Bringing the Maternal and Child Health Handbook to the World

Japan is engaged in a variety of forms of international cooperation for developing countries. In this series, we will introduce examples of Japan’s international cooperation led by the Japan International Cooperation Agency (JICA), the governmental agency which implements Japan’s Official Development Assistance (ODA). Beginning with this issue, we will introduce examples of international cooperation related to the introduction of the Maternal and Child Health Handbook, an initiative of Japan to protect and nurture the lives and health of pregnant women and children in developing countries.

In Japan, when women register their pregnancy with the local government where they live, they receive a Maternal and Child Health Handbook (MCH Handbook). This handbook is used to continually record the health of mother and child during pregnancy and during childbirth, as well as the state of the child’s development, and it includes a variety of educational information on pregnancy, childbirth, and childcare. Distribution of the MCH Handbook began in 1948, and by the 1960s close to 100% of pregnant women possessed one.

Osaki Keiko, Senior Advisor at JICA*, says, “Other countries also have handbooks listing information related to the health of pregnant women and cards used to record vaccinations of children. However, a major feature of the Japanese MCH Handbook is that it contains information and records related to the health of mother and child all in one handbook, and the MCH Handbook is used as a tool of the healthcare system.”

Since the 1990s, JICA has supported the development and introduction of MCH Handbooks appropriate for each developing country while making use of the features of the Japanese MCH Handbook. So far, JICA has offered support in 34 countries and regions**, including Indonesia, Afghanistan, Palestine and Ghana.

According to Osaki, who has worked to promote use of the handbooks abroad for more than 25 years, the MCH Handbook has achieved a variety of effects. Pregnant women, their families, and healthcare providers are able to continuously understand the health condition of mother and child, and it has become possible to offer optimal care to mothers and their children. Additionally, it increases communication with the father and allows the father to participate in childbirth preparations and childcare. It also increases the rate of women getting the required consultations before and after childbirth.

In recent years, Laos is a country where great efforts have been taken to introduce and utilize the MCH handbook. JICA is involved in a variety of projects together with the Ministry of Health and healthcare providers to improve the situation in Laos, where there is a high rate of death among pregnant women and infants. Support to introduce the MCH Handbook in Laos began in 1995 by JICA’s Japan Overseas Cooperation Volunteers (JOCV)*** members, and it became possible to distribute the handbooks nationwide by 2008 through support from UNICEF (United Nations Children’s Fund), the WHO (World Health Organization), and other international organizations. However, there were issues, such as the content of these handbooks not being standardized and some healthcare providers not being able to properly record prenatal checkup and vaccinations or offer appropriate advice to pregnant women.

Nagatani Shiori, a former JOCV member who was dispatched to Laos as a midwife from 2014 to 2016, says, “I recognized the situation that the handbooks weren’t being fully utilized, and felt it was a waste. So, we brought midwife JOCV members together and had discussions about how we could support more effective utilization of the handbooks.”

Through these discussions, Nagatani and others worked with the Laos Ministry of Health’s Mother and Child Health Center to create a user’s guidebook explaining how to use the MCH Handbook, and they worked to host training for healthcare providers using the guide.

Training was held in the Mother and Child Health Center in the capital city of Vientiane and at the public healthcare facilities in areas including southern Salavan Province where Nagatani was dispatched. Training sessions were two days long, and participants studied how to record information in the MCH Handbook as well as health education for pregnant women. They also learned how best to communicate with pregnant women through role-playing scenarios, such as by taking turns playing the roles of pregnant woman and midwife.

Nagatani says, “As JOCV members worked closely with locals on a daily basis, we naturally acquired the regional accents. The participants were delighted to see the JOCV members engaging in role-playing while speaking accented Laotian. Our ambition seemed to inspire them.”

Starting in 2019, the Ministry of Health began distributing an edited and standardized MCH Handbook across the country through the support of JICA and the WHO. The new handbook featured more educational information related to the health of mother and child and also featured many illustrations in consideration of pregnant women from minority groups who struggle to communicate in the Lao language.

Makimoto Saeda, Principal Research Fellow at the JICA Ogata Sadako Research Institute for Peace and Development and who was involved in the work of editing the new handbooks, says, “They made use of suggestions from JOCV members and JICA’s knowledge. The Ministry of Health established the MCH Handbook as an important tool to support the health of mother and child.”

These handbooks have drawn attention from the international society in recent years. In 2018, the World Medical Association released a statement, saying, “The use of MCH handbooks has helped improve the knowledge of mothers on maternal and child health issues, and has contributed to the improvement of behaviors during pregnancy, delivery and post-delivery period.”****

One goal of the Sustainable Development Goals (SDGs) is to reduce the death rate of women related to pregnancy and child delivery as well of infants and children. The MCH Handbook’s role in achieving this is becoming more and more important.

* https://www.jica.go.jp/english/index.html
** https://www.jica.go.jp/english/our_work/thematic_issues/health/technical_brief_mc.html
*** JOCV members live with local people in developing countries and regions and work to solve their problems with them. For more information, https://www.jica.go.jp/english/our_work/types_of_assistance/citizen/volunteers.html
**** WMA Statement on the Development and Promotion of a Maternal and Child Health Handbook – WMA – The World Medical Association https://med.or.jp/dl-med/wma/mchhandbook_e.pdf