Inflammation and stories on maternal health

Child Hunger in IdlibThe Syrian conflict continues to rage through this pandemic. The locus of fighting has shifted to the provinces of Idlib and Aleppo. Since 2019, the Syrian government — with support from Russia — has engaged in various bombing campaigns in the region and sent ground forces as well. Idlib is clearly feeling the effects of this violence. The need for aid in the province grows alongside the increasing size of the humanitarian crisis. One particularly important but overlooked aspect of the devastation in Idlib is the rising cost of food. Child hunger in Idlib is a result of the rise in levels of food among the youth due to price increases.

The Issue

Child hunger in Idlib — for infants in particular — has become an area of concern as COVID-19 has become more prevalent throughout the country. One big factor is that food has generally become much less accessible. According to The New Humanitarian, “‘An infant needs one container of formula per week, but the price has risen to $12,’ up from $9 three months ago … For many parents, that sum is out of reach.” This increase in price manifests itself often in the form of Severe Acute Malnutrition (SAM). The disease primarily affects children under the age of 5, is highly dangerous and often turns life-threatening. Effects of SAM include a process known as “stunting,” which limits the physical growth in very young children. Stunting and other effects of SAM lead to other problems later in life for these children.

Another frequent issue is malnutrition in pregnant and breastfeeding women. It not only affects them personally but impacts the growth of their infants as well. The New Humanitarian also reports a rise in SAM hospital cases over the summer of 2020. The ratio jumped to 97 out of 1,692 people screened from the January status of 29 out of 2,199. This is likely a lower estimate given the number of people who cannot get screened or don’t have access to testing. Time is of the essence after receiving a SAM diagnosis. Once a child with this condition reaches 2 years of age, they will likely deal with the consequences of SAM for the rest of their life.

Fighting Worsens the Problem

Child hunger in Idlib — and in Syria more widely — is deeply concerning. The issue is compounded by the broader poverty levels and violence that plague the entire country. As a result of the fighting, the majority of  Syrians are internally displaced from their homes.

There is no clear end in sight to the fighting between rebel forces and the Syrian state military. Refugee camps are essentially at capacity and can’t withstand an influx of people if the civil war persists. Additionally, COVID-19 continues to ravage the country, which will likely increase the number of Syrian refugees and displaced persons.

In addition to the housing issue, food scarcity is prevalent in the country. Food options are usually unavailable or unaffordable. As such, many Syrians rely on foreign assistance and aid from NGOs as resources for food.

Aid

There are, however, numerous aid organizations and NGOs working to provide food security and address the growing refugee crisis. They are especially targeting the northwest, where Idlib is located. The Syrian American Medical Society (SAMS) is an organization working to expand health care access to those who need it. SAMS also provides meals to both children and adults at risk of food insecurity. Yet another part of their work focuses specifically on care for those with Severe Acute Malnutrition.

SAMS fights against child hunger in Idlib and throughout the rest of the country. They report that in 2019, the last year for which data is available, SAMS performed more than 2.5 million medical services for the Syrian population, at no or greatly reduced cost. Since 2011, they have provided more than $207 million worth of aid and medical resources as well.

SAMS and other similar organizations are vital to the survival of millions of Syrians. However, there is still more to be done. The international community must redouble their efforts to provide resources to those displaced and malnourished. Everyone must work to end the violence that has been a constant in the country for so long.

Leo Posel
Photo: Flickr

Women's Rights in the DRC
The Democratic Republic of the Congo (DRC) has suffered from longstanding conflicts that have only exacerbated the country’s poverty crisis. About 70% of the country’s population lives below the poverty line. While these conditions have greatly affected the status of women’s rights in the DRC, much work is occurring to raise the standard of living for women.

Gender-Based Violence

The DRC documented more than 35,000 sexual violence cases in 2018, and U.N. Women reports that gender-based violence has risen by 99% with the onset of COVID-19. In war-torn states, conflict uniquely affects women and they are often subject to rape or sexual violence as a weapon of war. To combat these alarming statistics and improve women’s rights in the DRC, the country revised its strategy for combating gender-based violence in August 2020. The new national strategy includes a care framework for survivors, prevention methods for crimes and increased scope of the strategy throughout the entirety of the country, reaching over 51 million women in the DRC.

