Speaking cloth: Including women’s account of body experiences in health innovations

This paper is about a project that works upon getting women to reflect upon their bodily experiences and to draw and paint their experiences as a way to communicate-out their journeys of childbearing. I arrived at this project of visual narratives because of the dissatisfaction I felt upon reading the solutions within texts on the subject of Maternal deaths in poorly serviced contexts. Words are a great vehicle for the urban educated but as ‘technical vocabulary’, through demanding a medicalisation of local knowledge of childbearing practices, they also become the very instruments that disenfranchise the lived experience of pregnant women. The research question then was – how can these women speak so that they are heard, so that their voices are heard in all their complexity and not in a simplified way that fits into current medical and public health theory? My answer has been to use the gallery, the exhibition space in urban centres as the stage where these voices are expressed. The first hand-drawn cloth was a cultural probe that was used in field work encounters with women in remote communities in Assam, India. The experience of using the ‘painted cloth’ as a vehicle to incite an outpouring of experiences from affected women and hurt families led to the development of 5 themes of narration. These themes were illustrated for exhibition by a Melbourne based artist where she reflectively drew upon her personal experiences to draw-out her narratives. I have since been working with a New Delhi based Textile artist to set up a project to get remote-rural-poor craftswomen to do similar paintings. These paintings are their stories – telling of their experiences of their childbirth experiences and of incidents in their community. These works are a way for the “voices” of these women, and the stories from remote rural communities, to be heard in urban centres through exhibitions of their works. The aesthetics and form of the story will go a long way in retaining the details in the narratives. By becoming images these narrative works are not reducible, as words often are, to being bracketed  as “formulaic problems”. This format (gallery) and this location (urban) is one part of the project focussed upon contributing a unique dimension that of  the perspective of remote-rural-poor women, to the policy discourse surrounding maternal deaths in communities distant from urban centres. Once the pieces are produced the next activity is the performance. The project envisages a travelling exhibition that stops at key places to conduct a conversation as a workshop, a provocation or a symposium. This event is envisaged to be a reading of the stories from the cloths as a conversation that aims to look at maternal health from the perspective of the women. The amplifying of the voices of remote-rural-poor woman is intended to give health innovators access to the lived experiences of pregnant women and to consider the women as partners and components of the solution ecosystems being developed.

Abstract submitted to Include 2013


Maternal and Perinatal Conditions — Disease Control Priorities in Developing Countries — NCBI Bookshelf

In 2001, maternal and perinatal conditions represented the single largest contributor to the global burden of disease, at nearly 6 percent of total DALYs (Mathers and others 2004). Reducing that burden is widely stated as a priority at both national and international levels, but the track record of translating the rhetoric into action on a sufficiently large and equitable scale to make a difference at the population level remains disappointing. The literature abounds with examples of this disappointment (see, for example, Maine and Rosenfield 1999; Weil and Fernandez 1999). Many reasons account for the limited progress, especially in the poorest regions of the world, and researchers offer many interpretations of the bottlenecks. Lack of evidence on the size of the burden and on the effectiveness of alternative intervention strategies figures prominently in these interpretations.

via Maternal and Perinatal Conditions — Disease Control Priorities in Developing Countries — NCBI Bookshelf.

There is a really extensive bibliography listed in this site.

Human Rights Facts (37): Maternal Mortality « P.A.P. Blog – Human Rights Etc.

Maternal death, or maternal mortality, is the death of a woman during or shortly after a pregnancy. More than half a million women die during pregnancy or childbirth every year, and many millions suffer from inadequately treated complications. About half of these deaths occur in sub-Saharan Africa and about one third occur in South Asia – the two regions together account for about 85 per cent of all maternal deaths. In sub-Saharan Africa, a woman’s risk of maternal death is 1 in 22, compared with 1 in 8.000 in developed countries.

via Human Rights Facts (37): Maternal Mortality « P.A.P. Blog – Human Rights Etc..

DevInfo – di Facts

The vast majority of maternal deaths – more than 99 per cent, according to the 2005 UN inter-agency estimates – occurred in developing countries. Half of these (265,000) took place in sub-Saharan Africa and another third (187,000) in South Asia. Between them, these two regions accounted for 85 per cent of the world’s pregnancy-related deaths in 2005. India alone had 22 per cent of the global total.

via DevInfo – di Facts.


Research_Projects_for_PhDs, originally uploaded by soumitriv.

A sketch of research projects at the meta level – potential PhD questions or areas of work. The idea of capacity development includes the development of research capacity-expertise in India. So these could be international research students.

What other projects could there be?


MH_Expertise_network, originally uploaded by soumitriv.

I was looking to create a network of experts – a network that will mirror what will be available in India. This will make for easy collaboration and for discipline or expertise orientated capacity development projects to be visualized.

Have I missed out a discipline?

Thinking through how the project will work

bub_MHP1, originally uploaded by soumitriv.

There are a whole series of ways we currently work in Industrial Design – on design orientated projects and capacity development project. There are therefore a raft of agencies supporting the students, scholars and staff in their research. I have captured some of the dimensions in this mind map.

Are there other ways to enable the action research project?

Sweden to help AP in curbing infant mortality

HYDERABAD: The Swedish International Development Corporation Agency (SIDA) has agreed to continue its assistance to the State Government for Advanced Midwifery Training (CAMT) in the State. The CAMT offers skillbased midwifery training to provide high quality services to mothers and newborns for reducing maternal and infant mortality and morbidity.

A Swedish delegation led by Sweden State Secretary to Minister for Health and Social Affairs Karin Johansson called on Chief Minister K Rosaiah here today and assured all support to the State Government in providing total healthcare to the citizens, particularly the poor and low income groups in the rural areas.

The Swedish delegation appreciated various healthcare initiatives of the State Government including Rajiv Aarogyasri, 108, 104 ambulance and mobile healthcare services.

They termed Andhra Pradesh as a role model for other countries in providing free quality healthcare to the poor and low income families.

Established in 2007 at Niloufer Health School, the CAMT offered midwifery training with the support of SIDA. When an agreement signed between both the institutions ended in November 2009, SIDA officials withdrew their services.

Later, the State Government took over and started training programmes from January this year with funds from National Rural Health Mission (NRHM).

Health Minister D Nagender and officials of the Health department were also present.

via Sweden to help AP in curbing infant mortality.

India: Reviving public health services | Economists’ Forum | FT.com

What about replicability? Can other states reorganise their health systems along the lines of Tamil Nadu and reap the major health benefits that seem to accrue? Yes, they can. The administrative foundations are similar across the country. The key difference is that Tamil Nadu “(a) separates the medical officers into the public health and medical tracks, (b) requires those in the public health track to obtain a public health qualification in addition to their medical degree, and (c) orients their work towards managing population-wide health services and primary heath care…”. The additional investment required to train a cadre of public health managers is modest: in Tamil Nadu this cadre amounted to hardly 1 per cent of more than 10,000 government doctors. Of course, reverting to a separate directorate of public health and having a good public health act may also be necessary and quite feasible. And the data suggest that the costs are affordable. The central issue is not resources, but how they are organised, mandated and managed.

via India: Reviving public health services | Economists’ Forum | FT.com.

Where there is no midwife: birth and loss in rural India By Sarah Pinto

The MEDP Project

The overall objective of MEDP is to help in building the capacity of midwifery and maternal health in India. It is closely linked with the material health policy under the National Rural Health Mission (NRHM) and the Reproductive and Child Health (RCH) programme of the Goverment of India which aim at the development of SBA (midwifery) and EmOC as key strategies for decreasing maternal mortality rate.

This Project is coordinated by IIM, Ahmedabad, and is being implemented through the core group of institutions including ANS, Hydrabad; TNAI, SOMI and WRAI/CEDPA in India. The coordination institution in Sweden is Karolinska Institute, Division of Reproductive and Perinatal Health. The Sweden Association of Midwives is provoding technical assistance.

via Welcome to MEDP.

Continuity, change and collaboration in midwifery: from Japan, memories of a midwife at 95 years of age; and from India, news of a new project to improve midwifery education and care for safe motherhood | International Midwifery | Find Articles at BNET

RELATED ARTICLE: Indian midwifery delegation to the Netherlands and Sweden.

ICM member association, the Society of Midwives of India, is carrying out a project called ‘Developing inter-institutional collaboration for improving midwifery and EMOC services in India’.

The partner organisations in Europe are the Karolinska Institute, Sweden, and the Swedish Association of Midwives; and in India, the Academy for Nursing Studies, the Trained Nurses’ Association of India (TNAI), White Ribbon Alliance of India and the Indian Institute of Management (IIM).

The project’s main components are the strengthening of midwifery and emergency obstetric services for Sate Motherhood. It involves the establishment of three centres of advanced midwifery training in different parts of India.

via Continuity, change and collaboration in midwifery: from Japan, memories of a midwife at 95 years of age; and from India, news of a new project to improve midwifery education and care for safe motherhood | International Midwifery | Find Articles at BNET.

SASNET: Reproductive Health Karolinska

The Division for Reproductive and Perinatal Health is responsible for the training of midwifes. It is involved in several International collaboration projects, funded by Sida, WHO and the World Bank.

In South Asia collaboration has been established with Trivandrum Medical University, College of Nursing, in Thiruvananthapuram, Kerala (India), Punjab Agricultural University in Ludhiana (India) and Fatima Jinnah Medical College in Lahore (Pakistan).

