Strong Communities Start with Good Maternal and Child Health

When women have access to essential labor and delivery and newborn care, more than half of newborn deaths can be averted.

Strong Communities Start with Good Maternal and Child Health

When women have access to essential labor and delivery and newborn care, more than half of newborn deaths can be averted.

Overview

Approximately 830 women die every day from preventable causes related to pregnancy and childbirth, according to the World Health Organization – that’s 34 women every hour. With 99 percent of those deaths occurring in lower- and middle-income countries, maternal and child health inequality is a significant issue around the world.

While there are significant maternal health disparities between and among countries, there are also dramatic differences within countries. A woman’s economic status, education, age, ethnicity, religion, and geographic location along with access to and use of prenatal, intrapartum and postpartum care all play a role in determining her chances of survival. The same is true for newborns and children.

While there have been significant reduction of deaths in children under five over the past two decades, nearly 15,000 children still die every day due to conditions that can be prevented or treated with access to basic, affordable care. Unfortunately, decreases in newborn mortality rates have been much slower and approximately 2.5 million newborns are dying each year—the majority in sub-Saharan Africa and South Asia. When good quality care is provided during labor and delivery, and essential newborn care is provided, more than half of newborn deaths can be averted.

Supporting Maternal and Child Health Around the World

PCI promotes maternal, newborn, and child health through its integrated, community-driven programs focused on health promotion and disease prevention. Our success is driven by our commitment to addressing the root causes and social drivers of poor health outcomes and leveraging the power inherent in the communities where we work. Ensuring access to quality and respectful health services and promoting behavior change for good maternal, newborn and child health is vital to building strong families and communities.

PCI’s comprehensive programming places individuals, families, and communities at the center of our approach to improving the health of women, babies, and children when they need it most. We work together to holistically—along the life cycle and continuum of care—address risks, vulnerabilities, and challenges rather than focus on a particular disease or health issue. Working at the community level engages people in a process of discovery and empowerment, helping them to understand and own the challenges they face and how best to implement the most effective solutions. This process builds sustainability, because community members are included as both the co-authors and ultimate owners of all of PCI’s programs. Communities then serve as the ongoing custodians of the knowledge, skills, and approaches they have learned, ensuring that these maternal and child health practices live on past the end of our programming and that their families continue to grow healthier and stronger because of them.

Along with helping pregnant women access essential maternity services, PCI addresses the underlying causes of poor maternal, newborn, and child health outcomes. We promote good nutrition during pregnancy and the first two years of a child’s life through our food security programs by promoting breastfeeding, evidence-based complementary feeding practices, engaging parents in community conversations about health and wellness, and sensitizing men to adopt positive communication strategies and make shared household decisions about infant and child feeding with their partners.

Additionally, PCI works in close partnership with Kirk Humanitarian to distribute multiple micronutrient prenatal vitamins to underserved populations. Evidence shows that maternal multiple micronutrient supplementation containing iron-folic acid during pregnancy improves survival of female newborns and provides “greater birth-outcome benefits for infants born to undernourished and anemic pregnant women.” (Lancet Global Health, 2017)

PCI has been a valued partner of Kirk Humanitarian since 2010 and to date, has shipped and distributed 438,058 bottles of prenatal vitamins to project countries including Botswana, Guatemala, Haiti, Liberia, Malawi and Zambia. The vitamins have been distributed to pregnant women in these countries via national distribution systems, including ministries of health and PCI projects. In partnership with the Nicaraguan Ministry of Health, PCI will distribute 160,000 bottles of prenatal vitamins in 2020.

Women’s health is a comprehensive issue, affecting and affected by mental, social, and economic well-being. Therefore, across countries and programs, PCI links women and families to platforms such as PCI’s Women Empowered savings and lending groups as a way for women to generate the income they need to care for themselves and their families and as a space for women to discuss and address group-driven social issues that impact the well-being of their families and communities.

woman feeding babies

Impact / By the Numbers

  • In Bihar, India, PCI reached over five million women with self-help, support groups designed to improve maternal, newborn, and child health practices—including access and utilization of essential services.
  • In Malawi, PCI’s Every Preemie—SCALE project improved Kangaroo Mother Care services in six facilities, reaching nearly 1,000 early/small newborns in 2018.
  • In 2017, PCI Care Groups in Malawi empowered over 70,000 families through peer-to-peer maternal and child health education. And, in 2018-2019, 144,000 community members participated in Care Groups to improve health and nutrition behaviors for women of reproductive age and children under five.
  • Since its inception in 2000, PCI’s Casa Materna (Mother’s House) benefited more than 79,000 vulnerable women, adolescents, and their families.
  • In Zambia, PCI reached more than 9,000 beneficiaries with messages promoting obstetric care by skilled providers, including facility-based deliveries through community sensitization, facility-based group counseling, and home-based counseling.

