Inflammation and stories on maternal health

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

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

Maternal Mortality LaosIt is hard to imagine how giving birth can be fatal to so many women around the world. However, even in 2021, maternal mortality remains a significant issue, especially in developing countries where modern medicine is scarce and medical facilities are not easily accessible. Fortunately, these maternal mortality rates have been dropping all over the world, especially in Laos.

Birth Complications in Laos

Laos, or Lao People’s Democratic Republic, is a landlocked nation between Thailand and Vietnam. With a population of 7.2 million, the country suffers from a declining fertility rate. In 2020, women in Laos had an average of 2.7 children, yet this rate was more than doubled just 30 years ago. In addition to infertility, women in Laos are at a greater risk for birth complications. According to the U.N., a mother’s risk of dying in Laos due to delivery and post-delivery complications is one in 150. This number is especially alarming when compared to statistics in Europe, where a woman’s risk of death is one in 3,400.

Declining Maternal Mortality Rates

Since the turn of the millennium, maternal mortality rates have dropped significantly all over the world due to the spread of modern medicine. According to the World Health Organization (WHO), the maternal mortality ratio dropped by approximately 38% worldwide in less than 20 years. Similar encouraging statistics are emerging from Laos. Eksavang Vongvichit, the nation’s former health minister, discusses Laos’s progress in tackling this issue: “We’re in third place worldwide in terms of bringing down the maternal mortality rate… We’ve brought down the number of maternal deaths from 450 out of 100,000 live births down to 220.”

The Ongoing Fight Against Maternal Mortality in Laos

Maternal mortality is a more frequent reality in developing countries. On average, women in low-to-middle-income countries more likely to die during or immediately after pregnancy than women in developed nations. This is largely because many birth-related deaths result from easily preventable causes, including severe bleeding, infections, high blood pressure, complications from delivery and unsafe abortions.

To prevent such avoidable deaths, numerous charities and NGOs are working on better educating reproductive healthcare workers in developing nations. The United Nations Population Fund (UNFPA) is a prime example of this work, being stationed in Laos and other developing nations all over the globe. In Laos, the program helped the Ministry of Health create better training programs for volunteers and midwives in reproductive care. This education includes bringing awareness to mothers about proper family planning, which covers how long to space out pregnancies and prevent undesired pregnancies. Not only will such education prevent unnecessary fatalities, but it will also aid families in properly planning for the future to break the cycle of poverty.

With the continued implementation of modern medicine and reproductive education in developing countries, there is great hope that the rate of maternal deaths will continue to decline in Laos.

– Amanda J. Godfrey
Photo: Unsplash

Maternal Mortality in Sierra Leone

Maternal mortality may not be a constant fear of yours if you think about pregnancy. However, this threat has not been eliminated in many parts of the world. Simply because developed countries have significantly decreased this issue with medical advances, many women in various regions must contend with this terrible plight. Maternal mortality in Sierra Leone, specifically, is still considered to be of high risk and something women should consider prior to pregnancy.

The Most Dangerous Place to Become a Mother

The most dangerous place in the world to become a mother, in fact, is Sierra Leone. This country has one of the highest maternal mortality rates globally. Around every one in 17 pregnancies end in the death of the mother- an overly alarming statistic. An endeavor that is supposed to be filled with joy and excitement is now clouded with fear as mothers worry about their health instead of being able to focus on their babies. This worry is not one experienced globally: Sierra Leone women are 300 to 400 times more likely to die with each pregnancy in comparison to women in Sweden, Finland, and other high-income countries.

Factors That Contribute to Higher Rates of Maternal Mortality in Sierra Leone

Postpartum hemorrhaging has accounted for 32% of deaths along with bleeding, hypertension, abortions, obstructed labor, and infections. Hemorrhaging is problematic because a blood transfusion is required immediately to resolve the issue. However, when a woman gives birth at a local clinic, it can take hours to transport her to a hospital for the procedure. Unfortunately, many women bleed to death while waiting. However, most of these conditions can be treated with the correct healthcare, but due to extreme poverty, an overwhelming percentage of families do not have access to the necessary care.  This has resulted in unnecessary deaths.

Another significant factor that contributes to higher maternal mortality rates is that women in low-income countries tend to have more children. As a result, this increases their risk of complications. On average, women in Sierra Leone have five children, which, is considerably high when looking at countries like the United States whose average is 1.73 children. More children typically mean earlier pregnancies. In a 2016 report, researchers found 20% of deaths were girls ages 15 to 19 years old; a grim statistic especially when considering a 15-year-old is three times more likely to die during childbirth than a 22-year-old.

The Good News

Although the facts appear troubling, all hope is not lost. The United Nations has recognized maternal mortality as a serious issue. Thus, it has begun to combat the risk of death during pregnancy and the six weeks that follow.

