Inflammation and stories on maternal health

PeriWatch Vigilance programMalawi, a landlocked yet welcoming and beautiful country, is one of the poorest countries in the world. In Malawi, 50.7% of the population lives below the poverty line, and one of the leading causes of this is poor access to healthcare. On June 24, 2021, the Texas Children’s Pavilion for Women announced the commencement of the PeriWatch Vigilance program in Malawi. This program has the capabilities to improve maternal health, lives of children and poverty in Malawi.

What is the PeriWatch Vigilance Program?

This program is a partnership between multiple foundations, ministries and companies to provide fetal monitoring systems at no cost to Malawi health facilities. Partners of the program include the Texas Children’s Global Women’s Health Program, Area 25 Malawi Ministry of Health, Baylor College of Medicine Children’s Foundation in Malawi and PeriGen.

The program’s ultimate goal is to assist doctors in reducing neonatal deaths and maternal deaths. The PeriWatch Vigilance tool has clearance from the FDA and has many key features. The tool:

  • Improves timeliness and accessibility to care
  • Tracks and manages crucial patient information between numerous hospitals
  • Records heart rate, labor progression and contraction statistics of mothers
  • Notifies doctors about any irregularities in vital signs

The PeriWatch Vigilance program in Malawi will allow for more successful births and hospital stays for mothers, children and doctors.

Hope for Malawian Mothers and Children

In Malawi, 400 mothers die per 100,000 births, and one in 50 babies die. At the Area 25 Malawi Ministry of Health, more than 7,000 births occur each year. This number is comparable to the number of births per year at the Texas Children’s Pavilion for Women. However, Malawi has not had the technology to provide a safe labor and delivery experience. With the PeriWatch Vigilance program in Malawi, the well-being of mothers and children will now be at the forefront of healthcare centers. The artificial intelligence tool will provide doctors with crucial warnings, vitals and statistics all through mobile devices.

This quick access will give doctors an advanced warning of any possible maternal or fetal danger. It will also allow healthcare workers to keep watch over the whole unit compared to just a few patients. In addition, clinicians can now spend more time caring for patients, as PeriWatch Vigilance calculates data and measures statistics through its secure data system and technology. The program has recently kicked off, but in the short term it has been running, there has already been a decline in the neonatal mortality rate. Within the next two months, the leadership team hopes to have PeriWatch available for all 7,000 yearly births.

Long-Term Effects

The decline of maternal and fetal deaths in Malawi can create vast improvement for the overall health and wellness of the country. As neonatal disorder cases decrease, poverty rates will consequently follow this decline. When a child is born prematurely or is not healthy, this can impact the rest of their life. They can face neurological and physical damage, preventing them from receiving proper education or going to work. These potential complications will only promote poverty.

On the other hand, neonatal and maternal mortality presents another set of problems for poverty. There is a lack of confidence in the healthcare system in areas with high poverty. This uncertainty creates a fear of survival during and after labor and delivery, leading families to have more and more children. This cycle leads to overpopulation and an increase in poverty as more children are born into a country that cannot yet provide for them.

The PeriWatch Vigilance program in Malawi is helping to assist with safer practices, better care and more advanced technology that will keep both the child and mother safe and confident throughout all stages of birthing. This program will give Malawi the chance to improve healthcare, save lives and ultimately fight poverty.

– Delaney Gilmore
Photo: Flickr

Spreading Awareness About Fistulas in ZambiaFistulas in Zambia are still a devastating problem for impoverished, young mothers despite being preventable. An obstetric fistula occurs when a mother endures prolonged (oftentimes up to five days long) labor in which obstruction occurs. This obstruction then cuts off the blood supply and causes tissue death. Tissue death leads to holes between the vagina and bladder or rectum. Without treatment, fistulas can mean a woman will “uncontrollably leak urine, stool or sometimes both” for a lifetime. The Fistula Foundation and other organizations seek to help women suffering from fistulas in Zambia.

The Cost of Fistula Surgery

The fistulas come with a myriad of infections and chronic pain and can even cause nerve damage to the legs. While fistulas in Zambia are completely preventable and treatable, there are significant barriers to care for mothers. The surgical costs range from $100-400, an expense that is often far higher than what the majority of patients can afford.

