Postpartum Haemorrhage in Humanitarian Crises : Obstacles and facilitators to the adoption of the non-pneumatic anti-shock garment (NASG) into humanitarian settings

Abstract: In 2013 around 289,000 women died from what was categorised as maternal complications. This figure is likely to be higher as only 40% of the world has an adequately function health reporting system (WHO et al 2014, p.1). Severe bleeding causes around 27% of all maternal deaths; this is the single biggest threat to pregnancy and childbirth. Moreover, maternal complications are the second biggest cause of death for women of reproductive age globally. The risks women and girls face through pregnancy and childbirth are the outcome of socio-cultural structures and norms, which increase the inequalities in many societies. The decisions we make, the choices we have, and the actions we carry out are a product of our social system’s structures and norms. Humanitarian crises painfully display the divisiveness and destruction that these structures and norms can have on the members of that system. But, crises also offer an opportunity to either, rebuild structures and norms in a way that reduces inequality and protects the vulnerable, or a regression to more traditional, more patriarchal and more hierarchical structures and norms which will ultimately disadvantage women and girls further in their plight for equality. There is a vicious circle of poverty and mortality that can be triggered by maternal death. In order to prevent these cycles from continuing, creative, simple and appropriate strategies need to be developed for humanitarian response that build on the knowledge systems and capacities of those affected, as well as the experience and expertise of practitioners. Instead of a discussion between development or humanitarian, the conversation should try to find ways for all interventions to be more homophilious with those affected and ensure that they do not worsen the structures protecting the most vulnerable. Innovation has long since been seen as a process for those who ‘have’, and not for those who ‘have not’. Criticisms of increasing inequality through a division based on socio-economic markers have only led to self-fulfilling stereotypes of who is innovative and who is not. This research is trying to shift the focus from one that is divisive to a more inclusionary approach. To address maternal mortality caused by severe bleeding, it is imperative to understand the context in which it is happening. Who is affected? Why? What do they think and believe? What happens to the family, the community? How are the structures and norms of the society affecting it? What solutions have been offered? In answering these questions it is clear how far the impact of maternal mortality can reach. It is the hope of this research, that its can be used to reduce and lessen this impact through better-targeted and tailored responses using appropriate tools – such as the non-pneumatic anti-shock garment, implemented in a mind frame of sustainability and resilience in an environment receptive to innovation. There is a need for fresh ideas and approaches to reduce a burden that does not exist in resource stable parts of the world, and a burden that has come to be seen as a problem of the poor. The non-pneumatic anti-shock garment is a game changer. It has the potential to inspire interest and access health systems, yet implementation thus far has been limited in humanitarian response. This research investigates maternal mortality caused by postpartum haemorrhage in humanitarian crises, in an endeavour to improve the discussion on including the NASG into the MISP as an appropriate tool to fight maternal mortality and the inequality that is found at its root.