Inflammation and stories on maternal health

Maternal health in GuineaGuinea, officially known as the Republic of Guinea, is a country in West Africa with a significant amount of natural resources, such as bauxite and iron ore as well as gold and diamond mines that could bring the country immense wealth. However, due to its reliance on agriculture and the Ebola outbreak of 2014, the country remains in poverty and has some of the lowest health rates in the world. The philanthropic focus on eradicating Ebola has shifted funds from maternal health to ending the Ebola crisis, endangering the lives of women and children. Improving maternal health in Guinea needs to become a priority.

Maternal Health in Guinea

Of the numerous social problems facing Guinea, maternal health is one of the most detrimental to the country. The neonatal mortality rate in Guinea is 25 deaths per 1,000 live births. The maternal mortality rate is 679 women out of 100,000 live births. This compared to a global neonatal mortality rate of 18 deaths per 1,000 live births depicts a country struggling with maternal health development. Throughout the country, only 36.1 percent of children are vaccinated and approximately 31 babies die each day while 21 babies are stillborn.

One aspect of maternal health that could use improvement is prenatal care and scheduled doctor visits. In rural areas, fewer than 40 percent of women receive prenatal treatment while 71 percent of women in urban areas attend doctor visits before the birth of their child. These low percentages of prenatal care correspond to equally low rates of women who give birth in facilities with trained personnel. The main reason women do not want to give birth in facilities is the mixed-gender wings. Women feel uncomfortable giving birth where men are present.

Global Funding to Reduce Maternal Mortality

To combat these statistics, the government of Guinea and various non-profit organizations are implementing programs to help improve the health and mortality of infants and mothers. In 2018, the World Bank approved $55 million in funding for the two poorest regions of Guinea, Kindia and Kankan. This money will go to improving reproductive, maternal, newborn and child health.

The grant was distributed to two different associations. The International Development Association will receive $45 million to provide low to zero-interest rates for programs that improve economic growth and reduce poverty. The Global Financing Facility will receive $10 million to prioritize underinvested areas of maternal and infant health.

In 2015, the USAID began the Maternal and Child Survival Program in Guinea, which improves the quality and availability of maternal and infant services. The goal of this program is to empower district-level lawmakers to strengthen local centers through a bottom-up approach. Through this initiative, MCSP has established seven healthcare facilities with 42 healthcare providers and 125 healthcare educators.

Focusing on Maternal Health

In 2015, the IDA approved a grant to implement the Primary Health Services Improvement Plan as part of a five-year plan to improve maternal health, child health and nutrition in Guinea. The grant specifically targets health centers by increasing the number of health centers and the availability of equipment and supplies in these centers.

Due to many centers focusing on fighting Ebola, this plan improves the availability of medicines in health centers, restores drug funds within health facilities, supports training in financial drug fund management and covers any financial gap to produce medicines in subsequent years. Additionally, the grant provides three-year training and continuous mentoring for nurse assistants. Furthermore, it recruits unemployed nurse assistants to work at these health centers.

Improvements Made

Since these initiatives began, there has been a significant improvement in developing maternal health in Guinea. The number of births attended by trained health professionals between 2016 and 2018 improved from approximately 27,000 personnel to 44,000. There were also 8 percent more women who received prenatal care by attending at least four doctor visits before the birth of their babies.

Similarly, the Ebola Response Project, although meant to target people affected by the Ebola breakout, has positively affected maternal health development in Guinea by helping fund a new maternity center in Koba. This center helps women attain the privacy they desperately desire by providing two separate wings for men and women. At this center, specifically, a program was initiated to distribute clothes, mosquito nets and soap to expecting mothers to encourage visiting the center.

Maternal health development in Guinea has been steadily improving through programs and governmental plans; however, there is still much work to be done. Although infant and maternal mortality rates are dropping due to an increase in health centers and personnel, a continued increase in funding and a restructuring of fund management is necessary to continue to improve maternal health in Guinea.