4 Factors That Increase the Risk of Fistulas

  1. Malnutrition: Persistent malnutrition is linked to the development of a smaller pelvis, which increases the risk of an obstructed delivery, potentially leading to the formation of a fistula.
  2. Child Marriage: Early motherhood means the narrower pelvises of underdeveloped girls make an obstructed delivery more likely.
  3. Lack of Education: When young women are pulled out of school for marriage and childbearing without proper knowledge about their bodies, the delivery process and their reproductive systems, health consequences ensue. A lack of proper reproductive health education leads to a lack of awareness about the preventability and treatability of fistulas.
  4. Poverty: Poverty augments the chance of food insecurity, younger marriage, childbearing and sacrificing a woman’s education for family duties. Even more importantly, poverty makes access to healthcare that much more difficult. Fistulas are also more prevalent in births that take place outside of medical facilities as women undergoing an obstructed delivery are unable to get a C-section or emergency medical assistance.

In wealthier countries that properly address these four issues, fistulas are virtually unheard of, showing that poor health outcomes and poverty are inextricably linked.

Stigmatization of Fistulas in Zambia

While the medical ramifications of fistulas are devastating, these consequences come in conjunction with complete social ostracization and shame. Husbands often view the typically stillborn births that come with fistulas as a failure of the mother. It is very common for husbands to shame and abandon their wives, labeling the woman’s medical issues as personal failures.

Doctors often do not adequately inform women with fistulas that they have a legitimate medical issue. The abandonment from their husbands is soon joined by the same treatment from family and friends. The isolation and stigma increase the risk of depression among women suffering from fistulas. Lack of proper awareness and education means fistulas have become a source of shame. Hence, many women suffer in silence for decades, even until death.

Spreading Awareness Through Radio

In 2017, the Fistula Foundation, a nonprofit dedicated to providing impoverished young women with proper and free medical attention for fistulas, launched a radio program to educate communities about fistulas in Zambia. The program reached extensively into many provinces of Zambia and mobilized many women to seek proper medical care to repair their fistulas at the six Zambian fistula care centers the organization established to perform the reconstruction surgery for free.

In 2019 alone, the Fistula Foundation performed 319 fistula repair surgeries, all free of charge. In total, the Foundation has aided in the provision of 774 surgeries. The Fistula Foundation also partnered with the famous Zambian singer Wezi to air a song about the dangers of fistulas. The spread of this song, through both radio and CDs, has created a surge in Zambian women seeking treatment. As a direct result of Wezi’s song, 56 women have sought treatment.

Grassroots Activism

In conjunction with the awareness campaigns and Wezi’s song, the Fistula Foundation has encouraged grassroots movements like the Safe Motherhood Action Group (SMAG) to work with community volunteers to spread awareness to help prevent fistulas and end stigma. SMAG leads discussions within communities about the dangers of child marriage with regard to the increased rates of fistulas in young mothers, the necessity of keeping girls in school and the importance of delivering children in medical facilities. SMAG has implemented more than 3,000 community outreach programs, reaching more than 90,000 people with crucial information about fistulas and interconnected social issues.

The Fistula Foundation heavily relies on community leaders to spread the word, designating them the “entry points” to communities and change. The organization’s work highlights the importance of creative community engagement and education initiatives in promoting proper care and destigmatization of fistulas in Zambia.

Jaya Patten
Photo: Flickr

healthcare access in LMICs
Around 2 billion people around the world lack proper access to surgical care or advanced medical care. On average, low-and-middle-income countries (LMICs) have fewer than two operating rooms and one trained surgeon per 100,000 people. Due to this, treatable maladies often result in death. In 2011, around 5 million people died of injuries in LMICs. The barrier between proper medical care and patients is the cost of care. More often, the costs of admission, medications and food are based on the strained economic conditions of impoverished countries. The shortage of medical professionals in LMICs has been identified as one of the most significant obstacles to achieving health-related U.N. Millennium Development Goals (MDGs). One can see the severity of this lack of healthcare access in LMICs in countries such as Mozambique, with only 548 doctors for more than 22 million people.

