Inflammation and stories on maternal health

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

Family Planning in ZinderZinder is a region in southern Niger with a population of more than 3.5 million as of 2012. It is one of the country’s most inhabited areas. While women in Niger give birth to an average of 7.6 children, this rate is even higher in Zinder where women have an average of 8.5 children each. Smaller families and slower population growth often correlate with a decrease in poverty. But in Zinder, where 53.8% of people live below the poverty line, large families and frequent pregnancies were associated with higher social status. Women give birth often and usually at young ages. Half of the girls in Zinder marry before the age of 15. This increases the population of a country that lacks the resources to feed, shelter and educate all of these children. Thus, there is a great need for widespread family planning in Zinder.

Global groups are implementing programs in Zinder to help normalize family planning and slow the population boom. Here are some effective programs that have been established to spread ideas and reduce the stigma surrounding family planning in Zinder.

UNFPA Schools for Husbands

Niger ranked last in matters surrounding gender equality in the 2013 Human Development Report. It is men, not women, who primarily make decisions surrounding pregnancy and childbirth. However, the United Nations Population Fund (UNFPA), an international organization that focuses on maternal and reproductive health, has dedicated itself to changing that. It has started more than 137 Schools for Husbands in the region since 2004 in order to improve family planning in Zinder.

These “schools” lack official lessons and schoolwork; rather, they are safe spaces for men to discuss possible solutions to reproductive health concerns. The men who attend them help each other understand the importance of family planning. Together they brainstorm ways to encourage “pregnant and breastfeeding women to attend Integrated Health Centers” in their area. These men, all of whom are married, also bring this information back to their wives, encouraging not only maternal health for the women in these relationships but also better communication among couples.

This program has been wildly successfulーthe use of maternal health resources has tripled in areas where these “schools” operate. Rates of prenatal doctors’ visits and safe births have increased. With these successes, the program has recently spread to several other regions in Niger.

The USAID and PSI Partnership

Population Services International (PSI), a family planning organization, has partnered with USAID to research reasons behind the lack of family planning in Zinder. It has made two important observations: the fact that Islam, the dominant religion in Niger guides many decisions around childbirth and pregnancy, and that families often fail to consider financial implications before having children.

Using this information, PSI created a series of programs in Zinder. These included a financial budgeting tool to help men calculate the cost of having multiple children. This initiative also urged religious leaders to speak with their communities about reproductive health. Another program that PSI created was a poster campaign that encourages family planning using verses from the Quran. These programs, which included more than 200 community members in nine villages, normalized family planning from both a financial and religious standpoint. They also encouraged open conversations around pregnancy prevention.

While the childbirth rate in the region remains remarkably high, many are making progress in normalizing family planning in Zinder. Organizations are working together to emphasize reproductive health in the region and slow the population growth rate.

Daryn Lenahan
Photo: Flickr

The Safe Delivery AppAcross the globe, thousands of women die every year as a result of complications during birth. A variety of organizations have been developing to combat these preventable deaths. The Safe Delivery app, a maternal healthcare app, provides one of these solutions. Below are four facts outlining the app’s purpose as well as its successes since its release in 2012.

4 Facts about the Safe Delivery App

  1. Maternal mortality is an issue around the world. Every year, more than 300,000 women die from causes related to pregnancy. Women typically die in pregnancy and childbirth for five main reasons: “severe bleeding, infections, unsafe abortion, hypertensive disorders, and medical complications like cardiac disease, diabetes, or HIV/AIDS.” There is also a greater chance of death for pregnant women who lack proper assistance. Unfortunately, in sub-Saharan Africa, less than 50% of women during birth have a trained midwife, nurse or doctor to help them through the process. Many instances of maternal mortality are 100% preventable when access to quality maternal care is provided.
  2. The Safe Delivery App educates. The University of Copenhagen, the University of Southern Denmark and the Maternity Foundation launched the app to provide skills and to assess knowledge of those assisting with births in remote areas of developing nations. The app consists of 12 modules that address numerous childbirth emergencies and the appropriate preventative procedures for each. It uses “animated instruction videos, action cards, drug lists, practical procedures, and an individualized e-learning component, MyLearning,” to guide healthcare workers. The Safe Delivery app also works offline so healthcare workers can access the modules in any place, at any time.
  3. The app’s creators collaborate. Some key partners include The Bill and Melinda Gates Foundation, Jhpiego, the Danish Emergency Relief Fund and MSD for Mothers. The app’s creators have teamed up to prep for launching the app in even more countries. For instance, Merck for Mothers is working with the Maternity Foundation to incorporate user feedback into the app’s design. They are also collecting user data through case studies and stories to help improve the app’s adoption in other countries. Additionally, the creators of the Safe Delivery App partnered with the United Nations Population Fund (UNFPA) to study the effectiveness of the app; for the study, the app trained 58 birth attendants across four different regions. After collecting feedback, the UNFPA found there was an “association between high user engagement and improvements in the health workers knowledge and competencies when handling childbirth emergencies.”
  4. The Safe Delivery app is succeeding and improving. The Safe Delivery app boasts over 17,000 downloads in 44 low- and middle-income countries. In 2019, the top five countries were Ethiopia, Sierra Leone, Ghana, Somalia and Togo. Also in 2019, a total of 10,418 users actively used the quiz functions. According to research conducted by Merck for Mothers, “Workers’ skills in handling complications increased by more than 100%” after using the app for 12 months. In 2017, a Hindi version of the app launched for users in India; this drastically increased healthcare workers’ skill sets in the region. The Maternity Foundation has also released multiple case studies that show the positive impact of the Safe Delivery app. For example, the Maternity Foundation tracked the app usage of 62 health workers across eight facilities in Congo. According to the Maternity Foundation, “The study showed a significant increase in the healthcare workers’ knowledge and confidence when handling post-partum hemorrhage and neonatal resuscitation.”

