Sustainable grassroots solutions to achieve zero infant and maternal mortality in Ghana

Introduction

Certainly, you agree that several things are painful in life. However, the death of your wife and/or your baby during childbirth causes the most excruciating pain.

The emotional wounds and psychological trauma last for a lifetime. Through our community work, we have come across women and men in mental hospitals as a result of infant or maternal death.

This accounts for why Youth Rise International (YoRI) is so passionate about leading the fight against stillbirth, newborn, infant and maternal mortality in Ghana and across Africa.

Youth Rise International (YoRI), a legally registered and government-licensed grassroots and advocacy NGO in Ghana that fights extreme poverty and hunger by empowering the poor, marginalized and socially excluded to become prosperous through social protection, decent work, education, maternal & child health and advocacy.

Since 2015 we have impacted and transformed the lives of over 170,000 children, men and women across Ghana.

The Wedding That Ended In Tears

In 2018, we encountered the case of a young man of 32 years old, who had struggled to settle down in marriage with his beautiful 28-year-old bride in Ghana.

Almost exhausting their life savings, they put together a beautiful wedding. In Ghanaian and most African settings, after couples marry, family and society look forward to pregnancy and the birth of a child, which to them, is a sign of blessing for the new nuclear family.

As was expected, the bride in question, became pregnant a month after the wonderful wedding. The groom, his extended family, the local community and the faith community who heard about and saw the pregnancy were very happy for them.

In fact, they began buying all the baby materials and clothing, in preparation to welcome their first child to the newly formed nuclear family. But will everything turn out according to their plans? Or should they make room for disappointment? Of course, not, to them, they were really excited and expectant.

Fast-forward to the ninth month and the day of delivery, this new couple boarded a car and travelled to the nearby hospital, full of hope and expectation.

But the unexpected happened! The worse episode began in the life of this nuclear family. Yes, this 28-year-old bride, who was also due to graduate from the university in few months' time, and the first daughter of her parents died together with her baby in the course of labour.

You can imagine the pain, misery and anguish that came on the groom and his family!

Africa, The Epicenter of Maternal Deaths

Unfortunately, today, “maternal mortality is unacceptably high. About 295,00 women died during and following pregnancy and childbirth in 2017. The vast majority of these deaths (94%) in low-resource settings and most could have been prevented” (WHO, 2017).

Surprisingly, Sub-Saharan Africa and Southern Asia accounted for approximately 86% (254,000) of the estimated global maternal deaths in 2017. And sub-Saharan Africa alone accounted for roughly two-thirds (195,000) of maternal deaths (WHO, 2017).

The NGO on A Mission to End Newborn & Maternal Mortality In Africa by 2063 Youth Rise International (YoRI), is a legally-registered and government-licensed grassroots non-profit organization in Ghana that fights the intersection of extreme poverty and neo-natal, infant and maternal mortality (NIMM) has spent the past 7 years ensuring that no mother or child dies before, during and after childbirth.

In 2018, Youth Rise International (YoRI) embarked on a series of deep individual, family, community and stakeholder engagement in the Western and Central Region of Ghana.

We were interested in discovering the root causes of NIMM in rural communities in Ghana. Also, we wanted to document the communities’ response to the practical solutions to NIMM or what every pregnant woman needs in order to prevent losing their life and/or that of their newborn during and after childbirth.

Interesting discoveries were made and through those, Youth Rise International (YoRI) designed and rolled out the implementation of the ‘Zero Newborn and Maternal Mortality’ project in partnership with government hospitals, CHIPS Compounds and community stakeholders in 2019).

In this feature article, I have generously shared with you the 5 practical and grassroots-driven support every pregnant woman needs to avert newborn and maternal mortality before, during and after childbirth. To this end, every pregnant woman needs:

1. Cash To Maintain Good Health

Through those participatory engagements, we discovered that the top root cause of NIMM was extreme poverty and economic hardship in families.

This dire situation was fuelled by climate change and its resulting impacts on the loss of family life as well as high unemployment rate.

