Inflammation and stories on maternal health

 

maternal and child mortality

Cameroon borders the coast of the Gulf of Guinea in Central Africa. The country is home to around 25.3 million people, comprising around 0.3 percent of the world’s population. Its population has increased significantly from 17 million in 2002. The nation has faced a number of health challenges, such as HIV/AIDS and tuberculosis, but is primarily plagued by extremely high maternal and child mortality rates. In 1998, there were 4.3 reported deaths per 1,000 live births. This rate has steadily increased in recent years. The 2018 UNICEF data report states that the national neonatal mortality rate is 24 deaths per 1,000 live births, and is as high as 36 deaths in rural areas.

Combating High Mortality Rates

In 2016, the World Health Organization (WHO) performed a study designed to identify the number of infant and mother deaths that occurred during childbirth in 2015 and 2016. The study included four health districts in Cameroon, Specific interventions focused on financing, strengthening necessary human resources, service provision, partnership and advocacy. WHO worked with a Cameroonian reproductive health organization, RMNAH, to train 87 healthcare providers in the operation and organization of regional blood transfusion around the four sectors. The organization also implemented 10 health facilities in central and east regions of Cameroon.

Despite the contributions of WHO and RMNAH, data showed that maternal and child mortality was the same in October 2015 and 2016. In May 2016, researchers traveling to Cameroon with the Center for International Forestry Research (CIFOR) discovered a superfood plant that may spark change in mortality rates.

The Superfood

A group of researchers first discovered the potentially transformative plant in the Takamanda rainforest region, located in southwest Cameroon. The group working with CIFOR was traveling to local communities, observing rates of malnutrition and maternal and child mortality and recording variation by village. One researcher, Caleb Yengo Tata, recalled that some communities witnessed infant death every day. The root of recurring health problems was anemia due to iron-deficiency in women who had reached reproductive age. In some regions of Cameroon, 50 percent of women and 65 percent of children face anemia-related health issues. These can include cognitive difficulties, low birth weight and generally increased maternal mortality. Tata and other CIFOR researchers found that women living in grassland communities were more prone to severe anemia than those living in forest areas. Around 75 percent of women inhabiting either terrain experienced a level of anemia.

Researchers found that the difference could be attributed to a dark leafy green plant called “eru,” which grows bountifully throughout rainforests in Cameroon and central Africa. The plant is predicted to have 85 percent more vital nutrients than fresh spinach, and has virtually no anti-nutrients, making it what Westerners would peg a “superfood.” Traditionally, eru is cooked in palm oil and served with crayfish and hot chili. Women in the forest regions of Cameroon have been harvesting the plant for years, but were unaware of its potential health benefits until recently.

The Eru Plant’s Impact

Science has not yet confirmed whether the eru leaf will adequately address the crisis of child and maternal mortality in Cameroon. Researchers found a statistically significant link between eru consumption and lower anemia rates, correlated to lower child and maternal mortality rates. Through research, scientists ruled out other environmental factors that may influence the prevalence of anemia, such as malaria and parasites. However, they were unable to collect information from a large sample. While the data itself is limited, the discovery is a step forward, representing a possibility of change and the beginning of a healthcare breakthrough.

Although significant changes have been made, maternal and child mortality in Cameroon is still high. For those living in the poorest areas of the country, there are 39 deaths per 1,000 live births. Even in areas considered the “richest sectors” report 29 deaths per 1,000 live births. Researchers, nutritional and medical experts and Cameroonians remain hopeful that the newly discovered eru could function as a breakthrough for child and maternal health. If successful, the superfood plant needs to be preserved, along with other micronutrient-dense foods likely hiding among grasslands and forests in rural sectors of the country.

– Anna Lagattuta
Photo: Flickr

Microlife CRADLE VSA Saves MothersRoughly 800 women die every day as a result of obstetric hemorrhaging, sepsis and pregnancy-related hypertension. The majority of these deaths occur in low-income areas that do not have the necessary tools to check a mother’s blood pressure and heart rate during or after childbirth.

