Global Birth Models
by Kay Sandberg and Shane Carnahan

[Editor’s note: This article first appeared in Midwifery Today, Issue 114, Summer 2015.]

Overview of Effective Global Birth Models

According to the World Health Organization (WHO), approximately 800 women and 8200 newborns die daily from preventable causes related to pregnancy and birth. Ninety-nine percent of these deaths occur in resource-limited global settings, and an estimated 90% could be avoided by proper care and nutrition before, during and after birth (World Health Organization May 2014).

The overarching goal of the Healthy, Compassionate Birthing Project, the flagship project of the Global Force for Healing and of each participating group is to dramatically reduce the number of preventable deaths among mothers and newborns, and to honor the power of love and compassion in the intimate setting of birth. We believe that birth, including the time period leading up to the event and the weeks immediately following, is a human’s first opportunity to experience unconditional love. Since love is a hologram, every loving birth extends love and healing to a much wider circle—parents, communities and the planet. In short, “As we are in birth, so we are with Mother Earth.” By modeling practices of gentle, loving birth, “birthkeepers” are simultaneously helping to heal the earth.

In order to fully grasp the “secret sauce” of each model, [five key factors] combined with other innovative aspects will paint a picture of what has been effective and why.

The Healthy, Compassionate Birthing project is in service to the United Nations Millennium Development Goals (MDG) established in 2000, to be achieved by the end of 2015. Goals 4 and 5 are to reduce infant deaths worldwide by two-thirds over 1990 levels and to reduce global maternal deaths by three-fourths over 1990 levels. While great progress has been made in many countries, many underserved populations are not likely to meet these targets, especially without the global community stepping up its efforts. We have included individual program initiatives to fulfill the MDGs to the extent the executive directors speak about their own work in these terms.

Purpose of This Article

The purpose of this article is to highlight effective organizational models for healthy childbirth in order to provide guidance, inspiration and ideas that may be useful to other cultural environments. It is our hope that by articulating why these organizational models have been successful, others may avoid reinventing the wheel and better serve remote and indigenous, underserved communities.

Model Projects Featured

The four model projects and their primary locations are:

  • One Heart World-Wide—Nepal; formerly in Tibet and Mexico; technical assistance to projects in Ecuador, Peru and Mexico (oneheartworld-wide.org)
  • Yayasan Bumi Sehat—Bali and Aceh, Indonesia, the Philippines (Bumi Wadah); formerly in Haiti (bumisehatbali.org)
  • Mother Health International—currently in Northern Uganda, training midwives in Haiti and advising the government of Guinea; formerly in Senegal (motherhealth.org)
  • CASA—Mexico; trains Mexican and global midwives (empowercasa.org)

It is especially noteworthy that all communities served by these projects have experienced dramatically lower maternal and infant mortality rates that far surpass each country’s national mortality and morbidity rates, due in large part to the remarkable work of these organizations and their dedicated staff, volunteers and donors.

One Heart World-Wide is an organization with 17 years of experience implementing maternal and newborn mortality prevention programs in remote rural areas of the world. The mission of OHW and the Network of Safety model is to reduce maternal and neonatal mortality in rural areas of the world by ensuring that all women have access to competent prenatal care and a safe, clean delivery.

Bumi Sehat Foundation’s model is focused on, and well-suited to, sending midwives to respond to natural disasters, such as the earthquake in Haiti in 2010, the tsunami in Aceh, Indonesia, in 2004, and Typhoon Haiyan in 2013, which devastated parts of the coastal Philippines. The volunteers have been early responders over the last 10 years, applying wisdom gleaned from providing midwifery and holistic health services for underserved families in Bali, Indonesia, for more than 20 years.

Mother Health International has achieved an admirably sustainable model of care. For example, the birth center in Atiak, Uganda, has been constructed with dedication to the preservation of natural resources. Their Earth Birth Center model is actively working toward financial sustainability in a number of ways, including selling items crafted by new mothers who also maintain a garden that feeds laboring and postpartum women. Mother Health demonstrates its commitment to the preservation of cultural traditions by advocating for the active involvement of traditional Ugandan midwives in all births.

CASA (Centro Para los Adolescentes de San Miguel de Allende) has created an exemplary model of midwifery education, with proven effectiveness in training midwifery professionals who demonstrate a high level of care and professionalism while offering mothers and families culturally sensitive support.