Hayley Jellison
Photo: Flickr

Urban and Rural Voucher SystemsEach year, millions of pregnant women give birth without access to proper health care services. Countries such as Ethiopia, Laos and Yemen are just a few parts of the world where this is a major problem. For example, in Ethiopia, 59 percent of women do not receive care by a medical professional during pregnancy. In Zimbabwe, however, access to prenatal care has drastically improved since the 2014 implementation of the Urban and Rural Voucher Systems (UVS and RVS, respectively). These systems allow for low-income pregnant women to receive the healthcare that they need. They have already had incredible benefits on thousands of pregnant women. Additionally, they set a great precedent for governments and NGOs to come together to find solutions to pressing maternal health issues.

Qualifications

The UVS and RVS service pregnant women whose incomes place them in the bottom 40 percent of households in Zimbabwe. Consequently, women who cannot afford the required $25 co-pay at many clinics can still receive care. Providing women with this essential health care helps to ensure that these women and their babies stay healthy and safe both during and after pregnancy.

Funding

The government of Zimbabwe, the World Bank and Codaid are the main sources of funding for the UVS and RVS. Cordaid is a local NGO that has assisted with much of the program’s implementation. Clinics are subsidized based on their performance. They measure performance on overall range and quality of coverage. This supply-side solution works to help promote jobs and economic growth in local communities, which contributes to the program’s long-term sustainability.

Impact on the Poor

Access to proper care during pregnancy is essential to ensure the health of expectant mothers and their child. In many countries around the world, women do not have access to this care. As a result, the consequences have been horrific.

For instance, there are roughly 3.3 million neonatal deaths recorded per year. Neonatal refers to the first four weeks of a baby’s life. Proper prenatal care can prevent these fatalities. A woman who receives such care is far less likely to give birth to a child with fatal health issues. Proper prenatal care can help identify and fix possible health issues before they become too serious. In addition, receiving prenatal care can offer educational resources. The care can educate a woman about the ways in which they should go about raising a healthy child.

Conclusion

Zimbabwe’s Urban and Rural Voucher Systems have had immense benefits since their implementation. The thousands of women that they have helped to serve reflect such benefits. The programs provide an affordable and accessible option for pregnant mothers to receive the care that they need to ensure both their health and the health of their babies. Also, the UVP and RVP supply-side design ensure that the programs are helping to stimulate local economies and bring communities together. All in all, while much progress must still be made towards increasing access to prenatal care for pregnant women around the world, Zimbabwe has taken an important first step with its Urban and Rural Voucher Systems.

– Kiran Matthias
Photo: Flickr

Child Health Care in EthiopiaEthiopia is a fascinating case study relating to the mission of downsizing poverty. Although many Ethiopians do struggle, the country has made significant improvements in recent years. For example, 30 percent have fallen below the poverty line as of 2011. The poverty rate decreased from 44 percent in 2000 to 30 percent in 2011. During that time, the percentage of Ethiopians who are uneducated decreased from 70 to 50 percent. Additionally, the average life expectancy rose by 10 years. Maternal and child health care in Ethiopia has been on a similar trend of improvement.

Maternal Care

In 2000, only 22 percent of mothers saw a doctor for an antenatal check-up before having their baby. This rate reportedly increased to 37 percent in 2011. Although this progress is promising, one in 52 women in Ethiopia die due to childbirth-related causes every year. Furthermore, 257,000 children in this country will die before reaching age 5. Fortunately, many organizations remain committed to improving maternal and child health care in Ethiopia through a variety of methods.

Organizations Dedicated to Improving Ethiopia’s Maternal and Child Care

USAID has worked alongside the Bill and Melinda Gates Foundation to bring change to Ethiopia. They have been working to improve coverage of universal family health care plans across the country. These plans include accessible prenatal care for
mothers. They also include increased immunizations and community-based management plans for childhood illnesses.