In response, Professor Andrew Shennan and the CRADLE research team at King’s College London developed the CRADLE Microlife Vital Signs Alert (CRADLE VSA). The device features a “traffic light” early warning system that uses the traditional red, yellow and green colored lights. The user-friendly system indicates when a patient has pre-eclampsia or sepsis, even if the user has not undergone formal training.

CRADLE VSA relies on Shock Index, “the most reliable predictor of serious maternal adverse outcome. Appropriate thresholds for shock index were therefore incorporated into the traffic light algorithm, together with universally understood hypertensive thresholds, to trigger the coloured lights.” Several research studies have investigated the benefits of CRADLE VSA devices.

2013

A CRADLE research team found that over 90 percent of health clinics in a rural district of Tanzania lacked blood pressure devices. Often, the ones they did have were broken. The team provided 19 CRADLE VSA devices, containing tally counters to monitor use, to these clinics.

The CRADLE researchers conducted preintervention and postintervention studies over 12 months in three rural hospitals in Tanzania, Zimbabwe and Zambia. During the three-month preintervention phase, pregnant women who went to the hospital at twenty weeks gestation or more had their blood pressure measured twice with the validated CRADLE prototype device. The three-month intervention phase resulted in twenty rural and semirural peripheral antenatal clinics receiving one to two CRADLE prototype devices. They also received training sessions, instructions and a guide to referring based on blood pressure readings.

The researchers analyzed readings from 1,241 women (694 from the preintervention phase and 547 from postintervention). They discovered a link between the use of the device in these rural clinics and improved antenatal surveillance of blood pressure. They found a decrease in the proportion of women who never had their blood pressure measured in pregnancy from 25.1 percent to 16.9 percent.

April 2016

Researchers held a 20-month trial to determine the device’s efficiency. Over this time, new healthcare sites received the CRADLE VSA device every two months until 10 sites had the device. The goal of the trial was to determine the device’s ability to detect obstetric hemorrhaging, sepsis and hypertension and help providers reduce the number of deaths occurring during childbirth. In June 2016, researchers implemented the device in 10 low-income countries including Uganda, Sierra Leone, Ethiopia and Haiti.

June 2018

Studies showed that clinics in twelve countries across Africa, Asia and the Caribbean were using over 6,700 CRADLE VSA devices. A cluster randomized controlled trial in Mozambique, India and Pakistan used a prototype of the device in the intervention phase of pre-eclampsia. The trial enrolled a total of 75,532 pregnant women.

The CRADLE VSA saves lives by foreseeing the early diagnosis of pre-eclampsia. For many women, these health risks may have otherwise gone unnoticed. This innovation is contributing to the prevention of maternal deaths. This could help the world meet the United Nations Sustainable Development Goal 3, “to reduce the global maternal mortality ratio to less than 70,000 per 100,000 live births by 2030.”

– Sareen Mekhitarian
Photo: Upsplash

Maternal Mortality Rate in MalawiThe maternal mortality rate in Malawi is one of the highest in the world. The country ranks at number 13 for the highest number of maternal deaths during pregnancy or after birth.

The maternal mortality rate in Malawi has decreased over the years, but it is still an alarming issue that the country is addressing. It is estimated that per every 100,000 live births, over 600 mothers die from mostly preventable causes.

In Malawi, the circumstances of maternal mortality are complex but preventable. Like most countries in sub-Saharan Africa, the health care system in Malawi is not as developed as the rest of the world. Having better access to health care and qualified personnel will save the lives of mothers and children in developing countries.

Causes of High Maternal Mortality

There are several causes related to the high maternal mortality rate in Malawi. Poverty is one of the main contributing factors. Given that half of the country’s population lives in poverty, most women cannot afford conventional health care.

The majority of the population live in remote, rural areas, making it difficult for mothers to find access to quality maternal health care. In many cases, they cannot travel long distances on foot to the nearest available clinic. According to a 2014 study, 44 percent of women in rural areas attended at least 4 antenatal care visits whereas, in urban regions, the figure jumped to 51 percent.

