This guest post was originally posted on the Frontline Health Workers Coalition (FHWC) website and is written by Joy Marini of Johnson & Johnson Global Community Impact and Global Health Council Board Member. Johnson & Johnson invests in people on the front lines of care as they change the trajectory of health for the world’s most vulnerable people, their families, and their communities.The Frontline Health Workers Coalition is an alliance of United States-based organizations working together to urge greater and more strategic U.S. investment in frontline health workers in low- and middle-income countries as a cost-effective way to save lives and foster a healthier, safer, and more prosperous world. FHWC and Johnson & Johnson is a 2018 Global Health Council member.
I could hear the jingling bells on the midwife’s hand-made, traditional dress as I approached the top of the mountain in Nậm Giang 2 community in the mountains of Lao Cai, Vietnam. Gasping for breath from the hike, I was greeted by the smiling midwife, Vàng Tả Mẩy, who was visiting the home of a young mother in this community. Mẩy and this young mother are one of 1.7 million Tày people, agriculturalists and the second largest ethnic minority in Vietnam. Tày homes are far apart with most not accessible by car, or even motorcycle. Tày indigenous midwives, many educated in a partnership between Johnson & Johnson and UNICEF, travel by foot up the mountains to visit soon-to-be moms, many of them girls between the ages of 15-20.
Mẩy shares information to ensure that pregnancies are healthy and that births take place in a health facility as much as possible. At the same time, the nearest hospital, which is still a long walk, plus a 2-hour drive on winding mountain roads, aims to provide high quality and culturally sensitive care with an emphasis on midwifery education and low-tech interventions. Dr. Nguyen Huy Du, a maternal-child health specialist at UNICEF, said, “The support from Johnson & Johnson has contributed to initial introduction and national wide scale-up of effective maternal and child health interventions in Vietnam, for instance early essential newborn care and Kangaroo Mother Care.”
Vietnam, like many low- or middle-income countries, showed improvement in maternal and newborn mortality during the era of the Millennium Development Goals, but a gap remains between disadvantaged groups and more privileged groups. Poverty, education, language and geography are among the many barriers to health care. Ethnicity may have a direct effect on health inequity, above income and education – indigenous people comprise 5% of the world population, but they make up 15% of the extreme poor.
Globally, inequity in health services is often most discernable for indigenous people during pregnancy and birth. Higher rates of home births lead to high maternal and neonatal mortality rates. Current solutions range from forcing Native women to travel to birth centers, to medicalization of birth, but these approaches do not address cultural issues, such as a view in some groups that birth is a ceremony with important rituals or celebration, rather than a medical process.
To achieve the SDGs for mothers and newborns, we must:
1) Ensure that communities have a skilled, indigenous midwife, who understands local culture
2) Deliver health services in native languages
3) Include indigenous people in decision-making and planning for health services
4) Learn from indigenous groups, who experience birth as part of their connection to community, history, and the land
5) Disaggregate data to make indigenous women visible, and understand their unique experiences during pregnancy and childbirth
6) Support solutions developed by indigenous communities from government, civil society and private sector
Programs such as the Bolivian government’s midwifery training program for indigenous midwives are already showing promise in saving the lives of mothers and babies. And there is a growing recognition that mainstream hospital practices are not always respectful of Native women, resulting in a resurgence of indigenous midwifery in Canada and the United States.
With a promise to “leave no one behind”, the SDGs present an opportunity for us to recognize and learn from indigenous populations, who bring cultural traditions and a hope for a rich, diverse future. A welcoming community of women who receive local, respectful care could be one answer to the healthcare gap for indigenous people.
As the bells on her dress whispered in the Lao Cai mountain breeze, Tày midwife Ms. Mẩy proudly said, “This community knows me and trusts me. I have lived here all of my life.”