Women, Peace and Security

As of July 2019, a mere 16% of women constituted the DRC’s Senate, and none of the country’s Constitutional Court judges or provincial governors are women. The Women, Peace and Security agenda, as the U.N. Security Council Resolution 1325 adopted, aims to promote the inclusion of women in positions of power. The DRC’s National Action Plans (NAP) has incorporated it to better include women in decision-making. The DRC’s second NAP experienced enactment in 2019 and expectations have determined that it will be implemented until 2022, with the goal of increasing the inclusion of women and girls in economic and political decision-making to at least 20%.

Women’s Education

An estimated 52.7% of girls between the ages of 5 to 17 do not attend school in the DRC. Gaining an education directly links to an increase in women’s rights and independence, as staying in school commonly leads to lower rates of child marriage, increased financial literacy and expanded job and life opportunities. Although women’s participation in the workforce (70.7%) is roughly equivalent to that of men (73.2%), women’s participation comes primarily from agricultural work where lack of education and gender roles restrict women’s access to financial freedom and property ownership.

While poverty and lack of infrastructure have historically barred women’s and girls’ access to education, UNICEF has worked to improve educational opportunities and thus increase women’s rights in the Democratic Republic of the Congo. UNICEF has partnered with the DRC’s Ministry of Primary, Secondary and Technical Education to facilitate distance learning during the COVID-19 pandemic, and has supported the education of close to 7 million students in the DRC.

Maternal Health

The DRC’s under-5 mortality rate is 84.8 per every 1,000 live births, and in 2011, the DRC accounted for half of all maternal deaths. Women are in particular need of proper healthcare facilities and ease of access to reliable medical centers, two factors that the DRC’s state of conflict and low status of women has greatly affected. To better aid pregnant women and uplift mothers post-birth, the DRC’s National Health Development Plan received €4.5 million ($5.3 million) in monetary aid in June 2020 from the European Union and UNICEF. The E.U. has sent additional doctors and provided blood bags, medicine, vaccines and food for newborns suffering from malnutrition, targeting six of the country’s provinces and 33 health zones.

Looking Forward

While the DRC continues to combat a myriad of issues in regards to women’s rights, it is clear that conditions are constantly improving and progress continues to occur in various sectors of society. As efforts make headway to improve women’s rights in the DRC, the country’s state of poverty and conflict should also experience reform.

– Caroline Mendoza
Photo: Flickr

Maternal Health in Yemen
The Yemen civil war, which began in early 2015 and still devastates the nation today, has created the world’s worst humanitarian crisis. A total of 24 million people require assistance. This crisis affects all aspects of life in Yemen, including healthcare. Millions are without access to life-saving medical treatment and supplies, leading them to die of preventable diseases, such as cholera, diabetes and diphtheria. Pregnant women and infants are particularly vulnerable during this health crisis as adequate medical care throughout pregnancy and birth is essential. Maternal health in Yemen is of the utmost concern now.

Yemen has one of the highest maternal mortality rates in the world with 17% of the female deaths in the reproductive age caused by childbirth complications. Maternal health in Yemen has never been accessible to all women. This crisis has escalated even further during the Yemeni civil war. However, global organizations are acting to save the lives of these pregnant women and infants who desperately need medical care.

Yemen’s Maternal Health Crisis: Before the Civil War

Even before the war began in 2015, pregnant women were struggling to get the help they needed. Yemen is one of the most impoverished countries in the world — ranking at 177 on the Human Development Index (HDI). Poverty is a large factor in the insufficiency of maternal health in Yemen as impoverished women lack the finances, nutrition, healthcare access and education to deliver their babies safely.

Many Yemeni women are unaware of the importance of a trained midwife during childbirth. Of all the births in rural areas, 70% happen at home rather than at a healthcare facility. Home births increase the risk of death in childbirth as the resources necessary to deal with complications are not available.

The Yemeni Civil War Increased the Maternal Health Crisis

Since the civil war began, the maternal mortality rate in Yemen has spiked from five women a day in 2013 to 12 women a day in 2019. A variety of factors caused this spike. The war has further limited access to nearly every resource, including food and water. This, in turn, depletes the health of millions of women and thus their newborns.

