A Growing area of interest for AMDD and Columbia University
More than half of the world’s population now lives in cities. Health plays a vital role in urban development and in the broader fate of urban inhabitants.
Both Columbia University and its AMDD Program are interested in the health and well-being of urban communities. Columbia’s Mailman School Urban Health Initiative, which will leverage the University’s eight Global Centers, is focused on cities across ﬁve continents. The Initiative is pursuing collaborations—both interdisciplinary and intercontinental—and will foster scholarship geared to advancing the science of urban health and reconﬁguring urban environments to maximize health and wellbeing for all ages. Read more about the University’s work in urbanization here.
AMDD is particularly interested in how urban dynamics affect women as they access maternal health services. In 2013, AMDD and the international non-governmental organization BRAC convened a two-day symposium in a broader effort to reframe urban health programs. The two organizations brought together actors and institutions engaged with aspects of rights, development and service delivery in urban “slums” in countries of Asia, Africa and the Americas. The symposium focused on what makes service delivery programs for slum-dwellers effective as well as how to link health programs with other community-based development efforts. Read more about the symposium here.
Evaluating a maternal, newborn and child health program in urban Bangladesh
From 2010 to 2013, AMDD also collaborated with BRAC to conduct an evaluation of BRACS’s maternal, newborn and child health “Manoshi” program in urban Bangladesh.
The evaluation revealed several core elements that accounted for the Manoshi program’s success. For example, BRAC recognized that for women in rural Bangladesh, childbirth was traditionally managed by pregnant women and their close networks of female family and friends, based in their village homes. But young women who had left the village for crowded slums were detached from these traditional networks, without the money (or sometimes the desire) to return to their villages to give birth.
Moreover, in the context of the urban slum, women faced a new set of challenges that they were ill-equipped to overcome. When pregnant women tried to access public health services, they were diverted by brokers trying to push them to use private facilities, and/or asked to pay for care that should be free. In response, BRAC created new resources for pregnant women in urban slums. BRAC’s program activities — including community health workers, birthing centers, and a robust, mobile phone-enabled referral network, created linking social capital for pregnant women. BRAC provided support to slum dwellers so they could access, with reduced exploitation, the resources of the city (including sophisticated health care) that otherwise lay beyond their reach.
Beyond the direct impact on maternal health, Manoshi helped the slum dwellers to realize their aspirations of creating “new lives” in the city, to benefit from the resources of urban Bangladesh, and to improve the health and wellbeing of themselves and their families. Implementation science sheds light on which project activities were essential, how BRAC created social capital that was responsive to the context, and how this capital spurred behavior change among health providers and pregnant women.
For more information on this evaluation, check out the following article:
Adams, A., Sedalia, S., McNab, S., & Sarker, M. (2015). Lessons learned in using realist evaluation to assess maternal and newborn health programming in rural Bangladesh. Health policy and planning, 31(2), 267-275.
Scoping the field of urban maternal and newborn health
In July 2016, AMDD published its findings from a global scoping of maternal newborn health (MNH) for the urban poor. The scoping was designed to review the state of policy, programs, and research in the field and entailed reviews of published literature; interviews of staff in headquarters and in county offices of seven Saving Newborn Lives (SNL) focus countries, urban experts, and representatives of donor agencies; and a scan of grey literature, donor websites, and policy documents. The scoping revealed that:
Changes brought about by urbanization are not adequately addressed with existing approaches to MNH, which are based on a rural mindset.
Little is understood about the unique dynamics of urban MNH as it has not been a focus of programming, policy, research, or investment.
Migration from rural to urban areas results in significant changes in physical environment; family and community structure; social networks; access to and relationships with political powers, social institutions, and basic resources needed for survival; and goals or aspirations.
Urban MNH is best addressed through an ecology-of-implementation approach, which entails working simultaneously at policy, program, and research levels, with a premium put on learning and adaptation.
For more information, access the full report here.