Professor Vanora Hundley’s clean birth kit research in New York Times

The work of BU Midwifery Professor Vanora Hundley has been featured in a New York Times article, looking at how ‘frugal innovation’ can support the world’s poorest people.

Hundley has conducted extensive research into clean birth kits: moderately inexpensive supply kits designed to prevent the deaths of women from avoidable causes in pregnancy and childbirth, such as an unsterile environment, in the developing world.

Approximately eight hundred women die daily from these preventable circumstances. Kits provide the basic equipment needed for a safe, sterile delivery, including plastic sheeting to cover a dirt floor and soap for washing hands.

Hundley said: “There is a tendency for kits to be made in high-income countries with good intentions, to be distributed as a charitable exercise.”

However, charitable intentions have not always resulted in effectiveness, especially when the designer is not aware of the customs of the recipient, as Hundley recalled a midwife disposing of an entire, unused clean birthing kit because it contained an image of a woman delivering in a horizontal position, while women in southern Africa stand during delivery.

Clean birth kits that accommodate the recipient’s culture are used much more successfully.

Frugal innovation, the process of designing products to meet the specific needs of the world’s poorest people, is gaining popularity.

Designers aim to produce an inexpensive, lightweight and durable product made of sustainable and local materials that does more with less and meets the specific demands of the people.

Read the New York Times article in full.

By Harriet Gilbraith

Harriet is a student at Budmouth College in Weymouth, who is working at Bournemouth University in the Press and PR Department. She joined BU on a Sir Samuel Mico Scholarship, which provides 10 students from the college with work experience for four weeks over the summer.


Surrogate mother producing faulty goods: the commodification of childbirth

By Edwin van Teijlingen, Professor of Reproductive Health Research, & Jillian Ireland Visiting Faculty, Centre for Midwifery, Maternal & Perinatal Health.

This week an interesting story appeared on the BBC news and in the Sunday papers. The story goes that an Australian couple left a Thai surrogate mother with a baby who is genetically their child.

The reason for this abandonment is that the baby is not perfect.  If that is not bad enough the couple has taken the healthy twin sister of this baby back home to Australia. Some newspapers reported that the Australian parents knew that the baby had Down’s syndrome from the fourth month of gestation onwards, but that they did not ask until the seventh month – through the surrogacy agency – for selective abortion of the affected foetus.

The surrogate mother, Pattaramon Chanbua, says that the couple were told: (a) that she was carrying twins and (b) that one of the twins had Down’s syndrome as well as heart problems. The surrogate mother refused the intervention on the grounds of her Buddhist beliefs.

Surrogacy is often a commercial transaction in the USA, although such a ‘business contract’ is not legal in the UK and some parts of Australia, as widely reported in the media.  However, in this case the Australian couple had paid Pattaramon Chanbua (a mother of two) to grow and carry the baby for them. She told the BBC that she had engaged in the surrogacy deal to get money to pay for the education of her other children.

This case epitomises several aspects of life that are of interest to sociology: (a) the commodification and commercialization of life (and health); (b) inequality and exploitation; and (c) globalisation. Commodification refers to the process by which something that was not originally bought and sold becomes a good or service, i.e. a commodity that is for sale.  As we become more modern and with economic progress/the rise of capitalism, more and more parts of our lives become commodified. Modernisation changes society and its social institutions and organisations. Economic development is based on industrialisation, but is also strongly linked to urbanisation, mass education, occupational specialisation and communication development, which in turn are linked with still broader cultural and social changes.

The second key issue sociologists are interested in is inequality and the link between poverty and poor health. In a global perspective where we, people in high-income countries, or so-called developed countries exploit people in low-income countries (or Third World, developing countries or under-developed countries).

Thirdly, globalisation refers to the world becoming a smaller place, both in terms of physical travel as well as the way we perceive it. It takes us less time to travel to London, Paris, Kathmandu than it took our parents’ or grandparents’ generation, and at the same time the information about a disaster or a  human tragedy story such as this one in Thailand reaches us more or less instantaneously. At the same time, modernisation and globalisation, particularly in many low-income societies, are contributing to rapid socio-cultural changes.

Surrogacy as commodification

Surrogacy is the commodification of a couple having a baby themselves. Other social solutions from the past to the problem of not being able to conceive include: (a) having more than one wife, a solution for men in a patriarchal society; (b) for women sleeping with their husband’s brother, to increase the likelihood that the baby ‘looks like’ the husband; and (c) adopting someone else’s child.

