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> 11. Knowledge, research and innovation
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What should we support in terms of knowledge, research and innovation?
What are the key gaps in the global knowledge about how to improve reproductive, maternal and newborn health, and which should we seek to fill?
How can we ensure that high quality research, already conducted, is then effectively translated in policies and practices?
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Our thanks for all the comments submitted. All of the ideas and suggestions put forward will feed into our new policy, helping to shape the direction of our work.
Once the final policy document is released you will be able to find it at www.dfid.gov.uk
Pharmaceutically, the key need is for a Long-Acting Reversible Contraceptive (LARC) for men – between condoms and vasectomies. Culturally, better research into the reproducible elements of the most successful fertility reduction programmes, from village education programmes by family planners, via radio soap operas, to voluntary incentive schemes, would help achieve the necessary shift in behaviour change.
Research plays an essential role in paving the way for more informed dialogue about public health issues and in facilitating changes in programs and policies. Abortion-related research has been relatively neglected. DFID’s support of the Consortium for Research on Unsafe Abortion in Africa is helping to rectify this harmful gap, but more investment is needed at the global level.
Data on abortion – particularly unsafe abortion – are notoriously difficult to obtain for a wide variety of reasons, including the strong stigma surrounding the subject. The difficulty documenting the true extent and nature of women’s reliance on abortion hinders recognition of the dimensions of the public health problems of unwanted pregnancy and unsafe abortion and development of effective approaches for addressing them. There is an urgent need to improve collection, monitoring and analysis of information on women’s use of abortion, within health systems and communities. In addition, operations research is needed to identify the best ways to deliver abortion-related care to women, with timely topics including use of medical abortion in low-resource settings. Qualitative research on topics such as abortion stigma and women’s pathways to unsafe abortion can also help suggest interventions and approaches to reduce unsafe abortion.
The strength of Christian Medical Fellowship (CMF) opinion is in the extensive network of its members, about 150 of whom are in day to day practical ‘hands on’ practice in the developing world – whether clinical or community, with around two thirds working in association with church groups or Christian faith based organisations.
There are many undocumented examples of Good Practice. CMF notes that the evidence referred to in this Submission is nearly always obtained from randomised controlled trials of carefully performed community interventions, published in peer reviewed journals. These are vital and often supported by the Wellcome Trust and the Gates Foundation. But there is very little data about what happens when such pilot schemes are scaled up – if they ever are. This is largely because funding sources do not support such operational research. CMF urges DFID to be more proactive in support of research which analyses what can happen when civil society (in very many if not most cases this means faith based organisations and communities) is given support to target, support and enable access to maternal health services for those not able to receive them.
For the MDGs, the answer is pretty much nothing. You don’t need to develop stuff, it already exists. That is why we aren’t trying to meeting the MDGs in the UK, because the NHS covers this pretty well. Surely in the main it is a case of funding.
a. We need to know quantify the scale or severity of the problem of malnutrition in pregnant and lactating women and reach a consensus on its diagnosis and what interventions work best in development as well as in fragile, conflict affected states and humanitarian situations. Understanding the causes of malnutrition at household and community levels is also important.
b. Investigate, encourage, reinforce and build upon good cultural and care practices for pregnant and lactating women.
c. Deconstruct and mitigate the effects of harmful care practices and focus IEC and behavior change campaigns on these targeted to the right people in the community and households who have the power to effect change. For example, although it is right to focus efforts on the individual woman, gatekeepers such as the mothers-in-law, grandmothers and husbands tend to have the most power in families and any advocacy to improve women’s health has to include them as much as possible. Taboos about foods that should be eaten or avoided during pregnancy and lactation and during critical periods of children’s lives like during growth and illness for example are required to enable us to start to disentangle the myths from the facts that can inform our strategies, IEC and behaviour change campaigns.
d. Assess what the barriers are to access to health care in each community and address these systematically (one size does not fit all). There needs to be investment on contextual analyses throughout the healthcare system right down to the end user at household level.
e. Funding assessments of the opportunity costs for women to attend health services in cash based economies (including urban and peri-urban areas) for the minimum recommended 4 antenatal visits needs is required urgently. Real gaps exist in what are the barriers to health seeking behaviours as small nuances in different contexts may have major impact on programme effectiveness. A lesson learned from the Zambian context in CMAM is that we haven’t fully understood the cost-benefit analysis in this context.
f. To enable women to breastfeed adequately, an analysis of the barriers to full breastfeeding should inform the activities DFID would want to prioritize in order to save maternal and child lives. We suggest that this should include saving women time on water and fuel collection
g. Funding an Infant and Child Feeding Specialist with expertise in breastfeeding practice and policy would be a good start to train health professionals and inform policy makers in each priority country.
h. Identify the lessons learned from the CMAM (community-based management of acute malnutrition) and that could be applied to the care of pregnant and lactating women in the community
i. More research is needed on the appropriateness of iron supplementation to mothers in malaria zones and the impact of blanket multivitamin distributions (topics which have demonstrated different results in different contexts and can be difficult to translate into policy).
DFID can encourage and provide more funding to conduct Ethnographic research (community as well as hospital based) on reproductive and maternal health. Because unveiling the reality relating to sensitive issues and exploring the underlying causes of particular health seeking behaviour need much more time, attention, affection and gaining trust. This is only possible by conducting ethnographic study. Findings of such research should be translated in to health programmes.