The UN agency called the United Nations Fund for Population Activities (UNFPA) has started supporting midwifery through three government-run schools that graduate 150 students each year to tackle the high mortality rates. This alone will not improve the situation, as the majority of women in Sierra Leone already have midwives. It should result in better outcomes as these midwives will be better trained and even more common.

The UNFPA also focuses on family planning which reduces mortality by 25 to 30%. This UN organization provides 90% of the country’s forms of contraception through an annual $3 million budget. They estimated that from 2015 to 2017 this service prevented 4,500 maternal deaths and 570,000 unplanned pregnancies.

Maternal mortality in Sierra Leone may be among the highest rates in the world, but the country is taking imperative steps to diminish the risks, steps that have been working thus far. By 2023, UNFPA hopes that they can reduce adolescent births to 75 per 1,000. This, in turn, will massively decrease maternal mortality.

Victoria Mangelli
Photo: Flickr

Doctors for MadagascarMore than 75% of people living in Madagascar are living under conditions of extreme poverty. Disease and natural disasters consistently fall upon the country. Madagascar faces a dangerous lack of proper healthcare provisions and a low number of medical professionals to meet the needs of all its inhabitants. The country does not lack hope of improvement though. Doctors for Madagascar carries out projects to help address the issues that Madagascar faces with appropriate medical care.

Doctors for Madagascar

Doctors for Madagascar (DfM) was founded by German doctors in 2011 after they observed the meager amount of healthcare provisions and trained professionals that were available. Its work is concentrated on providing for one of the country’s most poverty-stricken regions, being the remote south of the island.

This organization allocates immediate aid but it also wants to have a lasting impact and work toward sustainable solutions. Therefore, Doctors for Madagascar monitors its projects in the long-term to be sure that each one is reaching its maximum potential in both service and longevity. In keeping with this idea, the organization creates partnerships with doctors that are local to the south of Madagascar to base its aid on what experts in the community believe to be most necessary.

The Obstacles Madagascar Faces

  • Environmental challenges negatively affect the farming fields and threaten agricultural outputs.
  • Tropical storms have forced tens of thousands of people to evacuate their homes.
  • Hunger affects millions. In 2018, Madagascar ranked number six of nations around the world with the highest rate of malnutrition.
  • Diseases such as measles and plague affect thousands, especially due to low vaccination rates.
  • There is no universal health insurance.
  • Lack of consistent electricity.
  • Maternal health is inadequately meeting the needs of poor mothers and is especially complex during a complicated birth where proper facilities could be hours away from the mother’s village. Those who end up delivering without the assistance of medical professionals depend on the oldest women in the village.
  • Insufficient medical supplies along with difficult working conditions are some of the difficulties being faced within Centres de Santé de Base, which are facilities made of stone that provide healthcare in the countryside of Madagascar. Each one generally contains a nurse, midwife and sometimes a doctor.
  • A lack of trained medical professionals, especially in the south of the island.

 How Doctors for Madagascar Offers a Solution

Doctors for Madagascar does not discriminate against the members of the communities it helps, therefore, the organization takes care of the medical costs for those who cannot afford the treatment they need. Along with covering costs, the organization also provides cost-free maternal healthcare to women. As many women are unlikely to see a doctor throughout their entire pregnancy, DfM provides access to check-ups for women.

Transportation for pregnant women has improved as ambulances are provided and free hotlines have been made accessible for communication between ambulances and Centres de Santé de Base.

DfM builds health facilities and provides construction expertise to help carry out each project. The organization also renovates medical facilities that are necessary to the community’s health, providing medical equipment that is needed in the healthcare facilities and issuing training for its maintenance. Volunteering consists of doctors joining on aid missions. Each doctor that works with the organization must have sufficient experience and have a strong background in the french language to effectively communicate and treat Madagascans as needed. The organization also offers training to local medical professionals by experienced medical professionals that work or volunteer with DfM.

The Onset of COVID-19

As each nation confronts the global COVID-19 pandemic, Madagascar is not facing its first or only crisis. Dengue fever and malaria are killing more people in Madagascar than COVID-19, yet the pandemic is still emphasizing the urgency of improvement needed in medical care and the importance of access to healthcare. In fact, it is even shaping how some of the highest authorities in Madagascar influence this important matter through their advocacy. The Bishops’ Conference of Madagascar (CEM) stated that “The health crisis reveals the importance of an efficient health structure… we believe the time has come to look for ways to improve public health as a whole.”

The Future of Madagascar

The need for medical aid in Madagascar is a pressing issue. Doctors for Madagascar has proven that through awareness, action and understanding, impoverished communities can be helped in both the short and the long term. It is true that the country faces many recurring threats but that does not mean there has been no positive change. These changes can be seen in Madagascar today, which can provide an optimistic outlook on working to reduce poverty in other countries as well.

– Amy Schlagel
Photo: Flickr