These two organizations focus on policy and advocacy to achieve their goals. Their success is shown in how poverty has decreased by 45 percent since the Bill and Melinda Gates Foundation first established a grant in Ethiopia in 2002. They cannot take all the credit for this improvement, however, as other organizations have joined them in the fight for better maternal and child health care in Ethiopia.

The World Health Organization (WHO), with the support of the Children’s Investment Fund Foundation and the Ethiopian Federal Ministry of Health, has approached this issue from a different direction. In 2015, the WHO launched a program to monitor and improve the quality of health care in Ethiopian hospitals. In 2015, WHO collected baseline data. This was in addition to training and suggestions for improvement of labor and care in the hospitals.

Improving the Safety of Deliveries

One change implemented by many hospitals was the adaptation of the Safe Childbirth Checklist. The checklist presented 29 essential activities for doctors to perform during childbirth to ensure the safety of the mother and the newborn. The follow-up data collected in 2016 found significant change had been made after the initial visits. This resulted in an improvement in the quality of maternal and child health care in Ethiopia.

This is, as the Gates Foundation puts it, a story of “progress, not victory.” Many Ethiopians continue to struggle, particularly in the realm of maternal and child health. However, the past twenty years of Ethiopia’s history remains hopeful and inspirational, not only for the country’s future but also as an example of the change that is possible. The impact of these organizations on the situation in Ethiopia should serve as a reminder of the potential for positive change.

– Madeline Lyons
Photo: Flickr

Maternal Mortality Rate in GuatemalaAs of 2015, the maternal mortality rate in Guatemala was 88, and three-quarters of these maternal deaths occurred in women of indigenous ancestry. The maternal mortality rate among indigenous women is thought to be more than 200. Since midwives or comadronas primarily care for pregnant indigenous women in Guatemala, investments from the World Bank and UNFPA have been focused on training midwives and connecting them with hospital services when necessary. More than six million indigenous people inhabit Guatemala and comprise a large portion–estimated at 45 to 60 percent–of the population. Further, 21.8 percent of the indigenous population live in extreme poverty compared to only 7.4 percent of the non-indigenous population.

Improving Mortality through Training

In 2006, UNFPA, a U.N. agency focused on sexual and reproductive health, began to offer obstetrical emergency training to local comadronas and family planning methods. The agency also teaches the importance of a skilled attendant being present during births in order to improve the maternal mortality rate in Guatemala. Estimates suggest that a well-trained midwifery service “could avert roughly two-thirds of all maternal and newborn deaths.” Statistics show that from 2009 to 2016, UNFPA has trained more than 35,000 midwives.

The Department of Sololá in the western highlands of Guatemala is home to more than 300,000 people, most of whom are indigenous Maya. Only one in four rural births occurs in a hospital, compared with over two-thirds of urban births. In Sololá, comadronas attend more than 63 percent of births mainly outside of a hospital. Some estimates put this figure at more than 90 percent.

The Improving Maternal and Neo-Natal Health Initiative has a three-pronged approach and funding from the World Bank’s Youth Innovation Fund in 2017. The initiative has established a visually-based curriculum to help comadronas recognize dangers and risks during delivery, two-week long training workshops conducted in local healthcare posts, and endowment of “safe birthing kits” for all comadronas containing tools such as latex gloves and gauze pads. Unlike previous initiatives, these trainings have been conducted in local languages rather than solely Spanish. Rosa, a comadrona in the city of Santiago, said this simple change made her “feel more respected” and gave her an increased desire to participate because she felt empowered to save “more lives in her community.”

In collaboration with the Ministry of Public Health and the government of Guatemala, the Maternal Child Survival Program (MCSP), an international program with national and subnational branches, implemented a Midwifery Training Program in February 2018 to improve the maternal mortality rate in Guatemala. Their model uses a competency-based skills training approach. Working with the University of San Martin Porres, MCSP established a coursework protocol for certification.

