Mwambata wa Mama, Birth Companion in Tanzania

Sonder has been working with Columbia University In dar es Salaam to co-design and test a birth companion model for urban facilities. 

The World Health Organization (WHO) has included “emotional support” as a core component in the new framework for quality of maternal and newborn health care (WHO, 2016). The suggested indicators are that ‘every woman is offered the option to experience labour and childbirth with the companion of her choice”  and that “Every woman receives support to strengthens her capability during childbirth”. Cochrane Review: 2013

A companion accompanying a woman during birth has been demonstrated to improve clinical and experiential outcomes for women including 

Clinical:

  • More likely to have a spontaneous vaginal birth
  • Less likely to have intrapartum analgesia
  • Experience shorter labour
  • Less likely to have a caesarean section
  • Less likely to have an instrumental vaginal birth 
  • Less likely to have a baby with a low 5-minute Apgar score

Experiential:

  • More likely to report satisfaction with the birth experience

Little documentation exists regarding how to actually design and implement a birth companion program, particularly in low- and middle-income country (LMIC) health systems such as Tanzania. Successful birthing companions models have been introduced in rural Tanzania but not in urban Dar es Salaam, and not without considerable investment in resources and infrastructure that are not available in this context.

Success for me will be if the staff accept and support the Birth companion model.

Facility director

The project hypothesis is that a participatory Human Centered Design (HCD) approach can inform the design of a model that is tailored to the Dar es Salaam context and without significant investment in infrastructure and resources.

Our design questions are:

  1.  Is it  feasible and acceptable to implement a birth companion model  in the Dar es Salaam context, and what steps must be taken to introduce this model in public health facilities, within the constraints of existing infrastructure 
  2. Does the birth companion intervention increase respectful maternity care RMC and improve women’s experience of care during childbirth?
  3. Does the HCD process enable the design and implementation of a contextually relevant birth companion intervention that is both replicable (the process) and scalable?

Design challenges include how to establish authentic participation and trust between management, facility staff, mamas and birth companions so all can authentically share their experience and contribute to the design of birth companion models tailored to the needs and constraints of each facility. The project is participant lead Sonder has built design capacity for a design team at each facility, they meet regularly to discuss what is working, emerging challenges and the solutions they will test, the nurses are taking the lead evolving the model for each facility 

The design approach has focused on building a shared understanding of the vision for introducing birth companions to the facility  across all facility staff including management, doctors, nurses, cleaners, security staff and involving everyone in designing the role and guidelines for the Birth companion and problem solving as we gradually introduce and scale the model in the two facilities 

Today we have seen Mwambata and we believe it, we have seen the importance of the Birth Companion.

Facility nurse

In these urban facilities some of the challenges we are addressing include:

  • Infection control
  • Equity of access 
  • Security 
  • Visual and audio privacy

Neither facility has the physical space to allow for partitions between beds for privacy and there are other considerations: In a crowded urban facility where there are many women and limited staff,  there is a tension between privacy and safety. Safety is increased when staff can oversee the whole ward and in the case of Mwananyamala into the next ward. 

Privacy can be created in many ways from spatially  – putting up walls, using curtains to more intimate like covering with a kanga or blanket. This more intimate privacy is in the control of the woman herself.  In this pilot, the primary privacy solution is intimate privacy where the mama, the mwambata and facility staff all work to maintain the woman’s intimate privacy

Communication materials have been designed collaboratively between Andgood in the UK and the project team in Dar es Salam.

The pilot phase was completed during December 2018.