We must remember that aspects of maternity care have always been commodified. Rich British families in the nineteenth century would have been paying a wet nurse to breastfeed their babies and a nanny to look after their children whilst instant formula baby milk bought from a shop has been replacing breast milk supplied by the baby’s mother for nearly a century.

We don’t think surrogacy is the interesting issue here. We should be asking ourselves the more basic question, ‘What makes us think that every birth and every baby is going to be perfect or even okay?’.

One explanation is, of course, that we have seen a rapid decline in the number and the proportion of babies dying in high-income countries such as the UK over the past century and a half.  Women having better nutrition, fewer children, having one’s first child later (but not too much later), better sanitation, and improved obstetric care have all contributed to making childbirth safer now for both mother and baby than ever before in the history of humanity. However, these changes have also affected our ways of thinking about childbirth.

Social scientists recognise a social model and a medical model of childbirth. The former sees childbirth as a physiological event in women’s lives. Pregnant women need psycho-social support, but not necessarily high-technology interventions by doctors. The medical model stresses that childbirth can be pathological, i.e. every pregnant woman is potentially at risk. The medical model argues that every birth needs to be in hospital with high-technology screening equipment supervised by expert obstetricians.  In other words, pregnancy and childbirth are only safe in retrospect. In terms of social changes, we have moved from a more social model to a more medical model in a society which is more risk averse.


BU Midwifery Students receive funding for placements in Kenya

Third year BSc (Hons) Midwifery students Amanda Gill (Portsmouth) and Emma Barton (Bournemouth) have received funding from both the Iolanthe Midwifery Trust and the Global Horizons Fund to visit Kenya as part of their elective placements.

The Iolanthe Midwifery Trust is a charity which awards funding to pre-registration students for their electives to enhance their coursework.

The application process involved writing a funding application detailing their reasons for choosing Kenya, their plans while there and what they hope to achieve not only for themselves, but also for their education and the profession.

As well as Iolanthe, Amanda and Emma also applied to Global Horizons Fund, a scheme run by BU.

They each received £1,000 from each fund to cover travel, accommodation, subsistence and associated costs of the visit. They will be presented their awards at the annual Iolanthe Midwifery Trust award ceremony in Edinburgh in September.

Their three week visit will take place in July 2014, where they will be joining a small team from the UK to visit maternity services in central Kenya – Nanyuki District Hospital and the surrounding rural communities and health facilities of Lewa.

The initial project was established by three former BU students, aiming to provide training and sharing of skills and knowledge to midwives in Kenya to improve the lives of mothers and babies.

The project supports the development and provision of a range of education resources for use in the hospital and community clinic settings. Amanda and Emma were chosen to accompany these midwives and a paediatrician following interviews.

The elective experience will include observational placement of midwifery and obstetric services, visits to rural health facilities and participation in training and skills sharing sessions.

Amanda and Emma will have the opportunity to witness pregnancy and child-birth from different cultural perspectives, in both a district hospital and rural community settings.

Amanda and Emma are also raising money for training equipment and resources for the Kenya project.

Directly after the elective, Amanda will be partaking in a trip that includes climbing Mount Kilimanjaro, the highest mountain in Africa and, amongst other activities, Emma will be completing the Bournemouth half-marathon in October.

Should anyone wish to contribute to their fundraising efforts, they can do so on their JustGiving page.

Midwifery professors talk about their global work on Radio Solent

BU midwifery academics Professor Vanora Hundley and Professor Edwin van Teijlingen were interviewed by BBC Radio Solent’s Katie Martin about their work to improve maternity services around the world.

Katie, who presents Solent’s mid-afternoon programme, spoke to the pair about a conference that they had organised in Bournemouth, which looked at the international issues facing those giving birth and their babies.

Edwin, a Professor of Reproductive Health Research, said: “We were proud to have this international conference bringing people from a range of different countries including the United States, Ghana, Spain and the UK, of course, coming together to talk about what we need to do next on the world agenda to improve midwifery and maternity care for women in the next 15 to 20 years.”

He added that previous Millennium Development Goals looking at reducing maternal and child mortality, which had been set by the United Nations in 2000 with a target of being achieved by 2015, have had varying success.

“Some countries are doing well and reaching the targets, the majority of countries are getting there and some are not progressing that much.”

He also spoke about the work that he has been doing in Nepal, looking at improving access to midwifery services and some of the social and cultural reasons behind why and how women choose to use such services.

Katie also spoke to Professor of Midwifery Vanora Hundley about her recent appointment as an advisor for the World Health Organisation (WHO).