Discrimination Against Indigenous Peoples

Maternal mortality rates among indigenous populations in Guatemala face particular hurdles. In addition to access to care and infrastructure challenges, indigenous populations face heavy discrimination. They are often evicted from their ancestral lands only to face abuse within the criminal justice system. One young indigenous man reported abuse at the hands of a local gang to police. He believed that “the police don’t listen to us as indigenous people–they do not care about us.” A U.N. Special Rapporteur on the rights of indigenous peoples, Victoria Tauli-Corpuz, says she is very worried about “the grave situation of indigenous peoples” in Guatemala.

Guatemala has made consistent strides in reducing the national maternal mortality rate from more than 200 in 1990 to less than 100 today. However, the maternal mortality rate among indigenous populations remains high. Indigenous populations should be heartened by these improvements, but their unique struggles must not be lost in the larger narrative of maternal mortality in Guatemala.

– Sarah Boyer
Photo: Flickr

Maternal and Neonatal Health in ZimbabweProject HOPE stands for Health Opportunities for People Everywhere. It is an international health and humanitarian relief organization. The organization works to strengthen and improve health systems around the globe. Founded in 1958, Project HOPE responds to health crises and disasters but often stays in areas long after a disaster has hit to address other neglected health issues. Project HOPE entered Sierra Leone in 2014 in response to the Ebola outbreak. After sending an emergency response team and shipments of medical supplies to help contain the outbreak, permanent Project HOPE health workers remained in Sierra Leone. Now, their biggest health concern is to improve maternal and neonatal health in Sierra Leone.

Maternal and Neonatal Mortality Rates in Sierra Leone

Sierra Leone has the highest maternal mortality rate in the world with 1,360 mothers dying per every 100,000 live births. The main causes of maternal death include bleeding, pregnancy-induced hypertension, infection, unsafe abortions and anemia. An alarming 40 percent of Sierra Leone’s maternal deaths in 2016 were teenagers aged 15-19.

Sierra Leone also has one of the highest neonatal mortality rates with 33 deaths per 1,000 live births. Only 36 percent of newborns in rural areas and 47 percent of newborns in urban areas receive postnatal care within two days.

Sierra Leone’s lack of trained professionals and medical equipment are perpetuating high maternal and neonatal mortality rates. The country of 7 million only has around 165 doctors and very few neonatal specialists. Organizations like Project HOPE are working to improve maternal and neonatal health outcomes by providing renovation support for neonatal centers. Additionally, they are strengthening the skills and training of health care professionals and establishing neonatal programs. For example, programs such as Kangaroo Mother Care (KMC), which is for premature and low birth-weight newborns.

The Impact of Project HOPE on Maternal and Neonatal Health

Training local health workers is an integral part of Project HOPE’s efforts to improve maternal and neonatal health in Sierra Leone. Their programs include evidence-based training on maternal and neonatal intervention. For instance, training on emergency obstetric and neonatal care, resuscitation with a bag and mask and hygienic cord care.

Project HOPE collaborates with training institutions to provide neonatal nursing program development. They collaborate to teach advanced skills and provide training towards certificates, bachelor’s degrees and specialty nursing degrees. Overall, with more skilled health care professionals come improved healthcare for mothers and newborns in Sierra Leone.

Advanced Neonatal Care

Furthermore, to improve the care of preterm and underweight babies, Project HOPE has provided national and district training programs. These programs include universal modules such as Essential Care of Every Newborn, Essential Care of Small Babies and Helping Babies to Breathe.

Moreover, Project HOPE has established the first two Kangaroo Mother Care (KMC) units for premature and low birth weight newborns. The KMC approach is to securely wrap the fragile, underweight newborns skin-to-skin on the mother’s chest. This provides warmth and promotes regular breathing and breastfeeding for babies who are struggling with both actions. These community-based units are very effective in areas with low resources. In regions without incubators, this method is life-saving for vulnerable children who are unable to keep in their body heat. Certainly, Project HOPE continues to promote the creation of more KMC units in Sierra Leone.

Life-Saving Progress

International support from organizations such as Project HOPE is helping provide life-saving training, services and equipment for mothers and children in Sierra Leone. Though much remains to be accomplished, progress is certainly being made on maternal and neonatal health in Sierra Leone.

