Maternal Health in Tanzania
Pregnancy and childbirth can be a tremendously exciting time for a family if the expectant mother and her unborn child benefit from quality medical services and the baby is delivered in a safe environment. However, it can also be a traumatizing experience if the mother loses her life during childbirth or if the newborn is sick or dies.
In Tanzania many mothers and mothers-to-be are dying young and unnecessarily as illustrated by the following statistics:
- Tanzania's maternal mortality ratio is estimated at 460 deaths per 100,000 live births (in 2010); 8,500 women are dying every year because of pregnancy or childbirth.
- Maternal mortality has declined since 2005 (from around 610 deaths per 100,000 live births), but progress has been much slower than with child mortality.
- Tanzania's maternal mortality ratio also appears high compared to other countries, such as India (200), Kenya (360), Ethiopia (350) or Senegal (370).
The broader problems caused by poor reproductive health are far greater than what is suggested by these mortality statistics. For every maternal death, many more women suffer from pregnancy- or childbirth-related impairments, often with long-term negative impacts on their health and labor force participation. And of course, maternal health is closely linked to the wellbeing of newborn children.
A major factor behind the high levels of maternal mortality in Tanzania is the insufficient utilization of reproductive healthcare services:
- While the World Health Organization recommends that pregnant women (without complications) should have at least four visits to an antenatal care provider, 57% of Tanzanian women had fewer visits in 2010.
- 56% of rural and 17% of urban births were delivered at home, rendering advanced medical treatment difficult to access in case of complications. In the poorest quintile almost two-thirds of births occurred at home.
- In 2010 alone, around 900,000 births (49%) were not attended by a skilled provider: 15% of births were attended only by a traditional birth attendant, 29% were attended only by relatives or friends and just above 3% of births (more than 60,000) were delivered without any assistance.
This underutilization of reproductive health services is related to poor accessibility and the cost associated with seeking care. Another yet related reason is the poor quality of reproductive health services. In 2010, only around half of the women (53%) who received antenatal care were informed about potential pregnancy complications. Unlike healthcare needs of children, which are often addressed through large-scale immunization campaigns and other programs, reproductive healthcare needs are addressed through the general healthcare system, which suffers from the well-known problems of weak staff incentives, poor accountability and inadequate service delivery.
All of this raises the following questions:
- What are the most important factors deterring women from seeking antenatal care and delivering their babies at hospitals? Distance? Road infrastructure? Cost? Poor quality of service? Tradition? Desire?
- Can better education for girls reduce maternal mortality? Or would it be more effective to offer expectant mothers financial incentive to seek pre- and post-natal care?
- How can the quality of maternal health services be improved? Through incentive-based pay for healthcare personnel? Better equipped facilities?
- Is maternal health mainly the responsibility of the women themselves? What is the role of their husbands?
- Should Government step up family planning programs to further reduce fertility and the risk of mothers dying during childbirth?
The Workshop
In this workshop we will explore motherhood. What does it mean, what does it entail, what is important about becoming a mother, having a mother? We will facilitate a broad discussion on motherhood that will lead to questions about maternal health and mortality. The multiple goals include: raising awareness about maternal health; sharing ideas about problems mothers face (during pregnancy, delivery, and shortly after); using art/imagery to voice perspectives/views; produce an arts exhibition to share with community; to create document to share with material health professionals.
- Day 1: After a brainstorming session about the concept of motherhood, we will then train participants on using the cameras and show examples of images and digital storytelling. We will provide participants with information on what the goals of their photo-taking will be. Participants are then free to begin the photo process.
- Day 2: After discussions we will pose some questions about maternal health and mortality that will be both informative for workshop participants and will assist in answering some of the important questions above. In small groups participants will discuss their images, goals, and hear those of others. We will then engage in one-on-one conversations to select images, organize and add text materials.
- We will then present a final exhibition of the work. It could happen this day or on a 3rd day — in the community if possible to start a larger conversation.
A goal of the project will be to share this information (with the requisite confidentiality and consent given) with maternal health specialists who will be able to use results of the workshop to further create policy and programs that makes sense to Zanzibari women and families.
Additionally, the workshop will bring together all interested people — men and women, young and old alike, with youth from the area and youth from the US.
Methods
Participants are asked to represent their community or point of view by taking photographs and digital storytelling methods, discussing them together, developing narratives to go with their photos, and conducting outreach or other action. It is often used among marginalized people, and is intended to give insight into how they conceptualize their circumstances and their hopes for the future.
As a form of innovative participatory community consultation, PhotoVoice attempts to bring the perspectives of those "who lead lives that are different from those traditionally in control of the means for imaging the world" into conversation so that they have the opportunity to represent themselves and create tools for advocacy and communication to achieve positive social change. It is also a response to issues raised over the authorship of representation of communities.
Through this workshop individuals and communities gain tools and opportunities to create knowledge, understanding and imagery about the issues that are affecting them. By creating alternatives to mainstream modalities of expression, individuals are facilitated to speak, be heard and be seen having previously been excluded. In international development research, this methodology also enables participants from the developing world to define how they want to represented outside of their country — namely to the international community. Facilitating individuals to tell their stories and to have control over that process, enables them to maintain a firm authorship over their representation and helps to convey a fuller picture of what it means to live in a developing country beyond stereotypes.
Equipment
Cameras, compact printers, ink, printing paper, collage paper, exhibition materials, computers, note books, pens, tape.
The majority of the equipment will be supplied by the students of The College of New Jersey. Support for the purchase of additional supplies would be appreciated but if not possible we will try to find a way to get all that we need.