductive health is being understood as integrally connected to myriad other factors and outcomes. I think that with enough publication and awareness about the importance of maternal health ethnography/the use of WHO's "Behind the Numbers," we'll see a tipping point where even just aspects of this model can be integrated seamlessly into current program models. For instance, the increased use of maternal death inquest, verbal autopsy, etc. -- that the current information we have been gathering simply isn't enough, and doesn't address the complexity of this issue. I suppose I'm suggesting that end-user demand can help facilitate replication of this model.
Hope that answers some of your questions, but certainly let me know if you have other thoughts!
Best,
Jessica
Dear Jessica, I would love to know more about your research. Have you already completed it ? My organisation has maternal health projects in Ladakh and the information on background causes of mortality would be very useful.
Many thanks
Miren
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