Since the launch of this maternal healthcare app, researchers have seen great improvements in healthcare knowledge. While maternal mortality is still an issue around the world, innovations like the Safe Delivery app can eradicate the dangers of childbirth.

Sara Holm
Photo: Flickr

Maternal Care in BangladeshBack in 1972, Fazlé Hasan Abed started a small organization called the Bangladesh Rehabilitation Assistance Committee (BRAC). Originally dedicated to helping refugees after Bangladesh’s war for independence against Pakistan, the organization has since grown to serve 11 countries across Asia and Africa. One of the key focuses of BRAC is poverty alleviation and includes categories such as improving maternal care in Bangladesh.

BRAC’s Strategies for Poverty Reduction

BRAC engages several strategies to combat poverty, such as social enterprises. Social enterprises are self-sustaining cause-driven business entities that create social impact by offering solutions to social challenges and reinvesting surplus to sustain and generate greater impact. Some social enterprises include those seeking to promote access to fisheries, give people access to jobs in the silk industry and businesses that give seed access to farmers.

BRAC also prioritizes social development. These initiatives refer to BRAC’s on-the-ground programs. Social development efforts aim to build communities up by attempting to foster long-term development through the promotion of microfinance and gender equality and by eradicating extreme poverty.

The third focus of BRAC is investments. BRAC seeks to invest in local companies in order to create as much social impact as possible. This includes initiatives to expand affordable internet access for all and a range of other financial support services.

Finally, the organization founded a tertiary education institution called Brac University. The University, located in Bangladesh, aims to use its liberal arts curriculum in order to try and advance human capital development and help students develop solutions to local problems.

The BRAC Manoshi Maternal Care Initiative

Founded in 2007, the Manoshi program is specifically tailored to serve mothers and newborns by providing accessible care. There are a couple of unique methods that make this maternal healthcare initiative especially effective in reaching its goals of improving maternal care in Bangladesh.

One-third of people in Bangladesh live under the poverty line and a greater part of this group live in slums, making it difficult to access and afford necessary healthcare. Manoshi focuses primarily on empowering communities, particularly women, in order to develop a system of essential healthcare interventions for mothers and babies.

Manoshi’s Focal Areas for Community Development

  • Providing basic healthcare for pregnant and lactating women, newborns and children under 5
  • Building a referral system to connect women with quality health facilities when complications arise
  • Creating women’s groups to drive community empowerment
  • Skills development and capacity building for healthcare workers and birth attendants
  • Connecting community organizations with governmental and non-governmental organizations to further their goals

The main methods used in the Manoshi project to achieve desired outcomes are social mapping, census taking and community engagement.

Manoshi’s Impact on Maternal Care in Bangladesh

BRAC projected that improvement in healthcare access would cause neonatal mortality to decline by 40-50% and the most recent data from the Manoshi program shows just that. Manoshi’s data shows that from 2008 to 2013, both the maternal and neonatal death rates dropped by more than half. From 2007 to 2011, the percentage of births at health facilities increased from 15% to 59%, while national averages only increased from 25% to 28%, suggesting that mothers served by Manoshi have more access to resources and facilities for safe deliveries. Prenatal care also increased from 27% to 52% in the same years.

