Date Published: August 3, 2010
Publisher: Public Library of Science
Author(s): Luke C. Mullany, Thomas J. Lee, Lin Yone, Catherine I. Lee, Katherine C. Teela, Palae Paw, Eh Kalu Shwe Oo, Cynthia Maung, Heather Kuiper, Nicole F. Masenior, Chris Beyrer, Linda Wright
Abstract: Mullany and colleagues report outcomes from a project involving delivery of community-based maternal health services in eastern Burma, and report substantial increases in coverage of care.
Partial Text: In settings of conflict, the additional reproductive and maternal health risks faced by women are well established ,, and relief agencies increasingly recognize the importance of addressing them in crisis and conflict situations . Collaborative groups including the Inter-Agency Working Group on Reproductive Health in Crises (IAWG)  and the Reproductive Health Response in Crisis Consortium (www.rhrc.org) have made substantial progress in areas of advocacy, tools to assist relief agencies in prioritizing and selecting essential services, and development of technical manuals and guidelines, and knowledge sharing through research and international conferences ,. However, few data exist to support the effectiveness of programs that specifically aim to increase coverage of essential maternal health interventions in settings affected by conflict. Relative to refugee settings, internally displaced communities have been particularly neglected , in part due to substantial difficulties in access by humanitarian agencies .
The community-based maternal health services delivery strategy promoted in this pilot project was associated with substantial increases in access to a range of essential maternal health services. In particular, the three-tiered network of providers led to an almost 10-fold increase in the proportion of women attended to at delivery by individuals trained to provide emergency obstetric care. Further, coverage and comprehensiveness of ANC increased substantially, with large absolute and relative increases in screening for hypertensive disorders of pregnancy, urine testing, malaria, and provision of deworming, iron folate, and insecticide-treated nets. Similar increases were seen for postnatal visits within 7 d and targeted postnatal interventions such as post partum vitamin A distribution and promotion of skin-to-skin contact. This tiered network of providers was also able to meet the need for family planning services that was clearly expressed by the community at the outset: unmet need was decreased by 35% largely owing to increases in the use of oral contraceptives and depo-provera, and smaller absolute increases in condom use. All these improvements were observed after implementation of an innovative community-based approach to service delivery in the context of ongoing conflict, security concerns, and human rights violations.