2026
Maternal health policy reform
Individual project
Designed while studying at Uppsala University
Challenge
Pregnant women in the rural regions of Västerbotten and Norrbotten face increased and avoidable health risks due to long travel distances to maternity care, seasonal closures of delivery units, heatwaves, and gendered policy decisions that shift responsibility from the system to the individual.
Goal
To design a transformative, equity-oriented policy intervention that reduces maternal health risks by addressing the structural and intermediary determinants of health in northern Sweden.
Background
In northern Sweden, centralisation of obstetric services has forced many women to travel up to 300 minutes to reach delivery units. These risks intensify during summer heatwaves, when maternity wards close due to staff shortages and pregnant women are more vulnerable to heat exposure. The interaction of climate change, geographic marginalisation and gendered health policies produces a pattern of unplanned out-of-hospital births, psychosocial stress and reduced trust in the healthcare system.
Tools & frameworks
This project draws on the CSDH Framework (Solar & Irwin), the Iceberg Model and leverage points, the Three Horizons Framework, and Health in All Policies (HiAP) and Health for All Policies (HfAP). Together, these frameworks support a shift from downstream risk management to upstream, systemic and equity-focused intervention.
Health equity analysis
Maternal health risks in Västerbotten and Norrbotten are not randomly distributed but shaped by structural determinants such as governance decisions, macroeconomic policy, and gendered social norms. Women in remote communities experience compounded vulnerability through cultural disconnection, long travel distances and limited access to care. These inequities are avoidable, unjust and politically produced.
What if?
By using “What if?” questions, the insights from the health equity analysis were reframed from challenges into opportunities for equitable policy design:
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What if resource allocation policies ensured that rural regions have the staff, funds and emergency capacity to provide safe and timely maternity care?
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What if policies supported women instead of expecting them to manage long and risky travel to delivery units?
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What if climate adaptation, transport planning and healthcare policy were treated as a single system for maternal safety?
Discovering the causes of the causes
The health inequity was then analysed through the Iceberg model, revealing the "causes of the causes" and structuring insights into visible events and non-visible patterns, structural causes, and mental models.
This reframing reveals maternal health inequity as a systemic design failure rather than an individual problem.
Intervention design
The proposed intervention is a multi-component, gender-equitable policy reform that strengthens decentralised obstetric outreach, integrates climate and distance risk into health data systems, and redesigns service distribution to ensure safe and timely maternity care for rural populations.
Implementation strategy
Interventions were mapped across three horizons using the Three Horizons Framework to balance urgent maternal safety with structural change, moving from stabilisation to system redesign and long-term transformation.
Horizon 1 – Stabilisation (0–3 years):
Seasonal capacity alignment, heatwave preparedness, redistribution of workforce, and expanded use of existing primary care structures.
Horizon 2 – Reconfiguration (3–7 years):
Mobile maternity services, integration of climate and distance data into the Pregnancy Register, and cross-sector coordination between healthcare, transport and climate planning.
Horizon 3 – Transformation (7–15+ years):
Long-term decentralisation, gender-equitable policy norms, and regional economic capacity to sustain essential maternal services.
Health in All Policies & Health for All Policies
Maternal health is influenced by decisions in transport, climate adaptation, regional development and labour policy. Applying HiAP and HfAP ensures that maternity safety is considered across all sectors and that economic and infrastructure policies actively promote health equity.
Impacts on health inequity
By addressing the root causes of risk: distance, climate exposure, governance and gendered responsibility, this intervention reduces avoidable maternal harm, strengthens trust in the healthcare system, and improves safety for women in rural communities. It reframes maternal health from an individual burden to a systemic right.
Image sources:
1. © 2016 by Aditya Romansa, 2. © 2026 by Emma Thorman, 3. © 2021 by Jimmy Conover, 4. © 2010 by Solar & Irwin, 5. © 2023 by Fazey & Colvin, 6. © 2025 by Emma Thorman, 7. © 2018 by Cassidy Rowell, 8. © 2026 by Emma Thorman, 9. © 2017 by WHO, 10. © 2019 by Jonathan Borba