Inflammation and stories on maternal health

Maternal Healthcare in BelarusFewer than 30 years ago, maternal health care in Belarus was not treated as a top priority in the country and the numbers show it. In 1990, 33 out of every 100,000 live births resulted in the death of the mother. By 2015, that number had decreased to four out of every 100,000.

Reasons for Bad Maternal Health Care in Belarus

The reasons for this precipitous drop are numerous, but some stand out more than others. For a long time, public health in Belarus revolved around containing the fallout from two momentous events. One was the Chernobyl disaster in 1986 that directly affected more than 2.2 million people in Belarus, half a million of whom were children. Charities, nongovernmental organizations and United Nations system organizations focused on providing emergency care to those who had been exposed to dangerous amounts of radiation.

The other event was the breakup of the Soviet Union in 1991. According to the World Health Organization (WHO), health care in Soviet-era Belarus was centered on the Semashko system. In this system, industrial workers, believed to be the source of productivity and prosperity for the Soviet Union, were essentially considered more important than the rest of the population. This resulted in addressing their immediate health needs first while overlooking larger public health concerns and it also meant that health care professionals were not as highly regarded as industrial workers. Low pay and little respect for medical workers perpetuated a cycle of subpar health care in Belarus.

Government Initiatives

Independence from Russia brought economic decline for Belarus in the short-term, but it also created an opportunity to revamp the country’s approach to public health. Maternal health care in Belarus received some overdue attention. Between 2005 and 2010, several health resolutions were initiated under the new Government of the Republic of Belarus, including a greater focus on reducing maternal mortality rates.

One such initiative was to build health facilities in rural areas, so that expectant Belarusian mothers in agricultural townships would have the same access to care as their urban counterparts. Another was to create a multileveled perinatal care system, made possible with the support of the head of state who approved the allocation of funds to improve maternal health care in Belarus. This included employing almost 2,700 obstetrician-gynecologists to treat a population of roughly 4.8 million women of fertile age. This initiative was implemented in 2005.

The Progress of Maternal Health Care in Belarus

A doctor visit at the earliest point in a known pregnancy is optimal for the health of mother and child. To ensure that expectant mothers would adhere to this guideline, a monetary allowance was given to them as an incentive for seeing a doctor within the first 12 weeks of their pregnancy. As a result of this bold initiative, prenatal visits within the first trimester increased by approximately 93.5 percent.

Paid maternity leave in Belarus lasts between 126 and 140 days, depending on the difficulty of the labor. Fathers are encouraged to play an active role in the birthing process, with maternity wards made to accommodate families. Today, maternal health care in Belarus ranks 26th in the world. Belarus is a shining example of how a country can evolve over a matter of mere decades and transcend seemingly insurmountable difficulties.

With a maternal mortality rate among the lowest in the world and a compassionate and comprehensive maternal health care system, Belarus has defied expectations across the board. The aid provided to the country during the low points in Belarusian history following the Chernobyl disaster and the fall of the Soviet Union was an important stepping stone toward a healthier and more independent Belarus. The state of maternal health care in Belarus is a magnificent reflection of that.

– Raquel Ramos

Photo: Google

Maternal Health Program for Low-Income FamiliesSince 2001, the province of Manitoba, Canada, has provided 63,000 pregnant and low-income women with cash supplements to help them take care of themselves and their families. The program is called the Healthy Baby Prenatal Benefit.

The supplements are “financial cushions” meant to provide women with the money they need to get health care, healthy food and nutritional supplements. Researchers who have worked with the program say that it has provided a blueprint for other provinces in Canada to follow. If this maternal health program for low-income families works well on a cross-country scale, it could possibly be further developed to help other countries as well.

Maternal Health Program

The money is not the most important part of this project, though. Because the cash supplement was only around $62 per month, the mothers cannot afford many things with it. However, the financial cushion encouraged women to seek healthier food, better transportation options and other things they might not splurge on.

