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Saving Mothers and Their Children CCP sets out to determine why there are so many dying in childbirth in Nigeria -- and how to reverse the trend

The most populous country in Africa, Nigeria has seen improvements in maternal, newborn, and child health and nutrition indicators in recent years. But despite this progress, 13 percent of child deaths worldwide occur here. And one Nigerian woman dies every 13 minutes – that's 109 women dying each day – from preventable causes related to pregnancy and childbirth.

The Johns Hopkins Center for Communication Programs-led Breakthrough ACTION project, USAID's flagship social and behavior change initiative, is charged with improving a number of health outcomes in Northern Nigeria, including maternal and child health, nutrition and family planning.

The big question is this: How can we make the radical change necessary to save mothers and their babies? In our search for answers, we used a human-centered design approach, interviewing more than 290 people in Bauchi, Kebbi and Sokoto states in late 2018. CCP was assisted in this massive undertaking by ThinkAction and Save the Children.

We talked to people in their homes, their workplaces, in health facilities, even in social settings. We talked to pregnant women, their mothers-in-law and husbands, traditional birth attendants, health providers and religious and traditional leaders.

What we learned -- and how we incorporate these insights into our work -- could fundamentally change the lives of women and their children in Northern Nigeria.

As part of the human-centered design process, we gained a great appreciation for how religious, traditional and modern practices impact newborn care in this part of the world. We learned that women rarely receive medical care following the birth of their babies and that most babies are not delivered in health facilities. Instead, they are born at home, where complications can have deadly consequences.

In many localities, medical services for pregnant women about to give birth are unavailable or are of poor quality.

Here is one of the health providers we met. She has several years of experience. But despite her skills, her facility has limited supplies necessary when delivering babies.

In fact, women must bring their own gloves, antiseptic and buckets with them when it's time to deliver, she told us. And the facility itself is often far away from many of the people it is intended to serve, another barrier to improving health in the community.

This woman is a mother of five. She delivered her first child at home, when her family refused to let her to go to the health facility. After that, she insisted.

At the clinic, when her second child was born, she was encouraged to eat healthy foods and she noticed after how well she felt and how healthy her child was. Now, she shares that advice with her co-wives and other mothers so they, too, can have healthy children.

Unfortunately, affording healthy food is often a challenge.

This woman's story was difficult to hear. She has delivered seven children, but lost three of them soon after. The most recent was due to a health system failure.

The story is this: When this woman was in labor, the clinic where she had been seen for pre-natal care was closed. It doesn't have a night shift. So she went to another hospital. There, she was turned away because wasn't registered to deliver at that facility. She returned home and lost her child during delivery there.

She would like to have more children but she has lost trust in the health system.

Another insight from the Breakthrough ACTION Nigeria team: Religious and traditional beliefs are highly valued and strongly influence how maternal and child health is practiced.

Take this grandmother.

She cares deeply about her family and enjoys helping her daughters-in-law during pregnancy and when they delivery at home. But she prohibits the new mothers from breastfeeding until the milk is white (about three days after birth). Until that time, the baby is given water.

Medical experts widely agree that newborns shouldn't be given water, instead beginning to breastfeed as soon as possible after birth. But this grandmother's traditional beliefs run counter to that and she is the one whose beliefs matter here.

Another insight gleaned by team: Parents in this part of Nigeria are aware of the need for good food, but do not understand the impact of nutrition on child development or how they can improve it given resource limitations.

This man and his wives have 12 children. He is motivated to be successful and provide for his family, but he has limited knowledge of nutrition and how to keep his children healthy. Inconsistent harvests from his farm make matters worse, scrambling the best of intentions.

Armed with these and other insights, the Breakthrough ACTION Nigeria team is generating ideas, designing messages and testing interventions. Their goal is to find a way to reduce the number of mothers and children who needlessly die in Northern Nigeria.

This work is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the Breakthrough ACTION Cooperative Agreement #AID-OAA-A-17-00017. Breakthrough ACTION is based at Johns Hopkins Center for Communication Programs (CCP). The contents of this presentation do not necessarily reflect the views of USAID, the United States Government, or Johns Hopkins University.

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