Clean-delivery kit: a bar of soap, a plastic sheet, clean string, a new razor blade, and illustrated instructions.

Inexpensive but essential items fit into a box the size of a deck of cards. Photo: PATH.

Clean-delivery supplies help women and newborns avoid infection

Editor’s note: Our clean-delivery kit program provided basic, inexpensive tools to help mothers and newborns avoid acquiring infections during childbirth. The kits, which were modified to accommodate cultural birth practices, demonstrated the value of accessible, user-based products.

At midnight in a rural village in Tanzania, a woman goes into labor earlier than expected. She can’t make the 15-mile journey to the health center, but at least her mother is there to help. With a disposable delivery kit, the two women safely deliver a baby girl. Later, the newborn’s mother tells researchers that the kit protected her baby from infection. She says she will tell her friends to get one before their time comes.

Each year, millions of women worldwide give birth without the help of a trained health worker. These births often take place at home, where the risk of infection is high. Infection is a leading cause of death among these women and their infants. The clean-delivery kit is a simple approach to reducing this risk.

Small change for safer home births

For more than a decade, PATH helped to develop kits in Bangladesh, Egypt, and Nepal. Most contained a small bar of soap for washing hands, a plastic sheet to serve as the delivery surface, clean string for tying the umbilical cord, a new razor blade for cutting the cord, and pictorial instructions that illustrated the sequence of delivery events and hand-washing.

Formative research and field-testing during development ensured the cultural acceptability of the kits and allowed us to customize them for local conditions. In Nepal, for example, the PATH team found that it was traditional to cut the umbilical cord on a coin, for good luck. Out of respect for this custom, kits produced in Nepal were modified to include a plastic rupee to serve as a clean cord-cutting surface.

Ear to the ground

Once the kits were in use in Nepal, we conducted interviews and role-playing to gauge the responses of women who had used them. Mothers and birth attendants generally appreciated the kit and found it affordable.

In Tanzania, we quantified the positive impact of another delivery kit on women’s and children’s health through a 3,200-participant study funded by the United States Agency for International Development through our HealthTech program. Results suggested that women who used the kit were substantially less likely to develop genital tract infections. Their infants were substantially less likely to develop umbilical cord infections.

Keeping kits in women’s hands

A key goal of our work was to make sure the kits were available to the women they were designed to help. We built the capacity of local organizations and small businesses to produce and distribute or sell kits. In Egypt, we helped community health promoters develop a plan to use kits as an income-generating activity that would contribute to their health programs. In Nepal, we gave a local, woman-owned business a head start: the campaign we funded promoted the kit via wall paintings, advertisements, street dramas, and training for community health volunteers. Within one year, sales increased from 28,800 to 46,800 kits, contributing to the long-term stability of the company. Between 1994 and the ensd of 2005, they sold more than a million kits.

Flexible funding, provided almost exclusively by individual donors and families, supported our assistance to Nepali business partners and contributed to the success of several related projects, such as creation of a step-by-step manual for other organizations interested in developing kits.