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*Y.C.* Maternal Health Ethnography: Understanding and Preventing Maternal Death in the Himalayas
Localização
My idea is to tell a story that hasn’t been told before, or, rather, to tell it in a way that hasn’t been heard. I will undertake a maternal health ethnography in Ladakh, India – perhaps one of the more remote and extreme regions of the world – in order to ascertain new maternal health data for this sorely neglected region, and to pilot a new way of applying ethnography to understanding the multitudinous and interlocking causes of maternal death. I will carefully document my findings, placing great emphasis on monitoring and evaluation – both quantitatively and qualitatively – of how effective this model is in providing new information about maternal mortality, and how new discoveries can be leveraged to better implement and strategize programming on maternal health.
By truly examining the complex context in which women live, become pregnant, give birth, or die, I anticipate important findings that will show this is not the simple pattern of events. Rather, women are exponentially more than just their reproductive cycles, and the multitude of other factors, whether environmental, agricultural, or religious, in which they engage effect their reproductive health and ultimately, their maternal death. This goal of this idea is three-fold: first. to collect new qualitative and quantitative research on maternal health in a region of the world where such data is scare yet maternal mortality is high; second, to collect important information on the lives and positions of women in Ladakhi society and how factors besides reproductive health ultimately impact reproductive health; third, to pilot a model of maternal ethnography which will provide a strong case study for replication or scaling-up in other regions.
I propose to design a qualitative and quantitative study, which draws on WHO’s “Behind the Numbers” guide as well as an extensive background in Buddhism and reproductive health. I would like to implement this study to investigate numerous recent and past maternal deaths and near misses across the region, with the involvement and assistance of local midwives, providers, doctors, and NGOs.
By undertaking a maternal health ethnography, especially in such a remote region in Ladakh, may be time consuming, I believe that far fewer ethnographies than total deaths need to be carried out in order to find salient patterns and points of use. I will work with the District Hospital of Leh, and the resident Ob/Gyn there, Dr. Padma, to collect quantitative data on maternal deaths and practices.
Although Ladakh is quite sparsely populated for an Indian region, it is far more neglected in terms of infrastructure and funding than many of the other more populous states. India has emerged as a global force in the 21st century, yet continues to be plagued by a high rate of maternal death. The region of Ladakh is an important piece to solving the puzzle in a country where income inequity and socio-cultural discrimination remain serious barriers to care for women. Ladakh is home to just the type of vulnerable population that maternal health interventions should seek to reach: rural-dwelling, remote, low-income, and marginalized (because of their Tibetan ethnicity and Buddhist religion, Ladakhis stand as an anomaly in broader Indian culture). Piloting the project in such a community would be a helpful model for reaching other under-served communities, and especially those living in culturally traditional or religious settings.
I strongly believe that telling the story of women’s deaths and injuries due to pregnancy or childbirth can have an exponentially positive impact on the burden of maternal death. There is an important element of empowerment in telling a woman’s story – especially a woman who is not living to tell her own – in that she is no longer simply a number, but a face and a life. Seeking a deeper understanding of how maternal deaths and injuries happen, and just what factors commingled against a particular woman is also an important exercise in almost demystifying or deconstructing maternal death: it is no longer simply a death sentence that we bemoan meaninglessly, but in really working to understand it we may see more clearly the mundane, singular elements that contribute to it (a car that won’t start, a traditional belief in solitary birthing) and more effectively address them. By implementing a maternal health ethnography in Ladakh, I will help illuminate the problem so that activists and providers may work more efficiently and effectively to address it; I will tell the story of women’s lives and deaths in an effort to highlight the important role women play in societies as a whole; and I will collect new, first-time data on maternal health in the region.
Sobre Você
Seção 1: Sobre Você
Nome
Jessica
Sobrenome
Mack
Website
Organization
Country
Estados Unidos , NY
Are you an individual between the ages of 18 and 35 who would like to apply for a nine month Young Champions Program mentored by an Ashoka Fellow?
Sim
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Sua ideia
Dê um nome ao seu projeto
*Y.C.* Maternal Health Ethnography: Understanding and Preventing Maternal Death in the Himalayas
Country your work focuses on
Índia, JK
Describe Your Idea
My idea is to tell a story that hasn’t been told before, or, rather, to tell it in a way that hasn’t been heard. I will undertake a maternal health ethnography in Ladakh, India – perhaps one of the more remote and extreme regions of the world – in order to ascertain new maternal health data for this sorely neglected region, and to pilot a new way of applying ethnography to understanding the multitudinous and interlocking causes of maternal death. I will carefully document my findings, placing great emphasis on monitoring and evaluation – both quantitatively and qualitatively – of how effective this model is in providing new information about maternal mortality, and how new discoveries can be leveraged to better implement and strategize programming on maternal health.