Also, the civil war has dramatically decreased access to healthcare across the nation. An estimated 50% of the health facilities in the country are not functional as a result of the conflict. Those that are operational are understaffed, underfunded and unable to access the medical equipment desperately needed to help the people of Yemen. This especially affects pregnant women — who require medical care to give birth safely.

Organizational Aid

Though the situation in Yemen remains dire, various global organizations are acting to assist pregnant women and newborns. The United Nations Children’s’ Emergency Fund (UNICEF) is taking the initiative to help millions across Yemen, including pregnant women. The organization has sent health workers and midwives into the country’s rural areas to screen and treat pregnant women for complications.

Similarly, USAID trained more than 260 midwives and plans to send them into Yemeni communities to help pregnant women and infants. USAID is partnering with UNICEF, the World Health Organization (WHO), the Yemen Ministry of Public Health and Population and other organizations to ensure that maternal health in Yemen, as well as all types of healthcare, are adequate and accessible for all affected by the civil war.

Maternal health in Yemen, while never having been accessible for many, is now in crisis as a result of the Yemeni civil war. While the situation is still urgent, organizations such as USAID and UNICEF are fighting to ensure that all pregnant women and infants in Yemen have access to the medical care they desperately need.

Daryn Lenahan
Photo: Flickr

Maternal Health in Guatemala
In 2010, American supermodel Christy Turlington Burns founded the nonprofit organization, Every Mother Counts (EMC). Following Turlington’s own challenging experience with postpartum hemorrhage, she realized that many women do not have access to the necessary resources for safe child delivery, especially when physical or mental implications arise post-partum. The organization dedicates itself to making pregnancy a safe experience for all expecting mothers.

By globally campaigning and targeting the critical flaws associated with maternal health, EMC has made significant strides toward reducing maternal mortality rates. In addition to its mobilization and awareness efforts, EMC currently provides funding for community-based programs in six selected countries. This specific roster includes how the organization aids maternal health in Guatemala.

Maternal Health in Guatemala

The most common postpartum complication and the main cause of maternal mortality is postpartum hemorrhage, otherwise known as internal bleeding. When untreated, the uncontrollable loss of blood may become fatal. Despite the dangers this poses, it is possible to mediate complications and prevent death when a specially qualified doctor or midwife is present.

Similar complications and the lack of essential healthcare contribute to the high maternal mortality rate in Guatemala: approximately 115 deaths per 100,000 live births. This alarming ratio represents the highest maternal mortality rate in Latin America. It also indicates the dire reality to which many expecting mothers are subject, including inadequate and unequal distribution of necessary prenatal and delivery services, insufficient access to necessary nutrition and overall poor social conditions.

Women living in rural areas — typically practicing traditional, indigenous lifestyles — are most at risk. In comparison to the national average, nearly three-fourths of maternal deaths occur among the indigenous population.

The combination of unstable living conditions, high fertility rates and the fact that doctors attend a low percentage of births reveal the validity of this statistic. For context, more than half of rural births occur under the supervision of under-qualified indigenous midwives, known as comadronas. Since many of them do not have the necessary skills or medical training required in the event of an issue, this leads to greater risks during delivery.

Long-term Advancements by Every Mother Counts

EMC’s contributions have led to collaborations with regional organizations in Guatemala. In partnership with Asociación Corazón del Agua, EMC has provided $180,000 in grant support toward Corazón’s university-level training programs for midwives, or parteras. Corazón is a national midwife program; recruiting students from regions with high rates of maternal mortality and incorporating indigenous traditions, such as certain birthing practices and plant-derived medicines into their training. Corazón also provides national protection for the midwife profession by certifying midwives as qualified to aid in childbirth across the country.

EMC also partners with Asociación de las Comadronas del Area Mam (ACAM). ACAM is a collective of comadronas that provides pregnant women essential healthcare and transportation services through its birth center and mobile clinics. In addition, the collective also focuses on upholding and teaching Mayan traditions in relation to pregnancy and birth. ACAM is able to continue these services and make an impact nationally based on the grants from EMC: totaling $226,000 to date.

Through its investments in midwife training, EMC is actively preventing maternal deaths and improving the overall quality of maternal health in Guatemala.

