Safe Delivery Safe Mother

Pakistan loses 14,000 women during childbirth every year, which is 1 death every 37 minutes (UNFPA). Alongside an appalling maternal mortality rate, this number also highlights that we are one of the most populous countries of the world, with the highest fertility rate in South Asia. Over 60% (World Bank) of the population resides in rural areas and does not have access to or opts out of skilled maternal and reproductive healthcare resulting in preventable deaths. We provide affordable access through two cost-effective programs, one addressing the leading global cause of maternal mortality, Postpartum Haemorrhage (PPH), the loss of excessive blood after delivery which causes 70% of preventable maternal deaths, and second is provision of Postpartum Family Planning services which most effectively prevent unsafe abortions and unintended pregnancies. Our programs train and rigorously monitor government-deployed Birth Attendants (SBAs) and Health Workers (LHWs), with over 700 mobilized in low-resource communities positively impacting over 250,000 annual pregnancies and deliveries. Alongside, we strengthen government’s HMIS in data collection and reporting of key maternal and reproductive health indicators. With the Elevate Prize, we will scale our two public-private programs which collectively target over 70% of preventable maternal and reproductive deaths in Pakistan’s high-priority districts.  

My journey into maternal health started with an unexpected conversation with Safya Bibi, a pregnant woman in Narang Mandi village expecting her fourth child after a life-threatening previous home delivery experience which caused excessive bleeding. She tried to share her traumatic story, but was constantly cut off by her family repeating that she and her baby were in good health and home deliveries were a family tradition. While looking at a subdued Safya Bibi, who clearly had no agency over her own body, I realized that this was the reality for 52% of women who deliver at home in Pakistan. I really struggled to reconcile with the lives already lost to preventable maternal deaths. So, I founded the Safe Delivery Safe Mother (SDSM) NGO which advocates for health equity, reproductive justice and universal access as a basic human right. We equip SBAs as they are the first and often times only source of accessible and affordable skilled care with strong local ties and highest outreach in low-resource communities. This is even more urgently needed as Covid-19 disrupts essential maternal healthcare services. Our goal is to collaborate with provincial governments and partners to collectively up-skill and strengthen Pakistan’s 20,000 government-deployed SBAs.

Pakistan reports over 6 million annual deliveries with one national maternal mortality rate (186/100,000) ignoring widespread provincial and district disparities due to limited availability, access and uptake of skilled maternal healthcare. At SDSM, we are addressing these gaps by training government-deployed SBAs at primary health facilities, and creating and publishing real-time district data on key maternal and reproductive indicators. Over 60% (UNDP) of maternal deaths in communities can be prevented if women deliver with SBAs at primary health facilities. Our approach achieves high outreach and scale as we partner with provincial maternal health departments (MNCH) to target high-priority districts. Our programs equip SBAs with affordable skills and techniques to provide quality maternal healthcare, counseling and post-partum family planning services. Through role-plays, videos and interactive simulations of SBAs real-life challenges, we teach them tailored techniques, such as how to effectively empower pregnant women and counsel their families during antenatal checkups to choose a postpartum contraceptive option. After trainings, we remain engaged over the long-term through rigorous monitoring to acquire and report monthly real-time data by SBAs on key maternal and reproductive indicators. Through this, we assess and facilitate uptake, acceptance and integration of taught skills and tools into SBAs clinical practice.

At SDSM, our programs equip frontline SBAs to provide life-saving techniques costing between $0.3-3 which are readily available in low-resource communities where hospital referrals are not possible. We address socio-economic constraints of communities through pictorial counseling in local languages for low-literacy populations. SBAs are trained to use our taught techniques, specifically, administering misoprostol tablets, condom balloon tamponade method and IUCDs as standardized protocols to prevent PPH and unintended pregnancies. These techniques save a woman with PPH, who would otherwise bleed out in 10 minutes if not immediately treated. Through our monitoring, we create and disseminate key maternal and reproductive health indicators at the district level. As the pandemic disrupts health systems and diverts priorities, SDSM is working to provide open source maternal health district data for the first time in Pakistan. Our standardized metrics can highlight low performing districts, forecast disease outbreaks, preparedness and provide data dashboards for multi-stakeholder use. We first launched our unique digital app to collect real-time maternal health data at the district level in Lahore, which has a population of 11 million. Our app is simple, designed in Urdu, versatile and concise, taking SBAs fifteen minutes to enter monthly data which resulted in 80% cohort uptake.

SDSM has a three-pronged focus; amplify our voice for women-centered solutions, build collaborative partnerships and disseminate standardized maternal and reproductive health data for multi-stakeholder use. Our social media platform advocates for health equity, reproductive justice, raises awareness on statistics and challenges, and shares training sessions and stories of SBAs community impact. Our online presence led to SDSM sharing its story at the TEDx Lahore stage for women entrepreneurs. From there, we grew our network of maternal health, policy, behaviour and medical experts to foster knowledge exchange and expertise for program design and implementation. Now, we are working to create accessible and open-source district-level data which is critical to ensure evidence-based and targeted interventions. Building on the success of our digital reporting app, the MNCH of Punjab is integrating our maternal and reproductive health reporting indicators into its existing HMIS platform which can be scaled across the province. Our data shows that SBAs conduct 30-50 average monthly deliveries with 5% annual PPH hospital referrals. We cannot create sustainable impact alone or in silos, so we deliver through partnerships, create public discourse, and publish real-time and accessible data for partners to collaboratively address Pakistan’s maternal and reproductive health challenges with government ownership.