Also, this was a gateway for ensuring that women get into prenatal care as soon as possible. Along with the stipend comes a community. There are approximately 70 prenatal and postnatal support groups across Manitoba that educate women about their future children, what they need to know during pregnancy, and other tips and tricks they may not have received otherwise. All in all, it has been a successful maternal health program for low-income families.

Impact of the Program

Women who have participated in the Healthy Baby Prenatal Benefit program said they felt like confident mothers after going to support groups and using their supplements to better their lives. The program drew inspiration from France, the country that is touted as one of the best countries in the world to raise children. Programs like the Healthy Baby Prenatal Benefit are inspiring others around the world as well.

Cambodia has set up a UNICEF funded pilot project that gives stipends to women if they follow up on their prenatal checks. It was relatively successful, which gives hope to the government and other nongovernmental organizations that funding projects like this are important in the long term. Taking care of the mother’s body while pregnant not only helps the future child but also helps the mother. It decreases the death rate among pregnant women, which can drastically change a child’s future.

According to the World Health Organization (WHO), 830 women die every day from preventable issues related to pregnancy and childbirth and 99 percent of those women come from developing countries. Women in rural areas are affected the most because they do not have access to adequate health care. The most interesting thing that can be concluded from these facts is that skilled care before, during and after childbirth can save the lives of women and newborn babies. This directly relates to the cash programs in countries like Canada, France and Cambodia.

Other Countries That Need Similar Programs

There are a lot of countries that could benefit from the programs such as the Healthy Baby Prenatal Benefit program and that can develop their own maternal health programs. In this article, three of such countries are listed.

Sierra Leone is the first country on the list that could improve maternal health care. There are around 1,360 deaths per every 100,000 live births in the country, which makes the situation urgent. The second on the list is Chad, a country that has approximately 856 deaths per every 100,00 live births. Children make up for 57 percent of Chad’s population and this dangerous trend could potentially leave many of them without mothers. In Nigeria, there are approximately 814 deaths per every 100,000 live births. Nigeria has looked into cash supplement programs before, but creating one specifically for pregnant women would create a great and much-needed change.

Developing countries can and should follow Canada’s example and success with a maternal health program dedicated specifically to low-income families. There is a successful blueprint in the world and it just needs to be adapted to each country that needs it.

– Miranda Garbaciak
Photo: Flickr

Every Mother CountsChristy Turlington is a world-famous model. Those in the fashion world know her from Calvin Klein, Maybelline and Versace, just to name a few of her modeling platforms. However, in addition to her modeling career, Christy Turlington helps poor pregnant women avoid death from dangerous complications during birth. Not only does she enjoy doing this more than she ever enjoyed modeling but she has also saved the lives of thousands of women who could then live their lives and care for their babies.

How It All Started

It all started in the birthing center in New York City’s St. Lukes-Roosevelt Hospital. Christy and her husband, Edward Burns, arrived at the center not long after her water broke. The pregnancy had been normal up to this point, and the birth of their child, Grace, seemed to go off without a hitch. She did not even need pain medication.

However, the placenta had become embedded into Christy’s uterine wall, causing her to bleed heavily. This is known as postpartum hemorrhage (PPH), and it kills 1,000 women around the world every day. The midwife began to suspect this was happening when Christy had not passed the afterbirth after 45 minutes. (Normally, it takes less than 20 minutes.) After another 25 minutes, the doctor had to come in and remove the placenta manually.

The following day, the excessive bleeding had stopped. Christy, knowing that the doctors would likely be able to save her life again, decided to get pregnant again. While carrying her second child, Finn, she and her mother took a trip to the latter’s hometown, San Salvador, the capital of El Salvador. Once there, Christy learned that PPH causes the majority of postpartum deaths not only there, but all over the developing world.

Turlington also learned that many pregnant women in the developing world have to walk to hospitals instead of driving; as a result, many simply choose to give birth at home, without any access to medical care. Learning this inspired Christy to found Every Mother Counts, a foundation that helps cut down on the maternal death rate.

