In parts of the world where midwives and doctors are few and far between, traditional birth attendants (TBAs) play a critical though often controversial role in maternal healthcare. Though untrained, they function as medical leaders in their communities, sometimes delivering more babies than midwives. But as health experts reassess the functionality of untrained workers in the modern healthcare model, TBAs are at risk of being banned from assisting with births completely. Some African countries, such as Zambia and Sierra Leone, have already banned TBAs, although not without backlash. These bans have raised a very important and highly disputed question: are TBAs important or detrimental to the reduction of maternal mortality rates throughout the developing world?
TBAs, also known as traditional or community midwives, help pregnant mothers through delivery and the pre- and post-birth periods in areas where viable healthcare facilities are scarce or unreachable. They are typically older women who hold respect in their communities and often have children of their own. Unlike midwives and obstetricians, TBAs lack formal medical training and instead learn about the birthing process through oral tradition and delivery experience.
TBAs today work with mothers and their infants all over the world and are deeply rooted in the birthing cultures of many communities. TBAs are especially in demand in poor rural areas, where as few as 20 percent of births may be serviced by a skilled health worker. Much of their appeal comes from their accessibility, since TBAs offer their services at relatively low costs. TBAs are usually easier to reach than formal health professionals since they work within their communities, whereas bad roads, long distances and lack of transportation can deter women from seeking hospitalization. Women are especially unlikely to attempt the journey to a hospital if the care offered there is inadequate.
Some countries have attempted to make it easier for women to reach hospitals and receive inexpensive or free care, yet many women still seek out TBAs. This can most likely be attributed to the fear that is associated with clinics and hospitals, since many women are wary of facilities outside their communities, especially when surgery is involved. While there can be much trepidation and distrust surrounding doctors and hospitals, TBAs are well established and liked within their communities.
Mbarikit Eno of Nigeria was among the scores of pregnant women who feared hospitals when she was deciding where to deliver. “Two of my friends died in hospital during childbirth and I don’t want to die too,” Eno told the Global Health Next Generation Network in 2016. “Besides, those midwives in the hospital are very harsh; they shout at you and scold you as if you don’t know anything. They never use kind words on the woman despite the pain she experiences during labour. I know the traditional birth attendant that will deliver me. She is from within my community, she has delivered several women and they are all alive.”
Because there are both benefits and drawbacks to TBA-based care, health experts are divided on TBAs’ place in the modern healthcare model. TBA advocates claim that banning TBAs hurts mothers in disadvantaged communities, since TBAs are sometimes the only health workers available in these areas. This negative effect was demonstrated by a 2007 TBA ban in Malawi, which actually caused Malawi’s maternal mortality rate to rise. The country has since reversed the ban.
Experts also propose training and monitoring TBAs to ensure safe birthing practices. Organizations like the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) have taken steps in this direction by increasing regulations on TBAs in recent years to integrate them into the modern healthcare model. These groups have implemented programs to improve TBA education and forge stronger links between health professionals and TBAs, among other measures.
On the other hand, many researchers argue that TBAs should be eliminated from today’s health system completely. Proponents of the TBA ban claim that TBAs are “untrainable” and too set in their ways to adapt to new healthcare methods. They also warn that TBAs cannot address the main causes of maternal death, such as eclampsia and hemorrhage, and that their often-characteristic illiteracy makes it difficult to keep records.
“It stands to reason that decisions must be made with an eye to the future and not just with a mind for the present,” said former Finnish obstetrician and gynecologist Kelsey A. Harrison in an article for the British Medical Journal. “Traditional birth attendants have no place in this future.”
As modern medicine progresses and new medical technologies enter the mainstream, health experts will need to further re-evaluate the role of more traditional workers in today’s healthcare model. While the best course of action currently remains unclear, banning TBAs and other unskilled workers is only a temporary fix for the low utilization of hospitals and clinics in developing areas. Until the underlying causes that send women to TBAs in the first place are addressed, women around the world will continue to turn to TBAs instead of trained health professionals.
