Improving maternal health using partcipatory action research with women living in rural Papua New Guinea

Research Doctorate - Doctor of Philosophy (PhD)Papua New Guinea (PNG) has one of the highest maternal mortality rates in the Pacific Region. My thesis is that safe birthing is a human right and this has been denied to many PNG women. My research question: What can be done to improve maternal health in PNG? is in line with Global Millennium Development Goal 5 and favoured as a community development research approach which allowed me to research alongside fourteen women. Participatory action research (PAR) as articulated by Koch and Kralik was conducted in two phases. Phase One was an apprenticeship in PAR process conducted in Newcastle under the guidance of the PhD supervisors. Storytelling and facilitating group processes were data generation and analysis strategies learned. The objectives for Phase Two were: (1) to collaboratively explore maternal health, examine and describe factors and contexts that are associated with maternal mortality in Lomakunauru village, PNG; and (2) to build awareness about maternal mortality through the PAR process and alongside village women and collaboratively decide on action and /or reform strategies. Fourteen women told their stories about pregnancy and birthing: four English speaking PNG women living in Newcastle (Phase 1) and ten Lomakunauru village women speaking their own languages (Phase 2). The student researcher is indigenous to this area and speaks several local languages. Stories were transcribed verbatim and each story was returned to the women for their validation and ownership. Storied data were analysed and commonalities in village women‘s experiences were revealed. Women were voiceless in their birthing process. Rural populations are thinly spread and health services are located many kilometres away, often across open seas. Hence the distance a woman needed to travel to gain access to maternal care was one of the major problems recognised. Lack of support from husbands during birthing was common and not surprising in patriarchal communities. Women‘s preference for gender specific care was noted. Nurses assisting women during the intrapartum process were portrayed as perpetrators of negligence and/or abuse. Spiritual devotion and trust in God during birthing gave women strength. In this Seventh Day Adventist village abortion as a birth control measure was unacceptable. Village women were brought together to discuss ways to promote maternal health. Awareness was raised about the problems associated with maternal mortality. Resultant action was that women wanted to build an accessible Health Post in the centre of the village. The Health Post would be run by traditional birthing attendants (TBAs). Ten women in this PAR group volunteered to complete TBA educational preparation. This study shows what is possible when women are given a voice. Grass roots organizations led by women are likely to be sustainable in the promotion of maternal health. Educational preparation of TBAs is one of the recommendations given because professional registered midwives are not affordable in PNG context