The Charity and the Documentary

Every Mother Counts started out as an advocacy organization that simply aimed to make people aware of worldwide maternal deaths so that they could help. Their first act, spurred by Christy, was to make the documentary No Woman, No Cry. It was filmed in Tanzania, Bangladesh, Guatemala, and The U.S. over the span of a year and shows what birth is like in each country. The bottom line is that The U.S. is disproportionately better at helping women survive childbirth.

While advocacy remains a large part of Every Mother Counts’s overall mission, the organization has branched out over time to include other avenues to help. They sell several products, mostly clothing, and use the profits to help have a greater impact on the lives of the women they are helping. They host running events to raise even more donation money for their cause.

Their website contains forms that allow people to call, email or tweet their congressional leaders to get them to support bills that will help poor mothers survive childbirth. Every Mother Counts has had an impact on more than 680,800 individuals, including mothers, babies, and health care providers.

The Success of Every Mother Counts

Using only donation money, Every Mother Counts funds grants for projects that improve and save the lives of pregnant women in poor countries around the world. For example, in Malawi, they spent $113,740 to give portable solar suitcases to 40 rural clinics, which provided them with a reliable source of electricity with which to run their equipment.

In Syria, $40,350 was spent to help train and equip six midwives to deal with life-threatening emergencies, including giving them home visit kits, medicines, cell phones and more. In the Democratic Republic of the Congo, $10,000 went to giving clinics delivery and postpartum beds, emergency supplies and incinerators to get rid of medical waste. All of these efforts and more have saved the lives of over 400,000 women worldwide.

Christy Turlington has had a huge impact on women’s lives as the founder and CEO of Every Mother Counts. She has saved thousands of lives, made many U.S. citizens aware of postmortem deaths in the developing world and given health centers the equipment that they need to prevent many birth-related tragedies. Although she continues to accept modeling jobs, they barely matter to her anymore. The fact of the matter is that Christy Turlington helps poor pregnant women around the world avoid becoming another health statistic.

– Cassie Parvaz
Photo: Flickr

Maternal Mortality in ChadChad has one of the highest rates of maternal mortality in the world. Out of 15 women in Chad, one will die due to complications while giving birth. This makes a rate of 6.7 percent, which is dangerously high. In 2010, only 23 percent of women had help from someone medically qualified to do so while giving birth. Every couple of minutes, a woman in Chad dies due to birth complications.

Maternal mortality rates, along with child mortality are a good indicator of the status of health care in the country. Higher rates imply the lower quality of and access to health care. Lack of personnel and training prevents women from getting the help they need during childbirth. An increase in health care professionals and proper training will raise the likelihood of saving the lives of the mother and the child.

Chad Mother and Child Health Services Strengthening Project

In 2014, The World Bank approved funding of almost $21 million for the Chad Mother and Child Health Services Strengthening Project. The money comes from the Health Results-Based Financing Fund that is supported by the U.K. and Norway.

The Project targets regions that have particularly high rates of child and maternal mortality in Chad. Increased funding will go to health care services in the areas with low access to resources and higher indicators of maternal mortality. The Project provides care for the woman throughout her pregnancy, helps with deliveries by professionals and even immunizations for the newborn.

The Services Strengthening Project is set to conclude its goals by 2020. The Project is trying to reach 80,000 pregnant women and provide them with antenatal care during a health care visit. This number was exceeded in 2018 since the people of the Project reached 82,117 women by this year. Additionally, they are hoping to achieve 35,000 births with the help of skilled medical professionals by 2020. As of 2018, they are well on their way with 29,500 births. As for its other goals, that include child immunization and health personnel training, the Project is also right on track.

Education of Mothers in Chad

Community awareness is just as important in preventing maternal mortality in Chad as providing access to services. Women have extremely limited opportunities when it comes to education, and four out of five women in Chad between the ages of 15 and 24 are illiterate. Having limited knowledge of antenatal care, hygiene and disease greatly influence the likelihood that a mother or child will not survive the pregnancy.