– Camryn Lemke
Photo: Flickr

Uterine Balloon TamponadeThe Every Second Matters Uterine Balloon Tamponade (ESM-UBT), a device designed by Massachusetts General Hospital (MGH) to stop postpartum hemorrhaging (PPH), is a condom that is attached to a Foley catheter. When a mother experiences profuse bleeding which cannot be stopped through other means, the condom is placed within the uterine cavity and filled with water using a syringe and a one-way valve. Within minutes, the bleeding is expected to stop. This device has been effective in preventing fatalities associated with pregnancy and childbirth.

The device is easy to use and requires minimal training. Since the training of more than 850 South Sudanese health workers in 2010 and 2011, MGH began using and researching the usage of the device in the countries of India, South Sudan, Kenya, Sierra Leone, Ghana, Senegal, Tanzania, Zambia, Peru, Honduras, Uganda and Nepal.

The Beginning Stages

Training of 46 health providers from 12 health centers to use the device began in Kenya in August 2012. During the first year after training, twenty-six ESM-UBTs were used. The patients who required the device were either unconscious or in an unstable mental state as a result of the severe bleeding they were experiencing. In each case, once the device was put into place, the bleeding was stopped, and the patients were saved. As a result of these successful interventions, the Kenyan Ministry of Health has formally integrated the program into the national policy for PPH.

The ESM-UBT’s Potential

A study was published in 2013 that predicted how many lives could potentially be saved by the use of a uterine balloon tamponade in the year 2018.  These predictions were made based on the availability, use, and efficiency of technologies in health care centers that provide maternal and neonatal services. The model estimated that when the use of a uterine balloon tamponade is implemented, 6,547 lives can be saved, which is an eleven percent decrease in maternal deaths, 10,823 surgeries can be prevented and 634 severe anemia cases can be avoided in sub-Saharan Africa every year.

In 2018, there was a case that involved complex vaginal lacerations which may have resulted in death, but the ESM-UBT was used to control the bleeding. The 26-year-old woman, who was 39 weeks pregnant, went to the Muhimbili National Referral Hospital in Tanzania to deliver her baby. Although she was in good health, she began experiencing significant blood loss. After uterine massage, administration of oxytocin and removal of the placenta, the patient was still bleeding and became unconscious.

Upon examining her pelvis, doctors discovered second degree bilateral vaginal sulcal lacerations. They attempted to suture the lacerations, but the bleeding persisted, so they decided to insert an ESM-UBT device, which was inflated with 300 cc of water. Finally, the bleeding stopped. After forty-eight hours, the device was removed, with no more need for repair. The mother left the hospital two days after giving birth and had fully recovered by her six-week postpartum visit.

As of now, over 670 ESM-UBT devices have been used. MGH has plans of distributing these devices to 350 health centers in South Sudan and Kenya. In addition, technology has been developed to allow for the tracking of referrals of this device as well as the results of its use. The ESM-UBT device has great potential to reduce the number of maternal deaths in developing nations.

– Sareen Mekhitarian
Photo: Unsplash

maternal and child mortalityCameroon borders the coast of the Gulf of Guinea in Central Africa. The country is home to around 25.3 million people, comprising around 0.3 percent of the world’s population. Its population has increased significantly from 17 million in 2002. The nation has faced a number of health challenges, such as HIV/AIDS and tuberculosis, but is primarily plagued by extremely high maternal and child mortality rates. In 1998, there were 4.3 reported deaths per 1,000 live births. This rate has steadily increased in recent years. The 2018 UNICEF data report states that the national neonatal mortality rate is 24 deaths per 1,000 live births, and is as high as 36 deaths in rural areas.