By truly examining the complex context in which women live, become pregnant, give birth, or die, I anticipate important findings that will show this is not the simple pattern of events. Rather, women are exponentially more than just their reproductive cycles, and the multitude of other factors, whether environmental, agricultural, or religious, in which they engage effect their reproductive health and ultimately, their maternal death. This goal of this idea is three-fold: first. to collect new qualitative and quantitative research on maternal health in a region of the world where such data is scare yet maternal mortality is high; second, to collect important information on the lives and positions of women in Ladakhi society and how factors besides reproductive health ultimately impact reproductive health; third, to pilot a model of maternal ethnography which will provide a strong case study for replication or scaling-up in other regions.
I propose to design a qualitative and quantitative study, which draws on WHO’s “Behind the Numbers” guide as well as an extensive background in Buddhism and reproductive health. I would like to implement this study to investigate numerous recent and past maternal deaths and near misses across the region, with the involvement and assistance of local midwives, providers, doctors, and NGOs.
By undertaking a maternal health ethnography, especially in such a remote region in Ladakh, may be time consuming, I believe that far fewer ethnographies than total deaths need to be carried out in order to find salient patterns and points of use. I will work with the District Hospital of Leh, and the resident Ob/Gyn there, Dr. Padma, to collect quantitative data on maternal deaths and practices.
Although Ladakh is quite sparsely populated for an Indian region, it is far more neglected in terms of infrastructure and funding than many of the other more populous states. India has emerged as a global force in the 21st century, yet continues to be plagued by a high rate of maternal death. The region of Ladakh is an important piece to solving the puzzle in a country where income inequity and socio-cultural discrimination remain serious barriers to care for women. Ladakh is home to just the type of vulnerable population that maternal health interventions should seek to reach: rural-dwelling, remote, low-income, and marginalized (because of their Tibetan ethnicity and Buddhist religion, Ladakhis stand as an anomaly in broader Indian culture). Piloting the project in such a community would be a helpful model for reaching other under-served communities, and especially those living in culturally traditional or religious settings.
I strongly believe that telling the story of women’s deaths and injuries due to pregnancy or childbirth can have an exponentially positive impact on the burden of maternal death. There is an important element of empowerment in telling a woman’s story – especially a woman who is not living to tell her own – in that she is no longer simply a number, but a face and a life. Seeking a deeper understanding of how maternal deaths and injuries happen, and just what factors commingled against a particular woman is also an important exercise in almost demystifying or deconstructing maternal death: it is no longer simply a death sentence that we bemoan meaninglessly, but in really working to understand it we may see more clearly the mundane, singular elements that contribute to it (a car that won’t start, a traditional belief in solitary birthing) and more effectively address them. By implementing a maternal health ethnography in Ladakh, I will help illuminate the problem so that activists and providers may work more efficiently and effectively to address it; I will tell the story of women’s lives and deaths in an effort to highlight the important role women play in societies as a whole; and I will collect new, first-time data on maternal health in the region.
Website URL
INOVAÇÃO
What makes your idea unique?
WWhile the idea of a maternal death inquiry is not a new one in itself, it has only recently been highlighted as an effective intervention strategy and yet is still not being implemented as widely as it could or should be. My idea for a maternal health ethnography builds on the models of maternal health inquiry but integrate elements of medical anthropology and is informed by a strong background in Buddhist history and studies in the region, which puts a cultural and anthropological lens upon what might otherwise be a strictly public health approach to the issue of maternal health. My idea is also new in that it places a strong emphasis on documenting and disseminating the findings of my ethnography for several purposes. Maternal health inquiry has also not, to my knowledge, been undertaken in a region as a simultaneous method of collecting new data on maternal health. My idea pays homage to important work done on death inquiry, including by Dr. Gwyneth Lewis, WHO and UNICEF, builds on this model, and applies a more anthropological twist in an under-researched area.
Do you have a patent for this idea?
Impacto
Temas relacionados à inscrição
What impact have you had?
I have had an impact on issues of global maternal health by continuing to raise awareness in as many venues as I can: I talk on end to my friends and family about harmful policies, vertical funding, and pervasive gender inequities; I write weekly for a global feminist blog and often highlight pertinent issues to maternal health around the world; in my professional work as a communications specialist, I have conducted interviews and produced stories, presentations, web videos, reports, blog posts, and academic articles – all with the goal of bringing this issue onto center stage and to engage the general public with policy and funding implications. Almost more important than the impact I’ve had in my 26 years is the impact I plan to have. I feel strongly that I can contribute to an important body of knowledge around understanding maternal health care practices and attitudes from a cultural perspective, which will help inform culturally appropriate, sustainable, and effective programming to address outstanding needs. I am intellectually curious, care passionately for these issues, and am committed to learning as much as I can through work with others and on the ground. I am committed to building a meaningful career in international development that will make an important impact on the lives of women.