Levels of HIV in women also contributes to maternal mortality in Chad. Only 10 percent of women aged 15-24 have a thorough knowledge of HIV prevention. Without education on HIV, women easily contract it and spread it to their children. Training provided by programs like the Chad Mother and Child Project can significantly mitigate this issue simply through education and increase of awareness.

Training for health care professionals and midwives in the region, in addition to education for the mothers, lays the foundation for a long-term solution to maternal mortality in Chad. Lack of proper care for expecting mothers not only leads to deaths, but to abandoned families and children without mothers. This repercussion leads to an even longer lasting impact on communities as a whole.

Chad, in particular, is in desperate need of change and improvement in its health care for mothers. Many developing countries have improved their rates of maternal mortality in recent decades, but Chad’s only increased by 10 percent between 1980 and 2010. One of the Millennium Development Goals was to see a 75 percent decrease in pregnancy and childbirth-related deaths, but Chad has yet to reach this goal.

Trained staff on hand, proper medical tools and educated mothers can make the world of difference in decreasing the deaths of maternal and child mortality in Chad.

– Amelia Merchant
Photo: Google

postpartum hemorrhagingIn the advanced world, a postpartum hemorrhage is a very manageable and preventable condition; however, postpartum hemorrhaging is a leading cause of maternal mortality. A staggering 99 percent of all deaths resulting from postpartum hemorrhaging occur in lower income countries. Postpartum hemorrhaging is responsible for 59 percent of maternal deaths in Burkina Faso, 43 percent in Indonesia and 52 percent in the Philippines.

Why Postpartum Hemorrhaging Is Common

In these developing countries, the increased frequency of postpartum hemorrhages is due to a lack of experienced obstetricians and caregivers who can properly treat the condition. There is also a lack of access to proper medications as well as care for those medications.

Oxytocin is currently the most common drug prescribed for preventing postpartum hemorrhages. The World Health Organization recommends that oxytocin be routinely administered and actively managed; however, oxytocin must be stored and transported at two to eight degrees Celsius, two conditions of which developing countries cannot accommodate.

A Possible Solution

A rival drug has been in the works to be as efficient as oxytocin in preventing excessive bleeding post childbirth as well as be more manageable in the living conditions of developing countries. The drug is a heat-stable carbetocin. This type of drug does not need refrigeration and can maintain its efficacy for at least three years when stored at 30 degrees Celsius. These requirements are far more realistic and achievable in developing communities.

The World Health Organization conducted a comparative study between the heat-stable carbetocin and oxytocin for prevention of postpartum hemorrhages. Approximately 30,000 women were sampled and given either drug to study the effects each had on prevention. It was concluded that the heat-stable carbetocin was not inferior to oxytocin.

Saving Mothers’ Lives

With such a high rate of deaths from postpartum hemorrhaging in developing countries due to the strict requirements for oxytocin that cannot be met, the heat-stable carbetocin will drastically improve the mortality rates. The new drug will be readily available and easily managed where it was once not.

Permitting the usage of the heat-stable carbetocin has many benefits that will better developing countries in a multitude of ways. If used widely, the drug could very possibly put an end to this tragically common occurrence.

– Samantha Harward
Photo: Flickr

Maternal Healthcare in Mexico
Eight years ago, The Economist, a British business publication, described maternal healthcare in Mexico as “a perilous journey.” Although deaths in labor had decreased by over a third in the past 20 years, they still remained among the highest in Latin America. Preventable complications were common among women, especially those of indigenous descent, largely as a result of infrastructural and social challenges.

Maternal Mortality

Since then, substantial effort has been put into solving this problem, especially in anticipation of the 2015 Millennial Development Goals. Globally, maternal mortality is often the result of wider social problems related to extreme poverty. It especially affects poor rural women who lack access to modern medical facilities. Solving maternal mortality in Mexico requires implementing a wider health infrastructure that serves these disenfranchised groups.