All projects embody the midwifery model of care, meaning woman-centered, gentle, non-invasive approaches, which view birth as a natural process. The midwifery model is based on a deep respect for women’s voices and choices in childbirth. That said, not all projects rely on midwives. In fact, the birthing professional may be a birth attendant, a physician or a community health worker. These choices are based on the practicality of what works best and is most realistic given the remote regions where services are delivered. We hope to bridge any gaps in understanding and contribute to a climate of mutual respect among birthing professionals participating in the biomedical (modern medicine) framework as well as those who operate independent of it.

Key Factors Shared by Featured Projects

We have chosen five key factors that cut across all projects featured. All of these key ingredients are aimed at reducing maternal and neonatal mortality rates. In order to fully grasp the “secret sauce” of each model, the five factors combined with other innovative aspects will paint a picture of what has been effective and why.

  • Sustainability—the ability to meet basic commitments and needs on an ongoing basis for the communities in which they work. Note that the ability to be self-sustaining is a goal of some projects and a fulfilled promise for others at this point in time.
  • Cultural Sensitivity—a commitment to working in harmony with, and appreciation for, local cultural traditions, rituals and organizational structures, often as a result of years of research prior to project inception, and always based on respectful learning from and responsiveness to requests by community leaders and birthing mothers themselves.
  • Respectful Care—dedication to universal rights of childbearing women to high-quality maternity and newborn care, and to avoiding the disrespect and abuse of women that sometimes occurs in resource-poor settings. Some projects featured subscribe to the International MotherBaby Childbirth Initiative’s “10 Steps to Optimal MotherBaby Maternity Services” (imbci.org), which we also endorse.
  • Competency in Care—each project adheres to clear standards for training birth professionals and for the services they provide. Each focuses on ensuring consistent practices, attitudes and behaviors that are life-affirming and that reflect the highest quality of care for mother and baby.
  • Love and Compassion in Action—by the way of being with birthing families, communities, staff and volunteers, each project embodies its own unique expression of love and compassion. Even if not stated in published documents or performance guidelines, love is at the core of what these projects are accomplishing, starting with the attitudes of the founders/executive directors. Expressing love and compassion in action is also the guiding purpose of the Global Force for Healing and a hallmark of our projects.

Common Challenges

  • Ability to be financially sustainable in order to maintain current commitments and expand beyond present locations; there is an ongoing need for materials, funding for key staff and transportation.
  • Bias against traditional ways of giving birth on the part of “modern” medical providers.
  • Lack of local, state and national government support for the profession of midwifery.
  • Challenges in creating structures that serve all and are affordable, accessible and welcoming; it is often also difficult to remain fully staffed.
  • Communication linkages with remote locations, both during birth emergencies and for staff on an ongoing basis.
  • Remoteness of the rural location in and of itself often presents many logistical challenges for project staff and birthing mamas.

Future Possibilities

Through further collaboration within the network, expansion of alliances with other nongovernmental organizations (NGOs) and public-private partnerships, all of the birth model projects hope to become self-sustaining, if they are not already, and to thrive. This includes expansion of the number of birthing houses in countries where projects now work, extending services to include full-spectrum continuity of care (for example, integrating family planning where there are no existing programs) and fulfilling the missions of founders with all their uniqueness and commonalities.

Other Promising Models in Process

Other organizations in earlier stages of development are also providing valuable services based on the midwifery model of care in Africa, Asia, and South America. The list includes four members of Global Force for Healing’s Healthy, Compassionate Birthing network:

Gratitude

We are very grateful to the executive directors and staff of the four organizations featured here, who generously offered suggestions for this and future articles. We also offer gratitude to the co-authors of Birth Models That Work, a primary text and inspiration for this article. Finally, this article is dedicated to the courageous women around the world who risk death each time they give life.


Yayasan Bumi Sehat: Healthy Mother Earth Foundation

Gentle birth heals Mother Earth. —Robin Lim

When Robin Lim’s sister died from complications with her third pregnancy, Robin, her husband and their children left their home in Hawaii and relocated to Bali, Indonesia. She decided to use this difficult time in her life as an opportunity to become part of the solution to the tragedy of women dying while giving life. Ibu “Mother” Robin, who has eight children herself, started volunteering to help midwives in Bali in 1994. After strong encouragement, Robin decided to become a certified professional midwife via the North American Registry of Midwives (NARM). In 2003, she and many concerned Balinese went on to open a birth clinic for Bali’s underserved called Yayasan Bumi Sehat (Healthy Mother Earth Foundation).

