Mobility, Maternal Mortality and
Mainstreaming Gender
- A Need for Action
Jeff Turner,
Independent
Mobility,
gender, power and well-being
·
There is a relationship between mobility, power and
well being. There is clear evidence across the globe that there are significant
differences between male and female travel patterns. It is also clear that there are cultural rules
and societal roles that lead to and are associated with these differences. However,
these relationships are still under-charted in the policy environment.
·
It is also clear that the influence of constrained and
gendered mobility on bargaining also has its impact on what comes to be
available as resource and service within local constraints.
Maternal
Mortality – an operational ground
·
No better demonstration of these constraints can be
found than in
·
More than half of the 600,000 women who die every year
from pregnancy-related causes were in the African region which constitutes only
12% of the world's population and 17% of its births.
·
Maternal mortality ratio in
MDG Target 6: Reduce by three quarters, between 1990 and 2015, the
maternal mortality ratio.
·
Despite the various policy calls to action and
international networking amongst development agencies on the topic, in
·
In addition to displaying the scale of the gap there
is a need for a rapid identification of immediate operational measures which
can be taken to redress this glaring inequity.
·
Though much has been learned during the past decade
about the causes of maternal death, there is little evidence of significant
progress towards the ambitious goal of halving maternal mortality.
·
Every year, over half a million women continue to lose
their own lives to the hope of creating life. Women in Sub-Saharan Africa
continue to face a 1 in 13 chance of dying from pregnancy and childbirth, when
the risk for women in the industrialized world is only 1 in 4,085.
Linkages
between mobility, gender, power and maternal mortality
·
Medical models of maternal mortality such as the 'Three
Delays Model' developed by Thaddeus and
Fig 1. Three Delays Model of Maternal Mortality
(Thaddeus and
http://www.maternityworldwide.org/causes.html
)
·
The majority of
poor rural women give birth at home partly in the absence of transport means to
transport them to a health facility
·
The financial
and time cost of travelling to health facilities and their low status and
negotiating power within the household may mean there is a trade-off for rural
poor women which may delay the decision to seek care.
·
If they seek
care most women will walk (availability of bicycles and improvised stretchers
to be used in emergencies is often localised and ad-hoc) – which delays arrival
at the point of care.
·
Rural health
facilities often have large catchment areas and often lack trained staff,
drugs, equipment and effective transport and communication referral systems
which delays the provision of adequate care
·
It is becoming
accepted that poor access may play a role in maternal deaths and conditions
such as Fistula, but there is little research available on how important this
is and what may be effective interventions
Localised interventions and solutions
·
There are a
range of localised interventions being developed across
- Safe
motherhood transport plans in
- Safe
Motherhood Unions in
- Targeted
approaches which integrate transport in
- RESCUER
project in
- Yellow flag
initiative in some parts of
- Provision of
specialized obstretic care ambulances in
·
These examples and others, are often being implemented
in isolation and there is an urgent need for such examples to be shared widely
and evaluated to provide clear directions for a course of action. It can also
been seen that the transport lessons around the reduction of maternal mortality
in
- fast information links can save lives,
- rendering services locally can reduce the need
for mobility, and
- operating hostels for those at risk can
temporarily reduce distance within critical windows of care.
A Space for Action
·
Therefore, within the policy discussion there is a
need for:
- more accurate measurement,
- more focused solutions,
- more sensitive social scientific analysis of the
relationship between mobility, gender and health.
·
There is now a policy goal of dramatically reducing
maternal mortality in
·
However, the literature on concrete measures for
bringing about this goal and the operational activities of development agencies
in pursuit of this goal are thin on the ground.
·
This is particularly so in respect of the transport
and maternal mortality link.
A need for further investigation
·
There is also a
need for further investigation of the interactions between mobility and
maternal mortality and some of the questions include:
- What is the nature
of the interaction between physical access, communication and maternal,
neonatal and child health services and their outcomes?
- How can we capture
and measure the nature and scale of these complex interactions as part of
a wider multi-dimensional picture of maternal, neo-natal and child health
services?
- What can be learnt
from a more systematic evaluation of the range of localised access and
communication solutions that have been implemented to improve physical
access to maternal health services?
- How can greater community
involvement be encouraged in tackling barriers to access?
- What are the
institutional issues pertinent to maintaining the responsiveness of
patient transport services?
- What scope is there
for new communication technologies and 'telehealth' in overcoming access
difficulties and interacting with access solutions
The need for action on mobility, gender
and maternal mortality
·
There is sufficient evidence that transport
organisation and provision is highly gendered in both the developing and
developed context. Gender methodologies have not yet been sufficiently
mainstreamed to tackle this existing pattern of equity.
·
The reduction of maternal mortality in
·
There is evidence that more systematic approaches are
beginning to be adopted but as of yet transport and gender statistics are of a
limited character.
·
Web-based tools need to be developed which would provide
consolidated information on the relationship between gender, transport and
maternal mortality and carried detailed information on best practice and how to
effect it would be a useful addition to the toolkit and process necessary to
achieving the Millennium Development Goal of reduced maternal mortality in
Africa. A significant needs to be made in this area, but a start has been made
at:
http://www.people.cornell.edu/pages/mg294/maternalmortality.html