With the substantial impact of organizational programs like Manoshi prioritizing the wellbeing of women and children, advancements with regard to maternal care in Bangladesh will hopefully only continue upward.

– Thomas Gill
Photo: Flickr

4 Mobile Services Reducing Maternal and Child MortalityA woman in Africa is more likely to die from pregnancy or childbirth than a woman in Western Europe. The lack of nurses and midwives in comparison to Europe can make a significant impact on pregnancy and postpartum healthcare as well as maternal mortality in Africa. However, organizations and businesses are helping improve African women’s living conditions. Here are four mobile services reducing maternal and child mortality in Africa.

Springster

This mobile platform “connects marginalized and vulnerable girls to online content designed to equip them with knowledge, confidence and connections they need to navigate the complex choices of adolescence.”

Springster’s content can be accessed through social media channels like Facebook to provide a space for girls to engage in topics like puberty, education, money management and relationships. The app is based on sharing real-life experiences, helping girls make positive choices and change their lives for the better.

A major innovation with the app is Big Sis. Big Sis is a chatbot designed to provide personalized information about questions related to sexual health. This enables girls to find advice and answers 24/7. The app has impacted many girls’ lives with the reassurance and advice from shared stories and experiences from other girls like them. As a result, they are able to provide guidance and support from each other.

Mum & Baby

This service sends free health information via SMS three times a week to mothers, caregivers and partners. When people sign up for the service, they provide their age, location and stage of parenting they need help with from early pregnancy to taking care of a five-year-old.

After giving out personal information, Mum & Baby sends out personalized messages depending on the information given. Along with the messages, there is a free mobile site that does not use data. Instead, it offers articles, videos, tutorials and tools like the immunization calendar, due date calculator and pregnancy medicine checker.

A study was conducted to see the impact Mum & Baby has on people using the service. The study found 96% of users found the information via texts helpful and 98% of users say they would take action to care for themselves or their children.

Of the mothers and pregnant women surveyed, 95% of them say the information they received influenced their decision to breastfeed. Moreover, 96% of the people surveyed were influenced to get their kids vaccinated. More than 650,000 children were immunized as a result of free text messages.

RapidSMS in Rwanda

This mobile service has a similar style to Mum & Baby in the sense that it shares information via SMS. However, with this mobile platform, community health workers are equipped with mobile devices to collect and use real-time data on key maternal, neonatal and child health indicators.

The data is collected within the first 1000 days of life from pregnancy to childbirth to up to two years. This also includes a broad range of areas of childcare such as antenatal care, delivery, postnatal care, growth monitoring and even death indicators such as maternal and child mortality.

The indicators are recorded using the mobile platform and generate reminders for appointments, delivery and postnatal care visits. There is also an emergency care platform called Red Alerts. There is also a creation of a database of clinical records on maternal care delivery.

UNICEF did a study on RapidSMS to measure its effects on maternal and child mortality. It has contributed to some changes in the use of healthcare services and maternal and child mortality but has overall made improvements on health outcomes for mothers and children in Rwanda.

M-Mama’s Ambulance Taxi

This application “uses mobile technology to connect women in rural areas of Africa to emergency transport.” The project started in 2013 to help women in rural Tanzania gain access to healthcare where almost half of the women there give birth at home without the assistance of a healthcare worker. Many mothers and children die from preventable birth complications due to the lack of health systems and delayed access to care.

The people of M-Mama intend to change that and reduce maternal mortality rates which is a challenge faced by the U.N.’s Sustainable Development Goals.

The process of M-Mama’s ambulance taxi project starts when a patient makes a call to a 24-hour dispatch center. A call handler will then access the condition of the patient using the app, which would indicate whether the patient needs a transfer to a health facility. If healthcare is required, the nearest taxi will be notified and identified through the app, requesting the taxi driver to take the patient to the hospital. This way, taxis act as a cost-effective ambulance for the patient. The driver will then be paid after safely escorting the patient to the hospital.

Since M-Mama’s start, there has been a reduction in maternal mortality of 27% in the Lake Zone regions of Tanzania.

Conclusion

These mobile apps are reducing maternal and child mortality rates in Africa. Through the mobile services’ resources and aid, young girls can make better decisions and expecting mothers can get the help they need, despite their remote locations. Reducing maternal and child mortality by 1% can increase GDP by about 4.6% in African countries.

However, one issue that stands in the way is the lack of access to mobile phones and the internet. Women in Sub-Saharan Africa are 13% less likely to own a phone and 37% less likely to access the internet on mobile.

The more investment there is to reduce maternal and child mortality in Africa, the more it will generate social and economic benefits for Sub-Saharan Africa. To do that, governments and non-profit organizations need to work to close the gender gap and develop mobile health services. These efforts will help women be informed and make healthier decisions.