In Malawi, women have historically given birth in their homes due to cultural beliefs and practices. In most cases, traditional birthing attendants were present. However, many of them were not trained to respond if something were to go wrong. This most commonly occurred in impoverished families. Today, the country recognizes the need for professionally trained personnel. In 2015-2016, 91 percent of women were recorded giving birth in a healthcare facility.

Most maternal deaths are related to diseases or complications during pregnancy or childbirth. The most common direct causes of maternal death are:

  • hemorrhages,
  • infection,
  • eclampsia,
  • obstructed labor and
  • abortion.

The indirect causes include malaria, anemia, HIV/AIDS and tuberculosis. In most cases, these diseases or complications would have been preventable if there was better access to health care.

Improving Malawi’s Maternal Mortality

Due to foreign aid, and the dedication of the Malawian government, the maternal mortality rate in Malawi is improving with every year. In 2001, out of 100,000 live births, 868 mothers died. Today, that number is significantly lowered to just over 600.

Former Malawian president, Joyce Banda made maternal health her top priority in 2014. Through her influence, the government of Malawi constructed new maternal health facilities in rural areas, created a new system to better train birthing attendants and changed cultural norms and attitudes regarding maternal health and pregnancy.

Banda also believed in the importance of educating young women about their reproductive health. A survey on Maternal and Perinatal Health has shown that women with lower levels of maternal education are at risk of high maternal mortality even if they have access to health care facilities.

Banda made lasting changes in Malawi for the women and children of today and the generations to come.

USAID Investments to Improve the Maternal Mortality Rate in Malawi

The United States financially supports Malawi by investing in maternal and child care. USAID is investing in maternal health facilities and quality care interventions in order to progress the country’s healthcare system. USAID is also supporting national family planning programs that promote maternal education and informed decision-making for the mothers of Malawi.

As the country continues to develop, the maternal mortality rate in Malawi is decreasing.

Due to more accessible facilities, better-educated mothers and the addition of trained professionals, the status of maternal health care in Malawi has made significant strides.

– Marissa Pekular
Photo: Flickr

Women’s Health care in CambodiaThe Southeast Asian nation of Cambodia is currently experiencing its worst in maternal mortality rates. In Cambodia, maternal-related complications are the leading cause of death in women ages 15 to 46. The Minister of Health has created several partnerships with organizations such as USAID to help strengthen its healthcare system. Here are five facts about women’s health care in Cambodia.

Top 5 Facts About Women’s Health Care in Cambodia

  1. Health Care Professionals and Midwives
    USAID has provided a helping hand when it comes to educating healthcare professionals and midwives. Since USAID’s partnership with the Ministry of Health, USAID has helped raise the percentage of deliveries assisted by skilled professionals from 32 percent to 71 percent. The Ministry of Health was also able to implement the Health Sector Strategic Plan to improve reproductive and women’s maternal health in Cambodia.
  2. Health Care Facilities
    Between 2009 and 2015, the number of Comprehensive Emergency Obstetric and Newborn Care (CEmONC) facilities increased from 25 to 37. With more access and an increase in healthcare facilities, 80 percent of Cambodian women are giving birth in health care facilities.
  3. Postpartum Care
    The Royal Government of Cambodia renewed the Emergency Obstetric & Newborn Care (EmONC) Improvement Plan and extended the Fast Track Initiative Roadmap for Reducing Maternal and Newborn Mortality to 2020. This aims to improve women’s health care in Cambodia to improve the lives of women living with postpartum depression. It is also used to improve newborn care and deliveries.
  4. Obstetric Care
    Obstetric care has improved rapidly. According to a 2014 Cambodia Demographic and Health Survey, 90 percent of mothers receive obstetric care two days after giving birth, and three-quarters of women receive care three hours after. Intensive obstetric care has helped drop Cambodia’s maternal mortality rate significantly. In 2014, Cambodia’s maternal mortality rates decreased from 472 deaths per 100,000 live births in 2005 to 170 deaths per 100,000 live births.
  5. U.N. Women
    U.N. Women is working closely to help address the AIDS epidemic in Cambodia. The organization’s efforts to reduce the epidemic focus on protection and prevention. In 2003, 3 percent of Cambodian women reported being tested for AIDS. It has also been observed women in urban areas are more likely to get tested than those in rural areas. Ultimately, Cambodia has set a goal to eradicate AIDS from the country by 2020 through prevention and protection.