Lack of Medical Professionals

The absence of medical professionals in LMICs is often due to the poor economic situation of these countries. This results in limited financial resources to support a good healthcare system and provide proper training for doctors. Even when training is available, many skilled doctors work overseas due to others offering them a better medical career abroad, leading to a lack of healthcare access in LMICs. The British Medical Journal claims that “African countries have lost about $2.6 billion…training doctors who are now living in western countries.”

On average, there is less than one doctor for every 20,000 people in Chad. In addition, an equipment shortage in Chad means there are fewer than four hospital beds for every 10,000 people. Furthermore, inequitable distribution of service is a major problem in these countries. Due to a limited number of doctors being available to treat millions of people, often patients with a higher income receive what little medical support is available. Those of a lower income in these countries find it more difficult to afford treatment and especially cannot afford emergency medical procedures.

Consequences for Patients

Lack of trained medical professionals often means that diseases, surgeries, injuries and complications often result in death. Disease is excessive and often untreatable in these countries. Medical procedures often require advanced training and experience to be conducted successfully. The demand for these procedures greatly exceeds the supply of surgeons and institutions, leading to low healthcare access in LMICs.

For example, 90% of those who are visually impaired live in LMICs. According to the World Health Organization (WHO), 80% of cases involving visual disability are preventable. Eye surgery, an effective method of treating blindness, is rarely available. Furthermore, according to the National Library of Medicine, 6 billion people in LMICs lack access to safe and affordable cardiac surgery.

According to WHO, 94% of all maternal deaths occur in low- and lower-middle-income countries. Many women facing birth complications rarely have access to trained professionals who can handle these complications. Sometimes, doctors with insufficient training may perform emergency procedures improperly, resulting in debilitating injuries or even death. Furthermore, 99% of hemorrhage-related peripartum deaths occur in LMICs. These problems all stem from the fact that a qualified medical professional attends less than 50% of all births in LMICs.

Rising Cancer Rates

Another consequence of a poor global healthcare system is the rising cancer mortality rates in LMICs. More than half of the 10 million cancer deaths in 2020 occurred in LMICs. When comparing the healthcare systems of different regions, high-income countries usually spend around five to 10 times more per person. As a result, less than 50% of those diagnosed with cancer in high-income countries die from the disease. On the other hand, 66% of those diagnosed with cancer in LMICs die from the disease. This is mostly due to the fact that LMICs do not have the resources for treatment facilities or radiation therapy centers.

Organizations Making an Impact

Organizations like the Medical Education Partnership Initiative (MEPI) support the training of doctors to improve healthcare access in LMICs. MEPI works to increase the number of new healthcare workers, strengthen medical education systems and build clinical and research capacity in LMICs. Charities such as Mercy Ships send volunteer surgeons to provide lifesaving surgical procedures and invite local doctors to expand upon their surgical skills alongside the volunteer surgeons. Mercy Ships also provides mentoring programs for surgeons, anesthesia providers, ward nurses, operating nurses and biomedical technicians. By providing new medical tools and resources, constructing new medical facilities, providing training for local professionals and working with local governments, Mercy Ships leaves a long-lasting impact.

Poverty and disease are closely related. In order to have significant improvement in global health, economic development of LMICs and improved medical education is essential. The growing disparity in surgical access and other health services requires urgent attention. We can put this into action through the comprehensive development of healthcare access in LMICs.

– Arya Baladevigan
Photo: Unsplash

Drones Protect Botswana's MothersChildbirth in Botswana carries high risks, especially because remoteness threatens safe deliveries for women. If complications arise, it can take hours to transport patients to adequate medical facilities. The lengthy travel time to get medical assistance can prove lethal. In response, the U.N. devised a solution involving drone technology. Drones protect Botswana’s mothers by delivering essential medical supplies. Excessive bleeding is a primary cause of maternal mortality and medical drones can now deliver blood to women who need it. In May 2021, Botswana became the third African nation to implement the Drones For Health project in order to improve maternal health.

Botswana’s Maternal Mortality Rate

Prior to Botswana’s independence from the United Kingdom in 1966, the country had one of the highest poverty rates in the world. Since then, abundant resources and an adept government significantly reduced poverty. Botswana is now considered an upper-middle-income country. However, childbirth risks remain high. Botswana’s 2019 maternal mortality rate was 166 deaths per 100,000 births.