Yayasan Bumi Sehat’s Mission and Model

Currently, Yayasan Bumi Sehat Foundation International, a 501(c)(3) nonprofit foundation, operates two birth centers in Indonesia, in Aceh and Ubud, located on the island of Bali. A third center was recently opened in the heart of the Philippine disaster zone, Dulag, in the aftermath of super-typhoon Haiyan (2013). The clinic in Aceh was founded in 2005 in response to the devastating tsunami that killed so many in December 2004.

The mission of these centers and the foundation behind them is “to provide access to quality health care to families and kind, hygienic and culturally appropriate childbirth to traditionally under-represented populations.” To fulfill this mission, Bumi Sehat provides health services, emergency care, environmental and disaster relief programs.

Bumi Sehat offers a model of cost-effective, loving care that encourages replication. Services are free (donations are accepted by those who are able to pay), and patients are never turned away, including those not accepted by other health care facilities. Everyone receives the same loving, hygienic, evidence-based medical care. The model is unique because it offers holistic (blending allopathic and alternative/complementary) care and integrated community programs unified by the foundational goal of providing all people access to a safe, loving world. The large volume and range of global services—more than 500 births and 20,000 health consultations annually at the original clinic in Bali alone—and the ability to be early responders to natural disasters, including a tsunami (Aceh), an earthquake (Haiti), and the largest typhoon to make landfall in recorded human history (central Philippines), are truly remarkable.

Bumi Sehat’s Response to the United Nations Millennium Development Goals for 2015

Most of us are aware of the United Nations Millennium Development Goals and the target of fulfillment by the end of 2015. Team Bumi Sehat is most involved with attaining Goals 4, 5 and 6.

With regards to Goal 4, reducing the child mortality rate (the global goal is a two-thirds reduction over 1990 levels), the following facts are relevant:

  • Infant and under-five mortality rates in Indonesia are 25 and 29 deaths per 1000 live births, respectively (per unicef.org).
  • Sixty percent of infant deaths occur during the first month of life (neonatal period), and eighty percent of child deaths occur in infancy, from birth to age 1 (The World Bank 2014).
  • Infant mortality rates are highest among children whose mother gave birth at age 40 or older, had three or more children and who became pregnant after a birth interval of less than 24 months (Indonesian Ministry of Health 2013).
  • Infant mortality rates are higher in rural areas, where mothers have no education and children are in the lowest wealth quintile (Indonesian Ministry of Health 2013).
  • Bumi Sehat has a breastfeeding rate of 100% at this time. The caregivers at Bumi Sehat are breastfeeding advocates because they know that in Indonesia, an infant who is fed infant formula is 300 times more likely to die in the first year of life than breastfed babies.

Goal 5 is aimed at improving maternal health (the global goal is a three-fourths reduction over 1990 levels). Maternal mortality rates in Indonesia are 190/100,000 (WHO).

By providing free general health care to resource-poor women and families, the model strengthens community and promotes a healthy start for children. In addition, Bumi Sehat has youth education programs and environmental programs, adding grassroots solutions to address even more of the UN Millennium Development Goals. Unfortunately, the world is not nearly close enough to reaching these goals, which advocate for the basic human right to decent health care.

Women and families come to Bumi Sehat to receive excellent prenatal care and to be supported by midwives throughout pregnancy, labor, delivery and the postpartum period. Women and children experience a continuity of care that is extremely rare for low-income groups worldwide. The nurses, doctors and midwives at Bumi Sehat have specific, unique and culturally sensitive programs for educating families in the areas of conscious conception, birth control, family planning, HIV/AIDS and other diseases, and caring for their children’s health. A new lab supported by Every Mother Counts and Sokasi Banten has opened to provide screenings for HIV, malaria, complete blood count (used to monitor for many health conditions) and anemia.

Additional programs available at Bumi Sehat include educating youth and providing scholarships for girls with dreams of becoming midwives and nurses. Human rights and equal care for all people are an integral part of the mission. In fact, there is a strong promotion of gender equality and women empowerment by the staff at Bumi Sehat as they work every day to reach the UN Millennium Development goals. All programs at their clinics also emphasize the importance of sharing love and compassion with the world.

