Shifting Power in Practice: The Importance of Contextual and Experiential Evidence in Guiding MCH Decision Making

Abstract

Background Evidence is central to all maternal and child health (MCH) decision-making processes, continuously interacting with and influencing our work. There is a growing emphasis in MCH on using evidence-based approaches when addressing public health challenges, but the field lacks a unified understanding of what constitutes evidence. MCH must operate from an expansive understanding of evidence that centers community voice and acknowledges the role of evidence prioritization in achieving equitable population-level outcomes. Call to Action What we consider valid evidence has immense implications for MCH practice, including whose work is deemed worthy of funding and replication. The authors advocate for shifting the field’s evidence paradigm from being primarily focused on research findings to also recognize the importance of community-rooted evidence. Contextual and experiential evidence, alongside research evidence, should be considered for two purposes: (1) to support the effectiveness of a given practice generally, and (2) to support that the practice will work in specific contexts. Putting this shift into practice requires explicit power shifting – the MCH workforce must cede power to those who have been historically barred from participating in and guiding research. To facilitate this, MCH professionals must build skills in communication, equitable leadership, and change management. Conclusion The MCH workforce should position communities to set their own priorities and define, develop, and disseminate evidence representative of their priorities. Evidence co-creation is key to establishing and sustaining transformative relationships between community members and Title V programs, shifting power structures to build upon existing community leadership and assets.

Utilizing rapid qualitative assessment and thematic analysis methods to identify and share promising case investigation and contact tracing practices with people in refugee, immigrant, and migrant communities during COVID-19

“…Moreover, evaluation and measurement of innovative and rapidly adapted promising practices are an key to understanding what programs deem as successful. Thus, the promising practices disseminated by NRC-RIM, may not yet be identified as “evidence-based,” have the potential to be key components of a community-centered public health emergency response ( 35 , 36 ), ultimately promoting innovative, community-driven practices (often already feasible and acceptable within communities), with the potential for sustainability, and an opportunity for future evaluation ( 37 ).…”

Translating lessons to reinforce national stillbirth response; multi-stakeholder perspectives regarding priorities and opportunities to deliver quality evidence-based interventions within a limited-resource context in Uganda

“…There is a growing need to assess the effectiveness of these evidence-based interventions such as data quality improvements and maternal and perinatal death reviews among others in supporting response to the stillbirth burden [ 17 ]. Perspectives from stakeholders have long been valued as a crucial component of the feedback loop for health systems including such platforms as joint review missions [ 18 , 19 ].…”