The Woman and Child Health Research Centre (W&CHRC) is an interdepartmental and interdisciplinary centre at the Institute of Tropical Medicine, Antwerp, Belgium. The centre focuses on generating evidence to improve women’s and children’s health in developing countries with a life course perspective.
Based on the research currently carried out and on the new opportunities offered by the inter-departmental collaboration, the W&CHRC defined three priority thematic research lines: Adolescent health (preparing young parents for a healthy first pregnancy), Perinatal health (indirect causes of maternal mortality and continuum of care for both mothers and newborns), and Reproductive health (family planning and reproductive cancers).
Despite some encouraging progress in maternal mortality reduction, the Millennium Development Goal (MDG) 5 addressing maternal and reproductive health is the MDG which shows the least progress. Perinatal mortality and success to reach MDG 4 (reducing child mortality) is intrinsically linked to MDG 5, i.e. maternal health and quality of care and follow-up throughout pregnancy, delivery and post-partum. As evidence shows, reaching MDG 4 and 5 is also interlinked with success in reaching MDG 6 (combating HIV/AIDS, malaria and other diseases). Furthermore, although a number of interventions to improve woman and child health are supported by good-quality evidence, these interventions are often sub-optimally delivered. In contradiction to the continuity of health needs throughout the lifecycle, the health services appear often disjointed. Reasons for this are complex, including the targeting of specific patient populations by cross-cutting programmes and the lack of integration of programmes with separate funding and management streams.
Life course perspective
The health of women, newborn babies, and children consists of health trajectories and transitions throughout the lifecycle. Women need services to help them to plan and space their pregnancies and to avoid or treat sexually transmitted infections. Pregnant women need antenatal care that is linked to safe childbirth care provided by skilled attendants. Both mothers and babies need postnatal care during the crucial 6 weeks after birth; postnatal care should also link the mother to family-planning services and the baby to child health care. Adolescents need education and services for nutritional, sexual, and reproductive health. A continuum of care is necessary throughout the lifecycle (adolescence, pregnancy, childbirth, the postnatal period, and childhood). If women, babies, children, or adolescents experience complications or illness at any point, a continuum of care from household to hospital, with referral and timely emergency management, is crucial.
A life course approach examines how biological (including genetics), behavioural and social factors throughout life, and across generations, act independently, cumulatively and interactively to health (Misra et al. 2010). It is an interdisciplinary framework that views persons in context over time (Daaleman et al. 2007). The shift to this new paradigm of health and health care has been triggered by the mounting evidence that individual health develops over the life span and across generations. The most striking example is probably the link between low birth weight and the future risk of cardiovascular disease, as enlightened by Barker in the early 90s (Barker 1992). Women born with a low birth weight are also more likely to deliver babies suffering themselves from intra-uterine growth retardation (Kebanaoff et al 1989). So far, the life course approach has been poorly used and documented in reproductive health, maternal, and newborn health in LMIC. Our Centre aims at filling in this gap.
The life course approach, with our reference principles of continuum of mother’s/patient’s centred and the gender approach/ empowerment, guides our actions in the following domains:
- Advocacy / networking in Belgium
- Institutional collaborations and capacity strengthening in LMIC
The life course approach is included in our teaching and influences the organisation and content of our teaching sessions (chronic diseases; RH option).