Community perceptions of a policy promoting exclusive skilled birth attendance and banning traditional birth attendants (5)

26 May, 2019

A community-based emergency referral system needs to be established for geographically marginalized women even if lay health workers (including selected TBAs) are equipped with misoprostol and other life-saving tools.

Data suggesting that most women are within two-hour transport time from a life-saving institutional delivery is specious data.  For thousands of women, the only public transport is the weekly market lorry that departs early in the morning and returns late in the evening. Neither normal deliveries nor maternal emergencies can be timed to this narrow window. Poor road systems and frequent road wash-outs combine with poverty and ignorance to sustain high maternal mortality ratios. A UK aid health system strengthening programme in Northern Nigeria reduced maternal mortality by 16.7% within four years.  Significantly, one third of the lives saved were women evacuated in a timely manner from geographically marginalized communities where we catalysed the establishment of Community Communication Emergency Referrals.


Our innovative communication body tools empowered low and non-literate peers to saturate their communities with small, informed discussion groups. Communities established their own maternal savings schemes along with volunteer transporters and blood donors. It is unconscionable to continue to insist that the life-saving solution for these marginalized women is assisted delivery or widespread education and/or poverty reduction when these solutions remain clearly in their distant future. Please see Aradeon, SB. and Doctor, HV. Reducingrural maternal mortality and the equity gap in Northern Nigeria: the public health evidence for the Community Communication Emergency Referral  strategy. International Journal of Women’s Health 2016:8 77–92.

Susan B.Aradeon,

International Social and Behavioral Change Consultant

HIFA Profile: Susan B Aradeonis an International Consultant, Social and Behavior Change Communication, in the USA.

Professional interests: community communication integrated with mobilization, Maternal Newborn and Child Health, Reproductive and Sexual Health, including Adolescents. Susan led the development and scaled up implementation of Community Communication—a health promotion approach based on empowering community volunteer health promoters and community members to become the communicators reaching deep into their own communities. Innovative communication body tools and rapid entertainment education tools empower health workers, community volunteers and health session participants to become community communicators regardless of their literacy level or social status. The Community Communication MNCH e-Manual: Participatory Health Sessions and the associated Job Aids serve as an implementation guide for trainers. Susan advocates for expansion of the SDG3.1 Skilled Birth Attendant strategy to include safer home deliveries and rural community mobilization for timely emergency evacuation on behalf of the over 100 million women who will continue to deliver at home in the near and intermediate term. More background information is freely available on Linkedin.

Email: saradeon AT