– Sabine Poux
Photo: Flickr
Six Important Facts About Child Poverty in Norway
Despite these troubling facts, the good news is that as the world’s most developed country, child poverty in Norway is defined differently in relation to the poverty of children globally. It mostly means for children to have little to no resources to participate in life experiences such as birthday parties, a school trip and other experiences that are socially and culturally enriching. Norway is also a welfare state. Generally, there is little difference between children from rich and poor backgrounds in the sense that they get equal education and healthcare among other social services. Further, the number of children who die has decreased by 50 percent in the last 20 years.
Clearly, poor children in Norway still have the resources to give them the best chance of growing up to be healthy, educated and successful adults; however, there need to be government efforts aimed at the underlying causes in order to prevent child poverty in the first place. Only then will these children have access to necessary socially and culturally uplifting experiences.
– Aslam Kakar
Photo: Flickr
Czechia Poverty Rate Remains Low
In the OECD, Czechia ranks behind only Denmark in terms of poverty rate, which measures the amount of families living below a country’s poverty line. In Czechia, that number is 10,220 crowns (about $431 USD) per individual and 21,461 crowns (about $906 USD) for families with children.
Based on population-weighted estimates drawn from household surveys, the poverty rate is not necessarily a perfect benchmark for comparison between nations. Indicators are specific to each country’s economic and social circumstances, and a variety of factors influence perception of poverty.
However, other metrics tell the same story of a robust quality of life within Czechia. Not only is the Czechia poverty rate one of the lowest, the nation’s wealth inequality outperforms other high-performing countries. Only 22 percent of Czech income is held by the wealthiest 10 percent, lower than the U.S., China, Indonesia and Chile, who have rates of 30.2, 31.4, 31.9 and 41.5 percent respectively. The Gini coefficient, which measures income inequality, is a relatively low .26 for Czechia, and unemployment lingers at an impressive 3 percent as of 2017.
Explanations for the country’s favorable economic indicators are many. Czechia has an excellent education track record, with enrollment standing at 99.75 percent. Government funds have been redirected to education over the past decade, while decreasing in other sectors such as infrastructure. Public reform following the 2008 global economic crisis saw a VAT hike and reduction of social welfare benefits, but included significant tax discounts in other sectors of the economy and pensions that nearly doubled.
Though these factors have aided in suppressing the Czechia poverty rate, conditions for the majority of employees are not necessarily as complimentary. As average Czech wages increase, they still remain substantially lower than the EU median. An average wage across industry of $23,003 USD reflects Czechia’s tough minimum wage, which remains one of the lowest among OECD nations. The country’s main source of income comes from engineering and machine-building industries, which accounts for 37.5 percent of the economy. With a popular tourist destination for a capital, services bring in around 60 percent of Czechia’s wealth.
Forecasts predict a sustained pace of economic growth but slowing rates of employment. Inflation, which jumped from 2016 to 2017, is expected to decline as debt continues to diminish post-recession. It remains to be seen whether or not the trend in Czechia’s low poverty rate will continue.
– Mikaela Krim
Photo: Google
Causes of Poverty in Malaysia
Malaysia is a nation in southeast Asia with a rich history and a population of over 30 million. The nation has been one historically plagued with deep poverty; however, in recent decades, the conditions for a large swathe of its people have greatly improved. The government has undertaken a monumental effort to attempt to eradicate the causes of poverty in Malaysia and has been largely successful. Nevertheless, the country still suffers from the ills of impoverishment and plenty of work still needs to be done.
Since the Millennium Development Goals were introduced in 1990, the Malaysian government has done a lot to reduce poverty in the nation. The percentage of households living on less than $8.50 per day (the national poverty line) fell from over 50 percent in the 1960s to 1 percent currently. The Asian Development Bank claimed this to be the largest reduction among all Asian countries. Another government goal was to halve the number of people living on $1 a day by 2015, which they also successfully achieved.