Improving Maternal and Child Health India

PCI has been working collaboratively with the Government of Bihar to improve reproductive, maternal, newborn, and child health and nutrition outcomes for 32 million people throughout the poorest and most marginalized communities in rural Bihar State.

Funded the Bill & Melinda Gates Foundation, PCI’s JEEViKA Technical Support Program has reached more than 6.5 million women with integrated health and nutrition social and behavior change interventions through government livelihoods programming.

PCI’s JEEViKA program is helping individuals, families, communities, and districts adopt life-saving health and nutrition behaviors through women’s self-help groups, community-powered campaigns, health sub-committees, and district-level meetings that catalyze support for frontline health workers.

Since 2011, PCI has designed, tested, refined, and scaled this social and behavior change model while also building the capacity of the government to monitor health and nutrition outcomes. Evaluations of the program have shown a significant improvement in all health and nutrition indicators assessed, including the use of modern contraceptives, institutional delivery, newborn health and care, timely initiation of breastfeeding, exclusive breastfeeding, and child nutrition.

These efforts and outcomes have been acknowledged by other states in India, as well as the national government, and led to requests for support in designing and implementing additional health and nutrition interventions throughout the national and state-level.

San Diego’s Healthy Start

PCI’s Healthy Start program offers free prenatal, childbirth, and child development education sessions to families throughout San Diego. Our trained health educators provide home-based visits for qualified families from the time they are pregnant until their child is two years old.

Through this program, families have access to a variety of care, including doula support during labor, lactation consultation, car seat safety classes, programs for fathers, mental health wellness classes, and other special events. PCI also works to help parents see themselves as their children’s best teacher and advocate; stimulate and support early child development through healthy and nurturing parent-child interactions; improve women’s health before, during, after and between pregnancies; and strengthen family resilience.

In addition, the Healthy Start Community Action Network (CAN) provides the opportunity for partners throughout San Diego to come together and support healthy pregnancies and safe births, as well as nurture positive parenting practices and education. CAN has active working groups that meet monthly.

Engaging Fathers in Tanzania

PCI’s Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS) project is a study measuring the impact nutrition and parenting interventions have when introduced to peer-based groups.

EFFECTS seeks to answer two primary research questions:

  1. Does a father’s engagement improve child nutrition and development?
  2. Will integrating child stimulation with nutrition programming improve child nutrition and development more than just nutrition programming alone?

The program’s goal is to diversify child nutrition, support early child development and growth, improve meal frequency, promote stimulation and positive disciplinary practices, improve maternal and paternal mental health, and encourage health water and hygiene-related practices.

Currently, 960 households (mothers and fathers with children 0-18 months of age) are enrolled in the study throughout the Butiama and Musoma Rural districts of Mara, Tanzania. Participants engage in 12-month nutrition, or nutrition + parenting, or control interventions through structured, bi-weekly peer group sessions facilitated by community health workers.

PCI staff supervise and mentor 96 community health workers who facilitate 64 women’s peer groups and 32 men’s peer groups. These groups increase caregiver knowledge, skills, and self-efficacy to help them overcome barriers to access, use, and consumption of diverse, nutrient rich and hygienic foods; provide responsive caregiving and stimulation to their children; and address gender norms in the households that affect child nutrition and development.

The EFFECTS study uses specific intervention materials and methods to evaluate changes in behavior, specifically geared toward improving nutrition and child development, such as:

  • Infant and young child feeding,
  • Food access,
  • Water, sanitation, and hygiene practices,
  • Couples behaviors such as couples communication; household decision-making; conflict resolution; stress management; family planning; and women’s control over household resources, along with
  • Parenting behaviors such as play, communication, responsive caregiving, praise, and positive discipline.

Intervention sessions include interactive skill-building activities, such as cooking demonstrations and visits to local community gardens, while also promoting supportive environments for the practice of optimal nutrition and parenting behaviors.

EFFECTS is funded by the Eleanor Crook Foundation and Conrad N. Hilton Foundation and implemented by PCI in collaboration with the Harvard T.H. Chan School of Public Health, Purdue University, and the Africa Academy of Public Health.

Supporting Mothers and Newborn Health in Guatemala

Casa Materna (Mother’s Home) is a PCI-run facility that provides lifesaving women’s health services in the mountain l region of Huehuetenango, Guatemala—filling a critical gap in the country’s healthcare system.