While the worldwide maternal mortality rate dropped by nearly half from 1990 to 2010, progress has been slower in many sub-Saharan African countries. Through projects like Drones For Health, Botswana works toward a 2025 goal of reducing its maternal mortality rate to 71 deaths per 100,000 births.

How Maternal Mortality Impacts Poverty

Maternal mortality harshly impacts poverty as a mother is often a central figure in a household and in society, taking on multiple functions and responsibilities. Surviving children often drop out of school in order to fulfill household obligations or take on employment to compensate for lost household income due to a mother’s death. Children without mothers often have deficient health outcomes because they are less likely to be immunized and often do not receive adequate healthcare when sick. Furthermore, due to the severe economic challenges of losing a mother, some young girls are forced to marry early.

The Drones For Health Initiative

Botswanan academics and government officials worked with the United Nations Population Fund (UNFPA) to put the Drones For Health initiative in motion. The medical drones have launch pads in four locations across the country, all situated next to healthcare facilities. The drones protect Botswana’s mothers by completing quick deliveries of blood. As long as the cargo is less than two kilograms, the drones can also carry medications and other medical supplies. Medical drones are also able to bypass infrastructure limitations such as uneven roads or missing bridges. These barriers prevent land-based vehicles from delivering blood to remote areas. In addition to providing a life-saving service, the battery-powered drones cause much less pollution than a land vehicle making the same trip.

Poverty is the main predictor of women’s endangerment during deliveries. Without traveling to medical facilities or hiring a midwife, childbirth becomes exponentially more difficult and risky. Botswana’s medical drone project exemplifies the benefits of creative and tech-savvy strategies to reduce maternal mortality.

– Lucy Gentry
Photo: Unsplash

Postnatal Care in Kenya
Postnatal care in Kenya lacks proper recognition, however, it is rapidly changing. When it comes to looking after newborn babies and their mothers, the right type of postnatal care is crucial to assure wellbeing. According to the Maternal Health Task Force, more than 60% of the world’s maternal deaths occur during the postnatal period, which is about six weeks after delivery. However, the International Journal of Africa Nursing Sciences reports that this period is the most ignored aspect of maternal care globally. Because of the lack of global acknowledgment, countries suffering from widespread poverty have an even harder time implementing postnatal care policies.

Postnatal Care in Kenya

Kenya tried setting up plans for assistance in the past decades with little success. In 2005, the Ministry of Health in Kenya implemented guidelines increasing the way in which it assesses childcare during the postnatal period. Even though about 80% of the country’s hospitals offer postnatal care, only 42% of Kenyan women give birth in a healthcare facility. This leads to high unreported maternal mortality rates in Kenya. In sub-Saharan Africa, every woman has a one in 16 chance of dying during pregnancy or childbirth.

In order to improve this aspect of the maternal care system, multiple approaches have been proposed as potential solutions to advancing postnatal care in Kenya.

Community-Based Care

Because of these facts, Community Health Workers (CHW) are starting to play a crucial role in healthcare. CHWs can reduce maternal deaths and improve the delivery of healthcare services. Unlike hospitals, CHWs are normally the first point of intersection between the healthcare system and communities. They have more access to mothers who may not be able to afford a hospital birth and can provide them with postnatal care.

Communities select the workers who then serve to give home-based counseling and care services. Because they are well-trained at recognizing diseases, CHWs are held in high regard and receive significant respect in health-related manners. This gives the community the knowledge to know to demand better health services. Additionally, these community workers help link citizens to higher-tier resources.

Better Midwives

In at-home births, midwives are key to ensuring that the whole process occurs smoothly. The Journal of Africa Nursing Sciences states that there should be improved and more professional midwife selections.  There should also be supervision of midwives by supportive initiatives in order to ensure qualifications.

These initiatives support work at all levels of postnatal care while providing midwives with positive encouragement. Strong human resources are also necessary for effectively employing these midwives and securing an improved quality of maternal and neonatal care.

Looking Forward

Access to good postnatal care relates to many broad social issues such as poverty and gender equality. However, many are working for advances in postnatal care in Kenya, laying down the plans to make sure maternal services improve. Hopefully, this will lead to healthier children and fewer deaths during childbirth.