Vanora, who is working on a study to create tools to help improve birth outcomes, said that women giving birth in developing countries faced a number of risks – including infection and blood loss.

She said: “These are particularly great when women don’t give birth with a skilled person, and that’s why midwifery was so important and so central to the conference that we held and also towards meeting the Millennium Development Goals.”

She added that her work with the WHO would build on experiences with high income countries, looking at getting more women to come into hospitals and facilities to give birth – but making sure that they do so at the right time.

“One of the problems is that if you bring women into hospital too early, before labour is established and before women are actively in labour, you increase the risk of the medicalisation – so a woman is more likely to have intervention that she doesn’t need if she’s in hospital early in the labour.”

Katie ended the interview by saying how wonderful it was to have leading names in midwifery based in the South, “changing the world,” and asked what it meant for students to have their lecturers working and recognised on such an international level.

“I think it’s important that they see that research is real,” said Vanora.

“It’s not something that you do in an ivory tower – it has real impact, it improves the outcomes for mums and babies and they can actually see the value of it then.”

Listen to the interview in full (starts 1 hour and 15 minutes into the programme)

Midwifery conference discusses future of global childbirth healthcare


An international conference exploring the challenges facing maternal and newborn health worldwide has taken place at Bournemouth University.

The conference, organised by Bournemouth University (BU), looked at the international health issues facing those giving birth and their newborn babies and aims to influence the global agenda for the next 15 years.

Professor in Midwifery at BU Vanora Hundley, who has helped to organise the conference, said: “Midwifery should be the backbone of universal access to reproductive health services.”

The conference, called Midwifery and the post MDG Agenda, comes as the Millennium Development Goals (MDGs) set by the United Nations end in 2015.

Two of these MDGs focused on reducing child mortality and improving maternal health, and the conference will look at what has been achieved so far, and what still needs to be done.

Dr Zoe Sheppard, from BU’s Clinical Research Unit, said: “The MDGs helped focus attention on reproductive health and rights over the past 14 years.

“Now we need make sure we set challenging but achievable targets for the next 15 years.”

Delegates at the conference were encouraged by speakers to promote access to pregnancy- and birth-related healthcare for all women worldwide, regardless of economic situation or country of birth.

The conference also included a poster exhibition hall that displayed the latest research taking place in the field of midwifery. Posters included information on midwifery in poorer countries, such at Sheetal Sharma’s (pictured) poster on midwifery in Nepal.

Speakers at the one-day conference included Dr Neil Squires, from the Department for International Development (DFID), and Brigid McConville from the White Ribbon Alliance, a non-profit organisation which campaigns for safe birth worldwide.

BU midwife elected to Royal College of Midwives board

A midwife from Bournemouth University has been elected to a prestigious position on the board of the Royal College of Midwives (RCM).

Susan Way, Lead Midwife for Education at Bournemouth University, has been elected as one of the RCM’s 11 national board members.

She took up office on September 1st for four years.

Susan said: “I am extremely proud to serve as a member of the RCM Board and look forward to taking up this important role.”

The Board is the governing body for the RCM, setting the organisation’s strategic direction and ensuring it is viable, properly managed and properly governed.

It gives direction, exercises control and holds the Executive to account in its day-to-day management of the RCM. All Board members are midwife members of the RCM.

Cathy Warwick, chief executive of the RCM, said: “I am delighted to welcome Susan as one of the new board members and look forward to working with her. Our board members play a vital role in providing direction, ensuring the organisation is fit for purpose and securing accountability.”

Find out more about midwifery at BU

Midwifery lecturer Dr Catherine Angell on BBC Radio Solent

By Dean Eastmond

Senior Lecturer in Midwifery at BU, Dr Catherine Angell, featured on BBC Radio Solent talking to presenter Katie Martin about midwifery and how a woman’s life changes in a variety of ways after having a baby.

Dr Angell explained what physically happens to a woman’s body during pregnancy – including ligaments softening and certain hormones being produced to help the pregnancy – before going on to talk about a woman’s life in the first few weeks of being a mother.

“It’s very much an emotional rollercoaster,” she said.

She continued by explaining what “the new normal” was in terms of childbirth for a busy woman’s life.

Dr Angell told BBC Radio Solent that it’s nice to see when family and friends help out new mothers in terms of practical jobs such as “taking out the washing, cooking meals and taking the children to school”

“I think we’ve moved a long way in terms of actually now regarding birth as a normal event so for most women it will be completely normal, but that doesn’t mean to say that it is an everyday event, and I think we sometimes we muddle the two things up”, Dr Catherine Angell explained.