Cambodia has seen much economic growth over the years, but the money provided for health care is minimal. Consequently, it is difficult for the government to provide all services. However, there have been great strides in improving women’s healthcare in Cambodia. By fighting to better the lives of women, the Cambodian government has set a goal to establish universal health care by 2030.

Andrew Valdovinos
Photo: Flickr

Antenatal Care in NigeriaMany developing countries have reduced their maternal mortality rates by expanding maternal care through policy innovations. Between 1990 and 2015, maternal mortality has dropped by 44 percent. While this is a considerable amount, maternal mortality remains high in developing countries. For example, in Nigeria, only 61 percent of pregnant women visit a skilled antenatal care provider at least once during their pregnancy. The average rate for similar lower-to middle-income countries is 79 percent.

Maternal health concerns the health of women during pregnancy, childbirth and the postpartum period. During this time, major causes of maternal mortality include hemorrhaging, infection, high blood pressure and obstructed labor.

Every day, 830 women die from preventable causes related to pregnancy and birth. In fact, 99 percent of maternal deaths occur in developing countries. It is necessary for policy innovation in developing countries because sustained use of maternal and antenatal care and increased rates of institutionalized delivery reduce maternal mortality.

Antenatal Care in Nigeria

Of the women who did access and antenatal care, 41 percent did not deliver in a health care facility. Nigeria ranks in the top 16 nations in maternal mortality: 576 deaths per 100,000 births. Containing only 2.45 percent of the world’s population, Nigeria contributes to 19 percent of maternal deaths globally.

There is a stark difference in the number of women who seek antenatal care in urban and rural areas: 75 percent versus 38 percent, respectively. Studies also show that more skilled professionals attended births in urban areas, revealing that 67 percent of women had a trained professional helping them. In rural areas, only 23 percent of women had the help of trained professionals. In these rural areas, only 8 percent of newborns receive postnatal care, whereas 25 percent of children do so in urban environment.

Due to the lack of health coverage and used resources, many of Nigeria’s infants die from preventable causes. Approximately:

  • 31 percent die from prematurity,
  • 30.9 percent die from birth asphyxia and trauma and
  • 16.2 percent die from sepsis.

Ways to Increase Access to Antenatal Care in Nigeria

Improving maternal and antenatal care in Nigeria can encourage women to utilize services such as improved facility infrastructure and amenities. Policy innovation in Nigeria can result in better equipment, more available drugs and an increase in overall comfort for the spaces.

In a study of antenatal patients in Nigeria, women responded positively to increased interpersonal interactions with providers. The study also suggested that improved maternal care should include access to providers who have technical performance skills and experience. Improved maternal care also includes access to providers who display empathy for their patients. Furthermore, policy innovation in Nigeria could improve increased access to facilities for those in rural areas.

Accessed to maternal and antenatal care in Nigeria can be improved with policy innovations made throughout the country. By making health facilities more accessible to more women and giving them the supplies and support they need, Nigeria will be able to decrease its maternal mortality rate and save its families from preventable complications of during pregnancy and infancy.

Michela Rahaim
Photo: Flickr

How Poverty Affects PregnancyWomen living in poor rural communities have a higher risk of maternal mortality. An astounding 99 percent of maternal deaths take place in developing countries. More than half of these victims lived in sub-Saharan Africa and one-third lived in South Asia.

The number one cause of death for adolescent females in developing countries is complication in reproduction. The risk of death is higher in girls of the age 15 years and younger. Their country’s health systems often fail to provide adequate health services to survive pregnancy and childbirth.