Key Success Factors of the Bumi Sehat:
1. Experience Sustainability

Bumi Sehat works in partnership with local communities to improve the quality of life for each member, regardless of cultural/religious background or ability to pay for services provided. In their words: “We are devoted to working in partnership with people to improve the quality of life and to build peace—one mother, one child, one family at a time” (bumisehatfoundation.org). Local partnerships allow Bumi Sehat to implement important community-related environmental sustainability programs in Bali. Bumi Sehat Foundation International’s donor assistance allows them to implement a successful community recycling program. Several other environmental awareness programs and ecological initiatives have been put into place as well. For example, Bumi Sehat staff and volunteers practice organic farming and offer an Earth-friendly food supply.

Educating and engaging Balinese youth in growing food and saving seeds has the potential to eradicate food insecurity and provide a sound nutritional foundation for each person. Bumi Sehat has inspired programs like community gardens and recycling, which create community cohesion and encourage environmental responsibility.

2. Cultural Sensitivity

It is a strongly held belief at Bumi Sehat that all people are entitled to information and resources needed to improve their lives according to their own cultural principles and faith. A deep commitment to cultural sensitivity is vital to their work, whether it be in Indonesia, a country with a wide diversity of religious and cultural traditions, or in adapting rapidly to a new cultural milieu in places like Haiti after the earthquake in 2010 and most recently, coastal Philippines after Typhoon Haiyan in 2013.

3. Respectful Care

Bumi Sehat’s founder, Robin Lim, believes that peace begins at birth. By caring for babies and mamas with love and kindness, peace is nurtured, quality of life is improved and society moves toward this peace.

At Bumi Sehat Foundation International, the team provides kind and gentle care for women, providing choices and encouragement as these families traverse the path of parenthood. Kind and gentle care is also extended to babies, who are sung to at the time of birth by midwives and families. Babies are not separated from their mothers and umbilical cords are kept intact long enough to provide newborns with their full blood supply to prevent future problems.

4. Competency in Care

Bumi Sehat Foundation International offers an array of programs aimed at addressing child mortality. They provide free pediatric clinics and support for healthy pregnancies through high-quality care including prenatal check-ups, childbirth services, postpartum care and breastfeeding support.

All Bumi Sehat clinics are open 24 hours a day, 7 days a week. Providers at Bumi Sehat transport women in need to emergency facilities via ambulance, finding ways to pay for their care if the family does not have funds. Other services provided by Bumi Sehat include nutritional support, prenatal yoga, acupuncture and natural family planning.

In 2013, the clinic in Ubud completed construction on a building that serves as a laboratory for testing, research and data collection. This lab gives free confidential access to each mother to screen for sexually transmitted infections, HIV/AIDS, blood count workups relevant to pregnancy, and urinalysis. These tests help recognize potentially complicated situations and greatly reduce risks during pregnancy.

Bumi Sehat is committed to providing educational capacity-building programs aimed at encouraging community members to engage in peaceful practices to improve their lives and the lives of their families while caring for the earth in a sustainable way. The organization also actively supports education and internships for midwives-in-training from across the globe as well as within Indonesia and the Philippines.

5. Love and Compassion in Action

Here’s a quote from Robin Lim:

Every baby’s first breath on Earth could be one of peace and love. Every mother should be healthy and strong. Every birth could be safe and loving, but our world is not there yet. The situation is bad…babies are unattended, deliveries have become commercialized and mothers die from hemorrhage after childbirth because they can’t afford proper care.

The courage and willingness to respond to devastating circumstances in the wake of natural calamities is another illustration of staff and volunteers’ commitment to being a force for love and compassion to help heal our world. Wherever these early responders are called, the focus is on assisting birthing mothers and infants and supporting local midwives by a cadre of global midwives. Since 2013 in the Philippines alone, 100 local midwives have been supported and given supplies after their clinics were destroyed by the typhoon. More than 600 mothers received free childbirth services from midwives, and 11,500 medical relief appointments for families were provided.

Future Plans

To meet the growing needs of community members in Bali, a new clinic is being built using a traditional Balinese temple design. The building will be earthquake-resistant and is being designed in tune with the way midwives, doctors and nurses prefer to practice. Ground was broken in March 2013, and funds are being raised to complete the building and create an endowment to fund full-time salaries for local health care providers and staff. Bumi Sehat also plans to continue working in the Philippines as long as needed.