In Mexico, one of the groups most vulnerable to labor complications is girls under fifteen years old. This is not a generational issue, but rather a result of the dangers of underdeveloped girls giving birth. Twenty percent of Mexican births annually are a result of teenage pregnancy. Half of the sexually active teenage girls in Mexico become pregnant and 11,000 of Mexico’s births each year are to mothers between 10 and 14 years old.

While a proportion of these teenage pregnancies are the result of consensual encounters, some of them are the result of chronic child sexual abuse. One study found that a third of Mexican girls (and about a fifth of Mexican boys) had experienced sexual assault. Unfortunately, comprehensive statistics on the sexual abuse of children are relatively rare for developing countries, but it is likely that these high rates contribute to the phenomena of teenage pregnancy in Mexico.

Teenage Pregnancy and Healthcare Improvements

Ultimately, the key to achieving better maternal healthcare in Mexico lies in preventing teenage pregnancy and providing healthcare infrastructure. On the latter, the Mexican government has already established several programs targeting the country’s rural poor such as the Oportunidades (Opportunities) program, and additional support from the Mexican social security program. Specific programs, such as PRONTO, train hospital staff to intervene in dangerous labors and have shown to help reduce maternal mortality.

However, the Mexican government has taken little action against ending teenage pregnancy. This represents a major blindspot in the path towards achieving improved maternal healthcare in Mexico.

Maternal mortality and labor complications are especially common among young mothers; mothers under 15 are twice as likely to die in labor as older mothers. Their babies are more likely to die as well. Many of these teenage pregnancies could be prevented with education and awareness programs, but most of Mexico’s initiatives are geared towards older girls.

Supporting Maternal Healthcare

Several NGOs have taken initiative in reducing Mexican maternal mortality both by tackling infrastructure issues and generational sexual abuse. Conferences such as this year’s International Best Practices Meeting bring together experts from various fields and international organizations to discuss the issue.

Specifically, the role of midwives in the prevention of labor complications has also been reinforced in Mexican society. Such a prioritization could increase women’s access to maternal healthcare in Mexico, especially in rural areas.

Ultimately, despite the challenges facing Mexican mothers, there is hope that the danger of pregnancy in the country can be further reduced. Improved maternal healthcare in Mexico can be achieved with infrastructure and education, factors that also help combat extreme poverty in the country; only then, can Mexico truly achieve its development goals.

– Lydia Cardwell
Photo: Flickr

treating obstetric fistula
Obstetric fistula is a condition in which there is an abnormal opening in a woman’s birth canal due to prolonged, obstructed labor. When left untreated, obstetric fistula leads to skin infections, kidney disorders, incontinence and death of the child, and is responsible for around 6 percent of all maternal deaths.

This ailment is highly preventable and treatable, yet there are an estimated two million women living with it untreated in Asia and sub-Saharan Africa. An additional 50,000 to 100,000 women are diagnosed each year. These women are predominately underprivileged, poor and young.

Operation Fistula Raises Awareness of the Necessity of Treating Obstetric Fistula

Operation Fistula is one of the few organizations that has collected data on the condition. It has measured the burden on life that not treating obstetric fistula has had and compared that weight to that of other debilitating diseases. The organization found that living with obstetric fistula is ranked just below terminal cancer.

In developed countries, obstetric fistula is practically non-existent because women have access to the education and medical services that assure a healthy pregnancy. Unfortunately, these care services are not readily available to women in poverty-stricken areas.

Even with the establishment of care centers in the most prominently affected areas, the lack of attention that obstetric fistula receives is incredible. Because the condition is nearly unheard of in Europe and the U.S., there is limited global awareness and therefore very little capitalization. In fact, treating obstetric fistula receives less than1 percent of annual global health funding even though it is relatively inexpensive to care for.

Global Efforts Bring Treatments to Women in Need

To counter the mass neglect, Operation Fistula works to provide women with timely and high-quality treatment. It also plans to eliminate fistula altogether by 2045. The organization’s approach is data-centric and focuses on performance-based funding to surgeons who have successfully treated patients. This simple solution yielded four times the target amount of patient treatments between 2012 and 2014.