Through its maternal waiting home, postpartum in-patient facility, out-patient services, community outreach, and reproductive health counseling and services for adolescent teens, PCI has provided culturally sensitive, high-quality reproductive health care to more than 100,000 indigenous Mayan women.

Casa Materna has also provided:

  • Inpatient services to about 1,245 women each year, of which roughly 30 percent are minors
  • Safe child delivery for over 13,000 women annually
  • Counseling and care for women with early/small babies to support their transition from home to hospital

Over the years, PCI’s built a successful community engagement and mobilization network critical to the success of Casa Materna and to PCI’s adolescent sexual and reproductive health programming. PCI now has 300 traditional birth attendants who monitor pregnant women throughout the region’s remote communities and make referrals when early warning signs of serious conditions are detected.

The Pathways To Change

To address the underlying causes of food insecurity in the Balaka and Machinga districts of Malawi, PCI led the Njira “Pathways” development project from 2014-2019. Njira was designed to improve the health and nutrition of pregnant and lactating women and children under age five, with emphasis on the first 1,000 days. Using integrated and custom-tailored pathways and a peer group-based participatory behavior change platform, PCI was able to address the specific needs of food insecure populations.

Over this time, PCI reached 70,668 women of reproductive age in 2017 with integrated sanitation and hygiene education, along with maternal and child nutrition counseling and support. Additionally, PCI worked with 80 father groups to transform gender norms, engage fathers in more equitable household decision-making, and increase support for household health, nutrition, and healthy water, sanitation, and hygiene practices.

In the last two years of the project, 144,000 community members participated in care groups designed to improve health and nutrition behaviors for women of reproductive age and children under five.

PCI also worked with participants to construct backyard gardens which improved access to nutrient dense foods, provided skill-based training on processing, preservation, storage, and utilization of nutritious foods, facilitated growth monitoring and promotion sessions, and referred malnourished women and children to available services.

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Saving Mothers Giving Life: A Partnership in Zambia

From 2012-2018, PCI implemented Saving Mothers Giving Life—a model that addressed the three delays facilities and communities face in seeking, reaching, and receiving maternal, child, and newborn health care.

In partnership with the Ministry of Community Development/Mother and Child Health and Save the Children, PCI built the capacity of Zambia Defense Force sites to implement quality maternal, newborn, and child health services, which included:

  • Training 50 health care providers in emergency obstetric and newborn care and newborn resuscitation using the Helping Babies Breathe and Essential Care for Every Baby curriculums; and
  • Training health care providers on Kangaroo Mother Care to support and stabilize premature and small babies.

By modifying and adapting the Maternal and Child Health Integrated Program mentorship guide, PCI helped inform and train Defense Force Medical Services health care supervisors from the DFMS Medical Directorate and HIV/AIDS Secretariat on the provision and training of on-site mentorship. PCI also trained staff to conduct routine quality control/quality improvement visits to Saving Mothers Giving Life program sites.

In partnership with Defense Force Medical Services health facilities and Safe Motherhood Action Groups, PCI adapted the Ministry of Community Development/Mother and Child Health facility-based register to track mother/baby pairs in the community.

As a result of the project:

  • PCI trained 160 members to conduct home visits for women and children across the maternal and newborn care continuum, as well as refer women and neonates to facility services.
  • The number of deliveries in seven Zambian Defense Force Safe Motherhood Action Group facilities with access to skilled personnel increased from 452 to 1,181.
  • The total number of women with at least one antenatal care visit during the first trimester increased from 134 to 670.
  • The proportion of women receiving prophylactic uterotonic drug in the third stage of labor to prevent postpartum hemorrhage increased from 46 percent to 92 percent.
  • All seven facilities had documented performing each of the “signal functions” of Basic Emergency Obstetric and Newborn Care in line with the World Health Organization guidelines.
  • Safe Motherhood Action Group members reached over 9,000 beneficiaries with messages promoting obstetric care by skilled providers including facility-based deliveries through community sensitization, facility-based group counseling, and home-based counseling.

As part of the family planning/HIV plus-up acceleration program, PCI integrated a module on family planning counseling into the Safe Motherhood Action Group training guidelines. As a result, PCI trained members at four Zambian Defense Force Safe Motherhood Action Group sites to provide facility and home-based postpartum family planning counseling services. PCI included indicator tools on family planning to track uptake of postpartum family planning methods in Zambian Defense Force Safe Motherhood Action Group facilities and catchment areas.

Growing Through Partnerships

PCI is a proud member of CHIFA (Child Healthcare Information for All). We support child health rights and believe that every child, every parent and every health worker should have access to the health information they need to protect their own health and the health of children for whom they are responsible.

PCI is a proud CHIFA partner

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