Title: FCI Initiative Boosts Skilled Birthing Care
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Section/SPIG: Maternal and Child Health
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Childbirth is a time fraught with emotion: anticipation, nervousness, fear, joy. Anger is not what most people think about or feel. But Family Care International knew that they were touching the hearts and minds of their community when its Skilled Care Initiative team in Burkina Faso presented a play about the dangers of giving birth at home. From the audience, one of the men leapt up, grabbed a stick, and started yelling, enraged at the actor who had forced his “wife” to deliver with a traditional birth attendant instead of going to the health clinic.
As the Skilled Care Initiative wraps up its fifth and final year, there is every indication that it will meet its goal of increasing skilled attendance rates in the project areas by at least 10 percent. The Initiative, which is being implemented by Family Care International with funding from the Bill and Melinda Gates Foundation, has proven to be a truly effective weapon in the battle to save women’s lives. It reaches into four rural districts in Africa (in Kenya, Tanzania, and Burkina Faso). It emphasizes skilled care before, during, and after childbirth. It focuses on better training, support, and facilities for skilled attendants, along with a multifaceted “package” of activities including ground-breaking research and evaluation tools, and a community-centered strategy to ensure that women want to, and are able to, deliver with a skilled attendant by their side.
In this way, the Skilled Care Initiative is exploring what it takes to make skilled care available to women, based on a real understanding of the constraints women and health providers face. Only five years ago in Burkina Faso, rates of skilled attendance were among the lowest in Africa. Since the Skilled Care Initiative was introduced in 2000, the proportion of women in the project district who deliver with skilled care has risen from about one-fifth to about one-third, based on health facility records. In Tanzania, clinics in the Skilled Care Initiative project district are reporting that the number of women who deliver with skilled assistance each month has increased by 20-50 percent.
The first years of the Skilled Care Initiative were dedicated to research and a range of activities to strengthen local capacity and improve care in health facilities – training, providing supplies and equipment, upgrading communication and transport mechanisms, and strengthening supervision and monitoring. The next stage was a focused Behavior Change Communication strategy to give people the specific information and support they need to help them move from their previous practices to new and healthier behaviors.
While health talks, counseling, and printed materials are used in clinics and villages in each project area, some of the most exciting elements of the strategy take full advantage of popular culture. Participatory theater, songs, and dance are effective ways to encourage discussion and to inspire deeply personal commitments to saving lives.
Local leaders have also given the Initiative tremendous personal support. In Ratanga, Kenya, one local chief has asked his wife, a trained traditional birth attendant, to stop conducting deliveries in the home because “I do not want to write statements on deaths of mothers.” Another head chief, who oversees 18 villages, has made it a weekly ritual to visit the health centers on antenatal care days to encourage the women to return to the facility for delivery.
Although the final project data will not be collected and analyzed until 2006, the Skilled Care team has noted an interesting trend: Use of skilled care increased steadily in the beginning of the project (as health services were being improved), and then began to jump more sharply once the Behavior Change Communication strategy was launched. The data has also confirmed a strong link between knowledge and planning and the use of skilled care. In fact, women who can recognize the danger signs and are aware of the importance of delivery in a health facility, and women who discuss plans for delivery with their families and put aside money to pay for costs, etc., are between two and four times more likely to seek skilled care than others (<http://familycareintl.org/pubs/PDF/SCI/TechnicalBrief_HHS_Eng.pdf>).
In the discussion following the play in Burkina Faso, the stick-wielding audience member admitted that his own wife had given birth at home without any preparation and without his involvement. Watching an actor behave the same way, and seeing how that behavior could end in a woman’s death, brought the man to the swift conclusion that, “I must turn the stick against myself; we are often blind to our own actions, and deaf to our own words.” For more information, contact Lauren A. Goddard, program assistant, Skilled Care Initiative Family Care International, <lgoddard@familycareintl.org>.