Bumi Sehat needs assistance to complete and sustain these ambitious projects, which stem from a belief that health care is a human right even in the lowest resource, highest risk areas of the world. They need the world’s support to make this a dream come true.

Donations by check are to be sent to their 501(c)(3) nonprofit account in the US (bumisehatfoundation.org).

Health care is a human right and every mother, every baby, every family is a piece of Peace. —Ibu Robin Lim


One Heart World-Wide’s Mission and Network of Safety Model

One Heart World-Wide (OHW) is a 501(c)(3) organization with 17 years of experience implementing maternal and newborn mortality prevention programs in remote rural areas of the world. The mission of OHW and the Network of Safety model is to reduce maternal and neonatal mortality in remote areas of the world by ensuring that all women have access to competent prenatal care and a safe, clean delivery. Implementing the model and eventually transferring program maintenance to local partners ensures that this important work will continue and long-term sustainability will be accomplished.

The Network of Safety is a comprehensive, culturally sensitive, replicable and sustainable model aimed at addressing maternal and neonatal mortality within rural communities in developing countries. It is a community-based model that builds a network of equipped and staffed facilities, educates and trains local providers and community health volunteers to provide maternal and child health care and attend all deliveries, and it empowers local communities to take responsibility for the project’s success. The model involves the integration of local resources and people, including political leaders, religious leaders and health care providers, while respecting cultural norms and practices within communities.

An annual report is published by OHW containing detailed progress made in applying the Network of Safety, along with future plans in three major categories:

  1. Health education programs for medical providers
  2. Health facility improvement
  3. Community empowerment/health education for families

Work in Tibet

In 1997, OHW founder and president, Arlene Samen, met His Holiness the Dalai Lama, who asked her to help women and children in Tibet. The following year, Arlene launched a maternal and neonatal health program in Tibet through the University of Utah. Arlene discovered a great need for a local training program for community members willing to go into remote areas to assure that all pregnant women had clean birth kits, lifesaving medications, safe motherhood education and a delivery plan. These community members in Tibet became “foot soldiers” for community health.

Ten years after initiating a pilot program in Medro Gongkar County (Tibet Autonomous Region), the rate of unattended births decreased from 85% to 20%, and maternal and newborn death rates decreased from 10% to 3% (oneheartworld-wide.org). During this 10-year period, 140 midwives and 1500 foot soldiers were trained. In 2009, OHW turned the Tibet programs over to a local team of Tibetans they had trained. The dedicated Tibetan staff have continued to implement the OHW model after establishing a new nonprofit organization called Lhasa Prefecture Maternal Child Health.

Applying the Network of Safety Model in Nepal

Successful implementation of the Network of Safety model in Tibet inspired OHW to open a new site in northwestern Nepal, another remote region with extremely limited health care and access to resources. In Nepal, the OHW model provides training courses for skilled birth attendants (SBAs), community outreach providers and female community health volunteers (FCHVs) in the Baglung and Dolpa regions. In addition, there are plans to train more master trainers in Dhading on One Heart’s Network of Safety. As part of the Network of Safety, the master trainers are trained in safe motherhood, newborn care, the use of the drug misoprostol to prevent postpartum hemorrhage, and to recognize complications and danger signs. OHW is happy to report there have been no maternal deaths in Baglung and Dolpa since their work began (One Heart World-Wide 2013).

To varying degrees, these trainings teach interested individuals the basic principles of anatomy and physiology as it relates to pregnancy, labor, delivery and postpartum health. Nutrition is emphasized and instruction is provided on the use of interventions to prevent and treat postpartum hemorrhage. Postpartum hemorrhage is a major contributing factor to maternal mortality in low and middle-income regions across the globe (United Nations Children’s Fund and World Health Organization report 2014).

SBAs complete the training program with sufficient knowledge regarding proper nutrition, screening tests/procedures, labor and delivery assistance and best practices concerning the recognition of high-risk situations and birth emergencies. The training program includes basic life-saving techniques and access to transportation for women who need emergency assistance from medical providers in hospitals.