The Division is also engaged in an inter-institutional collaboration for improving midwifery and emergency obstetric care in India. The partnership project titled ”Developing inter-institutional collaboration between institutions in India and Sweden for improving midwifery and emergency obstetric care services in India” was agreed upon in 2005 between Karolinska Institutet, the Swedish Midwifery Association and a core group of organisations from India (Academy of Nursing Services, Trained Nurses Association of India, Society of Midwives in India, the White Ribbon Alliance India), with funding from the Swedish International Development Cooperation Agency, Sida. The Indian Institute of Management in Ahmedabad, through their Centre for Management of Health Services, coordinates the collaboration. The project was funded by Sida with SEK 20 million for the period December 2005 – June 2009.

via SASNET: Reproductive Health Karolinska.

Drop the Demon Dai: Maternal Mortality and the State in Colonial Madras, 1840-1875 — Lang 18 (3): 357 — Social History of Medicine

Drop the Demon Dai: Maternal Mortality and the State in Colonial Madras, 1840–1875

Seán Lang

Anglia Polytechnic University, East Road, Cambridge CB1 1PT, UK. E-mail: sf_lang@hotmail.com

Writing on midwifery and women’s health in nineteenth-century India has concentrated on the role of medical missionaries and on voluntary organizations, such as the Countess of Dufferin’s Fund; the role of the state has been generally discounted. However, a close study of government records from Madras Presidency suggests that there was considerable state interest in the issue from the 1840s onwards. This took the form of running and supporting a major lying-in hospital in Madras and smaller lying-in wards at provincial dispensaries, in order to train midwives to work throughout the Presidency. State action was heavily influenced by revulsion at the methods of the dai, the traditional Indian birth attendant. The strategy both at Madras and elsewhere was to replace her with a class of Indian trained midwives who would operate within the community. Various explanations for state interest in the issue are suggested, including political rivalry between the different British Presidencies.

via Drop the Demon Dai: Maternal Mortality and the State in Colonial Madras, 1840-1875 — Lang 18 (3): 357 — Social History of Medicine.

604 Dileep Mavalankar at al, Strengthening midwifery services

Strengthening midwifery services


Over the last few years some states and NGOs in India have developed interesting models of midwife-nurse based maternal health care services supported by needed emergency obstetric care services. For example, in Tamil Nadu, the government has developed a model of primary health care centres staffed by three nurses to provide a 24-hour service for childbirth. Tamil Nadu has also established a good system of recording all maternal deaths and conducting a maternal death inquiry to find preventable factors. It has also developed centres for emergency obstetric care throughout the state.

Similarly, the Academy of Nursing Studies, Hyderabad has developed a nurse-based model of maternal care in the Medak district through the government health system. Arth, an NGO has developed a nurse-based model in rural and tribal areas of Udaipur district by appointing its own nurses for a cluster of villages. The Swedish Sida-assisted midwifery and maternal healthcare development project coordinated by IIM Ahmedabad, is also trying to help develop midwifery training, practice and research in five states in India through teacher training, skill training of ANM and networking with Swedish partners. The Indian Nursing Council has also developed a one-year curriculum for training nurses to become practitioners of midwifery. CEDPA with help from Jhpeigo has developed a model of skill-based training of midwives in rural Jharkhand.

via 604 Dileep Mavalankar at al, Strengthening midwifery services.

WHO | Achieving Millennium Development Goal 5: is India serious?

Achieving Millennium Development Goal 5: is India serious?

Dileep Mavalankar a, Kranti Vora a, M Prakasamma b

Absence of comprehensive maternal care services

With the change in the role of ANMs and programme priorities, comprehensive services have been neglected. Not only delivery care but antenatal and postnatal care are also neglected. The National Family Health Survey (2006) shows that only 52% of women receive three antenatal contacts and 42% receive any postnatal care.9 Abortion and birth-spacing services are receiving less attention lately. All of this has a major impact on maternal health indicators.In spite of rhetoric from the National Rural Health Mission, changes on the ground to improve maternal health care are slow and lack focus. We feel strongly that without a clear strategic focus on skilled birth attendance, EmOC and referral services, India will not be able to reduce maternal mortality rapidly. There is a need to provide comprehensive maternal health services, including antenatal care, delivery care, EmOC and postnatal care, within an efficient health system. The extent of the increase in political priority, managerial capacity and resource allocation will determine, if and when, India will be able to meet MDG 5.

via WHO | Achieving Millennium Development Goal 5: is India serious?.

Govt nod for setting up 132 nursing and midwifery schools – India – The Times of India

NEW DELHI: The Government gave its go ahead for setting up 132 nursing and midwifery schools across the country at a cost of Rs 660 crore.

The proposal for setting up the schools during the XIth plan was cleared by the Cabinet Committee on Economic Affairs.

