“Dr. Jim Kim, anthropologist, clinician, and former WHO advisor has commented that anthropologists have a long history of providing ‘moral witness to human suffering’. What is needed now, he argued, is ‘moral witness to human possibility'”.

The readings for this week on community mobilization for safe birth provide two different examples of how human possibility and morality can improve public health – in this case, maternal and child health.

The community-based participatory research study in the Dominican Republic found that both men and women were dissatisfied with the maternity services in the hospitals. While the Dominican Republic is a relatively developed nation, there are substantial socioeconomic inequalities. Although 97% of births occur in health facilities, an optimistic number compared to some other areas of the world, the MMR is high, at 150-160/100,000 live births. A main issue identified by the communities involved in the study is a delay in accessing care. The researchers aimed to determine why women delayed going to the hospital amidst complications.

The findings were unfortunate. The community recognized pregnancy as a vulnerable and fragile time for a woman. However, they did not receive adequate, compassionate care at health facilities. “No me hace caso” – “they pay no attention to me” – became a recurring theme throughout the study. Wait times for appointments and even surgeries were absurdly long, even though the commute was manageable. Doctors were not comforting women and their families when they were anxious. The women felt that nobody was there for them or taking care of them, and procedures and outcomes were not explained properly.

This project shows that when a team of researchers, professionals, community members, and hospital staff come together, a common goal can be reached. Since the maternity service providers have now been made aware of the dissatisfaction of the community, steps can be taken to improve the quality of care. It is unsettling that while the backbone of a potentially successful maternal health system exists, that something like staff attitudes have an impact on MMR. Hopefully, the future of maternal health services is bright in those communities.

In Humla, Nepal, a project was done by the PHASE Nepal foundation to change a harmful cultural practice – keeping a new mother and her baby in a cowshed after delivery for one month. This is very dangerous, given the high possibility of infection, in addition to uncomfortable living conditions. However, the researchers knew that changing engrained beliefs is difficult, and did not want to appear as judgmental outsiders. They came up with the idea to provide useful incentives – new clothes for the mother and baby – in exchange for a safer area for the mother and newborn to live postpartum. Another part of the initiative was increasing skilled birth attendance. The project had a successful outcome, with 50% of births being attended by skilled birth attendants and almost 100% of families accepting the clothing for safer postpartum living spaces.

This project demonstrates that changing a cultural belief is possible, when the community understands what the problems are and how to adhere to their beliefs in safer ways (i.e. separate room of the house dedicated to mother and baby, room restrictions, or a small guest house).

With the risk of sounding cultural insensitive, the underlying problems in both articles remind of me Sue Ellen Miller’s Ted Talk, when she said that women are “discriminated to death”. In both of these articles, we see that change is often needed in areas besides access to medicine and equipment. These initiatives both dealt with cultural issues, which with the right plan, can be altered to benefit not just mothers and infants, but the entire community.