Reflecting on Georgia’s Childbirth Revolution

I’ve had the privilege of being JSI’s home office-based “senior advisor” to Georgia for the past five years. JSI has just completed 12 years of work in maternal and reproductive health in Georgia, through two USAID-funded, back-to-back projects: Healthy Women in Georgia and the Sustaining Family Planning and Maternal and Child Health Services in Georgia (SUSTAIN) Project.

It is no exaggeration to say that these two projects revolutionized the way babies are delivered, the way women are treated during pregnancy and childbirth, and how modern family planning is practiced in Georgia. And we have the numbers to prove it!

Maternal mortality has declined by 40%, thanks in large part to the introduction of effective perinatal care. Some 80% of babies in Georgia are delivered using effective perinatal care, which has made childbirth safer for mothers and babies. The average length of stay in hospitals for childbirth has decreased by four days. Modern contraceptives provided through the project accounted for nearly 300,000 couple-years of protection, including in previously unserved remote and rural areas. But as with every project, there are so many stories behind the numbers.

JSI contributed to a major shift in the culture around childbirth in Georgia by modernizing care practices, reducing unnecessary medical interventions, and promoting respectful care of women and their families.

Reflecting on this work, I wanted to capture the story of the project from the perspective of a woman, a clinician, a policymaker, and a technical assistance provider. However, in order to reflect the breadth of everything that was accomplished, these stories would have to be fictionalized composites. Instead, I offer just a few anecdotes to illustrate my colleagues’ key accomplishments.

My JSI colleagues:

• Were part of a veritable revolution in maternal and newborn care. I met women in Zugdidi who had just delivered their new babies and who enthusiastically described the difference between this childbirth experience and their previous experiences.

• Promoted family planning and reproductive health in challenging times and social currents. I met women in Tbilisi and in towns and villages who shared that their mothers had had dozens of abortions to end unplanned pregnancies, which was common during Soviet times. They are now able to use contraception instead, and modern family planning methods are available even in very remote locations!

• Adapted readily to rapid, profound changes in the health sector. Our technical assistance had to be incredibly flexible during a decade of sometimes chaotic flux in Georgia’s political landscape. We worked side by side with Georgian counterparts through changes in government, the war with Russia, economic crises, and dramatic back-and-forth-and-back-again shifts in health policy. I heard directly from policymakers, who thanked us for being there through it all, conducting trainings, developing protocols, crafting and re-crafting quality improvement approaches for the public and private sectors, and who finally simply said that “we could not have done this without [JSI in Georgia].”

• Demonstrated the power of modernized medical education. SUSTAIN worked with Georgian medical schools to introduce modern, student-centered teaching methods; Tbilisi State Medical University (TSMU) became the first university in the region to hold the internationally-renowned OSCE (objective structured clinical examination) in obstetrics and gynecology. One seasoned clinician emotionally noted that she was so, so grateful for the new training, sharing how proud she is that she now practices “European medicine,” meaning modern, quality-focused, patient-centered, evidence-based care.

• Developed a constituency for quality health care and quality improvement among clients, providers, and the Georgian government. Our USAID-funded work is completed, but we know the “revolution” will live on. I was told by Ministry of Health and private sector colleagues that there’s no going back on effective perinatal care (EPC); they see both the medical and business rationales for it and women are demanding it! EPC is leading the way for the quality of other health disciplines, such as pediatrics and surgery, to be improved and scaled up as well. შეიძლება ეს ასე იქნება  May it be so!

Written by Carolyn Hart