Title: Birth across the Borders: exploring contextual education as a catalyst for improved maternal health.
Funder: Economic and Social Research Council

Abstract: The aim of our project is to identify and implement a contextually designed, community-based educational meta-intervention to impact risk factors associated with maternal mortality in remote communities of Myanmar. This includes identifying the critical factors which influence maternal health and mortality and including key common and unique cultural and contextual components within the education, tailoring the meta-intervention and associated toolkits to each region to increase the effect. Each objective has been incorporated into work packages to address identified development challenges. Management and implementation will be co-led by co-investigators and partners in each region. 1) Explore and develop culturally relevant approaches to partnership at national, regional and community levels. Further objectives include the development of a work package (1) for project management and implementation which will include strategies to develop effective contextual equitable partnership approaches across the regions, liaison and communication methods and a robust system to implement and deliver the aims and objectives of the project. 2) Build community capacity to address health and socio-economic challenges influencing maternal health. Building community capacity is critical to sustainable change in socio-economic and health related development challenges. This will be achieved through work packages 2, 3 and 4 (see case for support). Each work package includes regional and local partners who will co-develop and lead the research and interventions. Stakeholders, beneficiaries and communities to be be included at each stage of the project and resources will be co-developed during each phase to build community capacity to meet the challenges identified. 3) Analyse cultural and contextual factors influencing education and maternal health within ethnic groups in remote and post conflict regions. Further objectives include data collection for each intervention through work packages 2, 3 & 4 to identify the key influencing contextual and cultural factors related to maternal health. Following analysis common beneficial customs will be included into educational interventions and toolkits. Unique components to each region will then also be identified and included to increase relevancy of the knowledge and make it culturally and contextually appropriate. 4) Co-design and evaluate innovative and culturally relevant educational initiatives to address development challenges with regional and local communities. Each intervention design will be mapped to identified development challenges affecting each region and evidence-based strategies will be incorporated into the educational interventions to address these through work packages 2, 3 & 4. This will include research methodologies, guidelines, research tools and educational resources. Evaluation will be completed through a pre-and post-test step wedged design. 5) Identify and include common and unique cultural components to inform the design and equality screen the proposed interventions. Based on previous work from our team at Ulster University we have identified the importance of cultural and contextual information to increase motivational content of education and facilitate behaviour change. In this project our objective is to integrate these unique components into each educational intervention through the co-design process with our local partners and beneficiaries. Each intervention will then be screened to ensure equity of access, understanding and relevancy across the ethnic groups. 6) Develop and test a contextually adaptable holistic maternal health education model. This project will be guided through the implementation of two key theoretical models. However, due to the complexity of the influences and barriers a maternal health education model will co-developed to include the multiple layers of influence with a focus on fragile and conflict states.

Lay abstract: Families that lose a mother in pregnancy or childbirth face many challenges. They are left with a gap that can lead to a loss of income and poverty. It can cause a lot of family pressures, especially for girls are left to care for younger children and are not able to go to school. Many of these families come from communities that are already poor, with very little infrastructure and limited access to decent healthcare. This can cause a much higher risk of death, both for mothers and babies, especially in poor countries. Opportunities are more limited because families lack money and education. Myanmar is a South East Asian country that has had many years of tension and conflict between the different people groups. Many of these groups live in remote mountainous areas where basic resources and infrastructure such as electricity are limited. There is often little healthcare in these areas with very few doctors, nurses or midwives to care for mothers and their families. One in 23 women in Eastern Myanmar either die or come close to death during pregnancy or childbirth. These challenges are all very typical in developing countries across the world today, but a lot can be changed with education that makes sense to mothers and families in their situations. Working together with our local partners we intend to learn more about the specific challenges facing families in four regions of Myanmar. From this we will co-develop three education programmes which will be especially adapted for each region. One of these programmes will help families and communities understand the processes of pregnancy and birth, recognise what is normal, what is unusual and what is dangerous and to know what to do and where to go to get help. Our second programme will further train health workers to understand the different signs and symptoms that are dangerous in pregnancy and birth and find ways to help mothers in time to prevent complications. Poverty is very high in parts of Myanmar, so our third programme is for community leaders and local people to support them to start and grow businesses. This way families can afford to eat well and get good healthcare when they need it. Our project will focus on remote regions in Myanmar and together we plan to learn how to find ways to overcome the legacy of many years of poverty and conflict. This project will include staff from our universities in Northern Ireland and Thailand as well as local partners who come from or have been working in the region for many years. Through this project we hope to help support the work of all our partners and improve education for mothers, families and communities. A key part of our project is making sure that the education they receive makes sense in their situations and includes their beliefs and customs leading to improved health, social and economic opportunities and accessible healthcare. We plan to share what we do with other organisations working in Myanmar who may also benefit from our research. Finally, it is hoped that our research will contribute to current policies and practices in partnership with the government of Myanmar and the ethnic health organisations.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH