Addressing the First Delay in Saving Mothers, Giving Life Districts in Uganda and Zambia: Approaches and Results for Increasing Demand for Facility Delivery Services

Abstract

The Saving Mothers, Giving Life initiative used 3 coordinated approaches to reduce maternal deaths resulting from a delay in deciding to seek health care, known as the “first delay”: (1) promoting safe motherhood messages and facility delivery using radio, theater, and community engagement; (2) encouraging birth preparedness and increasing demand for facility delivery through community outreach worker visits; and (3) providing clean delivery kits and transportation vouchers to reduce financial barriers for facility delivery. These approaches can be adapted in other low-resource settings to reduce maternal and perinatal mortality.

Did Saving Mothers, Giving Life Expand Timely Access to Lifesaving Care in Uganda? A Spatial District-Level Analysis of Travel Time to Emergency Obstetric and Newborn Care

“…According to exit interviews at EmONC facilities conducted at the conclusion of Phase 1, 90% of women used motorized transportation to reach the EmONC where they delivered 53 . Additionally, SMGL implementing partners supported the use of motorized transportation through “boda-for-mothers” vouchers—private-service vouchers that included subsidized motorcycle transport—and organized a district ambulance network that included 5 4-by-4 ambulances and 16 eRanger tricycle ambulances at facilities 20 , 21 . Linking ambulances through a district network allowed the closest ambulance to the emergency to be assigned for timely referral of mothers and newborn babies with complications 53 .…”

<p>Adolescent Pregnancy and Parenting: Perceptions of Healthcare Providers</p>

“…Home visits and community outreach services have been acknowledged in the literature as crucial to public health interventions, especially in maternal child health programmes. 48 Support groups are also strategic in helping pregnant and parenting adolescents who are often isolated and stigmatised. 49 The use of traditional healthcare is prevalent in sub-Saharan Africa, 44 and thus engagement with traditional healers is important in harnessing their role in efforts to enhance the care of pregnant and parenting adolescents.…”

Sustainability and Scale of the Saving Mothers, Giving Life Approach in Uganda and Zambia

“…While not unique to SMGL, the scale of distribution of birth plans, mentoring of health workers to use the birth plans for counseling, and systematic inclusion in the package of support for safe motherhood made the tool a routine part of facility outreach and counseling and, as demand for services increased, was appreciated and requested by expecting mothers and facility staff. District MOH leadership in Zambia, recognizing the importance of the plans, committed to continued printing and distribution beyond SMGL 24 …”