It is common knowledge that pregnancy comes with a high level of routine expenses. Therefore, the family needs money to ensure that the pregnant woman eats well in order to achieve the right hemoglobin (HB) level as well as for the child to develop well.

Also, almost every month, the family needs cash to pay for scans, laboratory tests, injections, drugs and other bills during the Ante-natal clinic (ANC).

Moreover, pre-and-post-delivery items such as baby clothing needed to warm the newborn within the first weeks of delivery are required. This is very critical because, if the baby is not well clothed, it can die of pneumonia.

Therefore, they requested short-term cash support to address those inevitable costs over and above what they are able to pay from their meagre and unstable family income stream.

So, in the short-term, Youth Rise International (YoRI) pays directly to hospitals and health centers the cost involved in those critical expenses in addition to providing baby clothing and mother care materials for pregnant women and nursing mothers.

This has resulted in sharp reduction in neo-natal, infant and maternal mortality in our project communities in Ghana.

2. Livelihood Support To Improve Family Income Sustainably

Climate change and unemployment has really caused much damage to the livelihoods of families in rural areas in Ghana. Most of these families have lost their jobs or experienced crop failure due to unpredictable, unreliable and fluctuating rainfall patterns induced my climate change.

As a result, pregnant women are not able to eat well, provide decent accommodation and secure protection against malaria which is a key cause of maternal and neo-natal mortality in Ghana. To cushion family income and assist poor families to regain their economic dignity, Youth Rise International (YoRI), empowers families economically. Over the past years, they have equipped families with alternative livelihoods such as vocational/skills training and micro-venture development.

As a result, families are able to diversify their income sources as a coping mechanism from external and internal economic shocks. In the end, families are able to afford decent meal, accommodation and prevent against malaria and pay for drugs for pregnant women, newborns and nursing mothers thereby averting mortality.

3. Ante-natal Clinic To Obviate Childbirth Complications

The World Health Organization (WHO) confirms that most neo-natal, infant and maternal mortality cases are preventable. The deep community and stakeholders’ engagement revealed that complications during childbirth is a leading cause of NIMM. Sadly, most of complications could have been avoided, if the pregnant woman has attended and followed the routine ANCs visits and reviews by midwives and medical doctors. How? When a pregnant woman attends ante-natal clinic (ANC), warning signs and potential complications are discovered early through scans and laboratory test.

Then treatment can be initiated by midwives and medical doctors. However, sadly, the communities engaged indicated that most pregnant women do not attend ANCs.

Youth Rise International’s (YoRI) team dived deeper to identify what accounts for the failure of pregnant women to attend ANC, though it’s critical to their lives and that of the fetus?

To our amazement, we identified issues such as ignorance (of the health implications of not attending the ANCs or patronizing the services of health facilities during pregnancy), access (difficulties in accessing ANC facility for families who lived in very remote and hard-to-reach rural communities in Ghana) and extreme poverty (their inability to pay for transportation every week/month and to cover expenses for scan, laboratory test, cost of drugs and other medical bills not covered by the National Health Insurance Scheme (NHIS).

To address this critical gap, Youth Rise International (YoRI) and its community partners such as Women In Distress Africa, Ghana Health Service and other faith-based organizations such as Elpis Chapel International have embarked on massive awareness-raising and sensitization campaigns.

What is unique about their strategy is that they leverage on the socio-ecological model, health belief model and innovation diffusion theory to design and disseminate the campaign messages targeting behaviour and social change.

The evaluation of this campaign has revealed life-transforming outcomes and it’s more sustainable. To address the extreme poverty and economic factors, the solution and strategies proffered above under the cash and livelihood factors suffice.



Today, majority of Ghana’s population live in the rural and remote areas. In those remote areas, culture, traditions and customs are really endemic and entrenched. Most of the indigenous people don’t accept the orthodox and modern medical care. They are used to resorting to herbs and medically unauthorized medication and health care.

This traditional system has heavily impacted the neo-natal, infant and maternal health space. For instance, from the deep community engagements, Youth Rise International (YoRI) discovered that in some of the communities, giving birth at a health facility was foreign. Rather, they encouraged pregnant women to give birth at home. Also, they don’t trust orthodox medicine.

