Our Work

Malawi

In Malawi, one of the poorest countries in Africa, mortality rates during childbirth are particularly high. Nurses and midwives deliver 7 out of every 10 babies, and the need for training and mentoring is urgent. At the invitation of Partners In Health, Neno district, Malawi was chosen as the first GAIN site.

  • 1 in 262 women in Malawi dies of childbirth-related causes; compared to 1 out of every 4,545 in the U.S.
  • For every 1,000 live births in Malawi, 52 infants die; compared to 6 out of every 1,000 in the U.S.

At all our sites we work closely with the Ministry of Health to ensure alignment with country priorities and to promote sustainability. Since 2017, a team of expert nurse-midwives provide training to all labor and delivery nurses and midwives at two hospitals and eight health facilities in the rural, southern district of Neno to improve maternal and infant health. In 2019, GAIN expanded to Blantyre district, a large urban area, with the GAIA Global Health as our in-country partner. Seven health facilities with high volumes of births are part of the project.

We are leading the way in shaping decision-making at the policy level. In 2021, the WHO Safe Childbirth Checklist (SCC) was adapted by our team in Neno district, Malawi and is being introduced nationally in the form of an easy-to-follow flowchart.

Next steps in Malawi include a focus on building strong mentorship teams based in each individual facility to ensure sustainability of practices. We are also working on a research project designed to improve timely referral from peripheral health facilities to a tertiary care hospital for women and neonates with life-threatening complications.

Liberia

In Liberia, nurses and midwives deliver half of all babies born.

  • 1 in every 134 women in Liberia dies of childbirth-related causes
  • For every 1,000 live births in Liberia, 63 infants die

In collaboration with Partners In Health, we are specifically focusing on efforts to improve neonatal outcomes in rural Maryland County. Priorities in Liberia include:

  1. Providing mentorship and training for new graduate nurses and midwives
  2. Working with the Liberia monitoring and evaluation team to track important indicators of success
  3. Developing a response to local needs

The first GAIN training in Liberia was completed in October 2020 in three facilities responsible for approximately 2,000 births a year. In response to local need, this training was centered around the neonate. GAIN is also working in Liberia with the Ministry of Health and our NGO partner to revise and update national neonatal care guidelines.

Sierra Leone

In Sierra Leone, outcomes for birthing women and neonates are among the worst in the world. Similar to other GAIN sites, nurses and midwives are the true front-line providers and responsible for supporting women during childbirth.

In Sierra Leone, nurses and midwives deliver half of all babies born.

  • 1 in every 140 women in Sierra Leone dies of childbirth-related causes
  • For every 1,000 live births in Sierra Leone, 71 infants die

Collaborating closely with Partners In Health, we are supporting the placement and training of mentors in rural, hard-to-reach communities. Having local expertise can prevent many complications from progressing and identify those needing referral to higher level of care early so outcomes are favorable. Priorities in Sierra Leone include:

  1. Developing expert mentors for deployment to rural sites
  2. Improving documentation of each patient
  3. Creating a network among the rural sites and referral hospital

Memphis, TN, USA

In the United States Black, Indigenous, People of Color (BIPOC) individuals are more likely to have fewer prenatal visits, higher rates of pregnancy related complications, and experience discrimination by their providers when receiving care. These disparities also affect BIPOC newborns, who face significantly higher levels of birth-related complications and neonatal death.

In Tennessee, specifically, the disparities are striking. Black pregnant people are 1.5 times more likely to die within a year of pregnancy and 3 times more likely to die from pregnancy related complications than their white counterparts. At CHOICES Center for Reproductive Health the birth center is run by Black midwives.

GAIN shared the fellowship model used in Liberia to co-develop a novel fellowship aligning with CHOICES Black feminist midwifery. Priorities in Memphis include:

  1. Growing the number of Black midwives in the United States
  2. Improving the use of data to advocate for Medicaid coverage of the birthing center and promote the acceptance of midwifery care
  3. Highlighting the excellent outcomes of the birthing center and its positive impact on maternal and neonatal morbidity and mortality among their patient population

References:

  1. Insights into the U.S. Maternal Mortality Crisis: An International Comparison. doi:10.26099/cthn-st75
  2. Maternal Death Malawi - Maternal Death in Malawi: A Report. Malawi Maternal Deat. Accessed September 17, 2024. https://www.mdmalawi.net
  3. Malawi. Healthy Newborn Network. Accessed September 17, 2024. https://healthynewbornnetwork.org/country/malawi/
  4. Akinyemi OA, Fasokun ME, Weldeslase TA, Makanjuola D, Makanjuola OE, Omokhodion OV. Determinants of Neonatal Mortality in the United States. Cureus. 15(8):e43019. doi:10.7759/cureus.43019
  5. Lisgis LI of S and GIS, Moh M of H, ICF. Liberia Demographic and Health Survey 2019-20. Published online April 15, 2021. Accessed September 17, 2024. https://dhsprogram.com/publications/publication-FR362-DHS-Final-Reports.cfm
  6. Sierra Leone’s determination to stem maternal and child mortality. WHO | Regional Office for Africa. September 5, 2023. Accessed September 17, 2024. https://www.afro.who.int/countries/sierra-leone/news/sierra-leones-determination-stem-maternal-and-child-mortality
  7. Sierra Leone (SLE) - Demographics, Health & Infant Mortality. UNICEF DATA. Accessed September 17, 2024. https://data.unicef.org/country/sle/
  8. Alexander GR, Kogan MD, Nabukera S. Racial Differences in Prenatal Care Use in the United States: Are Disparities Decreasing? Am J Public Health2002; 92: 1970–5.
  9. Dahlem CHY, Villarruel AM, Ronis DL. African American Women and Prenatal Care: Perceptions of Patient-Provider Interaction. West J Nurs Res2015; 37: 217–35.
  10. Meghani SH, Brooks JM, Gipson-Jones T, Waite R, Whitfield-Harris L, Deatrick JA. Patient–provider race-concordance: does it matter in improving minority patients’ health outcomes? Ethn Health2009; 14: 107–30.
  11. Petersen EE. Racial/Ethnic Disparities in Pregnancy-Related Deaths —United States, 2007–2016. MMWR Morb Mortal Wkly Rep2019; 68. DOI:10.15585/mmwr.mm6835a3.
  12. Collins JW, David RJ. Racial disparity in low birth weight and infant mortality. Clin Perinatol2009; 36: 63–73.
  13. Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Matern Child Health J2003; 7: 13–30.