– Samantha Acevedo-Hernandez
Photo: Flickr

Maternal Health in PeruEfforts to improve maternal health in Peru have seen incredibly positive growth in recent years. At one point, the country was losing mothers to childbirth and childbearing causes at an incredibly high rate. Now, it is far more in line with its neighboring countries’ maternal health rates. However, some regions of Peru that are more rural remain causes for concern by both the Peruvian citizens and government when it comes to the health of mothers.

A Look at the Numbers

In 1990, statistics were released that showed the under-five mortality rate of children to be a staggering 80.3 per 1,000 live births in Peru. The maternal death rate was 200 deaths per 100,000 live births. These statistics were both among the highest in South America. The Peruvian government and the greater world quickly recognized a need to step in. They needed to create change in the quality of maternal healthcare in the country. Two primary programs helped lead the fight for improving conditions for women and maternal health in Peru between 1990 and today.

Mothers Matter

In 2006, CARE ran a crucial case study and program to benefit the health of mothers in Peru called Mothers Matter. The program sought to protect the lives of women through a combination of implementing family planning education. It also provided well-trained medical professionals in obstetrics and postpartum care and addressed big-picture concerns in Peru’s health policy.

As part of the Mothers Matter program created by CARE, the organization partnered with Columbia University. It did this to create The Foundations to Enhance Management of Maternal Emergencies (FEMME). Through FEMME, the organization reduced maternal deaths by 50% in a region of Peru called Ayacucho, one of the poorest in the country. FEMME was driven by eight central goals including standardizing obstetric care. The goals also included working with medical professionals to improve the use of referrals and creating new emergency guidelines for obstetric and newborn care. Throughout this program, the organization stressed a maintained focus guided by human rights.

PARSALUD

Additionally, in 2017, The World Bank reported helping to fund a program called PARSALUD. It aimed to support the Peruvian government and its goals to reform healthcare for women and children. The program successfully helped to improve family planning practices. It also improved healthcare services for women in need of pregnancy and postnatal care. The organization claims a 30% increase in hospital deliveries for women in rural areas. It also claims an increase of almost 50% of women attending a prenatal care visit before their second trimester.

Progress and Remaining Concerns

These organizations, the government and the resilience and dedication of citizens in Peru know they deserve better. As a result, the under-five mortality rate is now down to an all-time low for the country at 13.2 deaths per 1,000 live births. However, this is not the end of the story for maternal health in Peru.

The regions which are poorer, more rural and more populated by Indigenous people are still suffering more deaths. These deaths are due to improper health education and lack of access to safe facilities and competent care. They are also a result of language barriers between Indigenous and Spanish-speaking citizens. For example, according to recent reports, Puno, a primarily Indigenous area, maternal mortality is nearly 50% higher than the country’s average.

Overall, great strides have been made in the care for maternal health in Peru. Nonetheless, it will require continued efforts by everyone involved to bring proper health equity to the varying regions of the country and its mothers.

– Aradia Webb
Photo: Flickr

Finding Hope for Women with FistulaFistula is a medical condition faced by women of every nationality, background and income level. However, these factors affect the rate at which women encounter fistula. Although income level is the largest determinant, nationality is also highly influential in countries where women have limited economic opportunities. However, recent developments are providing hope for women with fistula.

What is Fistula?

Fistula is an abnormal connection between the organs that often occurs when women have troubles with pregnancy and laborspecifically when labor is prolonged. When fistula occurs, especially in places where women have financial and geographic access to medical care, medical experts can normally address the problem with procedures such as C-sections. However, for women who lack access to these services, the issue worsens.

The labor period can last for days, which causes extreme pain and usually causes the baby to die in the process. During labor, the baby’s head presses against the mother’s pelvis and disrupts blood flow. This disruption creates holes, or fistulae, between the vagina and bladder or rectum. Permanent leakage of waste occurs in the mother if the condition goes untreated. Thus, women’s health and well-being directly impact access to emergency medical treatment.

Women with fistula usually live in underprivileged parts of Africa and Asia. To make matters worse, these countries largely lack access to sanitation services or goods like running water and incontinence pads. Fistula causes severe physical and psychological pain in affected women: in addition to uncontrollable leakage of urine and stool, women with fistula also face social issues. For example, this condition causes an unpleasant scent that repels family and friends. This condition can also cause a plethora of infections with the potential to impact others.