– Jack Parry
Photo: Flickr

Emergency Maternal Transport in Developing Countries
In 2017, across the globe, 810 women died each day from preventable pregnancy and childbirth-related complications. Sub-Saharan Africa has the highest maternal mortality rate in the world. Women face 15 times the risk of dying from pregnancy and childbirth complications compared with women in developed countries. In this region, over half of the women do not have access to emergency obstetric care during labor, citing financial concerns or issues with accessing emergency maternal transport to hospitals. Vodafone and Transaid are organizations working to mitigate the barriers pregnant women encounter in accessing emergency maternal transport in Africa.

During an obstetric emergency, every second a pregnant woman experiences a delay in skilled care, the higher the risks of stillbirth, neonatal or maternal death. Many cases of maternal mortality are due to severe bleeding after childbirth, postpartum infection and blood pressure disorders. All of these are preventable and treatable with timely and skilled care. Urgent emergency maternal transport to adequate health facilities can be the difference between life and death.

Accessing Emergency Maternal Transport in Africa

Demography and Health Survey data from more than 40 countries revealed that while 50% of women cite finances as the primary obstacle for seeking obstetric care and 37% reported transportation challenges. In addition, 37% cited distance to be their main barrier. Access to mobilized vehicles in developing countries is incredibly rare. For example, only one vehicle is available for every 3,000 people. For comparison, in the U.S., there is one vehicle per 1.19 persons.

A study in rural Ghana found that 65% of women use public transport, 29% walk, 4% use personal cars and 1.6% ride by motorbike. However, much of this transportation is inaccessible because of high costs. The distance to an adequate healthcare facility is highly determinant of maternal outcomes, especially in rural areas of developing countries. A study in Southern Tanzania by Lancet Global Health found that “living more than 35 km away from a health care facility has a much higher likelihood of maternal mortality compared with those only living at a distance of only 5 km.”

Even when vehicles are available and distance is not a barrier, insufficient and dangerous road systems inhibit transport to hospitals. In developing countries, poor road networks make access to skilled healthcare challenging, especially for remote, rural areas. With road conditions unsuitable for many vehicles, women have few viable options.

Effective Interventions: Transaid

Organizations involved in transportation interventions often include direct provision of transportation or monetary schemes. This eliminates the financial burden on families seeking emergency maternal healthcare. Dependent on each community, organizations tailor the intervention to best support the residents.

Transaid, in partnership with the National Union of Road Transport Workers, has implemented emergency maternal transport interventions in Nigeria for more than a decade. Transaid’s project “focuses on training and encouraging local taxi drivers to transport pregnant women to health centers.” Drivers are incentivized to volunteer because they receive permission to park in front of the loading queue. This can “potentially save many hours of waiting for passengers.” Transaid has also had a huge impact through its More Mamaz campaign in rural Zambia. The More Mamaz campaign has trained 236 drivers and safely transferred more than 3,500 women to health facilities. The percentage of women delivering at health facilities rose from 64% to 89% from 2014 to 2017.

Vodafone

Vodafone, a mobile technology company, working in conjunction with Touch Foundation, created the m-mama program, a mobile technology program that connects women in rural Tanzania to local taxi drivers acting as “taxi ambulances.” The 24/7 dispatch center is called in an obstetric emergency and the dispatcher skillfully assesses the patient’s condition and connects them to a network of more than 100 taxi drivers responding to emergency calls. Upon arrival at the health center, drivers receive their pay instantly via Vodafone’s mobile money transfer system. Additionally, the service has also trained over 250 community health workers in the Sengemera and Shinyanga states of Tanzania. Vodafone’s successes have led to a partnership with the Lesotho Ministry of Health in South Africa to expand this program.

The Impact of Emergency Maternal Transport in Africa

The results of interventions have been promising. When South Africa issued 18 dedicated vehicles for maternity care, there was a “sustained reduction in mortality.” Similarly, in the Gambia, a “freely available ambulance service in connection with women’s obstetric needs correlated with substantially reduced pregnancy-related mortality.”

In an effort to provide safe, timely and reliable emergency maternal transport to specialized obstetric care, organizations have shown great innovation in how they train, incentivize and mobilize communities to improve outcomes for pregnant mothers.

