Late last year, on World Polio Day, the global health community celebrated the eradication of one of the two remaining wild poliovirus strains. Growing up in Nigeria, it is a disease that I know all too well. I remember observing women, men, and often children walking with exaggerated limps and deformed limbs.
Many women in rural Africa must decide between delivering at home and embarking on a long journey to reach a health facility. In Zambia, are maternity waiting homes effective at improving maternal and child health outcomes?
It was frightening and devastating to my impressionable 7-year-old self and was so prevalent across the country that I never would have thought then that it could be eradicated in my lifetime. However, fast forward several decades later and Nigeria has not recorded a case of wild polio since 2016 and the disease is close to complete eradication. Unfortunately, the same cannot be said for maternal deaths.
According to the World Health Organization, in 2017, over a quarter of a million women died during and after childbirth. The majority of these deaths occur in sub-Saharan Africa, which contributes two-thirds of the global average. While polio and maternal mortality are very different health issues, there are lessons that can be learned from the worldwide response to the former, that could help us tackle the latter.
First, we need community involvement. Engaging and mobilizing communities at all levels was instrumental in gaining the trust of families in communities that were previously hesitant to the polio vaccine. Thousands of volunteer community mobilizers, chosen because of their trusted positions in local communities provided mothers with vital information to prevent the disease as well as on other important factors that impacted healthy pregnancies and childbirths such as nutrition, hygiene, and even child marriage.
Putting communities at the heart of the polio eradication program was critical to their receptiveness. Similarly, if the global health community builds its maternal mortality reduction efforts around mothers in a way that respectfully addresses community needs, the likelihood of success will increase.
Second, rapid detection is key. In the polio response, high-performance disease surveillance and program monitoring systems made the rapid detection of polio cases and outbreak response possible even in low-income countries. This surveillance system was composed of people, transportation, communications, and data management systems in even hard-to-reach areas.
In Nigeria, only a third of women deliver in a health center or are attended by a skilled caregiver. This means that many deliveries and maternal deaths, particularly in rural areas, go underreported and thus the causes of death are unknown. Having a national maternal death surveillance and response system in place across rural and urban settings in low- and middle-income countries, would help account for the numbers and causes of maternal deaths taking place in communities.
Although the Maternal and Perinatal Death Surveillance and Response launched by WHO, the United Nations Population Fund, and UNICEF exists, it has not been implemented widely across communities — leaving a huge gap in knowledge of factors contributing to maternal deaths, especially those occurring outside health facilities. In following the polio response model, surveillance and response systems like this must be put in place in communities.
Third, efforts must be made everywhere, not only where it is easy. The polio eradication initiative was implemented even in conflict-affected regions. In order to rapidly reach children in these areas, the initiative mobilized substantial human and financial resources, deploying hundreds of thousands of trained health workers and vaccination teams to vaccinate vulnerable children in these conflict zones.
Using global platforms such as the World Health Assembly, the United Nations General Assembly, and international health regulations, the global polio eradication initiative persuaded countries deemed “low-performing” to increase their financial and policy commitments and improve the quality of their polio eradication efforts. Similarly, substantial financing commitments to strengthen primary health care and maternal health services are critical to reducing maternal deaths to sustainable development goal targets of less than 70 deaths per 100,000 births by 2030.
Lastly, no efforts will work without accountability. In the few countries still affected by polio, the lack of strong management and accountability have significantly hindered eradication. Engaging political leadership nationally and sub-nationally, setting up systems for accountability of staff and finances is critical. Country-level emergency action plans include the creation of national oversight bodies, quality assurance, accountability frameworks, and independent monitoring teams. To ensure that any finances that have been committed to tackling maternal mortality are efficiently used, similar accountability and monitoring mechanisms must be implemented.
Polio is on the precipice of global eradication because of the strategic efforts of the global health community. As we mark the International Day of Maternal Health and Rights on April 11, let us take some of the key lessons from this hard-worn battle against polio and confront another devastating battle at hand — reducing the number of women who die bringing their young into the world.
For too long and in too many countries, what should have brought joy has instead brought sorrow for millions of families. By taking lessons from the war against polio, we can put a stop to this.