How can we get life-saving interventions to women and babies?
Innovative research approaches & measurement through photography
Images © Paolo Patruno/IDEAS
The start of a journey
The day of birth is one of the most dangerous days for women and newborns in low-income areas like rural Ethiopia.
On the front line
Quality health care from front-line health workers is vital...
....such as wiping and wrapping newborns immediately after birth to keep them warm....
....active management of the third stage of labour, ensuring the placenta comes out safely....
... and cutting the newborn's cord with a sterilised knife....
....and weighing the newborn.
These life-saving interventions are low-cost but, for reasons such as difficult journeys to get to health facilities, many women and newborns miss out.
Do innovations enhance interactions between families and front-line workers and increase life-saving intervention coverage?
This is one of the IDEAS research questions we are answering through household and health facility surveys.
In addition to household and health facility surveys to measure behaviours, we also carry out in-depth interviews with families and front-line health workers in Ethiopia, Nigeria and India to find out what mechanisms drive families and front-line workers to change their behaviour and carry out life-saving interventions.
We hope our results will help understand what drives the health behaviours of families and front-line workers and what kind of innovations work to improve future maternal and newborn health programmes.
Photography as a research tool?
On a field trip to Ethiopia, a photographer hired for the usual publicity materials quickly becomes part of the research methodology. How?
For one of their study components, the IDEAS team aimed to explore the barriers and enablers for the adaptation of certain health improving behaviours during pregnancy and first hours and days of the newborn's life, and what role community health workers played in this.
Were these community health workers able to encourage mothers and their families to – for example - start breastfeeding immediately after giving birth, delaying the first bath of the baby and refraining from giving the baby water during the first 6 months of its life? If not, what were the main barriers?
IDEAS brought on board Paolo Patruno, an award winning social-documentary photographer and video maker based in various African countries over many years, to provide materials for the project's publicity needs - like images for the IDEAS website, presentations, flyers and so on.
However, it quickly became apparent that Paolo's work could be become a core project component in documenting specific behaviours that the IDEAS team wanted to discuss with the local population and record for the projects research.
For their research methodology, the team made use of several alternative and creative methods that were aimed to try and get the participants to talk openly and honestly about matters of maternal and newborn health services: direct questions about such a topic were often prone to "social desirability bias", i.e. the mothers given the answer that they think is “right”.
One of these alternative methods was "the picture round" in which the participants were shown a picture of the - correct or "incorrect" - execution of one of the life saving behaviours that we were studying. They were then asked to tell the interviewer the first thing that came to their mind when seeing the picture.
In first instance the team used more generic pictures not specifically from the area where they were undertaking their research.
“We had tried out some of the picture rounds with pictures from several big multilateral organisations and most of the comments we received from the participants were "this baby is not from here, this mother has a strange necklace" etc. which was not very helpful in the research.”
Dr Pauline Scheelbeek, London School of Hygiene and Tropical Medicine
So, the team asked Paolo if he could capture some specific behavious in the local area, documenting local women’s experiences of giving birth. It was these pictures the team used to ask the questions in their research surveys.
With Paolo's new local pictures, the discussion became - in most of the cases - much more focused on the behaviour itself, and proved a major help in understanding the drivers of local maternal and newborn behaviours.
It is Paolo's striking images that make up this IDEAS story….
Charting progress in maternal and newborn health
These insights into the mechanisms that drive behaviour also help IDEAS to understand the changes observed through our surveys.
Between 2012 and 2015 there is good evidence that the coverage of interactions between mothers and frontline health workers has improved across the continuum of care.
There is also evidence that the quality of care, defined by the readiness of health workers and facilities to provide care when it is needed, is also improving.
However few women and newborn babies receive the recommended components of quality antenatal or post-natal care and this could be improved by focusing on the behaviour of health workers.
While intrapartum interventions (during the birth) are improving, there is mixed evidence on the changes in coverage of life saving interventions for the newborn. For example, immediate thermal care, delayed bathing, immediate breastfeeding and sterile cord cutting all still need improvement.
Births at health centres increased from 14% to 43%
Births attended by skilled birth attendants like doctors, nurses or midwives increased from
15% to 46%
Primary health centres with the essential equipment needed for care during delivery increased from
26% to 68%
More women had the recommended four or more antenatal care visits
Yet few women and newborns receive the quality antenatal and postnatal care they need