One Woman’s Story

Edis, a Ugandan woman suffering from fistula, provides a powerful example of the struggle to receive adequate urgent care. With a recently deceased husband, Edisa gave prolonged birth at home because she could not access a nearby hospital to go through labor. As a result, she contracted a fistula with all of its negative side-effects. Fortunately for Edisa, she was eventually able to receive a treatment procedure. Despite accessing care from a USAID-funded hospital, however, Elisa was forced to travel 11 hours away and incur significant transportation costs as a result. For financially struggling women like Elisa, these expenses can become highly burdensome.

Many other women also face hidden costs when seeking fistula repair surgeries, even if the surgery itself is free. These expenses can include loss of income, child care during recovery and food. USAID is using this information to improve conditions for these women by drafting actions like providing financial support for these hidden costs.

Hope for the Future of Fistula

While women with fistula are still suffering across the globe, especially in impoverished areas, this condition is now much less common than in the past. Additionally, many efforts are being initiated to provide funding and support to women in need of care.

– Fahad Saad
Photo: Flickr

Maternal Mortality Rate in GhanaIn September 2000, the United Nations launched the Millennium Development Goals (MDG): eight steps aimed at making the world a better place. These goals ranged from establishing universal primary education to slowing the spread of HIV/AIDS. The fifth goal in the MDG plan is to improve maternal health, with one of the specific targets being to reduce the maternal mortality rate by 75% between 1990 and 2015. The World Health Organization defines maternal death as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.” Unfortunately, the World Health Organization could only report a 44% decrease in global maternal mortality by the end of 2015. The African nation of Ghana was one of these countries that sat right at 44%. In comparison to the original goal, the overall statistics seem poor; however, a 44% decrease is still a notable feat. Here are three factors that have been especially influential in reducing the maternal mortality rate in Ghana.

3 Reasons Why the Maternal Mortality Rate in Ghana has Decreased

  1. Free maternal health services. Free services for those who could not afford to pay full price made a huge impact on pregnant women in Ghana. This assistance was especially helpful given that, at that time, the country used a “cash and carry” healthcare system that required upfront payments to receive attention from healthcare professionals. This requirement restricted low-income women from obtaining adequate maternal care. In 2003, affordable services were extended to all Ghanaian womenregardless of economic statusafter the country adopted universal healthcare. The combination of universal healthcare and maternal health services provided by the United Nations enabled more women to schedule maternal care visits within their first trimester: in 2017, 98% of pregnant women received antenatal care by a professional, and 84% received postnatal care. With this improved accessibility, women could now monitor their babies’ health, prepare for any special cases and get the help they needed during pregnancy and following childbirth.

  2. Midwives. About 79% of women giving birth in Ghana were assisted by a nurse or midwife, a trained professional who helps during pregnancy and labor. Due to lower education requirements relative to medical professionals, midwives are often more accessible than doctors. Despite less schooling, these individuals are still able to provide physical and emotional support throughout pregnancy, write prescriptions and advise mothers on safely preparing for labor. Two training schools have recently opened in Ghana, accompanied by a 13% increase in national enrollment.

  3. High Impact Rapid Delivery Program (HIRD). The High Impact Rapid Delivery program was established by the Ministry of Health. This program addresses the need for quick and effective change in health policies to increase safety and maximize health within a given nation. Examples of high-priority items include promoting the use of iron tablets during pregnancy, guaranteeing skilled attendance during deliveries and regular de-worming. Of note, Project Fives Alive!, a group assisting HIRD from 2008-2015, advocated for stronger “coverage, quality, reliability and patient-centeredness” in the health industry. The initiative engaged future health professionals in a 12- to 18-month training program designed to quickly teach effective ways to improve their skills in caring for pregnant women and children under the age of 5. Project Fives Alive! made significant progress: the organization helped foster an 11% increase in skilled delivery, a neonatal care institution that boasted a coverage rate seven times higher than its baseline and representation in 33 of Northern Ghana’s 38 districts.