– Brittany Granquist
Photo: Flickr

The Aama ProgramMaternal health is a pressing issue in developing countries as they often lack infrastructure and facilities to adequately care for pregnant women. Women often lack the incentive to use health service centers and choose to rather give birth at home, resulting in high maternal mortality rates. In Nepal, attempts to remedy this issue have led to a cash transfer scheme, which seeks to encourage pregnant women to use medical facilities to give birth by giving them a certain amount of cash to do so. Known as the Aama (or mother) program, the initiative aims to address Nepal’s poor maternal health by making sure that more births are overseen by health professionals.

Overview of Maternal Health in Nepal

Nepal’s healthcare system has long suffered from neglect due to civil strife and political instability. Despite this, it has seen an improvement in maternal health over the past few decades as more government attention has been spent toward this end. The country has received praise from the United Nations for its efforts in reducing its maternal mortality rate by almost three-quarters between the years 1990 and 2015, reflecting the government’s commitment to addressing the issue.

These developments can be attributed in part to improvements in infrastructure and education, as better infrastructure makes health facilities more accessible and higher levels of education raise awareness of medical issues. Additionally, government programs were implemented to assist Nepali women in receiving better healthcare and offset potential costs of doing so. These smaller programs, which were consolidated in the Aama program in 2009, have been an important aspect of Nepal’s attempt to improve maternal health.

The Aama Program

Predecessors to the Aama program were formed to address the issue of maternal health in Nepal. In 2005, the Safe Delivery Incentive Programme (SDIP) was introduced to pay pregnant women to use public health facilities to give birth. These payments vary based on region, reflecting the fact that women in remote parts of the country incur additional costs to access quality healthcare. As a result, women in the Himalayan regions of the country receive 1,500 rupees as these areas have a difficult terrain, and therefore, more costs are involved to reach medical facilities. Those in the middle hill regions receive 1,000 rupees because the terrain is still quite challenging. Those in the southern plains region receive 500 rupees as the land in this area is flat and easy to manage.

In 2009, the program was renamed the Aama program while a provision was added to provide reimbursement to health facilities and any costs associated with delivery services were removed. Finally, the program was further amended in 2012 to provide cash incentives for women to complete at least four antenatal care visits.

Since the inception of the program in 2005, there has been an increase in the usage of medical facilities to give birth. A study from 2005-2009 shows how this increase can be seen throughout every region of the country. Overall, births in medical facilities have almost doubled from 2006 to 2011 with an increase from 20% to 39%.

Room for Improvement

While Nepal has seen progress in increasing the usage of health facilities to give birth, there is still room for improvement. As of 2018, 58% of women still gave birth at home, even those with knowledge of the Aama program. This discrepancy can be explained by social and economic factors. For example, women who choose to give birth at home may do so because they are not comfortable with a hospital setting. Furthermore, women who are economically disadvantaged often receive substandard care. As a result, these women may still choose to give birth at home even after receiving a cash incentive to use a medical facility.

The Aama program is a promising initiative undertaken by the Nepalese government to improve maternal health in the country. It seeks to incentivize pregnant women to use health facilities to give birth rather than giving birth at home and risking complications. While Nepal has seen a decrease in maternal mortality over the past decade, the Aama program can be expanded even further by accounting for the various socio-economic issues women face.

Nikhil Khanal
Photo: Flickr

Ethiopian maternal and child mortalitySince the year 2000, Ethiopia has halved its maternal and child mortality rate. While this statistic seems impressive on the surface, the rate of maternal and child mortality in Ethiopia remains one of the highest in the world. The child mortality rate stands at 67 deaths per 1,000 children. The Ethiopian maternal mortality rate (MMR) per 100,000 live births is 412. This number is 25 times the United States MMR.

The Global Context of Maternal and Child Mortality

The rate of maternal and child mortality in Ethiopia is best understood by examining the larger global context of maternal and child mortality. Globally, neonatal mortality remains significantly high, with 7,000 newborn deaths a day. Neonatal mortality comprises 47% of the deaths of children under 5. This number is up 7% from 1990 when it stood at 40%. Furthermore, the greatest number of neonatal deaths occur in sub-Saharan Africa.

