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The University of Southampton

Educating for better maternal health

Improving maternal health in the world's poorest countries.

1 July 2016

Update: Professor Nyovani Madise has left the University of Southampton. To find out more about our ongoing research on maternal health, visit our Centre for Global Health, Population, Poverty and Policy web pages.

Around 250 babies are born every minute in developing countries – that’s almost 10 times the birth rate of the developed world. Ahead of the University of Southampton’s public lecture on maternal health, Nyovani Madise, Professor of Demography and Social Statistics, gives an overview of today’s greatest challenges for the health of pregnant women and their babies in the world’s poorest areas.

My research focuses on the social determinants of health; I’m particularly interested in investigating the influence of poverty on maternal and child health, as well as nutrition and reproductive health in low-income countries in Africa.

There are three main challenges to the health of pregnant women and their babies in low-income countries. The first is the early age of childbirth. In rural Africa for example, around 20 per cent of girls aged 15 to 19 years have begun childbearing; by the age of 18, more than a third are mothers. Many of these pregnancies happen before marriage, which means that the girls often delay telling their families that they are pregnant – sometimes right up until they give birth – so they have no access to antenatal care, information about good nutrition in pregnancy and, if needed, drugs to prevent HIV being transmitted to the baby.

Five things you might not know about maternal health:

  • More than 135 million women give birth per year
  • One woman dies every 90 seconds from complications during pregnancy or childbirth
  • The risk of maternal death is 2.7 times higher among women with no education
  • In sub-Saharan Africa, less than 50% of women have a trained midwife, nurse or doctor with them during childbirth
  • 140 million women worldwide would like to delay or avoid pregnancy, but don’t have access to voluntary family planning

Giving girls the opportunity to stay in school for longer would solve this. In sub-Saharan Africa, there is a shortage of secondary school places for girls. As well as providing opportunities, access to education empowers women to make informed and healthy choices for their families – for example in terms of good nutrition – and to ask more questions to health professionals, rather than simply accepting what they are told. Only a handful of African countries, including Kenya, Uganda and Mauritius, provide free and universal secondary education, and this is something that governments need to adopt more widely.

The second challenge is lack of access to skilled birth attendants’ care during labour. Currently in Africa, only around 50 per cent of women give birth in a healthcare setting with a qualified practitioner. This is partly due to what we call the ‘three delays’ in accessing care – these are delays in: making the decision to go to a healthcare setting; getting there, for example waiting for a relative who has the money for transport; and waiting for a bed to become available.

We are trying to increase the proportion of women who give birth attended by skilled health workers, because if there are complications and the woman is at home, it can be fatal for mother and baby. Our research has shown that improving the quality of care, including interpersonal communication, advising women during antenatal to deliver at health facilities and engaging male partners, can be effective in the decision to deliver at health facilities.

The third challenge, to the health of the babies, is low rates of breastfeeding. The World Health Organization recommends that women exclusively breastfeed for at least six months – particularly in areas of poor sanitation. However, we have found that in the poorest areas, there are some of the lowest rates of breastfeeding because mothers often need to go back to work soon after giving birth and leave their baby with a crèche or a friend or relative.

My team and I recently carried out an intervention in the slums of Nairobi in Kenya with the aim of encouraging more mothers to breastfeed. In this particular area, the rate of exclusive breastfeeding for six months was just two per cent, compared to 20 to 40 per cent across Africa. We gave community health volunteers and the mothers information on the benefits of breastfeeding and support to help them in practice. By the end of our study, breastfeeding rates in this area had risen to around 50 per cent.

In Kenya, a bill approved by Parliament in April 2016 states that employers must offer workplace support for breastfeeding mothers in line with the International Labour Organization (ILO), so things are starting to change. Specific employer groups – such as the flower industry, which relies heavily on women – are already starting to make some concessions so that women can, for example, breastfeed or express milk while they are at work. I hope that large firms will also start looking at providing more crèche facilities and, over time, that small firms can provide flexible hours.

For more than 15 years, we have been supporting several African universities and young African researchers to take on the challenges of their own countries by identifying their own opportunities and outlets for research. I think this is the way forward

Nyovani Madise - Professor of Demography and Social Statistics

Education for healthy choices

Across the world, it’s often the poorest people that are making the most unhealthy choices. Babies that are fed formula milk often put on too much weight and this is very hard for them to shift in later life. Even in the poorest parts of Africa there are now fast food outlets and the intake of cake and other high-calorie foods is on the rise. I believe that educating adolescents is the bridge between childhood and a healthy lifestyle in adulthood. Here at the University of Southampton we pioneered LifeLab – a unique laboratory dedicated to give school pupils first-hand experience of the science between the headlines. This type of approach would be ideal for schools in Africa.

I am very optimistic that things will change for the better in maternal health. I’m especially encouraged by the way we are starting to empower researchers in Africa to carry out their own research studies, so that in time they can drive this research and we will have more of a supportive role. For more than 15 years, we have been supporting several African universities and young African researchers to take on the challenges of their own countries by identifying their own opportunities and outlets for research. I think this is the way forward.

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Shedding new light on the fascinating philosophical questions the state of pregnancy presents, for a real-world improvement in care for women and their babies.

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