Combating High Mortality Rates

In 2016, the World Health Organization (WHO) performed a study designed to identify the number of infant and mother deaths that occurred during childbirth in 2015 and 2016. The study included four health districts in Cameroon, Specific interventions focused on financing, strengthening necessary human resources, service provision, partnership and advocacy. WHO worked with a Cameroonian reproductive health organization, RMNAH, to train 87 healthcare providers in the operation and organization of regional blood transfusion around the four sectors. The organization also implemented 10 health facilities in central and east regions of Cameroon.

Despite the contributions of WHO and RMNAH, data showed that maternal and child mortality was the same in October 2015 and 2016. In May 2016, researchers traveling to Cameroon with the Center for International Forestry Research (CIFOR) discovered a superfood plant that may spark change in mortality rates.

The Superfood

A group of researchers first discovered the potentially transformative plant in the Takamanda rainforest region, located in southwest Cameroon. The group working with CIFOR was traveling to local communities, observing rates of malnutrition and maternal and child mortality and recording variation by village. One researcher, Caleb Yengo Tata, recalled that some communities witnessed infant death every day. The root of recurring health problems was anemia due to iron-deficiency in women who had reached reproductive age. In some regions of Cameroon, 50 percent of women and 65 percent of children face anemia-related health issues. These can include cognitive difficulties, low birth weight and generally increased maternal mortality. Tata and other CIFOR researchers found that women living in grassland communities were more prone to severe anemia than those living in forest areas. Around 75 percent of women inhabiting either terrain experienced a level of anemia.

Researchers found that the difference could be attributed to a dark leafy green plant called “eru,” which grows bountifully throughout rainforests in Cameroon and central Africa. The plant is predicted to have 85 percent more vital nutrients than fresh spinach, and has virtually no anti-nutrients, making it what Westerners would peg a “superfood.” Traditionally, eru is cooked in palm oil and served with crayfish and hot chili. Women in the forest regions of Cameroon have been harvesting the plant for years, but were unaware of its potential health benefits until recently.

The Eru Plant’s Impact

Science has not yet confirmed whether the eru leaf will adequately address the crisis of child and maternal mortality in Cameroon. Researchers found a statistically significant link between eru consumption and lower anemia rates, correlated to lower child and maternal mortality rates. Through research, scientists ruled out other environmental factors that may influence the prevalence of anemia, such as malaria and parasites. However, they were unable to collect information from a large sample. While the data itself is limited, the discovery is a step forward, representing a possibility of change and the beginning of a healthcare breakthrough.

Although significant changes have been made, maternal and child mortality in Cameroon is still high. For those living in the poorest areas of the country, there are 39 deaths per 1,000 live births. Even in areas considered the “richest sectors” report 29 deaths per 1,000 live births. Researchers, nutritional and medical experts and Cameroonians remain hopeful that the newly discovered eru could function as a breakthrough for child and maternal health. If successful, the superfood plant needs to be preserved, along with other micronutrient-dense foods likely hiding among grasslands and forests in rural sectors of the country.

– Anna Lagattuta
Photo: Flickr

Microlife CRADLE VSA Saves MothersRoughly 800 women die every day as a result of obstetric hemorrhaging, sepsis and pregnancy-related hypertension. The majority of these deaths occur in low-income areas that do not have the necessary tools to check a mother’s blood pressure and heart rate during or after childbirth.

In response, Professor Andrew Shennan and the CRADLE research team at King’s College London developed the CRADLE Microlife Vital Signs Alert (CRADLE VSA). The device features a “traffic light” early warning system that uses the traditional red, yellow and green colored lights. The user-friendly system indicates when a patient has pre-eclampsia or sepsis, even if the user has not undergone formal training.

CRADLE VSA relies on Shock Index, “the most reliable predictor of serious maternal adverse outcome. Appropriate thresholds for shock index were therefore incorporated into the traffic light algorithm, together with universally understood hypertensive thresholds, to trigger the coloured lights.” Several research studies have investigated the benefits of CRADLE VSA devices.

2013

A CRADLE research team found that over 90 percent of health clinics in a rural district of Tanzania lacked blood pressure devices. Often, the ones they did have were broken. The team provided 19 CRADLE VSA devices, containing tally counters to monitor use, to these clinics.