Several volunteers in Dolpa have also been instructed on proper use of misoprostol to treat postpartum hemorrhage. Misoprostol is a medication that acts on the musculature in the uterus, encouraging contractions to reduce postpartum bleeding (Vallerand, Sanoski and Deglin 2013). Instruction in various lifesaving skills to treat postpartum hemorrhage and uterine prolapse has been essential in indigenous communities, where excessive bleeding is a leading cause of maternal mortality (Haeri and Dildy 2012).

Existing governmental health centers in Baglung and Dolpa have been upgraded and equipped as a key component of OHW’s work in Nepal. These upgrades include basic renovations, such as bathrooms, insulation, roofing, water systems, paint, solar power, flooring and doors. Once the buildings have been renovated, OHW works with the Nepalese District Health Office to have them certified as official birthing centers. In 2013 alone, over 530 deliveries took place at these newly upgraded birthing centers, with no loss of mothers’ lives.

One Heart World-Wide has implemented a master trainer education program in Nepal to specifically address the prevention and management of uterine prolapse. Uterine prolapse is a condition of the uterus descending into the vagina and can be life-threatening if it is not treated as an emergency. Uterine prolapse can lead to postpartum hemorrhage or conditions related to alterations in bladder, bowel or sexual function. In collaboration with Karuna Schechen, a pelvic organ prolapse prevention program is currently being implemented in Baglung and Dolpa.

On the Leading Edge: Mobile Phone App to Improve Health Outcomes in Nepal

One Heart has piloted the use of low-cost SMS texting-based mobile phone technology to improve data collection and ensure provider communication, positively affecting the continuity of care for mothers and babies. In conjunction with Medic Mobile and SamaHope, the cell phone program has been implemented in four Village Development Committees in the Baglung region of Nepal. This creative partnership provides community health workers and volunteers with the ability to capture patient data, communicate with patients, make referrals for treatment and alert health care personnel of mothers and babies in need of treatment. To date, there have been 265 pregnancies and 49 births registered in the Medic Mobile database (One Heart World-Wide 2013).

One Heart’s Work with the Tarahumara of Northern Mexico

In 2011, OHW began implementing the Network of Safety model in Chihuahua, Mexico, with the Tarahumara indigenous people. The Tarahumara reside in a remote area of the Copper Canyon. Though their population represents only 3% of the area, 34% of all maternal deaths in the state have occurred here, representing a strong need for One Heart’s birth model implementation. After three years of implementation of the Network of Safety there, the maternal mortality rate has dropped to zero in the communities in which One Heart has worked. The program in Chihuahua has recently been transitioned over to a local nonprofit organization. One Heart will continue to be expert advisors in this region as needed.

Technical Assistance for China, Liberia and Ecuador’s Jungle Mamas Program

OHW has provided assistance to Direct Relief International and the Amitabha Foundation by designing and implementing maternal child health programs and improving data collection in China. One Heart has also provided assistance to Tiyatien Health in Liberia, where they helped design and implement community-based maternal and child health services based on needs assessments of community members and facilities.

In January 2013, One Heart World-Wide conducted a complete needs assessment of the existing Jungle Mamas program of the Pachamama Alliance and provided recommendations to improve program activities.

Key Success Factors to the One Heart World-Wide Experience: Sustainability

Long-term sustainability is a fundamental component of the One Heart model. The Network of Safety advocates local sustainability by teaching community members how to care for women and babies and creating partnerships with local stakeholders, thereby allowing local villagers to directly influence the lives of the people in their region. One Heart World-Wide also collaborates with existing non-governmental organizations, government agencies and officials in the countries where they work. A key component of One Heart’s model is to avoid creating a parallel system wherever they work; by partnering with the government, the model becomes incorporated into the health care infrastructure.

Community birth center volunteers in Nepal are given food incentives for getting involved. The food trade system fosters sustainability in these rural communities. According to a systematic review across several cultures, it is suggested that community participation largely has a positive impact on maternal and newborn health (Marsten et al. 2013). By integrating local resources and collaborating with local providers, the One Heart birth model is a shining example of community sustainability.

Finally, the Network of Safety model empowers local communities to take responsibility over time to ensure the project’s ongoing success. Long-term sustainability and improved birth outcomes are based on the integration of local resources, collaboration with key local religious and political leaders, participation of local communities and providers and respect for cultural norms and practices.