The schools will be set up in high-focus states like Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu and Kashmir, Madhya Pradesh, North Eastern States, Orissa, Rajasthan, Uttarakhand, Uttar Pradesh, West Bengal and other districts in the country, preferably which do not have auxiliary nursing and midwifery schools.

via Govt nod for setting up 132 nursing and midwifery schools – India – The Times of India.

Birth in India: One Chosen Perspective – by Diane Smith

Birth in India: One Chosen Perspective

by Diane Smith

[Editor’s note: This article first appeared in Midwifery Today Issue 61, Spring 2002.]

“There are 700,000 traditional healers and dais (midwives) in India. 70 percent of the nation’s babies are born at home and the dai’s work is a living tradition. Ironically, modern hospitals and public health clinics fully represent allopathic medicine. There is a precarious balance being kept here between these paradigms of care. Women are being coerced and convinced by government advertising programs to leave the home and all that is traditional to give birth in environments that suggest safety and promise degradation. It is my feeling that we face a highly critical time here of losing a primal force—an ancient way—to a superficial, transient understanding of the birth process. The scales remain tipped toward tradition, while the trend is galloping toward the worst of western medicine’s offerings in childbirth technology. I am grateful to be sending down roots into an India that provides me the freedom to witness change, to practice the art of midwifery without tied hands, and to have a role in recultivating women’s power in childbirth through teaching and serving women. The sorrows lie in seeing women being beaten, ridiculed, abandoned, butchered and neglected in their hospital experiences. The joys are in remaining at home within tradition, teaching village dais and adding to the enhancement of their skills and in providing attitudes of sensitive care to government-trained midwives in the small health center here in Auroville, Tamil Nadu where I live.

via Birth in India: One Chosen Perspective – by Diane Smith.

Doubling of maternal deaths in U.S. ‘scandalous,’ rights group says – CNN.com

(CNN) — Deaths from pregnancy and childbirth in the United States have doubled in the past 20 years, a development that a human rights group called “scandalous and disgraceful” Friday.

In addition, the rights group said, about 1.7 million women a year, one-third of pregnant women in the United States, suffer from pregnancy-related complications.

Most of the deaths and complications occur among minorities and women living in poverty, it noted.

Amnesty International issued a report Friday that calls on President Obama to take action.

“This country’s extraordinary record of medical advancement makes its haphazard approach to maternal care all the more scandalous and disgraceful,” said Larry Cox, executive director of Amnesty International USA.

“Good maternal care should not be considered a luxury available only to those who can access the best hospitals and the best doctors. Women should not die in the richest country on earth from preventable complications and emergencies,” Cox said in a news release.

via Doubling of maternal deaths in U.S. ‘scandalous,’ rights group says – CNN.com.

FRHS Foundation for research in Health Systems

FRHS focuses mainly on strengthening existing health systems. Through evaluation of ongoing programs and policies, we identify gaps. Using available evidence we recommend interventions. FRHS’ field practice area serves as a laboratory for such interventions where their utility, relevance, and cost- effectiveness are tested. Those found effective, are disseminated to various stakeholders.

via FRHS Foundation for research in Health Systems.

In Silence: Maternal Mortality in India | Human Rights Watch

Video from Human Rights Watch

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What are the 10 big design challenges in the social sector? » Design Thinking

We have relatively few design thinkers operating in the world. What would happen if instead of that capacity working randomly on problems it was focused on a small number of big issues? Could we use new mechanisms like open source or prizes to motivate larger numbers of creative people to collaborate? Could we create categories where creative competition causes us to build on the ideas of others to create the breakthrough ideas many areas of society need? I think we could.

The first step is to generate the list of big design problems in the social sector. I want to take a stab at starting that conversation here. One place to start is the list of Millennium Development Goals published by the UN. What do you think? Is this the right list? What about social issues in the developed world like obesity or crime? What kind of metrics should we use to determine the potential impact of tackling any given challenge? Should we use a return on investment approach like Bjorn Lomborg? How do we go from these general categories to more specific design challenges? I would love your thoughts and ideas.

UN Millennium Development Goals:

Eradicate extreme poverty and hunger

Achieve universal primary education

Promote gender equality and empower women

Reduce child mortality

Improve maternal health

Combat HIV/AIDS, malaria and other diseases

Ensure environmental sustainability

Develop a global partnership for development

via What are the 10 big design challenges in the social sector? » Design Thinking.

The Borgen Project: MDG#5 – Improve Maternal Health

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UNFPA Online Video Channel

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WHO | Great expectations

The subject of World Health Day 2005 was maternal and child health.

In Great expectations, six mothers living in different countries of the world are sharing their experiences of pregnancy, childbirth, and life with a young baby. The babies are now one year old. This is the final instalment of Great expectations. The series was launched over 12 months ago to highlight World Health Day 2005 – the theme of which was maternal and child health.

via WHO | Great expectations.