Our interventions have cut neonatal mortality in half.
The state of Bihar sees 2.6 million births a year. About 109,000 infants will not survive the first year. Why? First time mothers in rural India are often teenagers who have recently married, and have no support system outside their husbands and in-laws. They are anemic, but few receive iron-and-folic-acid supplements from the public health system (they’re out of stock, or the community health workers are apathetic). The risk of complications, even death, from any postpartum hemorrhage are thus needlessly increased. The lucky ones deliver at a public hospital, but that does not guarantee that a nurse or physician will actually supervise delivery. New mothers return home just a few hours after childbirth, and may not get the time to properly recover. Neonates are often bathed and then inadequately clothed until a ceremony on the 6th day postpartum. Families have no knowledgeable resource to turn to in emergencies. They make life and death decisions in the dark.
Our interventions have cut neonatal mortality by half. In our catchment of 45,000 of some of the most vulnerable communities in Bihar, we’ve cut neonatal mortality by almost half (19/1000 compared with 37/1000). The program has not lost any mothers. 93% of deliveries are now attended, compared with 53% when we started. The program has served almost 2700 women and supervised about 1400 deliveries in partnership with the public health system. (March 2018).
Our MNH program accompanies pregnant women from the first trimester to until 6 weeks postpartum, the period of the greatest risk to the mother and newborn.
Identifying and tracking high-risk cases From pregnancy through the postpartum period, the program identifies and tracks patients most at risk, e.g., pregnant mothers with severe anemia or high-blood pressure; low-birth-weight neonates; newborns with unresolved fever, etc. This allows the program to triage cases, and make advanced preparations in certain cases (e.g., suspected multiples, etc.) With thousands of cases annually under management, this system ensures that the neediest receive immediate attention.
A 24x7 emergency response system Mothers and families are counseled on identifying emergent situations (labor, hemorrhage, newborn with a fever, etc.) and calling a 24x7 hotline. The program ensures that the patient is expeditiously seen by a trained person. Transport is immediately arranged. Patients are triaged and transported to an appropriate facility (e.g., neonatal ICU, district-level hospital, etc.)
Helping patients make informed decisions, and navigate public and private care Program staff help patients make informed decisions in difficult circumstances, e.g., the need to transfer to an operative facility if complications develop during labor, etc. Should private care be necessary, the program ensures predetermined, transparent, predictable pricing, and rational care.
Strengthening skilled birth attendants (SBAs) The program addresses barriers that SBAs (auxiliary nurse midwives, or ANMs in Bihar) face in their work: they are overworked, communities do not trust them, and the best among them are seldom recognized. The program ensures that every mother checking in to deliver is accompanied by a community volunteer or trained CHW or program staff. This “birthing partner” works with the ANM to manage each case. ANMs who used to refer mothers out at the first sign of trouble are now more willing to intervene, given the program’s support and role as a mediator between the public system and the community. The program tracks ANM performance and works with PHIs to recognize the best ANMs.
Promoting behavioral changes to reduce risk Families are counselled intensively about behavior that put newborns at risk, e.g., giving newborns baths; waiting for the 6th day to properly clothe them; not allowing the newborn to leave the house for 6-40 days, even for immunization; etc.
Creating a cadre of community counselors The program identifies and trains volunteer women from the community who counsel mothers and families, conduct surveillance (report new pregnancies; emergent situations, etc.), and accompany mothers to the hospital.