Cultural Sensitivity

The birth model created by One Heart World-Wide is tailored to the needs of the specific local cultural contexts to ensure that appropriate methods of teaching and empowerment are implemented. The One Heart model places community members at the very heart of creating positive changes in their communities, encouraging social cohesion and long-term sustainability.

Prior to introducing programs within a community, the Network of Safety requires a needs assessment of the population. These assessments are considered by One Heart to be a fundamental step in creating a culturally competent model. Assessments are done locally, allowing community members the opportunity to express their thoughts and concerns regarding maternal health, while pinpointing specific areas of need. Inclusion of community voices helps build trust, rapport and mutual respect. The community at large is also involved in the implementation process, creating long-term “survivability.”

Respectful Care

Caring for mothers and babies focuses on educating the mother in ways that empower her. Mothers are provided with choices, interactive learning and opportunities for personal growth through education.

In Nepal, One Heart’s trained SBAs and FCHVs are also trained in culturally appropriate and respectful communication to promote safe motherhood. After four years of implementing the Network of Safety model, maternal and neonatal mortality were reduced by 80% in the Baglung district. Likewise, after three years of implementation in the Dolpa district, both maternal and neonatal mortality were reduced by more than 50%.

Another example of respectful care comes from implementing the Network of Safety among the indigenous Tarahumara population of Copper Canyon, Mexico. The initial needs assessment found that a language barrier and misunderstanding about cultural beliefs and practices was contributing to increased maternal and infant mortality rates. Tarahumara women were increasingly choosing to give birth at home without assistance because they felt that there was a lack of understanding of their cultural practices and beliefs by the health care providers. Confusing medical language compounded the problem. Prior to the Network of Safety model, almost 90% of Tarahumara women were delivering their babies without an SBA—a key contributing factor to the dismal maternal and neonatal survival outcomes of the region. The One Heart team, including a male Tarahumara nurse-midwife, provided culturally sensitive, compassionate education in their own language, another contributing factor to reducing preventable deaths of mothers and babies.

Competency in Care

One Heart’s mission is to decrease maternal and infant mortality in remote and rural areas of the world, particularly where no one else has gone. All programs focus on competent care delivered in a culturally sensitive manner. The vision is to implement a simple, effective, replicable and sustainable intervention to reduce maternal and neonatal mortality by at least 50% in areas served. Based on program data from the two regions where One Heart World-Wide has operated for over three years, One Heart has demonstrated that their programs are able to reduce maternal and neonatal mortality 50–80% or more.

Depending on location, programs include:

  • Teaching various skills to birth attendants, master trainers and female community health volunteers within indigenous communities via community outreach programs: prenatal and newborn care, delivery with a skilled provider, provision of prenatal supplements and nutrition, recognition of danger signs, use of clean birth kits and means of emergency evacuation.
  • Providing trainings for local health clinics and hospital staff.
  • Renovating existing health posts to become certified birthing centers.
  • Partnering with other organizations to determine emergency evacuation plans.

Future Plans

In 2014, the OHW Nepal program began expanding its coverage to at least 80% of the population and offering refresher courses for local health providers in the Baglung and Dolpa regions. They have already conducted a needs assessment in new districts in order to implement the Network of Safety model in 2015 (Darchala and Sindhulpalchowk). Their long-term intention is to offer Network of Safety services and education to all of the remaining underserved districts of Nepal and to eliminate all preventable deaths of mothers and babies.

Love and Compassion in Action

Love and compassion permeate the OHW approach and are a cornerstone of their work, as evidenced in many stories of grateful mothers, communities and volunteers. This motivation is partly a reflection of how One Heart began at the request of the Dalai Lama, and of the personal commitment of its staff in Nepal and the United States.

Because of the devastating earthquakes that rocked Nepal, OHW is focusing current efforts on partnering with other NGOs and district health offices to deliver supplies, aid and compassionate care to the most highly impacted regions. For updated information, visit their website (oneheartworld-wide.org) or Facebook page. Donations are gratefully accepted.

Kay Sandberg is the founding president of Global Force for Healing, a visionary nonprofit which convenes the Healthy, Compassionate Birthing Network of global grassroots projects for underserved, remote communities based on the midwifery model of care (globalforceforhealing.org/project-one).

Shane Carnahan is currently a senior nursing student at Oregon Health and Science University. She is an active member and media/communications chairperson of the OHSU Nursing Students Without Borders university organization and an intern with Global Force for Healing, a local nonprofit organization.


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