In addition, USAID’s Health Service Delivery project is working to make the proper medical services available by establishing treatment centers at multiple hospitals in Guinea, where obstetric fistula is extremely prevalent. The treatment centers allow women to undergo the reconstructive surgeries necessary for recovery.

Operation Fistula’s most recent effort in continuing its 2045 eradication plan is working with the government of Madagascar and the United Nations Population Fund to wipe out fistula in every region of the country.

Operation Fistula concentrates on the patient first and foremost. With its performance-based funding, Operation Fistula makes sure that each patient gets the best possible treatment rather than focusing solely on the number of patients treated. Through their endeavors, every woman that Operation Fistula has treated so far has gained back, on average, almost 11 years of healthy life.

While advancements in the global treatment of women with obstetric fistula have been made, there is still a need for prevention. Health professionals in affected areas are being trained continuously and efficiently in order to prevent and manage obstetric fistula, but the most basic method of prevention is through awareness.

– Samantha Harward
Photo: Flickr

Improvements in Maternal Health in Sierra Leone
The life expectancy of women in Sierra Leone is just 61 years old. The country leads in the world in maternal mortality ratio, ranking in 1,360 deaths per 100,000 live births — nearly 500 more than the next nation and three times higher than the average for sub-Saharan Africa. Lack of clean water and well equipped sanitary equipment has unsurprisingly come with generally high maternal health risks. Maternal health in Sierra Leone is improving (albeit with further necessary upgrades) despite its numerous impediments.

Sierra Leone’s Economic and Political State

In 2010, the government in Sierra Leone announced an ambitious program — the Free Health Care Initiative — to provide free care in public facilities for pregnant and lactating women and young children. Still, mothers felt care to be inadequate as little transportation assistance, sociocultural barriers and poor quality still remain difficult years later.

In addition, a devastating 2014 outbreak of Ebola further stunted improvements in health conditions in the nation. In fact, according to a 2015 paper, the reduced number of health personal after the epidemic may have forced maternal mortality to increase by 74 percent in Sierra Leone. But workers are on the ground making progress — individuals from as close as neighboring communities, to as far as a dozen time zones away in Asia, are dedicated to creating improvements in maternal health in Sierra Leone.

Impact of Aid Organizations

A UNICEF partner, Sierra Leone Social Aid Volunteers, built modern toilets, a laundromat, incinerator, placenta pit, water well and water supply system in the nation. And that’s not all — UNICEF and other humanitarian aid organizations have offered aid to over 150 facilities across Sierra Leone.

Fatmata Conteh, midwife at the Konta Line Community Health Center, stated that as a result of these efforts, people in Sierra Leone “can easily clean the health facility and wash all our equipment here. Mothers have access to convenient toilets and water in the bathroom to have a bath after delivery.”

The health center where Conteh is employed provides service to over 7,000 individuals across nearly 30 cities in which nearly one half of patients are under the age of five. In December 2015, UNICEF, funded by the European Union, oversaw 16 separate construction and rehabilitation projects started across the country. All theses projects aimed to improve basic health infrastructure, including maternal facilities.

In November 2017, the World Health Organization (WHO) launched a new five-year strategy for Reproductive, Maternal, Newborn, Child and Adolescent Health in Sierra Leone. The strategy highlights several focus areas, including emergency obstetric and neonatal care, management of newborn and childhood illnesses and prevention of teenage pregnancy. This strategy will hope to launch off the recent progress of late — the females’ increased attendance (at least four checkups) during pregnancy and malaria treatment.

“WHO is proud to have supported the country in developing this strategy together with our partners, but we are also aware that this is just the beginning,” said Alexander Chimbaru, Officer-in-Charge of WHO Sierra Leone.

External Influencers

China has also been an influential partner in the region through its support of aid programs in Sierra Leone. In early June, a group of Chinese health workers touched down in Freetown and joined other medical technicians at the Jui China Sierra Leone Friendship hospital. The hospital provides medical care to children, pregnant and mothers free of charge.