The CRADLE researchers conducted preintervention and postintervention studies over 12 months in three rural hospitals in Tanzania, Zimbabwe and Zambia. During the three-month preintervention phase, pregnant women who went to the hospital at twenty weeks gestation or more had their blood pressure measured twice with the validated CRADLE prototype device. The three-month intervention phase resulted in twenty rural and semirural peripheral antenatal clinics receiving one to two CRADLE prototype devices. They also received training sessions, instructions and a guide to referring based on blood pressure readings.

The researchers analyzed readings from 1,241 women (694 from the preintervention phase and 547 from postintervention). They discovered a link between the use of the device in these rural clinics and improved antenatal surveillance of blood pressure. They found a decrease in the proportion of women who never had their blood pressure measured in pregnancy from 25.1 percent to 16.9 percent.

April 2016

Researchers held a 20-month trial to determine the device’s efficiency. Over this time, new healthcare sites received the CRADLE VSA device every two months until 10 sites had the device. The goal of the trial was to determine the device’s ability to detect obstetric hemorrhaging, sepsis and hypertension and help providers reduce the number of deaths occurring during childbirth. In June 2016, researchers implemented the device in 10 low-income countries including Uganda, Sierra Leone, Ethiopia and Haiti.

June 2018

Studies showed that clinics in twelve countries across Africa, Asia and the Caribbean were using over 6,700 CRADLE VSA devices. A cluster randomized controlled trial in Mozambique, India and Pakistan used a prototype of the device in the intervention phase of pre-eclampsia. The trial enrolled a total of 75,532 pregnant women.

The CRADLE VSA saves lives by foreseeing the early diagnosis of pre-eclampsia. For many women, these health risks may have otherwise gone unnoticed. This innovation is contributing to the prevention of maternal deaths. This could help the world meet the United Nations Sustainable Development Goal 3, “to reduce the global maternal mortality ratio to less than 70,000 per 100,000 live births by 2030.”

– Sareen Mekhitarian
Photo: Upsplash

Maternal Mortality Rate in MalawiThe maternal mortality rate in Malawi is one of the highest in the world. The country ranks at number 13 for the highest number of maternal deaths during pregnancy or after birth.

The maternal mortality rate in Malawi has decreased over the years, but it is still an alarming issue that the country is addressing. It is estimated that per every 100,000 live births, over 600 mothers die from mostly preventable causes.

In Malawi, the circumstances of maternal mortality are complex but preventable. Like most countries in sub-Saharan Africa, the health care system in Malawi is not as developed as the rest of the world. Having better access to health care and qualified personnel will save the lives of mothers and children in developing countries.

Causes of High Maternal Mortality

There are several causes related to the high maternal mortality rate in Malawi. Poverty is one of the main contributing factors. Given that half of the country’s population lives in poverty, most women cannot afford conventional health care.

The majority of the population live in remote, rural areas, making it difficult for mothers to find access to quality maternal health care. In many cases, they cannot travel long distances on foot to the nearest available clinic. According to a 2014 study, 44 percent of women in rural areas attended at least 4 antenatal care visits whereas, in urban regions, the figure jumped to 51 percent.

In Malawi, women have historically given birth in their homes due to cultural beliefs and practices. In most cases, traditional birthing attendants were present. However, many of them were not trained to respond if something were to go wrong. This most commonly occurred in impoverished families. Today, the country recognizes the need for professionally trained personnel. In 2015-2016, 91 percent of women were recorded giving birth in a healthcare facility.

Most maternal deaths are related to diseases or complications during pregnancy or childbirth. The most common direct causes of maternal death are:

  • hemorrhages,
  • infection,
  • eclampsia,
  • obstructed labor and
  • abortion.

The indirect causes include malaria, anemia, HIV/AIDS and tuberculosis. In most cases, these diseases or complications would have been preventable if there was better access to health care.