The task of solving the root causes of poverty in Malaysia, however, is still far from over. Over 60 percent of the country still lives on less than $1,600 a month, and in rural areas, that number can climb up to 85 percent. Furthermore, although only about 1 percent of people currently live under the extreme poverty line, that still accounts for 300,000 people, a significant number.
The government recognizes that it still has not fully addressed the causes of poverty in Malaysia, and has laid out a road map of its future plan of action. This plan of action revolves around four main focal points.
Addressing the Causes of Poverty in Malaysia
If the Malaysian government continues on the path they have been on so far and successfully addresses these goals in their plan of action, poverty and the ills it brings could be effectively eradicated in the nation once and for all.
– Alan Garcia-Ramos
Photo: Flickr
Tanzania to Use Zipline Drones to Deliver Medicine
The California-based company Zipline, which designs and operates drone delivery networks, will start delivering medical tools and vaccines via drones to Tanzanian clinics in 2018.
The East African country has 0.03 doctors per 1,000 people and 5,640 public health facilities for a population of over 56 million. Blood transfusions and treatments for deadly diseases like HIV are hard to come by. In 2014, the CEO of Zipline drones, Keller Rinaudo, noticed this harsh reality as he browsed a database of health emergencies. The database would collect real-time data about patients who were suffering in different regions of the country, but people would not receive aid based on this information. Rinaudo, as he states in an interview with NPR, imagined “the other half of that system — where you know a patient is having a medical emergency and can immediately send the product needed to save that person’s life.”
The ‘other half of this system’ will start in January 2018, as per a statement from the Tanzanian government. Drones will be used for on-demand delivery of vaccines, blood transfusion materials and other medication or medical tools.
A drone medical delivery system is already up and running in Rwanda, with overwhelmingly positive results and stories. Tanzania hopes for an even larger system, where 120 drones will make 2,000 deliveries a day from four distribution centers spread across the country.
Zipline has hired locals to operate both the drones and distribution centers. When a hospital or clinic requests an item, a worker will stock the products into a shoebox-like container and pack the drone, which would zip to the hospital and deliver the products by parachute. This process takes what could be an eight-hour process and cuts it down to under a half hour.
The medical future is bright for rural and impoverished communities like those in Tanzania with the help of drones. Studies have found that blood samples and lab results were safely transported between medical facilities without any change in result, except for the time they took to be transported.
Rinaudo sees the system as a win not only for his Zipline drones company, Rwanda, or Tanzania, but for medical communities across the globe. In the same interview with NPR, he says that operation teams are “phenomenally smart, ambitious and driven. They work 12 hours a day, seven days a week. They will do anything to save human lives…Rwanda showed what’s possible when you make a national commitment to expand healthcare access with drones.”
– Gabriella Paez
Photo: Flickr
Alleviation of Global Poverty a Benefit of Tourism
After the United Nations declared 2017 the International Year of Sustainable Tourism for Development, governments worldwide have been growing their tourism industries to facilitate the alleviation of global poverty.
Year after year, the United Nations has seen an increase in money circulating in various countries’ tourism industries. However, these countries are some of the wealthiest in the world, among them the United Kingdom, United States and Germany.
The United Nations is working to increase the benefits of tourism in countries struggling with immense poverty, but it will not be easy. To accommodate tourists, a large amount of money—money that these countries do not have—will need to be spent on building and maintaining hotels, airports and other tourist amenities.
If these countries are able to build successful tourism industries, an abundance of jobs will be created and a large percentage of the profits can go directly to local communities living in poverty.
Samoa is an example of this progress. From 2005 to 2015, Samoa’s tourism industry grew from $73 million to $141 million. Samoa’s tourism industry had an impact on the alleviation of global poverty, as it ensured that visitor dollars resulted in local benefits.
Similar to Samoa, Ecuador, South Africa and Fiji are among other countries that have seen poverty relief as a benefit of expanding their tourism industries. The United Nations has played a role in the alleviation of global poverty by helping poor countries finance transport connectivity and facilitate infrastructure investment.