There has indeed been considerable progress in lowering the maternal mortality rate in Ghana over the past 25 years. However, there is still much progress left to make: the country still experiences an alarming rate of 308 deaths per 100,000 (2017), whereas the global rate stands at 211 deaths per 100,000. With continued help from the aforementioned initiatives, the development of new drugs and technology and a commitment to improving maternal health, there is hope that these numbers will further decline.

– Rebecca Blanke
Photo: Flickr

Heart Disease in Bolivia
Bolivia is the second poorest country in South America, performing poorly in education, life expectancy, economic strength and overall development. Most alarmingly, it lacks sufficient medical care due to a limited supply of adequate resources. Bolivia’s unique geography advances its tremendous healthcare challenges, causing children to be 10 times more likely to be born with congenital heart defects. These conditions are nearly impossible to treat without trained cardiologists and updated facilities, two things often inaccessible to most Bolivians. Thus, addressing heart disease in Bolivia is quite challenging as a result of these factors. However, Franz Freudenthal, inventor and cardiologist, is improving medical care with a simple technique that utilizes an indigenous hobby to heal holes in hearts.

What is PDA?

Patent Ductus Arteriosus (PDA) is a common congenital heart defect, particularly prevalent in certain parts of Bolivia. The defect is caused by an opening between two major blood vessels traveling away from the heart. The opening is crucial to a baby’s circulatory system before birth, but it should close almost immediately upon exiting the womb. PDA cases, however, present holes in the heart that remain open. Although the exact cause of congenital heart defects like PDA is typically unclear, decreased oxygen levels have a direct impact on fetal heart health. Because La Paz, Bolivia sits at 3,600 meters above sea level, where the atmosphere has lower oxygen levels than most parts of the world. Therefore, Bolivia’s altitude is the likely cause of irregular blood. Also, the mother’s inability to provide appropriate oxygen levels to her child can result in severe complications.

Breathlessness and failure to thrive are the most common symptoms in mild cases, but fatigue and failure to gain weight can also occur because harmed hearts must work three times harder to pump blood than healthy hearts. Children with severe cases of PDA are at a higher risk for pulmonary hypertension, arrhythmias, infective endocarditis, anticoagulation and congestive heart failure. However, each of these symptoms can be relieved by skilled women in the Andes Mountains’ high plains.

Ingenuity to Fight Heart Disease in Bolivia

Aymara women have been knitting clothes and blankets for centuries, but with help from Franz Freudenthal, they are now knitting heart-closure devices to mend PDA. The Nit Occlud is a hi-tech medical advancement modeled after an occluder, an industrially-produced device intended to block holes in babies’ hearts. Unlike a normal occluder, the Nit Occlud’s design cannot be mass-produced due to its intricate design. Therefore, Freudenthal had to search for an alternative production plan. The perfect method, he soon found, was the wonderful weaving skills of the Aymara women.

The Nit Occlud is composed of a super-elastic metal known as nitinol, a nickel-titanium alloy capable of memorizing its own shape. After a doctor inserts the device through the body’s natural channels, it travels through blood vessels, expands to its original shape, plugs the heart’s hole and permanently restores basic cardiac functionality.

Typical treatments for PDA include surgical procedures, cardiac catheterizations, or heart transplants, but these are not available Bolivia and are not welcomed by the Aymara people. Even though the Aymara people have recently adopted Catholicism, they still believe in the power of the Andes Mountains spirits and their effects on human souls. Keeping in mind that manipulating a heart – performing open-heart surgery or a transplant – is considered desecration according to the spirits, Freudenthal created a minimally invasive innovation to respect patient beliefs and to “make sure that no child is left behind.”

Making Impact

Although congenital heart defects remain the fourth leading cause of premature deaths in Bolivia, the rate has dropped 36% since 2007. Freudenthal’s Nit Occlud has saved more than 2,500 children in nearly 60 countries after experiencing immense success in Bolivia. The country is also succeeding in its fight against poverty. The number of Bolivians living on less than $3.20 a day is projected to decrease by 35% in the next 10 years. Additionally, more children are being vaccinated and more prenatal care opportunities are becoming available to mothers. With these advancements in healthcare and poverty reduction, the economy will soon flourish and rates of heart disease in Bolivia are sure to drop .

