How gender equality is helping to prevent preterm birth
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How gender equality is helping to prevent preterm birth

The Born on Time initiative makes strides in Mali

A Malian woman holds her child, whose health is being monitored at the Niena community health centre. The mother is a member of the solidarity fund group, where she has been saving money to access health services so her child can receive regular medical check-ups, nutrition advice and vaccinations. Photo: Save the Children/Benjamin Eagle

Bintu Kone* gave birth to her child Issa* in Dec. 2017. At 42 years old, it was her first full-term pregnancy after experiencing two preterm births – of which neither child survived.

Kone, who lives in a rural village in the southern region of Mali, says Born on Time’s program, implemented by Save the Children in Mali, was essential to keeping her informed about her reproductive health, supporting her throughout her pregnancy and helping her deliver her son safely.

“Thanks to the assistance of the program, I was more confident knowing that I had support. I am happy that this baby is safe,” Kone says.

Poor access to health care and low rates of female autonomy are among the many roadblocks that women in Mali face when pregnant. About 12 per cent of babies are born prematurely in the West African country – most of whom have a low chance of survival, as 30 per cent of neonatal deaths are due to prematurity.

Born on Time is tackling this issue through a holistic, community-based approach. The initiative aims to improve the quality of reproductive health services throughout the Sikasso Region in Southern Mali, and equip couples like Kone and her husband with the tools they need to support a healthy pregnancy. This includes knowledge of preterm birth risk factors, and the importance of antenatal visits, vaccinations and healthy, nutritious foods.

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Aminata, a midwife with Born on Time, monitors a baby’s heartbeat during a prenatal care appointment. Photo: Save the Children/Benjamin Eagle



“When women visit me during their first three or four months of their pregnancy and complete four prenatal visits, I know they will have a safe delivery,” explains Fatoumata, a midwife who works with Aminata. “But for those who I meet for the first time on their delivery day, they generally come in with complications.”

“There are many causes of preterm birth,” she adds. “In our community, women do a lot of hard work, such as traditional mining, carrying large piles of wood, and washing clothes. These conditions can stimulate early labour for pregnant women.”

Kone is among countless women who have received critical support from Born on Time in the four years since the project started. Save the Children, in conjunction with World Vision Canada and Plan International Canada, the Canadian government, and Johnson & Johnson, is working to reduce rates of pre-term birth in Mali, Bangladesh and Ethiopia.

Premature births are the leading cause of newborn deaths; UNICEF estimates show there are 7,000 of them globally every day. The Born on Time initiative was launched with the knowledge that affordable interventions are the most effective way to halt this epidemic.

In 2019 alone, Born on Time held more than 56,160 community awareness sessions and reached nearly 600,000 people in Mali. It also provided essential medical equipment and supplies to more than 134 health facilities. Last year, more than 75,500 pregnant women received prenatal services and 67,650 women benefited from skilled delivery in the health centres supported by the project. In 2019, Born on Time supported the health facilities in providing family planning counselling to nearly 92,000 adolescents girls and women in Mali.

In addition to promoting healthy lifestyles and improving health care, Save the Children’s work through the Born on Time program is working to end another underlying factor that contributes to premature birth rates: gender inequality. The project focuses on educating and empowering women and adolescent girls to make informed decisions about their bodies and pregnancies, including when to seek health care.

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A Malian woman sits with her newborn baby in the maternity ward at the community health centre. Her baby was born preterm and received support with help from the Born on Time project. In the maternity ward, this woman learned to practice Kangaroo Mother Care (skin-to-skin contact with her newborn to keep the baby warm and support early breastfeeding.) Photo: Save the Children/Benjamin Eagle


The project engages men and boys as partners for change. Through workshops and community outreach – often via local and religious leaders – Born on Time encourages men to help carry the burden of household chores and childcare, accompany their wives to health clinics, and to share, recognize and respect the decision-making power of their wives.

The initiative also works with local healthcare providers to champion services that respond to the needs of women and girls – including screening for intimate partner violence.

“Thanks in part to our efforts, we’re now seeing a decrease in gender inequalities in our project locations” says Mali-based Dr. Jean-Pierre Okitakoy, chief of party, Born on Time. A midterm study conducted in 2019 shows decision-making power within households has grown more equitable over time in relation to women of reproductive age seeking health care services. For example, at the beginning of the project, only five per cent of women and six per cent of men reported equal decision making in seeking health services during pregnancy and using family planning methods. Three years later, these rates climbed to 15 per cent and 14 per cent respectively.

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Barakissa Sanogo, a community health worker, explains to women in the community the benefits of having their husbands accompany them to their medical appointments before, during and after pregnancy, as a means to improve communication and foster equitable parenthood and relationships. Photo: Save the Children/Benjamin Eagle

In addition, the number of women in leadership positions in community health management groups has increased from 12 per cent to 30 per cent.

The Born on Time program team is also seeing more men accompany their wives to antenatal care services, explains Dominique LaRochelle, head of gender equality and program impact at Save the Children in Canada.

“Other anecdotal evidence showed that many men support women’s participation in community organizations and associations, and for women to hold positions of leadership,” she adds. “These changes are important steps towards greater gender equality in the communities where Born on Time has been working.”

The initiative’s success would not be feasible without buy-in from local governments. In Mali, for example, the government integrated Born on Time’s approach to solving rates of prematurity in its National Strategic Plan, while the Ministry of Health has put resources into improving its data collection on prematurity at the health facility level. These steps have enhanced the national government’s ability to monitor and respond adequately to premature births.

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Mamadou Diakité, Save the Children’s health district officer, is in charge of training and supervision of community health workers. Here, he is explaining the objectives of the Born on Time project and ways of having a healthy full-term pregnancy to the community of the Zaniéna village. Photo: Save the Children/Benjamin Eagle



“Most of these [pre-term] deaths can be prevented with basic solutions such as affordable, quality health care delivered by skilled health providers,” LaRochelle says. “Having government stakeholders take ownership of the project is instrumental towards ensuring sustainable impact.”

The project’s efforts are in line with Save the Children’s overarching mandate. Since it was first established over 100 years ago, the aid agency has worked to advance the rights of children in crisis in Canada and 116 countries around the world through better education, health care, protection and economic opportunities.

“Every woman, regardless of who she is, or where she lives, has the right to a healthy, full-term pregnancy,” LaRochelle says. “And every newborn has the right to survive and thrive.”

*Names changed for privacy

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Aissata, a community health worker, is helping prevent preterm births in her community. “The arrival of the Born on Time project brought a lot of change to my work,” she says. “For example, contraception was a topic of taboo. Now, many women and men come for family planning.” Photo: Save the Children/Benjamin Eagle

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