African countries have benefited greatly from the United Nations’ assistance with their tourism industries. Today, Africa’s tourism industries support more than 21 million jobs and have aided the alleviation of global poverty through sustainable development in struggling countries. The sustainable development seen in Africa relies on tourists making ethical travel choices. Tourists are encouraged to “go local” with food, craft purchases and tour companies when traveling in developing countries.
Tourism alone cannot end global poverty. However, if travelers, local companies and large organizations such as the United Nations continue to show their support for developing countries, the world will be one step closer to total alleviation of global poverty.
– Kassidy Tarala
Photo: Flickr
How Military Conflict and Climate Change Intersect in Mali
A military coup has worsened Mali’s national security, amplifying the impact climate change has had on the country and its people. Conflict erupted in northern Mali in 2012. The violence of the proceeding five years has since destroyed the nation’s land, diminishing the abilities local farmers have to grow vegetation.
Since 2012, Mali has witnessed a wave of poor harvests, pushing a food crisis upon the country. Hostile physical and environmental circumstances have forced about 475,000 people from their homes to neighboring countries, and those who remain in Mali face food shortages and security threats. With 25 percent of families moderately to severely food insecure, the United Nations Food and Agriculture Organisation (UNFAO) estimates that 270,000 people face starvation.
Two thirds of Mali is a desert or semi-desert that experiences long yearly periods of drought. Furthermore, the Sahara Desert is expanding southward at a rate of 48 km per year. Climate change has significantly decreased the amount of rainfall, dropping by 30 percent since 1998. Consequently, Mali is also suffering from water scarcity. Only three-fifths of Malians have access to safe drinking water and only about one-third have proper sanitation.
The water shortage has weakened Mali’s agricultural activities, taking an immense toll on its citizens. Agriculture employs 90 percent of the country’s rural population and 70 per cent of Mali’s entire labor force. Cotton, gold and livestock make up 80 to 90 percent of total export earnings.
The World Food Programme (WFP) has been working on generating food security, particularly between harvests. The organization built a total of 3,966 environmental assets such as ponds, dams, and canals to help alleviate Mali’s lack of water. Technical and economic assistance have been provided for local farmers, broadening Mali’s market and strengthening the agricultural sector. WFP has also begun providing nutrition support for pregnant women, nursing mothers, underweight children and children under five suffering from chronic and moderate-to-acute malnutrition. Further assistance from organizations like WFP is necessary to lift Mali‘s people from the harsh grips of military conflict and climate change.
– Tiffany Santos
Photo: Google
Banning TBAs: A Double-Edged Sword
In parts of the world where midwives and doctors are few and far between, traditional birth attendants (TBAs) play a critical though often controversial role in maternal healthcare. Though untrained, they function as medical leaders in their communities, sometimes delivering more babies than midwives. But as health experts reassess the functionality of untrained workers in the modern healthcare model, TBAs are at risk of being banned from assisting with births completely. Some African countries, such as Zambia and Sierra Leone, have already banned TBAs, although not without backlash. These bans have raised a very important and highly disputed question: are TBAs important or detrimental to the reduction of maternal mortality rates throughout the developing world?
TBAs, also known as traditional or community midwives, help pregnant mothers through delivery and the pre- and post-birth periods in areas where viable healthcare facilities are scarce or unreachable. They are typically older women who hold respect in their communities and often have children of their own. Unlike midwives and obstetricians, TBAs lack formal medical training and instead learn about the birthing process through oral tradition and delivery experience.
TBAs today work with mothers and their infants all over the world and are deeply rooted in the birthing cultures of many communities. TBAs are especially in demand in poor rural areas, where as few as 20 percent of births may be serviced by a skilled health worker. Much of their appeal comes from their accessibility, since TBAs offer their services at relatively low costs. TBAs are usually easier to reach than formal health professionals since they work within their communities, whereas bad roads, long distances and lack of transportation can deter women from seeking hospitalization. Women are especially unlikely to attempt the journey to a hospital if the care offered there is inadequate.