Natalie Clark
Photo: Flickr

healthcare in peruPeru carries a heavy history of periodic instability that has made the establishment of an accessible healthcare system perilous. The country suffers from an inequitable distribution of healthcare workers. It also struggles with the partition between private and governmentally-sponsored healthcare, the provisions of which skew inequitably toward the wealthy. Peru’s wealth gap shows the richest 20% in the nation controlling nearly half of its income and the poorest 20% earning less than 5%. This inequality is quite literally killing Peruvians. According to the 2007 National Census of Indigenous Peoples conducted by the Peruvian government, over 50% of census-interviewed communities did not have access to any form of health care facility.

Healthcare in Peru by the Numbers

  • The life expectancy in Peru is 74 years, landing the country at 126 out of 224 countries.
  • The probability of a child in Peru dying before the age of five is 1.4%, compared to 0.1% in the United States.
  • Peru spends 5.5% of its GDP on healthcare, compared to the U.S.’s 17.1%, ranking the country at 128 out of 224 countries.
  • In Peru, there are one and a half hospital beds available per 1,000 individuals. This is a number that is especially dire during the coronavirus pandemic.
  • Peru clocks in at just under one and one-quarter of a physician per every 1,000 Peruvians in need of medical care.

Structure of Healthcare in Peru

Due in part to fluctuating governmental structures and rulers, Peru currently operates with a decentralized health care system administered by five entities. Two of these entities provide 90% of the nation’s healthcare services publicly, while three provide 10% of the nation’s healthcare in the private sector. This distribution results in considerable overlap and little coordination, depleting the healthcare system of resources and providers. In fact, many healthcare providers in Peru work an assortment of jobs across different subsectors.

As healthcare is a necessary sector of the economy, Peru’s healthcare worker density is increasing, even as health worker outmigration also increases. But since these workers are not equitably distributed, coastal and urban areas monopolize the majority of these providers. Lima and tourist coasts boast the highest distribution of healthcare workers, while rural and remote areas such as Piura and Loreto are home to few health providers.

Impact of the Healthcare Structure on Women

The detrimental effects of inequitable healthcare distribution are most visible in the country’s astonishing maternal mortality rate. In Peru, 185 out of 100,000 mothers dying from pregnancy-related causes, one of the highest in the Americas. The burden of maternal mortality rests squarely upon the shoulders of poor, rural, and Indigenous women. They are dying from largely preventable causes in a massive breach of human rights. These women disproportionately face countless barriers to pregnancy wellness and birth healthcare, including a dearth of emergency obstetric and neonatal services, language barriers and a lack of information regarding maternal health. Peru has implemented policies in recent years to reduce the rate of maternal mortality, such as the increase of maternal waiting houses for rural pregnant women to reside in as they approach birth. Unfortunately, women and health professionals attest that these measures are inadequate and improperly implemented.

The only cause of premature death that precedes neonatal disorders as a result of inadequate neonatal obstetrics is lower respiratory infections. This type of infection is the most likely cause of premature death, and it has remained so since 2007. This illness, too, disproportionately impacts women and children. They are the most likely groups to die from household air pollution, a type of pollution caused by the burning of solid fuels for cooking and heating purposes. In Peru, 429 out of an estimated 1,110 yearly childhood deaths are caused by acute lower respiratory infections resulting from household air pollution. Combined, neonatal disorders and lower respiratory infections cause more death and disability than any other factor in Peru. These are shortening the lives of Peruvian women and children by almost 20%.

Moving Forward with Healthcare in Peru

The healthcare system in Peru is one that suffers many flaws. It is straining to support its people, especially in the midst of a worldwide pandemic. While the going is slow, the country is striving to reform its healthcare system. Peru is doing this by reforming its healthcare system in the direction of universal coverage – an achievable but certainly strenuous goal. Since vigorously implementing healthcare reform in the late 90s, Peru reports coverage of 80% of its population with some form of health services. While this number is far from ideal, it is evidence that the Peruvian government is not only cognizant of but concerned about its healthcare failures, and it is striving for a fuller coverage future.

 

– Annie Iezzi
Photo: NeedPix

Reproductive Healthcare in SenegalThe country of Senegal has made major strides over the past 10 years for access and care in women’s reproductive and maternal health. Here are some initiatives and four recent centers that have opened to provide women with reproductive healthcare in Senegal in both rural and urban settings.