– Jackson Lebedun
Photo: Flickr

Progress for Maternal and Child Health Outcomes in Albania Located in the Balkan peninsula and nestled between the Adriatic Sea and Kosovo, Macedonia and Greece is the small country of Albania. Following World War II, the nation was a communist state until its transition to democracy succeeding the 1992 presidential election. The transition from a communist state to a democratic republic disrupted economic growth and the ways of life for many Albanian people. The country’s long-standing policy of isolationism contributed to Albania’s slow development, enduring poverty and lack of economic and political stability.

The Albanian Refugee Crisis

In the late 1990s, Albania became host to hundreds of thousands of people seeking asylum from violence and political unrest in the neighboring country of Kosovo. The rapid influx of refugees resulted in many Albanian regions becoming overcrowded and under-resourced. The country, already struggling to support its own people, barely coped with the increasingly dire refugee situation. During this time, Albania was recognized as one of the poorest countries in Europe. The percentage of the population living below the poverty line was estimated to be between 30% and 50%. Crime rates were high and social unrest pervaded.

Albania applied for membership in the European Union in 2009 and joined NATO later that same year. In response, the European Union invested $11 million dollars in emergency aid for Albanians, refugees from Kosovo and surrounding countries. Organizations such as the International Committee of the Red Cross and the United Nations Children’s Fund further worked to improve conditions for all people affected by the crisis.

The effects of political upheavals and the refugee crisis impacted many aspects of life for Albanians. Specifically affected were Albania’s healthcare system and the state of maternal and child health in Albania.

Healthcare in Albania

Historically, Albanians have had limited access to healthcare and health services. Prior to World War II, Albania had few foreign-trained physicians and a small number of hospitals and health clinics based predominantly in urban regions. When the country shifted to a communist state, the Soviet model of health was adapted. Health institutions and hospitals were erected but the quality of medical care was poor.

Investments in the health sector decreased in the 1970s. Recurring political upheavals throughout the 1990s and early 2000s resulted in the destruction of numerous healthcare facilities and the loss of valuable medical equipment. Immunization programs halted and the quality of basic sanitation services decreased drastically in rural and urban areas of Albania.

Maternal and Child Health in Albania

As a result of inadequate health services, health outcomes are poor in Albania. Mortality rates for communicable, infectious diseases are high. Cardiovascular disease is the leading cause of death in the region. Albania has also faced ongoing outbreaks of cholera, tuberculosis and hepatitis.

Health outcomes for women and children in Albania are similarly poor. Albania’s maternal and infant mortality rates are high. Analysis of mortality trends in Albania between 1989 and 1993 revealed that the infant mortality rate decreased from 9.8% in 1970 to 2.8% in 1990. Infant mortality rates subsequently began to rise steadily following the 1992 transition to democracy.

In rural areas, infant mortality rates are twice as high as those in urban regions of the country. Maternal mortality rates in Albania are four times as high as those in other parts of Europe as a result of poor prenatal care and abortion-related complications. Family planning practices are uncommon, as well as forms of birth control alternative to abortion.

Addressing the Issue

However, Albania has shown significant progress in improving its healthcare system as well as the state of maternal and child health outcomes. Albania’s government has shown initiative in restructuring the existing healthcare system to focus on addressing the leading causes of death and disease. The country has also adopted a progressive approach to improving the standards for the protection of women and children’s right to healthcare.

Albania has focused on increasing the accessibility and quality of neonatal and pediatric primary health care in an effort to reduce maternal and infant mortality rates. The nation has implemented additional staffing within women’s and children’s counseling centers and health centers. Albania’s government has partnered with the Ministry of Health to create innovative national health policies that address the needs of the healthcare system, health professionals and Albania’s population. Additional funding and resources have also been allocated to the nation’s health sector.

Further action taken by the Albanian government to improve the state of maternal and child health in Albania includes:

  • Albania signed and ratified the United Nations’ Convention on the Rights of the Child, a treaty outlining the cultural and health rights of children.
  • Albania has begun decentralizing the healthcare system and is ensuring that each village has access to updated and equipped health centers.
  • Albania’s government has adopted a new system of family planning that has improved women’s access to necessary reproductive services.
  • Albania implemented the National Action Plan for Children that increases access to essential health care for mothers and children, works to prevent malnutrition and weight-related disorders, stems the spread of preventable infectious diseases and reduces infection rates of HIV/AIDS and other sexually transmitted diseases.