Some countries have attempted to make it easier for women to reach hospitals and receive inexpensive or free care, yet many women still seek out TBAs. This can most likely be attributed to the fear that is associated with clinics and hospitals, since many women are wary of facilities outside their communities, especially when surgery is involved. While there can be much trepidation and distrust surrounding doctors and hospitals, TBAs are well established and liked within their communities.
Mbarikit Eno of Nigeria was among the scores of pregnant women who feared hospitals when she was deciding where to deliver. “Two of my friends died in hospital during childbirth and I don’t want to die too,” Eno told the Global Health Next Generation Network in 2016. “Besides, those midwives in the hospital are very harsh; they shout at you and scold you as if you don’t know anything. They never use kind words on the woman despite the pain she experiences during labour. I know the traditional birth attendant that will deliver me. She is from within my community, she has delivered several women and they are all alive.”
Because there are both benefits and drawbacks to TBA-based care, health experts are divided on TBAs’ place in the modern healthcare model. TBA advocates claim that banning TBAs hurts mothers in disadvantaged communities, since TBAs are sometimes the only health workers available in these areas. This negative effect was demonstrated by a 2007 TBA ban in Malawi, which actually caused Malawi’s maternal mortality rate to rise. The country has since reversed the ban.
Experts also propose training and monitoring TBAs to ensure safe birthing practices. Organizations like the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) have taken steps in this direction by increasing regulations on TBAs in recent years to integrate them into the modern healthcare model. These groups have implemented programs to improve TBA education and forge stronger links between health professionals and TBAs, among other measures.
On the other hand, many researchers argue that TBAs should be eliminated from today’s health system completely. Proponents of the TBA ban claim that TBAs are “untrainable” and too set in their ways to adapt to new healthcare methods. They also warn that TBAs cannot address the main causes of maternal death, such as eclampsia and hemorrhage, and that their often-characteristic illiteracy makes it difficult to keep records.
“It stands to reason that decisions must be made with an eye to the future and not just with a mind for the present,” said former Finnish obstetrician and gynecologist Kelsey A. Harrison in an article for the British Medical Journal. “Traditional birth attendants have no place in this future.”
As modern medicine progresses and new medical technologies enter the mainstream, health experts will need to further re-evaluate the role of more traditional workers in today’s healthcare model. While the best course of action currently remains unclear, banning TBAs and other unskilled workers is only a temporary fix for the low utilization of hospitals and clinics in developing areas. Until the underlying causes that send women to TBAs in the first place are addressed, women around the world will continue to turn to TBAs instead of trained health professionals.
– Sabine Poux
Photo: Flickr
Why Is Mongolia Poor?
Between one third and one half of Mongolia’s population currently lives in poverty. Since the nation ended their Soviet-style communist regime in 1990, many impoverished Mongolians have been wondering why the advantages of capitalism have not yet reached them. After nearly three decades of reform, why is Mongolia poor?
Since the turn of the 21st century, Mongolia has fostered great development. Income and school enrollment have risen, while sanitary concerns and maternal and child mortality have declined. However, the nation’s success has not been equal in all areas and has not had the desired impact on alleviating poverty.
Why is Mongolia Poor? Investments and Inequality
While economic growth is necessary for human development, human development is not necessary for economic growth. Between 2009 and 2013, Mongolia’s GDP rapidly increased by $8 billion – primarily a result of foreign investment in the country’s natural resources. Despite this flow of capital, there has not been a satisfactory increase in more and better job opportunities; thus, impoverished families are not able to lift themselves out of poverty and share in the new wealth.
Not only are not enough jobs being created, but most lower-class Mongolians are unqualified or under-educated for the advantageous jobs that are present. Furthermore, adequate job opportunities are not present where poor Mongolians live, so they must resort to low-productivity work that only provides enough income to sustain their livelihoods rather than improve them. In turn, the nation’s wealthy get richer while the impoverished remain poor.