Reproductive Healthcare Barriers for Senegalese Women

Senegal’s healthcare system is not free to the public. If one does not have the funds to pay for their needed care, they are refused treatment. With more than 50% of Senegal’s population in poverty, only 32.5% of births are performed with a healthcare professional, making the maternal death rate one in 61 women.

Senegalese women are averaged to have at least four children, which is often a result of early forced marriage and the patriarchal family structure. Young women are limited from attaining an education, inhibiting their ability to gain knowledge and power over their reproductive and maternal health.

Over 77% of Senegalese women who desire sexual contraception such as birth control, do not have access to that resource. This has led to unplanned pregnancies for women 20 years old and younger. Additionally, most young women do not receive sexual education in school or at home. This results in less than a third of women in Senegal having a comprehensive understanding of HIV/AIDs or how to protect themselves from such diseases. Government initiation and non-profit organizations are improving these statistics. More women in Senegal are receiving resources and education for their reproductive healthcare.

The Maputo Protocol

Before the 2000s, there was no access to national government or international organizations’ reproductive health for Senegalese women. In 2005 Senegal signed the agreement of the African Charter of Human Rights and Rights of Women, known as the Maputo Protocol, declaring Senegalese women’s reproductive health to be a “universal human right” that must be protected. Following the Maputo Protocol, the Senegalese healthcare system began providing contraception as well as pregnancy and STI testing for women over the age of 15.

4 Centers and Initiatives for Women’s Reproductive Healthcare in Senegal

  1. Keur Djiguene Yi Center: The Keur Djuguene Yi Center is the first public OBGYN clinic in Dakar, Senegal that provides complete reproductive and maternal care to women who cannot afford or have access to government-provided healthcare options. Opening its doors in 2017 with the help of Dr. Faye, the lead gynecologist on-site, more women than ever before in Senegal now have access to pre and post-natal exams, “education on contraception, HIV prevention, family planning and infant immunization,” free of cost. Dr. Faye has been consciously expanding on the center, adding another full-time gynecologist in 2019. She hopes to expand the center to operate at full capacity with an entire team of OBGYN professionals to help four times the number of patients the Keur Djiguene Yi Center services currently.

  1. VOICES mHealth Program: The World Health Organization partnered with the Voices project, created an initiative for reproductive and maternal awareness in Senegal. The VOICEmHealth Program uses voice messages to spread the word about openings of women’s healthcare centers as well as education on maternal care and child-feeding practices. The project works with Bajenu Gox, known as “community godmothers,” to extend the amount of knowledge and power for young women through home visits and information on their healthcare during and after their pregnancy to reach women who do not have access to a cellular device. Voices mHealth program is a highly effective project in its ability to have immediate, trusted contact with Senegalese women living in both rural and urban communities.

  1. Le Korsa: Le Korsa is a nonprofit organization that empowers communities and healthcare centers in Senegal to improve their provided healthcare with grants and educational resources. One of the organization’s most impactful recent projects was in 2017 when Le Korsa began the renovation of the Tambacounda Hospital’s Maternity and Pediatric Units. The project is expected to finish in 2021, providing more enhanced and comfortable care to the 47,000 annual visitors.

  1. Bajenu Gox Project — Action Et Developpement: The Action Et Developpement organization in Senegal has made major strides in having increased community inclusion and education on women’s healthcare with a global lense. Partnering with the Bajenu Gox of the Kaolack, Fatick, Saint Louis, Louga and Dakar regions in 2015, the Bajenu Gox project has brought new, needed knowledge to rural and urban Senegal. The Bajenu Gox in these locations are now trained on how to talk about the prevention of  STI’s and HIV/AIDs in their local communities. They are bringing a new wave of education to young women and forever changing the empowerment of women in Senegal through awareness of their rights.

With the remarkable breakthroughs in women’s reproductive healthcare in Senegal, women now have access to centers and initiatives. The foundation for a new perspective, action and approach towards the autonomy of a women’s health and reproductive system in Senegal is now able to grow and flourish.

– Nicolettea Daskaloudi

Photo: Flickr