Problem
We know the magnitude of global maternal mortality, and we also have the technology and tools to address it – from programs such as midwives with mobile phones to inventions like non-pneumatic anti-shock garments. Yet the rate of maternal death has remained unchanged. The appropriate and effective implementation of these solutions still remains, and in large part due to a lack of funding and political will on a global scale. But more pointedly, it’s due to a lack of clarity on WHY women are dying, and a deep understanding of how other cultural factors – agriculture, transportation, and environment – are interlocking and play contributory roles. In the field of maternal health, we have often seen women as individuals in vacuums, divorced from other aspects of their life beside their reproductive health. In the 21st century, women who die in pregnancy and childbirth still remain numbers, not stories. While the numbers are critical to understanding the scope of the problem, it is the stories of maternal deaths that are key to solving it. Essentially, I believe that the “problem” is that we do not understand nearly enough of the problem to effectively solve it.
Actions
My idea is to investigate and tell the story of maternal death so that we can more effectively address and prevent them. While I have not begun work on it formally, I have laid important groundwork and have already contributed to raising the profile of these issues in several respects, as I have laid out in the “Impact” section. I have also undertaken research on the role of Buddhist culture in reproductive health, through independent field work in India in 2006 and 2007; I continue to pursue independent research opportunities in India as well as mentor relationships with key researchers in the field, including Dr. Kim Gutschow, a Professor of Religion and Anthropology at William College who works on maternal health in the Himalaya region. I have remained informed, engaged, and passionate about these issues for as long as I can remember and continue to scheme up ideas for research projects, program models and stories that will continue to address these on a broader scale.
Results
The positive results of applying a model of maternal health ethnography in Ladakh will be multiple: first, it will uncover a deeper understanding of why and how women die in pregnancy and childbirth, which, if well-documented and disseminated, can inform more effective programming and funding; second, the project will contribute brand new data about maternal health in Ladakh which can be used to leverage increased funding and programs in the region; third, by applying a model which seeks and elevates the importance of women's stories, it sends the strong message that women's stories -- and women themselves -- matter. I see the application of a maternal health ethnography as an important strategy to understanding and improving the status of women in Ladakh; finally, piloting and documenting the use of this model in Ladakh will serve as a springboard for the replication of this model in other regions and countries as well. More broadly, I expect the use and documentation of maternal health ethnography to contribute to increased discussion on the importance of incorporating anthropology and cultural studies into a public health interventions.
What will it take for your project to be successful over the next three years? Please address each year separately, if possible.
Success in the first year will hinge on the development of strong, trusting relationships with local NGOs and providers, and the development of a rigorous survey tool and implementation plan for key villages in the region. I will undertake the ethnography all the while I am building collaborative relationships with local providers and health workers to introduce this model, gauge their feedback and interest, and adjust for sustainability. I will also take language classes and volunteer with a local community development organization in order to deepen my involvement and awareness of life in Ladkah. Success in the second year will be the successful completion of a one-year pilot, the synthesis and finalization of relevant data or findings, and the dissemination of these findings through at least one journal article and one conference abstract. Success in this year will also be the uptake of the maternal health ethnography model by community health workers and a close working relationship with the district hospital Ob/Gyn who will also be supportive. Success in the third year would be the continued implementation of this model and funding and programmatic support from either the government of key NGOs in the region. Success would also be the replication of this pilot in other regions.
What would prevent your project from being a success?
A complete lack of funds would make the implementation of this project quite difficult, but as aforementioned, I feel confident both in my grant writing and documentation skills to make a strong case for the cost effectiveness and value of this program model, from both a cultural and public health perspective. In addition to funding, a lack of buy-in from community members, health care providers, and government officials/NGOs – on the value of understanding maternal death in the effort to address – would prevent success. However, I have strong skills and knowledge in cultural competency (on which I provided technical assistance to Planned Parenthood across the US during my time at PPFA) in reproductive and maternal health care, and a strong commitment to making any program implementation fully sustainable. I feel confident that I would be able to adapt and readjust the program to ensure sustainability and success. In addition, I would pursue opportunities such as journal articles, blog posts, and conference presentations to raise awareness/generate interest in this program model. While the opinion and engagement of the community, internally, is paramount, it would also be important to interest other NGOs who might help ensure programmatic support and funding to guide sustainability in the long-term.