Since 2013, Mongolia’s economic growth has slowed, with its GDP dropping over $1 billion in three years. The economic slowdown, while not drastic, raises concern for the country’s most vulnerable and how the downturn will affect them, considering the previous upturn was not doing much to help them.
To answer and address the question of why Mongolia is poor, the nation must focus on equal and quality access to jobs and education. Fortunately, Mongolia has the tools to succeed and is currently implementing strategies such as the National Plan of Action for Decent Work and the National Employment Promotion Programme. Investing in education will also be crucial for increasing the population’s employability and potential for the generations to come.
Mongolia’s rapid development is worth celebrating, but to ensure the nation’s long term success the country must work toward closing the gap between the rich and the poor and evenly dispersing their development. Only when the entire population has the capability to succeed will Mongolia reach its full economic potential.
– Catherine Fredette
Photo: Flickr
Human Rights in Luxembourg
Luxembourg is a small, prosperous country in western Europe. Since the beginning of the 21st century, Luxembourg has made great strides in continuing to achieve and secure basic human rights in Luxembourg for their citizens.
As of 2017, the government of Luxembourg has met the minimum standards for the elimination of human trafficking. According to the U.S. State Department, “These achievements included increasing the number of prosecutions and convictions, finalizing and adopting a written national referral mechanism, enhancing the number of dedicated personnel to anti-trafficking positions” and others.
There were reported occasional cases of discrimination throughout the country over the last decade, specifically discrimination with respect to employment on the basis of race, color, political opinion, sex, gender, disability and other categories. Luxembourg law requires quotas for hiring diverse types of employees. It also mandates equal pay for equal work.
In September 2014, in reaction to reporting that employers paid women 8.6 percent less on average than men for the same work, the Ministry of Equal Opportunities began an awareness campaign using newspapers, online advertisements and posters in order to end the unequal treatment of women in the workplace.
On a more controversial note, Luxembourg legalized euthanasia in 2009, making it the third country in Europe to legalize euthanasia. The law on palliative care, advance instructions and end-of-life accompaniment “applied to anyone in a hopeless medical situation as a result of an accident or serious illness.” Many human rights advocacy groups, such as the Minnesota Citizens Concerned for Life Global Outreach, have spoken out against the practice.
The Human Rights Council will be reviewing human rights in Luxembourg early next year to determine whether they are fulfilling their human rights commitments. But it is safe to say that with a stable government and human rights laws that are routinely enforced, human rights will continue to be respected in Luxembourg.
– Melanie Snyder
Photo: Flickr
AIDS in Africa No Longer Leading Cause of Death
Africa has had a long history with AIDS and has struggled to find solutions to keep AIDS-related deaths low. However, in the past few years AIDS rates in Africa have decreased, and it is no longer the leading cause of death.
This achievement is mostly due to better diagnosis and treatment, along with more information and better education on the condition. Additionally, other preventive strategies, such as self-testing, have become more prevalent. In fact, 40 countries have already added HIV/AIDS self-testing to their national policies, with 48 more developing similar policies, almost double the amount in 2015.
With these strategies being implemented, the number of HIV/AIDS-related deaths in Africa have decreased by 24 percent over the last five years. In 2015, there were a reported 5.2 million deaths caused by group 1 conditions, which includes AIDS, with AIDS reportedly causing approximately 760,000 deaths in 2015, a decrease from 1 million in 2010 and 1.5 million in 2005.
With AIDS no longer the leading cause of death, lower respiratory tract infections have taken the lead. Yet AIDS is not the only disease that has decreased; malaria has also seen a decrease in deaths, reporting a drop of 60 percent in the last 15 years, accounting for about 6 million people saved from the disease.
With expanded education regarding AIDS prevention, treatment, and self-testing, Africa is on its way to fulfilling the U.N.’s goal of eradicating AIDS on the continent by 2030. Additionally, with funding from donor countries and supplying clinics with the proper drugs, AIDS in Africa will continue to see a drop in deaths over the next few years, meaning the continent can focus on other leading causes of death.
– Amira Wynn
Photo: Flickr