“So actually we want women to think about it as a normal thing in their life but actually it’s exceptional, it’s a profound thing to happen to them, so you need to kind of sit back and wait for the physical and emotional changes to settle in.”

The interview also mentioned the “royal baby hype” and what life will be like for the Duke and Duchess of Cambridge for the first few weeks of baby George’s life.

Dr Angell said: “It’s still a really big emotional change for whoever you are and it comes with that sense of responsibility and that can be scary for many first time parents.”

Dean is a student at Budmouth College in Weymouth, who is working at Bournemouth University in the Press and PR Department. He joined BU on a Sir Samuel Mico Scholarship, which provides 10 students from his college with essential work experience for four weeks over the summer.

BU students win national midwifery award


Two student midwives from Bournemouth University have been jointly named Student Midwife of the Year, after raising more than £4,500 to help bereaved mothers.

Third year BSc (Hons) Midwifery students Emma Knott and Jo Mockler received the honour at the British Journal of Midwifery Practice Awards 2013.

Emma, 36, of Dorchester, said: “We were really proud and exciting just to be nominated, let alone to win.

“Just going to the awards ceremony was amazing and it was a great event.

“The judges told us it was a really difficult category, with lots of nominations.”

The Student Midwife of The Year award is open to all student midwives and recognises the enthusiasm and willingness to question practice that students bring to midwifery.

The pair were nominated for the accolade by Jo Hartley, Head of Midwifery at Dorset County Hospital, after raising more than £4,500 for the maternity unit there over the past two years.

While Emma raised money for a cold cot in the hospital’s maternity bereavement suite, which allows grieving parents to keep their baby with them for longer, Jo designed and produced 700 Forget-Me-Not memory books for families who have lost their babies.

The books feature poems and space for families to write down their memories and place photos of scans.

Emma, 36, of Dorchester, said: “We started the course together and became friends quite quickly. I wanted to get the money for the cold cot and she did the books.

“The Forget Me Not books really help parents because they have got something concrete to keep going back to, particularly on memorable days like anniversaries.”

They each received a glass trophy and framed certificate at the awards ceremony, which took place on May 16 at Le Meridien hotel in London.

“Our friends and family have been really supportive,” said Emma, who plans to work in hospitals in India for a few months when she finishes her degree.

“They are really proud of us.”

Academics to look at access to maternity services in Nepal with Fellowship grant


A team from Bournemouth University will look at why women in Nepal don’t use health services when giving birth, after receiving the first International Fellowship for Midwives.

The Fellowship is awarded by the charity Wellbeing of Women, in association with the Royal College of Midwives, for research into maternity services and women’s health from an international perspective.

The team from BU will use the £20,000 Fellowship grant to look at the real and perceived barriers to women in Nepal giving birth within a health facility with a skilled birth attendant.

“There is evidence that access to skilled birth attendant is likely to lead to a better outcome for the mother and baby,” said Lesley Milne, senior lecturer in Midwifery at Bournemouth University, who will lead the project.

“If they don’t, it is more likely to end in a maternal mortality, and we are trying to determine why women in Nepal don’t access health services.”

Lesley will be supported by Vanora Hundley, Professor in Midwifery at BU, Edwin van Teijlingen, Professor of Reproductive Health Research at BU, and Dr Padam Simkhada, from the University of Sheffield.

The year-long project will start on April 1 and the money received as part of the Fellowship will enable Lesley to go to Nepal for three weeks in September to undertake the research.

She said: “This would not be possible if we had not been awarded this money.

“It’s fantastic to have received this grant and we are really pleased about it.”

She added: “There is an under-utilisation of health services in Nepal. It is about getting women to use the services available and trying to find out why many of them currently don’t.

“I will be going out to Nepal to observe and also undertake some interviews of health personnel of both a rural hospital and a hospital in Kathmandu, to try to see what they think is preventing women from accessing services.”

Lesley added that possible reasons for women not accessing health services could include having to travel a long way, having had poor previous experiences or their cultural beliefs.

Bournemouth University has been building links with Nepal across a number of areas and academic schools, including the School of Health and Social Care, and both Lesley and fellow researcher Professor Edwin van Teijlingen have experience in the surrounding area.

Lesley said that she hoped the research could be a springboard for future study.

“I hope that we may have a great insight into why women aren’t accessing services and hopefully will be able to address that in the future,” she said.