Maternal health refers to the well-being of women during pregnancy, childbirth, and the first year after delivery. It encompasses physical, mental, and emotional health to ensure positive outcomes for both mothers and their babies.

Underserved communities face significant challenges due to limited access to essential resources, services, and healthcare. These communities often struggle with inadequate healthcare facilities, lack of trained professionals, and low awareness about the importance of prenatal and postnatal care.

You may ask, do communities ever exist that are not underserved in some way? While improvements can always be made, underserved communities are those that lack the basic resources necessary for survival and well-being. In the context of maternal health, these communities experience significant health disparities that affect access to quality healthcare during pregnancy and childbirth. As a result, these areas have higher rates of maternal morbidity and maternal mortality, contributing to preventable maternal deaths and health complications.

Understanding the struggles faced by underserved communities is key to improving maternal health outcomes. By addressing these challenges, we can reduce maternal health risks and ensure better healthcare access for women and babies in these areas.

 

THE URGENCY OF IMPROVING MATERNAL HEALTH: ADDRESSING DISPARITIES AND REDUCING MATERNAL MORTALITY

 

In the year 2020, according to the WHO, Nigeria was third on the list of countries with the highest maternal mortality rates worldwide, with an estimated 1047 deaths for every 100,000 live births coming next to Chad with 1063 and South Sudan with 1223. These numbers are alarming and stand as an awakening call to us all to work at changing this narrative not for the applause of anyone but for the reversal of the detrimental effects of losing our women and in many cases babies to many preventable causes!

 

These significant disparities existing in underserved communities, may be thought of mainly with regards to situations like a delay in access to emergency services like blood transfusion, anti-shock garment use or even receiving oxytocin infusion to hasten labour. Which are already basic emergency needs! But rather they suffer severe disparities like access to education about pregnancy, screening tests, pre-natal supplements, delivery options, obstetric scans to mention but a few.

 

WHAT PROBLEMS PLAGUE MATERNALLY UNDERSERVED COMMUNITIES

 

Underserved communities are plagued by a myriad of problems which have been broadly categorised following many studies from the WHO, the lancet, the Nigerian Ministry of Health and the world bank amongst others. The categorisations are as follows:

 

• Healthcare Infrastructure and Access
• Cultural and Social Factors
• Economic Barriers
• Geographical and Environmental Barriers
• Policy and Governmental Challenges
• Political and Security Issues

 

These problems may appear too broad or complex to address when considering the role individuals can play. Therefore, they have been broken down into smaller aspects under the pre-pregnancy, pregnancy, and post-pregnancy phases of a woman’s life.

 

1. Pre-Pregnancy Phase

 

In underserved communities, younger women of reproductive age often lack access to awareness about reproductive health, preventing them from making informed decisions about when to get pregnant or how to plan for healthy pregnancies. Some who are somewhat informed, often lack access to family planning services or even interest in it, leading to unintended pregnancies. This could be as a result of limited understanding of contraceptive options, longstanding cultural norms based on fear, superstitious beliefs or comfort in the known way of doing things as well as limited availability of such facilities in their community.

 

 

 

2. Pregnancy Phase

 

Many pregnant women in underserved areas face challenges in accessing regular prenatal visits due to long travel distances, poor road infrastructure, or the lack of nearby healthcare facilities. Additionally, inadequate education on the importance of prenatal care leads to delays in detecting complications or preventing preventable issues during pregnancy. One such community is Ijomu Oro in Kwara State, which was reached by POHEI in 2022. Through our interactions and observations, we found that while the community had some awareness of the importance of healthcare, the cost and difficulty of transportation to access care were significant barriers.

 

Prenatal care, including medications, blood tests, and other services, can be expensive. And due to the high financial dependence of women on their partners who may not have been educated on the importance of such care can result in women opting to skip important tests or visits because they cannot afford them. Such screening tests often help categorise pregnant women into high or low risk enabling early detection and treatment. Sadly, even when women finally arrive at some of these healthcare facilities, the lack of trained healthcare providers like doctors, nurses, midwives and insufficient medical equipment such as ultrasound machines, blood pressure monitors, may prevent proper monitoring of the pregnancy.

 

In some other cases, cultural beliefs or family pressure may discourage women from seeking formal prenatal care and rather align with the cultural preference for traditional birth attendants over skilled many times leading to delay in the recognition of health risks. This may also contribute to the lack of birth preparedness.

