Our Section’s own Mary Anne Mercer was featured in the Winter edition of Johns Hopkins magazine! The piece tells the story of Dr. Mercer’s career in public health, with a particular focus on a program she developed in East Timor to decrease maternal mortality by combining a text-message alert service for pregnant women with a training program for midwives. The article is a slightly longer read, but here is an excerpt:
Back in Seattle, Mercer began writing SMS messages that could be sent to pregnant women, dispensing advice and reminders about how best to stay healthy. These were translated into Tetum, the most commonly spoken language in the country. HAI purchased smartphones to distribute to midwives, and Mercer flew out in January 2012 to oversee the first midwife training. The program was simple. When a woman came in for her first prenatal care visit, the midwife asked if she had a phone, and if she did, the midwife took her picture and some basic information: her name, her estimated due date, her phone number, the village in which she lived, and other pieces of identifying information. Then, twice a week, the woman began receiving messages appropriate for her stage of pregnancy. The first message read: “Congratulations on your pregnancy! You should be checked by the midwife at least 4 times at a health center to ensure a healthy pregnancy and healthy baby.” A first trimester message read, “During the [antenatal] visit the midwife will measure your blood pressure and feel your belly to see how your baby is growing and moving.” A message as the woman’s due date approached was, “The baby is getting bigger and may cause your back to hurt. You should stay active but try not to lift heavy things like water or other children.” The messages were meant in part to get women to think about having a midwife, now trained by HAI, present for the delivery. After birth, the messages continued for six weeks, with advice on postpartum and newborn care.
The program’s early results were so impressive that HAI and Catalpa International were asked to scale up the program into three new districts, with a tentative plan to expand to all of the country’s 13 districts in the next five years. In Manufahi, the number of deliveries in clinics rose by 70 percent, and total births assisted by a skilled attendant, whether at home or in a facility, increased by 32 percent. But Mercer is the first to take those numbers with a grain of salt. “There are a lot of complicated factors involved in evaluating whether the program works,” she says. The ultimate outcome they hope for, of course, is decreased maternal mortality. But those numbers are hard for HAI or the Timorese Ministry of Health to measure, given how expensive and difficult it is to gather them. So the key outcome measure remains whether the women use a midwife or doctor. In the most densely populated area with the largest number of midwifery staff—the places “close to the road,” as Mercer would have said in Nepal—the results were swift and impressive: more women came in for prenatal care visits, more women had their births attended by a skilled attendant, and more births occurred in a health facility.
The full article is available here.
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