The following post was written by Janna Oberdorf from Women Deliver and contributed to the HNN by the Maternal Health Task Force. For more posts about the Global Maternal Health Conference, click here.
Clean Birth Kits. It seems like a no-brainer. And, as one audience member at the Global Maternal Health Conference said, “There’s no doubt these would work.”
But, there is doubt, as I learned at the session, “Clean birth kits: do we need them?”. There’s serious speculation on what impact and effect clean birth kits (CBKs) would have on saving lives. The session panelists presented a review of the existing evidence on clean birth practices and the potential role for CBKs in supporting these preventive practices, and they found serious gaps in knowledge and research.
One thing that all panelists agreed on is that clean births are necessary to reduce maternal mortality – each year around 1 million newborns and mothers die from infections soon after birth, and this burden is highest for the poorest families. Of the world’s 60 million home births each year, many occur without adequate hygiene, and some facility births also lack basic hygienic care. There are “six cleans” that make up a clean birth: clean hands, clean perineum, clean delivery surface, clean cord cutting implement, clean cord tying, and clean cord care.
But CBKs are not a new idea. They have been around for decades… centuries. The problem is that little research exists that shows how these kits are used, and more importantly, what effect they have on women and providers.
Wendy J. Graham, from Immpact and University of Aberdeen, used this panel to discuss the Birth Kit Working Group, a compilation of health experts who are assessing existing research on CBKs, and considering the development of a decision guide to assist in the planning of overall strategies relating to the use of CBKs. Their key focus has been on CBKs for use in facilities, and trying to determine whether these kits are a help or a hindrance.
“The fact is: We don’t know,” said Graham, who highlighted the gaps in knowledge and research around CBKs effects. “We’ve heard so much about poor quality of care, and we need to identify catalysts for change.”
Though, as Graham and her colleagues Bilal Avan and Vanora Hundley discussed, the CBKs could work as a catalyst for change in a positive way, or a negative way. The presenters and the participants had a heated debate on how the kits could be distributed: would it be more effective if they are housed at health facilities and used when pregnant women arrive for delivery, or should they be given to pregnant women at antenatal visits. Giving women CBKs might actually deter them from having facility births, thinking that they can use the kit at home. Or, it might empower and enable them to return to the facility for their birth. On the other hand, housing the kits at facilities might create dependence from health providers that would be problematic when supplies run out. Or, the kits could sit on a shelf and never be used.
“This is not black or white; not positive or negative,” said Graham. “It depends on where we’re talking about. And it’s hard to really find out about adverse effects when studies don’t talk about failures.”
In the a community that likes to so often stress, “There’s no magic bullet for maternal health,” the CBKs offer the possible potential of what the bed net has done to curb malaria. Moderator, Ann Starrs of Family Care International, put the CBK issues into a broader global advocacy perspective. “Kits are being looked at and promoted almost as an advocacy tool, and as a way to sell this issue to a broad range of audiences as a problem for which there are quick and easy solutions,” said Starrs.
The main takeaway seems to be clean births are essential, and there is serious potential for CBKs to have an impact on maternal health and maternal mortality. The problem is: We have no idea what that impact will be. And before we roll out (and massively fund) the creation of distribution of CBKs, we need to be clear on what the likely outcomes will be.
More questions to consider:
- What are the most important contextual factors to consider regarding introducing CBKs into facilities? How do we address equity and ensure that poor women and women most in-need receive them?
- What should a kit include? What’s the criteria?
- What are the potential uses for CBKs, specifically in conflict or disaster situations?
- Are birth kits just an expensive diversion? Read a post on this issue by Ann Blanc, Director of the Maternal Health Task Force.