An estimated 75 percent of maternal deaths are caused by:

  • High blood pressure: during pregnancy preeclampsia should be detected and can be remedied with magnesium sulfate.
  • Infections: when recognized in a timely manner, they can be treated, and good hygiene following childbirth can prevent it.
  • Excessive bleeding after childbirth can kill a healthy woman in a matter of hours. To reduce this risk, oxytocin is injected immediately after birth.
  • Diseases such as malaria and AIDS (during pregnancy) account for all other maternal deaths.

Poor Health Systems

In developed countries, it is typical for women to have at least four prenatal care visits. Postpartum care is also recommended and received by high-income countries. Unfortunately for millions of poor mothers, there is no access to skilled providers to help them.

The lack of access to health workers can be due to lack of information or an issue of distance. At times, cultural practices prevent women from getting the care they need, and most often the nearest health facility is in another community.

The World Health Organization is contributing to the Global Strategy to improve health for women and children. Their goal is to ensure access to a better health system with effective treatments, trained health workers, and health coverage programs. Without access to quality health care during these critical times of development, this is another way in how poverty affects pregnancy.

Food Insecurity Impacts Female Health

Food insecurity is another way in which poverty affects pregnancy. Creating a new life requires a lot of energy from a woman’s body. This is why women facing food insecurity are at risk of health problems. A poor diet can cause:

  • gestational diabetes
  • iron deficiency (the mother becomes anemic)
  • low birth weight.

If women do not intake the appropriate amount of nutrients, the baby will take the vitamins and minerals from their mother’s body. This weakens a woman’s immune system which is needed to fight off disease and infection.

The Importance of Nutrition for Child Development

A healthy diet when creating a new life is consuming 1,800 calories a day in the first trimester, 2,200 in the second trimester and 2,400 in the third trimester. Essential nutrients include:

  • calcium for healthy growth
  • iron for a baby’s blood supply and
  • folic acid, which reduces the risk of spina bifida and anencephaly (a brain defect).

Without proper nourishment, a child will suffer from chronic malnutrition. This leads to impaired brain development, a weakened immune system and shorter stature. This could mean that some children will be unable to complete schooling. This is yet another factor in how poverty affects pregnancy.

The USAID study shows that girls with stunted growth have their firstborn at approximately four years younger than non-stunted girls. Additionally, these girls who are not fully developed to give birth to a child contribute to the maternal death rate.

It does not stop there. UNICEF estimates the under-performance of these victims will cost their generation’s global economy $125 billion. The five countries where nearly half the population of children under age five are chronically malnourished include Madagascar, Papua New Guinea, Eritrea, Burundi and Timor-Leste.

Overall, without access to a proper health system or proper nutrition, studies indicate the negative ways in how poverty can affect pregnancy. The health of a pregnant woman is vital for childbirth. Prenatal malnutrition stunts the development of children’s bodies and minds. Children can find themselves with learning challenges. This sets generations back from reaching their full potential to advance their communities, fueling the cycle of poverty.

-Crystal Tabares
Photo: Flickr

maternal mortality mozambique

Maternal health in Mozambique is a constant concern as the nation’s maternal mortality rate is one of the highest in the world. While some progress has been made, there is still much that needs to be done to ensure that mothers in Mozambique have to access high-quality healthcare. Recently, two initiatives have been created, the Mozambique-Canada Maternal Health Project and a project by the Maternal and Child Survival Program. They are working to improve maternal health in Mozambique.

The Current State of Maternal Health

In 2015, the maternal mortality rate was 489 deaths per 100,000 live births. Approximately one-fifth of these deaths are women under the age of 20. Maternal mortality has declined since 1990 when there were approximately 1390 deaths per 100,000 live births; however, maternal deaths remain high. It is clear that continued efforts are needed to improve the quality of maternal health in Mozambique. Each day, approximately 800 pregnant women die from preventable causes.

One of the primary factors determining maternal mortality rates is the availability of antenatal care. In regions where more women receive four or more antenatal visits, the maternal mortality rate is generally lower. Globally, 62 percent of pregnant women have at least four antenatal visits with a skilled health professional, while 86 percent of women have at least one. In Mozambique, only 51 percent of expectant mothers have at least four antenatal visits.

