Making Maama Kits Work RETURN TO PREVIOUS PAGE
Over the recent decade, Maama Kits have grown in popularity as a solution for improving health conditions of birth for both mother and child. The original idea was to identify the most inexpensive items that could still have a significant health impact. Based on conversations with in-house midwives, the bags typically contain a plastic sheet that would enable a clean birthing surface, a set of gloves for the caregiver, a clean razor blade to cut the umbilical cord without a risk of neonatal tetanus, a sterile receiving blanket, a bar of soap, and a suction bulb to clear the newborn’s airway. The cost of materials and distribution at this level were around $5 per kit.
The World Health Organization quickly became aware of the value of providing Maama Kits to women in impoverished regions and suggested their replication to development and relief organizations, which is currently underway. However, no academic literature has been written on the efficacy of the kits and the scaling up is currently taking place without any plans for evaluation. In an ethnographic case study in Uganda, Domestic Agenda founder Annie Feighery discovered that the kits were the sole supply of medical equipment for many hospitals and clinics. So few supplies reached medical centers that the boxes of Maama Kits were not distributed to rural mothers, but instead raided for basic necessities, such as gloves and soap.
While the healthcare providers were grateful for any supplies, the kits clearly need revision. Among the most blatant examples were gloves. The kits contain one set of wrist-high gloves per woman. However, several women routinely labor at the same time. On market days, when transportation options allow more laboring women to get to the clinic, many women are in the final stages of labor and delivery at once. Yet, with only one set of gloves per woman, the caregivers do not have the option of starting each exam with a new, clean set. They are left with the dilemma of washing and reusing gloves or seeing multiple women with the same pair. Further constraining supplies, in response to the high prevalence of HIV in the community, health workers prefer to double glove.
Largely due to the high prevalence of malaria and malnutrition, many women experience a crisis in delivering the placenta. The placentas commonly rupture and require a manual extraction. Caregivers are reticent to carry out this procedure, however, because their bare skin is not protected from blood exposure as they reach into the vagina and uterus to clear pieces of the placenta. One doctor said elbow-high gloves were his highest unmet need from the kits.
This project aims to redesign kit contents based on qualitative interviews with midwives and doctors, and test the improved kits for effectiveness. The project goals are to find:
- if different kits should be provided to medical facilities than individual women in outlying areas, considering their adapted use as a supply base;
- if the items in the kits are adequate;
- if additional supplies like a child’s first set of vaccinations can be affordably included;
- and if a small pictorial guide to safe delivery will reliably improve health outcomes.
The scaling up of Maama Kits is an exciting opportunity for women in impoverished regions. However, like so many medical issues concerning maternal health, the idea suffers from an absence of scientific evaluation. This idea is being replicated before anyone really understands how and if it works. This project proposes to make and distribute Maama Kits in a way that will guide future endeavors to scale up and replicate a meaningful intervention. The cost of the redesigned kit is expected to be between $7 and $10. This amount is designed to match the recent success of bed net donations for malaria at the amount of $10. Once the groundwork is completed, individuals worldwide can text a $10 donation or contribute online to this organization to provide a Maama Kit to a woman or facility.