To accompany such dutiful care, the first lady of Sierra Leone, Fatima Bio, officially launched the China-Sierra Leone Maternal and Child Health Care Innovation Project. At a launch event, Bio highlighted the importance of a strong education system and health network, as well as the negative effects of teenage pregnancy.

Closer to home, individuals make substantial sacrifices to assist mothers in giving healthy births. Health Poverty Action has featured Mary Turoy, a successful Maternal Health Promoter in the Kamalo village in the Northern Bombali District of the country. To mitigate the difficulties women face in just traveling to medical centers, Turoy and others in her community offer housing, pregnancy information and much-needed advice.

Maternal Health in Sierra Leone

One of the Sustainable Development Goal health targets is to decrease from 216 maternal deaths per 100,000 in 2015, to less than 70 maternal deaths. The United Nations (U.N.) holds that maternal deaths can be largely prevented if programs bolster the level of care during delivery. And improvements around the globe are, in fact, being made — infectious diseases and adolescent childbearing are down worldwide.

However, conditions remain the most concerning in sub-Saharan Africa. Improvements in maternal health in Sierra Leone are happening, but change is still necessary. Healthcare and maternal conditions in this coastal, west African nation are still an area of concern that could do with continued care today and in the future.

– Isabel Bysiewicz
Photo: Flickr

Maternal Health in Eritrea
The United Nations’ Millennium Development Goal (MDG) Five, improving maternal health, has two components: First, reduce maternal mortality by two-thirds between 1990 and 2015, and second, achieve universal access to reproductive healthcare by 2015.  Eritrea is one of the few countries in which these goals were fully achieved.

The maternal mortality ratio—which the U.N. defines as “the ratio of the number of maternal deaths to the number of pregnancies,” calling it “an indicator of the risk of dying that a woman faces for each pregnancy she undergoes”— was 1,700 deaths per 100,000 births in Eritrea in 1990. The goal for 2015 was to cut that number to 425 deaths per 100,000 births. In 2013, Eritrea not only met but surpassed this goal, with a maternal mortality rate of just 380 deaths per 100,000 births.

Eritrea saw almost as much success in its efforts to achieve universal access to reproductive healthcare. In 1991, just 19 percent of women had any prenatal care. By 2013, that number had risen to 93 percent, a nearly fivefold increase.

What Has Worked

From 1990 to 2015, maternal mortality declined 45 percent globally and 49 percent in Sub-Saharan Africa. Although this is a marked improvement, it is still considerably less than the MDG goal of a two-thirds decrease. As such, many are wondering what contributed to Eritrea’s huge successes.

Since the establishment of the MDGs, the government of Eritrea has been committed to engaging all people with its new development programs. It strove (and continues to strive) to build a national healthcare system that offers universal coverage that truly does reach everyone, no matter how poor or remote.

Efforts by the government, the U.N. and NGOs working to improve maternal health in Eritrea have reflected this emphasis on the universal and the importance of reaching all Eritrean women. Clinics that are mobile and transitory pop up in a community temporarily, and, after a period of time, move on to the next town. This allows more women to receive healthcare without necessitating more resources or medical personnel.

Empowering Women

Likewise, there has been a strong focus on improving gender equality in Eritrea. The government has outlawed both child marriage and female genital mutilation and is continually working to promote gender equality in education and in the labor force. Today, it is estimated that women in Eritrea make up between 35 and 45 percent of the workforce. This means that women are more visible, more engaged in society politically and socially and better able to advocate for their rights.

Despite Eritrea’s considerable successes, challenges remain for the East African nation. Eritrea has a long history of violence. After 30 years of brutal civil war, it gained independence from Ethiopia in 1993. Conflict with Ethiopia resumed between 1998 and 2000 and, even during times of peace, Eritreans live until a strict authoritarian government. Continued improvements in maternal health in Eritrea will be predicated upon future peace and stability in the region.