How many people will your project serve annually?
101‐1.000
What is the average monthly household income in your target community, in US Dollars?
Less than $50
Does your project seek to have an impact on public policy?
SUSTENTABILIDADE
Em que estágio está seu projeto?
Fase de concepção
Sua organização é
Não registrado
Is your initiative connected to an established organization?
If yes, provide organization name.
How long has this organization been operating?
Entre 1 e 5 anos
Does your organization have a Board of Directors or an Advisory Board?
Does your organization have a non-monetary partnerships with NGOs?
Does your organization have a non-monetary partnerships with businesses?
Does your organization have a non-monetary partnerships with government?
Please tell us more about how these partnerships are critical to the success of your innovation.
Approximately 150 words left (1200 characters).
What are the three most important actions needed to grow your initiative or organization?
Approximately 300 words left (2400 characters).
A História
What was the defining moment that you led to this innovation?
What was the defining moment that you led to this innovation?: (300 wds)
In mid-August 2006, I sat alone on the side of a mountaintop nunnery, in the village of Tia, in the region of Ladakh, soaking up the hot Himalayan sun and the vast views. I was completing my fieldwork as a Harvard graduate student in Buddhist Studies, and had, in a moment of creativity and luck, secured a post for myself working with a group of Tibetan Buddhist nuns in a part of the world I had never even heard of before. My friends thought I was crazy and my mom was quite worried as I headed off to India, entirely alone in this extremely remote place, for three months. My daily life was intense invigorating: hours-long walks to the nunnery where I’d lead discussions about health and hygiene, and more sensitive issues like gender identity and power; bearing witness to the rigorous lives of women in the region, carrying babies on their front and huge loads on their back or bearing children at home, alone, when the snow closed the mountain passes leading to hospitals. As I sat atop the nunnery that day, thinking over the past several months of life in Ladakh, I was overwhelmed by what it meant to be a woman in this place. To be at once at the nexus of millennia of Buddhist tradition, Tibetan culture, agrarian society, and a virtually inhospitable climate (Ladakh is situated at about 13,000 feet): what does this mean for one’s identiy as a woman, for the expression of one’s reproductive freedom, and for the priority of one’s reproductive health? I became entirely convinced of the importance of telling the story not only of life in this vey forgotten region, but specifically of life for women here. There is such a dearth of reliable data on women's reproductive and maternal health that it smacks of near-complete marginalization of this amazing community. I feel strongly that Ladakh embodies the important elements that maternal health interventions must address; more than anything, that is to say, a deep understanding of the interweave of culture and health. It has been more than four years since I was in Ladakh and I think of the place daily. I am 100% committed to returning within the next year to continue research, and plan to visit Tia nunnery to see my nun friends there and sit again at that same spot to consider the past four years.
Tell us about the social innovator behind this idea.
I am a global feminist and idealist. I have worked to develop a keen understanding of global development and women’s issues, through both study and first-hand experience. I have felt increasingly empowered to call myself an innovator, with the boldness to say, “I WILL make an impact.” I’m deeply committed to issues of women’s empowerment, and have gravitated toward related opportunities that challenge me – difficult fieldwork and thought-provoking topics. I feel proud that each opportunity I have had has been one that I envisioned, sought out, worked hard for, and realized. I feel grateful for the opportunities that I’ve had as a woman in the US, with access to health care, education, and the ability to exercise my reproductive rights. I am deeply cognizant that this is an anomaly compared to many parts of the world. As a Libra and social justice activist, I have always cared deeply for the principle of equity. No principle of equity resonates more with me personally than that which relates to the lives and experiences of women. I am the middle of three girls, and have been surrounded by strong women my entire life. This has helped shape my tenacity, emotional sensibility, and awareness on these issues. I also have a great sense of humor and an ability to adapt in many situations. My years of studying Buddhism have done me well in this regard. At one and the same time I can fight fiercely for universal rights while appreciating the impermanence or transience of life. Rather than making me detached or apathetic, this enables me to find humor and enjoyment in many situations, from Delhi traffic to the NYC subway rush. In sum, I really view myself as a searcher who has both feet on the ground and a head in the sky.
How did you first hear about Changemakers?
Friend or family member
If through another, please provide the name of the organization or company
 | Miren Bengoa said: Dear Jessica, I would love to know more about your research. Have you already completed it ? My organisation has maternal health ... about this Competition Entry. - 197 dias atrás leia mais > |
| jsewall said: Hi Jessica, You have a really sound proposal for identifying a broad range of barriers to maternal health and leading causes of ... about this Competition Entry. - 685 dias atrás leia mais > |
| Anonymous enviou esta idéia. - 696 dias atrás |