Moving Forward Amid the COVID-19 Pandemic

The current COVID-19 pandemic further puts pressure on Albania’s government and budget to continue ongoing efforts to improve the nation’s healthcare system. International partners as well as Albania’s government continue to work to improve the country’s healthcare system and advocate for the promotion of the rights of women and children. In doing so, the health outcomes of Albanian women and children will progress and the quality of life for all of Albania’s population will better in the years to come.

– Alana Castle
Photo: Flickr

How the Maternal Mortality Rate is Decreasing in Sierra LeoneThe capital of Sierra Leone, Freetown, is historically known for being a home for freed slaves during the transatlantic slave trade, giving Sierra Leone a prominent place in history. However, the small west African country boarding Guinea has faced many adversities. One is the significant increase in adolescent pregnancies and fertility being some of the highest in the world. Women in Sierra Leone have “a one in 17 lifetime chance of dying during pregnancy, delivery or its aftermath.” This article will discuss the main reasons for the decreasing maternal mortality rate in Sierra Leone.

Data Behind the Mortality Rate in Sierra Leone

For the government of Sierra Leone, keeping a consistent record of deaths was nearly nonexistent during the Ebola outbreak. According to an article by Financial Times, Dr. Sesay, who is “the government’s director of reproductive and child health,” conducts the government’s response to the maternal deaths. According to Dr. Sesay, procedures are set out to lower the maternal mortality rate in Sierra Leone. “We’ve put in place a maternal death surveillance and response team, and developed a technical guideline. When a death is reported, they go and confirm.”

Part of the surveillance is ensuring that reporting the deaths is imperative. This requires health workers within communities to report the deaths to major health facilities. Furthermore, this is vital to decreasing the maternal mortality rate in Sierra Leone as it ensures that all families are accounted for and not misrepresented in the sample population. However, the same health workers reporting the data are the same ones attempting to save these expectant mothers’ lives, which stretches on the ground workers.

Looking at the Numbers

Maternal mortality in Sierra Leone had reached 1,070 deaths between January to June of 2020. According to a report by the ministry of health and sanitation in Sierra Leone, from January to March of 2020, there was a total of 581 maternal deaths. And from April to June of 2020, the total was 489 maternal deaths.

Equally as important, the predominant reference of data for maternal deaths is CRVS (Civil Registration and Vital Statistics). The issue is that Sierra Leone doesn’t recognize this system of data reporting. When this occurs, other data systems are created, such as surveys and various studies, which leaves more room for inaccurate information. The organizations the World Health Organization, the United Nations International Children’s Emergency Fund, the United Nations Population Fund and the World Bank Group have collectively concluded that not all deaths can be recorded due to “systematic error.” Meaning the data presented won’t be accurate due to the actual number being lower or higher and this will impact how the maternal mortality rate is decreasing in Sierra Leone.

However, when using CRVS, “records will be systematically lower than the true number because there will always be deaths that go unreported. This is referred to as a systematic error.” Along with systematic error, there is the possibility of “random error,” meaning when a health worker records inaccurate information. This increases the inaccuracy of maternal deaths in Sierra Leone. Considering health workers are underpaid and overworked, random error is present when recording maternal deaths.

How to Improve Maternal Mortality Rate Efforts

There are multiple ways of decreasing the maternal mortality rate in Sierra Leone. However, today’s most beneficial way is by increasing and encouraging education for traditional birth attendants (TBAs). Undergoing childbirth for many women in Sierra Leone in the past meant being at home and having a TBA present. Usually, a TBA is an elderly woman from within the community and is often referred to as “auntie” or “mother.” Although this may sound beneficial and comfortable, such as having a midwife or doula, according to the government, TBAs were the primary reason for the country’s maternal deaths.

If patients were to have any complications during delivery, the TBA would inform the patient that emergency transportation would take too long to arrive and going to the nearest clinic would take too much time. In most cases, patients would bleed out as healthcare officials would arrive too late. The government attempted to resolve this issue by ratifying a law in 2010 forbidding TBAs to assist in deliveries outside of a clinical environment. If a TBA and anyone else taking part in the process, including the expectant mother, were caught defying this law they would face extreme retribution.

Established in 2001, the non-governmental organization IsraAID is working towards providing “emergency and long-term development settings in 50 plus countries.” The organization also has a medical care program that targets “reproductive health,” along with expanding educational opportunities. For the maternal mortality rate to decrease, the government of Sierra Leone has to establish effective maternal mortality reporting data and education for TBAs.

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

The Issue

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

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

Fighting Worsens the Problem

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

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

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

Aid

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

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

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

Leo Posel
Photo: Flickr