UNICEF has been applying the integral sustainability model to a range of children’s issues as part of its focus on the rights of the child. Interestingly this has meant that a number of its programmes focus on families and in particular women. The Safe Motherhood programme is a prime example of this. The future of children is directly linked to the health and well-being of their mothers and so it is important to take the widest possible view of the environment in which children live in poverty to make meaningful and sustainable changes.
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One example of this has been the work of the Safe Motherhood Programme in Bhutan. The rugged terrain and geographically diverse population of this remote nation make it difficult to provide effective pre- and post-natal care to mothers and their babies. In fact only 51% of women attend at least one antenatal class and 85% of deliveries take place in the home.
As a result it has one of the highest rates of maternal mortality in the region, around 260 per 100,000 live births. Whilst this number is high, there have been improvements over the last decade.
Transformation
Critical to improving this number is convincing women of the importance of delivering babies in hospitals so that complications can be treated. Currently 45% of all maternal deaths can be attributed to post-partum haemorrhaging; most occur at home and do not show any signs of complications in the lead up to delivery.
Given the lack of physical signs that complications might occur and the likely role of the mother in the home looking after other children, it becomes clearer why there may be difficulties in convincing women they should travel closer to towns or villages prior to their due date in order to deliver their babies in hospital.
In conjunction with the Government of Bhutan UNICEF has been upgrading the health system (We external) including expanding and improving facilities as well as training medical and non-medical staff in emergency obstetrics and identifying and referring potential high risk pregnancies.
But the programme has also focused on education and awareness amongst mothers to encourage them to use the facilities, focusing more on the internal quadrants and understanding the reasons why mothers may remain at home. These include stressing the importance of having healthy mothers who can take care of their children and keep them in better health.
It is also addressing low levels of adult literacy, particularly amongst rural women, which is seen as a linked issue.
End game
The programme is now being delivered throughout South-East Asia and in areas of South America. It has also been linked to other projects including those focused on HIV/AIDS, particularly mother to child transmission.
Whilst there is still a long way to go, the first 15 years of the programme have generated valuable learnings that are making a difference in these communities.
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© Article 13 - April 2010
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