The Future of Maternal Health in Eritrea

Access continues to be the main challenge. Women who lack money often struggle to find affordable healthcare. Despite the efforts of mobile health clinics, antiquated infrastructure, old roads and limited public transportation opportunities mean that traveling to a clinic still proves difficult for many women.

Furthermore, although 93 percent of women received at least some prenatal care in 2013, only 55 percent of women had a trained medical professional at their child’s birth. That is a huge improvement from 1991, when only 6 percent of babies were born under the care of a medical professional, but room for improvement remains.

Eritrea’s success in reaching and surpassing MDG Five ought to be applauded. Other countries should follow its example and commit to focusing on universal access to maternal and prenatal care. Despite considerable success regarding lowering the maternal mortality rate and achieving near-universal access to reproductive healthcare, Eritrea should continue to strive to increase the accessibility of healthcare. Eritrea, and the global community supporting women’s health and equity there, can continue to improve the availability of and access to affordable maternal and prenatal healthcare.

– Abigail Dunn
Photo: Flickr

Saving Mothers, Giving Life in ZambiaSaving Mothers, Giving Life in Zambia is working to improve maternal and newborn health in 16 districts. When a mother dies, her newborn is 10 times more likely to die. In Zambia, the rate of maternal mortality is among the highest in the world with an estimated 1,400 maternal deaths and 13,000 newborn deaths per year. The initiative aims to create safe and high-quality childbirth services for women and their newborns.

The Initiative

Saving Mothers, Giving Life is a $280,000, five-year public-private partnership extending from 2012 to 2017. The initiative was launched in 2012 by then-Secretary of State Hillary Clinton as part of the Global Health Initiative and to support achievement of the UN’s Millennium Development Goals.

The objective of the initiative is to quickly reduce the maternal and newborn mortality rates in Uganda, Zambia, and Nigeria. Saving Mothers, Giving Life brings together national governments, non-governmental organizations, the private sector, and professional associations to aid in reaching the common objective. Key partners include:

  • the governments of Nigeria, Uganda, Zambia, Norway, and the United States;
  • Merck for Mothers;
  • Every Mother Counts;
  • Project C.U.R.E.; and
  • the American College of Obstetricians and Gynecologists.

To reach its goal, Saving Mothers, Giving Life focuses on increasing demand for services, facilitating access to lifesaving care, and strengthening health systems at the district level.

The three primary delays of the initiatives that contribute to maternal and newborn mortality are:

Seeking Care

Local community members have focused on the importance of facility-based maternal and newborn health services in support of women, their male partners, and their family members. Activities have included conducting follow-up visits with pregnant women, educating them, their male partners and family members about budgeting and healthy pregnancies and distributing care planners.

Reaching Care

Saving Mothers, Giving Life in Zambia has appointed local community members to ensure that women receive proper and fair facility-based maternal services. The organization sold vouchers to women to cover transportation costs and developed waiting home models, places where women can stay during the late stages of their pregnancy to ensure they have immediate care.

Receiving Care

The local communities of Saving Mothers, Giving Life in Zambia work to persuade health providers to move to rural areas to practice. To accomplish this, they mobilize and contribute funding and labor for the construction of staff housing.

Results and Impact

Saving Mothers, Giving Life in Zambia quickly saw a positive impact due to the structure of the organization and support of the initiative. Five years into the initiative, Zambia had a 55 percent decrease in the institutional maternal mortality ratio and a 44 percent decrease of stillbirths and newborn deaths in facilities. Nearly 90 percent of women now give birth in a facility, compared to 63 percent at the outset of the initiative. In addition, the number of women who have received treatment to prevent the spread of HIV/AIDS to their infants has increased by 81 percent.

Although it was only a five-year initiative, due to its success and potential, Saving Mothers, Giving Life has the ability to extend beyond the borders of Uganda, Zambia and Nigeria. It’s organizing principles can serve as a model for other countries to use in similar communities.

– Anne-Marie Maher

Photo: Flickr