 

3. Delivery Phase

 

In many underserved communities, lack of access to skilled birth attendants (SBAs) or obstetricians, which is crucial for ensuring a safe delivery is a prevailing problem. While healthcare should be progressive and also advancing towards evidence-based care, traditional birth attendants may continue to implement practices that may be more harmful than beneficial. Women may also deliver at home without any birth attendants, further increasing their risk of complications like hemorrhage, infections, or even obstructed labor.

 

Inadequately equipped health facilities with insufficient staff, clean birthing environments or emergency services (e.g cesarean sections or blood transfusions) in cases of emergency during childbirth due to obstructed labor or hemorrhage can prevent women from receiving timely treatment leading to preventable maternal deaths.

 

4. Postpartum Phase

 

Limited Postnatal Care: After delivery, women in underserved communities may not have access to proper postnatal care, which is essential for detecting complications like infections, hemorrhage, or mental health issues such as postpartum depression which is in particular poorly understood in these communities and often associated with stigma and placing blame on the woman.

In some areas, there may be a lack of community health workers or support systems to help offer adequate education to mothers during the postpartum period, including breastfeeding counseling, family planning, and mental health support. Although largely, women are generally supported by family and friends.

 

 

IS IT ALL DOOM? HOW CAN YOU OR YOUR ORGANIZATION HELP CHANGE THE NARRATIVE?

 

When we think about solving problems or findings ways to tackle challenges, we often think of coming up with groundbreaking ideas the world has never seen or strategies we feel no one has ever thought out. And while that is great, because being visionary is always great, we should properly define the specific problem we want to solve and find out solutions that may exist. If we find that effective methods which have been tested previously, have never been applied to this problem, let’s start there. We stand a great chance of being able to utilize old strategies to speedily solve problems and move on to the next.

Therefore, to improve maternal health in underserved communities, it is essential to:

1. Choosea community of focus.
2. Identify and assess the factors that make thiscommunity underserved.
3. Research what has been carried out so far to contribute to the improvement of Maternal health in this chosen community.
4. Continue from where the efforts have ended.

These steps are essential preliminary steps to take in improving maternal health in underserved communities because far too often, repeated interventions are offered to communities who may no longer need them or need to be supported in the next intervention step.

Consider Ijomu Oro, one of the communities mentioned earlier. Through our engagement, we discovered that while they had some knowledge, they lacked the resources to act on it. Continuing to educate them once they are fully aware would be counterproductive. Therefore, it is crucial for organizations to document and make publicly available their interventions in communities to prevent unnecessary repetition of efforts that may prove ineffective.

 

After carrying out these preliminary steps, the following are strategies that have been used by private agencies, governments and international bodies to improve maternal health.

 

1. Innovative and creative education for women

 

According to a paper in the National Library of Medicine, written following a remarkable decline in maternal mortality in Peru by 70% in the last two decades and half, one of the major measures that contributed to this success was the education of women. Education of the girl child and not just women of reproductive age improve maternal health through three key pathways. First, it enhances women’s literacy, helping them access and understand health information, reducing child mortality. Second, it increases economic opportunities, leading to delayed childbearing and better access to healthcare. Third, education boosts women’s autonomy, allowing them to make independent beneficial healthcare decisions and seek necessary medical care. Together, these factors reduce maternal health risks, improve healthcare access, and promote healthier pregnancies and births.

 

In various Nigerian communities, drama has proven to be an effective tool for improving maternal health awareness and encouraging women to seek appropriate care during pregnancy and childbirth. Through performances and skits, radio jingles, market place campaigns, communities have been educated about the dangers of neglecting prenatal care, poor spousal support in pregnancy, relying on unskilled birth attendants, and not seeking medical help during childbirth. These drama-based campaigns have led to significant improvements in maternal health outcomes in communities in Sokoto, Enugu, Ondo state and others.

 

Action step: Offer education relevant to the specific community of interest. For example, the community could be knowledgeable about family planning but not know well about prenatal care or they could know well about prenatal care but not delivery options.

