The Value of Midwives: CHS Program Selected by Ecuadorean Government for National Scale-up

Maternal and infant mortality is a serious problem in Ecuador. In 2011 alone, 241 women died from pregnancy complications and 3,046 children died before their first birthday, according to figures from Ecuador’s National Institute of Statistics and Census.

To combat this trend, the Ecuadorian government is expanding the Essential Obstetric and Newborn Care (EONC) Network program that the Center for Human Services (CHS) launched in 2009 with funding from the US Agency for International Development.

CHS piloted the EONC (also known as Cuidados Obstétricos Neonatales Esenciales, or CONE program) to ensure access to essential maternal and newborn health care services for some of Ecuador’s poorest populations. The model includes home- and facility-based care by trained traditional birth attendants (TBAs) and skilled providers immediately following childbirth. Initially focused in the province of Cotopaxi, the program will be rolled out to all of Ecuador starting this year.

Dr. Jorge Hermida, CHS Director in Ecuador, explains that Cotopaxi was chosen because its population of about 390,000 is predominantly rural, indigenous and destitute. In the year CHS started the pilot, seven Cotopaxi women died in childbirth and 52 children died in their first year of life.

Even these startling numbers are likely underestimates. "The midwives told us about the deaths of newborns whose family did not even inform the community," said Dr. Mario Chavez, CHS Project Field Coordinator. "We were shocked because we found underreporting of more than 100%."

CHS began working with TBAs in the province to create a network of essential obstetric and neonatal care. "It seemed logical to go to the health worker who was already in the communities; there was no need to create something that already existed or to force something that communities were not used to," Dr. Hermida reported.

After identifying and training 200 TBAs in Cotopaxi, health facility deliveries increased by 25% and postpartum care for mothers and newborns by 45%. The key was getting TBAs to work with medical staff to monitor the progress and care of their patients, and also teaching the TBAs to identify risk factors for complicated cases to be treated in the health facilities. 

Respecting the wisdom of TBAs was a priority of the CHS initiative. "Yes, there are ways to build bridges, and not take away your worldview," Dr. Chávez noted. He added that CHS allowed TBAs to use alternative medicine that was considered appropriate, such as natural infusions, but worked to ensure that women with pregnancy complications received care in health centers.

Throughout Ecuador, TBAs and local health workers remain an essential element of health services for pregnant women and their children. Building on CHS’s groundwork, Ecuador’s Ministry of Health is working to integrate these essential connections to local populations into the larger health system, reducing rates of maternal and infant mortality and improving the quality of life for all Ecuadorians.

See the article featuring this work in El Pais (in Spanish) here.

Date 
March 04, 2014
Authors 
Yvette Castro-Green, Program Development Consultant and Rebecca Oser, Director of Communications
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