Improving Malawi’s Maternal Mortality

Due to foreign aid, and the dedication of the Malawian government, the maternal mortality rate in Malawi is improving with every year. In 2001, out of 100,000 live births, 868 mothers died. Today, that number is significantly lowered to just over 600.

Former Malawian president, Joyce Banda made maternal health her top priority in 2014. Through her influence, the government of Malawi constructed new maternal health facilities in rural areas, created a new system to better train birthing attendants and changed cultural norms and attitudes regarding maternal health and pregnancy.

Banda also believed in the importance of educating young women about their reproductive health. A survey on Maternal and Perinatal Health has shown that women with lower levels of maternal education are at risk of high maternal mortality even if they have access to health care facilities.

Banda made lasting changes in Malawi for the women and children of today and the generations to come.

USAID Investments to Improve the Maternal Mortality Rate in Malawi

The United States financially supports Malawi by investing in maternal and child care. USAID is investing in maternal health facilities and quality care interventions in order to progress the country’s healthcare system. USAID is also supporting national family planning programs that promote maternal education and informed decision-making for the mothers of Malawi.

As the country continues to develop, the maternal mortality rate in Malawi is decreasing.

Due to more accessible facilities, better-educated mothers and the addition of trained professionals, the status of maternal health care in Malawi has made significant strides.

– Marissa Pekular
Photo: Flickr

Women’s Health care in CambodiaThe Southeast Asian nation of Cambodia is currently experiencing its worst in maternal mortality rates. In Cambodia, maternal-related complications are the leading cause of death in women ages 15 to 46. The Minister of Health has created several partnerships with organizations such as USAID to help strengthen its healthcare system. Here are five facts about women’s health care in Cambodia.

Top 5 Facts About Women’s Health Care in Cambodia

  1. Health Care Professionals and Midwives
    USAID has provided a helping hand when it comes to educating healthcare professionals and midwives. Since USAID’s partnership with the Ministry of Health, USAID has helped raise the percentage of deliveries assisted by skilled professionals from 32 percent to 71 percent. The Ministry of Health was also able to implement the Health Sector Strategic Plan to improve reproductive and women’s maternal health in Cambodia.
  2. Health Care Facilities
    Between 2009 and 2015, the number of Comprehensive Emergency Obstetric and Newborn Care (CEmONC) facilities increased from 25 to 37. With more access and an increase in healthcare facilities, 80 percent of Cambodian women are giving birth in health care facilities.
  3. Postpartum Care
    The Royal Government of Cambodia renewed the Emergency Obstetric & Newborn Care (EmONC) Improvement Plan and extended the Fast Track Initiative Roadmap for Reducing Maternal and Newborn Mortality to 2020. This aims to improve women’s health care in Cambodia to improve the lives of women living with postpartum depression. It is also used to improve newborn care and deliveries.
  4. Obstetric Care
    Obstetric care has improved rapidly. According to a 2014 Cambodia Demographic and Health Survey, 90 percent of mothers receive obstetric care two days after giving birth, and three-quarters of women receive care three hours after. Intensive obstetric care has helped drop Cambodia’s maternal mortality rate significantly. In 2014, Cambodia’s maternal mortality rates decreased from 472 deaths per 100,000 live births in 2005 to 170 deaths per 100,000 live births.
  5. U.N. Women
    U.N. Women is working closely to help address the AIDS epidemic in Cambodia. The organization’s efforts to reduce the epidemic focus on protection and prevention. In 2003, 3 percent of Cambodian women reported being tested for AIDS. It has also been observed women in urban areas are more likely to get tested than those in rural areas. Ultimately, Cambodia has set a goal to eradicate AIDS from the country by 2020 through prevention and protection.

Cambodia has seen much economic growth over the years, but the money provided for health care is minimal. Consequently, it is difficult for the government to provide all services. However, there have been great strides in improving women’s healthcare in Cambodia. By fighting to better the lives of women, the Cambodian government has set a goal to establish universal health care by 2030.

Andrew Valdovinos
Photo: Flickr