 

 

2. Tackling the various stages of delay in access to healthcare through integration of care.

 

In 2009, a comprehensive health initiative called the Abiye (safe motherhood) programme was created by the Mimiko administration to address maternal and child health challenges in Ondo state following a Nigeria Demographic Heath Survey which revealed Ondo state as having the worst maternal and child health statistics in Nigeria. The program intergrated three levels of healthcare: basic maternity centers, regular hospitals, and Mother and Child Hospitals (MCH), with support from trained community health workers called Health Rangers. The programme addresses four key challenges:

 

• Decision to Seek Care: 1 Health Ranger (a trained community health worker) assigned to monitor 25 pregnant women at a time, scheduled visits to the women homes are carried out and easy communication with healthcare providers ensured through provision of prepaid mobile phones

 

• Reaching Care: To help women in rural areas, the program provides transportation, such as motorcycles, tricycles, and ambulances, to ensure they can reach health centers.

 

• Receiving Care: Health facilities were improved through renovations, new buildings, and better equipment, while healthcare workers receive training to provide quality care. This was shouldered by the government.

 

• Referral Delay: In 2014, the Agbebiye (safe birth attendant) Initiative commenced to address high maternal deaths linked to traditional birth attendants (TBAs) and faith-based healers who were delaying or avoiding referrals to proper healthcare facilities. The program encourages referral of pregnant women to tertiary health centers by offering them monetary rewards and vocational training Each time a woman they refer successfully delivers at a health facility, they earn a reward.

 

Through this integrated approach by “2016, the Ondo State Government had reduced maternal mortality ratio from the state’s 745 per 100,000 live births in 2009 to 112 per 100,000 live births, a 84.9% reduction.

 

3. Organisation of Training workshops to equipping birth attendants to enable women receive optimal care where they reside.

 

According to the WHO in a 2023 study, only 43% of births in Nigeria are attended by a skilled birth attendant. “A skilled birth attendant is an accredited health professional – such as a midwife, doctor or nurse – who has been educated and trained to proficiency in the skills needed to manage normal (i.e. uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of women and neonates for complications. Traditional birth attendants, whether trained or not, are excluded from the category of “skilled attendant at delivery”-WHO

 

This statement from the WHO may make one wonder where to start then. It is important that this is the ultimate goal however we must start with what we have by organizing training workshops to equip tradition birth attendants on how better to coordinate community deliveries, provision of safe birth kits (cord clamp, perineal underlay, new razors, gloves and others), identification of danger signs and a pathway for referral.

 

To change the narrative, we must apply damage control to already laid down problems and seek all avenues to understudy and tackle the real points where these problems begin and this is why improving maternal health starts with addressing the needs of the girl child and educating or equipping male children in their teens to begin to grasp the importance of the depth of the need of the support of the partner in making choices that help us as society preserve the lives of women and invariably children.

 

CONCLUSION

 

Across underserved communities, maternal health remains a life-or-death struggle for far too many women. Limited healthcare access, deep-rooted barriers, and widespread misinformation create a dangerous environment for mothers and their babies. But it doesn’t have to be this way. The time has come for us to break these barriers! Challenging the systems that keep women from receiving the care they need and deserve. The change starts with us, and together, we can build a future where every mother is empowered, supported, and given the opportunity for a healthy birth.

 

Whether you are a healthcare professional, an educator, a policymaker, or someone passionate about improving maternal health, there are many ways you can make a difference.

You can:

 

• Volunteer or Partner with Local Health Organizations: Like here at POHEI- Pouring Out Health Initiative where we have “a vision to ensuring health care is available to all irrespective of their age, location, gender, social status” or other community-based health initiatives, offering your skills, time, and knowledge to help improve access to maternal care.

 

• Support Maternal Health Education: Help educate women and communities about prenatal care, family planning, and childbirth through local workshops, educational campaigns, or even informal gatherings.

 

• Advocate for Better Healthcare Policies: Reach out to local governments and policymakers to push for improved healthcare infrastructure, better training for healthcare workers, and policies that prioritize women’s health in underserved areas.

 

 

• Donate or join fundraising teams: Your contribution, whether in donation of funds, medical supplies, or time, can directly support health facilities, transport services, and education campaigns in underserved communities.

 

Together, we can create lasting change. By breaking down the barriers that prevent mothers from accessing the care they need, we will ensure a healthier future for generations to come. It starts with us. Let’s take action today for a better tomorrow.