Globally, the MMR has dropped 38% from 2000 to 2017, which is the most recent WHO estimate, but it is important to note that even though the overall global MMR has reduced, some regions still disproportionately experience very high MMR rates. The greatest number of maternal deaths occur in Africa, just as with neonatal mortality. In fact, in 2017, 66% of all maternal deaths occurred in Africa.

A key cause of maternal and newborn mortality is malnutrition. Due to COVID-19, the World Food Programme predicted that the number of food-insecure people in low- and middle-income countries (LMICs) would double to 265 million by the close of 2020. Food insecurity often links to malnutrition or undernutrition. Therefore, this fact has the potential to increase maternal deaths due to a lack of iron and other essential nutrients. The WHO estimates that, as it stands globally, 40% of pregnant women are anemic. Anemia makes these women vulnerable to fatal bleeding and infections during childbirth. Furthermore, while high-income countries have very low anemia figures for pregnant women, in certain LMICs, up to 60% of pregnant women struggle with anemia.

Global Aid Organizations Leading the Battle

Fortunately, during and despite the COVID-19 pandemic, global aid organizations have been collaborating with the Ethiopian Ministry of Health and other regional bureaus to continue to decrease the rate of maternal and child mortality in Ethiopia.

As a major player in combatting maternal and child mortality in Ethiopia, the United States Agency for International Development (USAID) focuses on providing Ethiopian women, children and families, especially those in underserved communities, access to quality healthcare. USAID works with the Ethiopian Ministry of Health and regional bureaus to institute better training so that healthcare workers can improve the care provided at various levels (facility, community and household). USAID ensures access to integrated services such as prenatal checkups, skilled care for labor and delivery, newborn care, preventative care for childhood illnesses and nutritional guidance.

Quality of Care Network

Ethiopia is a member of a 10-country Quality of Care Network created by the WHO, the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA). The Network launched in 2017 with the aim of halving maternal and child mortality by 2022 and improving patient care. In Ethiopia, this commitment involves clinical mentoring and coaching since learning is an essential aspect. Ethiopia chose 17 districts that represent “pastoralist, urban and rural populations” to operate as “learning districts.”

Maternal Mortality Reduction

These coordinated efforts seem to be making headway according to the 2020 Gates Foundation Goalkeepers Report, which tracks progress on SDG goals. In 2019, the Ethiopian MMR was down to 205 deaths per 100,000 live births which would meet the Quality of Care Network goal of halving maternal and child mortality by 2022.

Ethiopian child mortality was down from 66 deaths per 1,000 children under 5 in 2015 to 52 deaths in 2019, which represents more modest progress. However, the Goalkeepers Report warns that COVID-19 could reverse progress made on global goals and asserts that a global collaborative response is essential in all areas.

It is critical to maintain heightened vigilance in coordinating efforts to continue to improve maternal and child mortality rates in Ethiopia despite COVID-19 challenges, so that progress is not lost.

Shelly Saltzman
Photo: Flickr

Maternal Healthcare Services in Spain
The foundations of the Spanish National Health System (SNS) are free access, equity of financing and funding from taxes. This allows the public sector to provide the most coverage. Oftentimes, this coverage is free of charge. Maternal healthcare services receive high regard in both public and private settings. However, this system faces many issues as well.

Healthcare is available to all Spanish residents for free. Social security payments guarantee almost everyone access to free healthcare. Moreover, some only need to pay a small percentage of fees. Furthermore, only non-residents with health insurance in other countries are not eligible for public healthcare in Spain.

Pros and Cons of Healthcare in Spain

The Spanish healthcare system generally offers high-quality services. There is a network of hospitals and medical centers with well-trained staff members. Additionally, the healthcare system also covers the direct family of a beneficiary. This includes dependents that are under 26 years of age and their siblings.

However, the waiting times for surgeries and treatment from specialist doctors can be extremely long. This is one of the main setbacks of public healthcare. Also, public healthcare services do not allow patients to choose their doctor or specialist. This is very troublesome for some people who wish to have a specific doctor.

Costs for Expecting Mothers

Mothers most often choose hospitals to have childbirth. However, the number of home births has been slowly increasing across Europe. In addition, the state health system does not cover home births in Spain. Moreover, less than 1% of Spanish midwives were registered to oversee home births legally in 2015.

