When Arianna Huffington first launched Global Motherhood, she spoke of the loss of her first baby five months into her pregnancy and her terror that the same might happen in her second pregnancy. Christy Turlington has likewise shared her personal experience of post-partum haemorraghe and that of her great grandmother in El Salvador. The three personal events demonstrate the reality that your geographical location, your access to midwifery and obstetric care and who is available if there is a complication is all too often a determinant of whether a woman and her newborn will live or die. This is the geography of maternal and newborn health that continues to blight the lives of millions of women.
Using geography to explore health outcomes has been around for hundreds of years. Perhaps the most famous example is John Snow's epidemiological study of London's cholera outbreak in 1854. Snow's analysis of the 500-plus cholera deaths studied the spatial environment and determined that the Broad Street water pump was the source of the outbreak. The association was most usefully captured in a map that plotted mortality alongside the cause of the disease, the water source. This "told the story" of the study's findings in a simple but easily understood way.
Snow's famous map is one of the earliest examples of "health data visualization." This is where health datasets are converted into figures and graphics that enable researchers and policy-makers to visualize the findings. Advances in digital technology, design and data management software are enabling a rapid acceleration in visualization, converting complex data sets into evidence and intelligence. The Institute for Health Metrics and Evaluation's Global Burden of Disease (GBD) Visualizations is but one current example of how health data visualization tools "will allow health researchers worldwide to engage in a broader discussion with policymakers and the general public about health."
So what does John Snow's street map and health data visualization have to do with maternal and newborn health (MNH)? How can health geography inform policy discussions and accelerate progress on the UN Secretary-General's Every Woman, Every Child campaign? And how might it support national and international decision-makers who are challenged by the High Level Dialogue on Health in the Post-2015 Development Agenda to "hard-wire" equity into health services? These are just some of the questions that a platform of global partners, led by ICS Integrare and the University of Southampton, is currently studying with catalytic funding from the Norwegian Agency for Development (Norad): "Mapping for maternal and newborn health."
In March 2013, we had the pleasure of convening a first face-to-face meeting of the platform of partners to answer these questions. Many of the partners participating in the platform were able to join us over two days, including the World Health Organization and USAID, to share their knowledge and expertise and jointly develop a 'state of the art' analysis. Health geographers, demographers and experts in MNH, health systems and human resources came together to explore the utility of geography in addressing equitable access to appropriate health services in the 49 low-income countries where the number of women and children dying from preventable causes is highest. A short video of the event is available here.
Health geography, boosted by modern technologies, is clearly a tool that can influence new analysis and interpretation of the barriers to effective coverage of MNH services. A rapid expansion in Earth-observation satellites and investments by the likes of Google and the Gates Foundation, means that geo-referenced data is now widely available and this is driving advances in Geographic Information Systems (GIS). GIS are widespread in the social and natural sciences, used in everything from monitoring floods, managing traffic, detecting landmines or mapping crime-risk. In the health sector, they have mostly been used to map out the position of health facilities, or to monitor the spread of communicable diseases, such as the Malaria Atlas Project (MAP). But the incredible potential of health geography and technology has not yet been fully realized in the field of MNH, with only a few studies to date considering spatial access to facilities. In terms of looking at the availability, accessibility, acceptability and quality of the midwifery/MNH workforce that provides critical services, the field is still very much in its infancy.
Hillary Clinton, in her former capacity as Secretary of State, made a call to the international community in 2010 to unleash its innovative potential and improve the ways in which data is used and understood in the pursuit of better health outcomes for the world's most vulnerable populations. She argued that "how we measure and evaluate impact... demands that we invest in improving how we collect, analyze, and share data." The same strong message -- for a "data revolution" -- is one of five key points noted in a Communiqué from the High Level Panel of Eminent Persons on the Post-2015 Development Agenda on 27 March, 2013. The HLP is calling for "improvements in national and sub-national statistical systems including local and sub national levels and the availability, quality and timeliness of baseline data, disaggregated by sex, age, region and other variables."
Responding to these challenges is absolutely critical if we want to improve the lives of women and newborns. Even those countries that are in reach of their MDG goals for women and children have large pockets of their countries where trends are not improving -- so that their success stories have only reached more affluent populations. The result? Huge inequities are opening up. Only with concerted efforts to look at the geography of inequity and adverse health outcomes we will be able to develop equity-focused MNH interventions that reach these women and their newborns.
Collating this data, visualizing it, and telling the story through maps, is part of the continuing work of the Mapping4MNH platform. We aim to put information into the hands of the people at the top, the decision-makers in governments and international development agencies who have the power to channel resources and investment directly into the underserved areas that need them. The technology exists, data is increasingly available, and concerted efforts to drive an open-access, open-source data revolution on MNH geography will reap huge dividends in improving the quality of care available and ending preventable maternal and newborn deaths. The goal is simple: to ensure that the place of birth does not determine the right to life.
Jim Campbell is the Director of ICS Integrare in Barcelona Spain. He works extensively in Human Resources for Health (HRH) and Health Systems Strengthening (HSS) and co-authored the State of the World's Midwifery 2011. Current research includes the HRH implications to accelerate progress on the MDGs and inform Universal Health Coverage and the post-2015 development agenda, with a particular focus on equity and effective coverage of essential health services.
Zoë Matthews is a Professor of Global Health and Social Statistics and Co-Director of Global Health, Population, Poverty and Policy (GHP3) at the University of Southampton, UK. Originally a statistician and demographer, her current work focuses mainly on international health - specializing in health systems with a particular focus on reproductive, maternal, newborn and child health, a field which she has worked in for nearly 20 years. She is currently working on a five year DFID-funded programme called 'Evidence for Action for maternal and newborn health' based in six African countries, the initiative behind the newly launched MamaYe campaign , and has previously worked with the World Health Organization and the UK Department for International Development.
The internet's best stories, and interviews with the people who tell them. Learn more