As such, even when pregnant women receive drugs after attending ANC, they still have to use herbals and local concoctions which in most cases contradicts the impacts of orthodox medications.

The most worrying of all, is the practice of pregnant women giving birth at home or the house of a traditional birth attendants (TBAs).

These TBAs are untrained, unprofessional and used strange tools and devices which are not sterilized for labour.

They have contributed to high rate of neo-natal, infant and maternal mortality in rural Ghana especially because, in most cases, pregnant women are unduly delayed and complications heightens before referring them to a hospital or health center for proper medical care.

To lead behaviour and social change, Youth Rise International (YoRI) and its partners designed the Health Communication for Social Change Campaign.

Through this campaign, series of community awareness, sensitization and dialogue with custodians of culture and traditions and community leader to re-imagine culture and the health of the indigenes.

Through strong negotiations and dialogue, significant modifications and integration of modern ideas concerning the health and protection of women, children and men in rural communities have been achieved.

This has contributed to significant reduction of the rates of neo-natal, infant and maternal mortality in those communities.

5. Quality Health Service Provision

It is undeniable fact that pregnant women and their families play a role in preventing neo-natal, infant and maternal mortality as well as the local community.

However, the health system plays the most critical role. Through the deep and participatory community engagement, we discovered that some of the health workers were not helpful.

Many pregnant women, indicated, they chose not to attend ANCs due to the poor attitudes and reception by health workers such as nurses and mid-wives.

According to them, some health workers were rude towards them, caused unduly delays in the health service delivery and prioritized care and service to pregnant women from rich and wealthy families. Undeniably, this is unfair, unprofessional and discriminatory.

To address this issues, Youth Rise International (YoRI) and its partners such as Women In Distress Africa and Elpis Chapel International have embarked on dialogues with health workers and we are pushing for professional ethics and customer service training for all health workers especially those at the frontline with priorities given to nurses, midwives and pharmacist.

We are excited that such strategic approach has begun producing amazing results and contributing to the reduction in the rate of neo-natal, infant and maternal mortality in Ghana.

2. Livelihood Support To Improve Family Income Sustainably

Climate change and unemployment have really caused much damage to the livelihoods of families in rural areas in Ghana. Most of these families have lost their jobs or experienced crop failure due to unpredictable, unreliable and fluctuating rainfall patterns induced by climate change.

As a result, pregnant women are not able to eat well, provide decent accommodation and secure protection against malaria which is a key cause of maternal and neo-natal mortality in Ghana. To cushion family income and assist poor families to regain their economic dignity, Youth Rise International (YoRI), empowers families economically. Over the past years, they have equipped families with alternative livelihoods such as vocational/skills training and micro-venture development.

As a result, families are able to diversify their income sources as a coping mechanism from external and internal economic shocks. In the end, families are able to afford decent meals, accommodation and prevention against malaria and pay for drugs for pregnant women, newborns and nursing mothers thereby averting mortality.

3. Ante-natal Clinic To Obviate Childbirth Complications

The World Health Organization (WHO) confirms that most neo-natal, infant and maternal mortality cases are preventable. The deep community and stakeholders’ engagement revealed that complications during childbirth are a leading cause of NIMM. Sadly, most complications could have been avoided if the pregnant woman has attended and followed the routine ANC visits and reviews by midwives and medical doctors. How?

When a pregnant woman attends an anti-natal clinic (ANC), warning signs and potential complications are discovered early through scans and laboratory tests.

Then treatment can be initiated by midwives and medical doctors. However, sadly, the communities engaged indicated that most pregnant women do not attend ANCs.

Youth Rise International’s (YoRI) team dived deeper to identify what accounts for the failure of pregnant women to attend ANC, though it’s critical to their lives and that of the fetus.