Residents of Spain who use state healthcare can give birth for free. Yet, there may be additional costs with private insurance depending on the insurance plan. Thus, this option makes it easier to find a plan to fully cover the cost of childbirth. The cost of giving birth in Spain is about $1,950 without insurance. This is one of the lowest costs in the world.

Women must hold a private insurance policy for 6-12 months in order to have maternity costs covered. As such, the European Health Insurance Card does not include maternity care.

Maternity Leave

There is also a complicated process in receiving maternity leave. In order to have a standard maternity leave of 16 weeks, mothers must have been paying contributions for a set period of time depending on their age. Mothers are eligible for 18 weeks of maternity leave if they have twins and 20 weeks for triplets. Additionally, maternity leave can receive an extension to 18 weeks if the child has special needs or if the mother is a single parent.

Spain’s Social Security System (Seguridad Social) pays for maternal healthcare services. Mothers must receive paid contributions for at least 180 days within the last seven years to qualify.

The Spanish maternal healthcare system helps many people living in poverty. This system provides a way for people to receive care regardless of their socioeconomic status or salary. Furthermore, it provides a way for residents to choose between public and private options. These options gear towards those who want personalized treatments with a specific doctor.

Expecting mothers benefit from these affordable and accessible maternal healthcare services. Although aspects of the process are difficult and intricate, this service provides a way for Spanish women to give birth easily. This public healthcare system has made Spain a highly rated country for quality care and service.

– Miranda Kargol
Photo: Flickr

Women in NigeriaDespite the United Nations’ global commitment to improve the health of pregnant mothers and reduce maternal death, the loss of women’s lives as a result of complications during pregnancy has been on the increase in most sub-Saharan African countries. In Nigeria, there are 59,000 maternal deaths annually. Compared to those in advanced nations, women in Nigeria are 500 times more likely to lose their lives in childbirth. At 545 per 100,000 births, maternity care for women in Nigeria is the worst in all of Africa. This means that out of every 20 live births in Nigeria, there will be at least one case of maternal mortality.

Maternal Death Leads to Poverty

In Nigeria, a high percentage of pregnant women do not receive adequate healthcare. This is either because their community does not offer services or because the women cannot afford healthcare. Many pregnant women in Nigeria do not seek care because they fear that the services are not high quality. In addition, the country’s patriarchal society and suppression of females can keep a pregnant woman from receiving adequate care. Cultural issues, lack of education and poverty can influence the healthcare choices of many pregnant women.

The toll on a family is enormous if a mother dies during childbirth. A mother’s death can force a family deeper into poverty and cause the daughters to be taken out of school to care for the other children and the household. For these young girls, the death of a mother perpetuates a cycle of poverty that can be hard to escape.

The difference in maternal death rates between the wealthy and the poverty-stricken is the largest among all of the health indicators tracked by the World Health Organization. Yet, mortality can be reduced by 80% with better access to reproductive health services along with high-quality care and skilled providers.

High-Quality Maternal Care for Nigerian Women

After losing a friend during childbirth, Michael Iyanro, a social entrepreneur and healthcare development expert, wanted to do something to ensure that top-quality maternity care for women in Nigeria was accessible to all.

He and other concerned individuals founded Tomike Health to address the problem. The organization launches clinics that provide high-quality maternal healthcare at affordable rates across neighborhoods in Nigeria. Tomike Health prioritizes the low-income residential areas on the outskirts of cities. These are the fastest-growing population centers as people migrate from rural areas to seek work. Tomike Health centers serve women who are often the primary breadwinners in their families.

Clinical Innovations

Rather than relying on donations and grants, the organization’s founders wanted their operation to be self-sustainable. To meet this goal, Tomike Health has combined job training and business expertise with clinical innovations. This approach creates self-sustaining solutions for maternity care. Its partners include Easier Health Consult, the Almonsour Women Foundation and the Gender Development Initiative. The organization and its healthcare providers continue to work hard to reduce maternal mortality rates in Nigeria, saving women’s lives and keeping their children from descending into poverty.

Sarah Betuel
Photo: Flickr