To our amazement, we identified issues such as ignorance (of the health implications of not attending the ANCs or patronizing the services of health facilities during pregnancy), access (difficulties in accessing ANC facilities for families who lived in very remote and hard-to-reach rural communities in Ghana) and extreme poverty (their inability to pay for transportation every week/month and to cover expenses for scan, laboratory test, cost of drugs and other medical bills not covered by the National Health Insurance Scheme (NHIS).

To address this critical gap, Youth Rise International (YoRI) and its community partners such as Women In Distress Africa, Ghana Health Service and other faith-based organizations such as Elpis Chapel International have embarked on massive awareness-raising and sensitization campaigns.

What is unique about their strategy is that they leverage on the socio-ecological model, health belief model and innovation diffusion theory to design and disseminate the campaign messages targeting behaviour and social change.

The evaluation of this campaign has revealed life-transforming outcomes and it’s more sustainable. To address the extreme poverty and economic factors, the solution and strategies proffered above under the cash and livelihood factors suffice.



Today, majority of Ghana’s population lives in rural and remote areas. In those remote areas, culture, traditions and customs are really endemic and entrenched. Most of the indigenous people don’t accept orthodox and modern medical care. They are used to resorting to herbs and medically unauthorized medication and health care.

This traditional system has heavily impacted the neo-natal, infant and maternal health space. For instance, from the deep community engagements, Youth Rise International (YoRI) discovered that in some of the communities, giving birth at a health facility was foreign. Rather, they encouraged pregnant women to give birth at home. Also, they don’t trust orthodox medicine.

As such, even when pregnant women receive drugs after attending ANC, they still have to use herbals and local concoctions which in most cases contradicts the impacts of orthodox medications.

The most worrying of all is the practice of pregnant women giving birth at home or the house of Traditional Birth Attendants (TBAs).

These TBAs are untrained, unprofessional and used strange tools and devices which are not sterilized for labour.

They have contributed to high rate of neo-natal, infant and maternal mortality in rural Ghana, especially because, in most cases, pregnant women are unduly delayed and complications heighten before referring them to a hospital or health center for proper medical care.

To lead behaviour and social change, Youth Rise International (YoRI) and its partners designed the Health Communication for Social Change Campaign.

Through this campaign, series of community awareness, sensitization and dialogue with custodians of culture and traditions and community leaders to re-imagine culture and the health of the indigenes.

Through strong negotiations and dialogue, significant modifications and integration of modern ideas concerning the health and protection of women, children and men in rural communities have been achieved.

This has contributed to a significant reduction in the rates of neo-natal, infant and maternal mortality in those communities.

5. Quality Health Service Provision

It is undeniable fact that pregnant women and their families play a role in preventing neo-natal, infant and maternal mortality as well as the local community.

However, the health system plays the most critical role. Through deep and participatory community engagement, we discovered that some of the health workers were not helpful.

Many pregnant women, indicated, they chose not to attend ANCs due to the poor attitudes and reception by health workers such as nurses and midwives.

According to them, some health workers were rude towards them, caused unduly delays in the health service delivery and prioritized care and service to pregnant women from rich and wealthy families. Undeniably, this is unfair, unprofessional and discriminatory.

To address this issue, Youth Rise International (YoRI) and its partners such as Women In Distress Africa and Elpis Chapel International have embarked on dialogues with health workers and we are pushing for professional ethics and customer service training for all health workers especially those at the frontline with priorities given to nurses, midwives and pharmacist.

We are excited that such strategic approaches have begun producing amazing results and contributing to the reduction in the rate of neo-natal, infant and maternal mortality in Ghana.

Conclusion

Today, the rate of neonatal, infant and maternal mortality is rising high at the global, regional and national levels. Through such a deep and participatory engagement, Youth Rise International (YoRI) discovered the root causes that drive such violations of human rights and the perpetuation of social injustice against pregnant women and their families.

To this end, to prevent such gross loss of lives, every pregnant woman and their family needs cash, livelihood, ante-natal care and mindsets and behaviour change.

Also, there is an urgent call to strengthen Ghana’s health system especially shaping the attitudes of health workers with a special focus on nurses, midwives and pharmacists who serve as the front-liners in hospitals, clinics and health centers.