Additionally, only 54 percent of births are attended by skilled health personnel. Age is also a factor, with 40 percent of women 20-24 years old reporting that they gave birth before the age of 18. Younger mothers have an increased risk of death during childbirth, particularly if there is not someone with medical training present.

Early marriage logically leads to childbirth at a younger age and improving maternal mortality rates in the nation relies on protecting young women. In response to this, the government of Mozambique created the National Strategy to Prevent and Combat Early Marriage in 2016. This program includes better education about sexual and reproductive rights with the goal of empowering women to seek out appropriate care and understand their legal rights. For poorer women, this knowledge is often not enough, however, as they may not have the autonomy to make a legal case or have a healthcare facility readily available to them.

Maternal and Child Survival Program (MCSP)

The Maternal and Child Survival Program (MCSP) has launched a project in Mozambique’s Zambézia Province focused on treating pregnant women with malaria. Malaria currently accounts for 9.6 percent of deaths in the nation, and the rate in the Zambézia Province higher than the average. This project seeks to improve maternal health in Mozambique by tackling maternal and newborn deaths due to malaria.

Malaria during pregnancy has many consequences, including higher rates of maternal anemia and low birthweight babies. These factors increase the likelihood of maternal death as well as stillbirth. A treatment known as IPTs-SP exists that can prevent malaria in expectant mothers, but fewer than 22 percent of women in Mozambique receive adequate dosages during their pregnancy.

The MCSP project is empowering healthcare providers in Mozambique to treat malaria cases in pregnant women regardless of their complexity. For example, a young pregnant woman who had malaria but was also HIV-positive could not receive IPTp-SP treatments because the drug is incompatible with her HIV treatment. However, a different medication was able to be prescribed by an MCSP-trained nurse who had been trained on how to handle a variety of malaria cases.

The project also implemented a Standards-Based Management and Recognition for Malaria program in 58 health facilities in the Zambézia Province. This program is working to collect better data about malaria cases and more effectively implement initiatives for prevention and treatment.

Mozambique-Canada Maternal Health Project

Improving maternal health in Mozambique is a priority for the University of Saskatchewan as well. Researchers from the university are working with Mozambique’s health ministry and the NGO Women and Law in Southern Africa (WLSA) to empower women in 20 different communities through the Mozambique-Canada Maternal Health Project.

Education is a key piece to this project, providing information on maternal, reproductive and sexual health to community members in a way that is participatory and engaging for adolescents and adults. The project is also prioritizing the education of health practitioners to improve the quality of care for mothers in Mozambique.

Additionally, the project seeks to improve resources in the community that can improve maternal and newborn health. They intend to provide local ambulances, establish maternal waiting homes nearby to clinics and support local midwives. The latter is the most important, as having locals who are trained health personnel can greatly benefit rural women who may not have the time or financial resources (particularly in situations of poverty) to travel to a clinic.

These efforts indicate that maternal health in Mozambique is continuing to be a priority. The work that these organizations are doing is focused on empowering women to make their own decisions about their sexual and reproductive lives, ensuring health personnel are properly trained and accessible and meeting the needs of poorer women.

Sara Olk

Photo: Flickr

maternal mortality rates tajThe Republic of Tajikistan is a country located in Central Asia. In 1991, when Tajikistan became independent it was the most poverty-stricken country of the Central Asia republics. A civil war hurt Tajikistan’s economic and social growth, which led to a decline in overall health in the region. One of these health issues is that Tajikistan has had a very high maternal mortality rate. However, in the last decade progress has been made and maternal mortality rates for women in Tajikistan are dropping.

Tajikistan currently has a rate of 32 maternal deaths for every 100,000 live births. This number has significantly decreased since 1990 when the rate was 107. There are multiple factors that are responsible for the decline in maternal mortality rates. One of the dangers had been the fact that many women have their babies at home. In fact, at least 15 percent of women still give birth without a doctor or midwife present.

Hospitals and Healthcare Facilities

A project by the name of Feed the Future Tajikistan Health and Nutrition Activity (THNA) is spreading information about the dangers of giving birth at home. They also teach women in the country about the benefits of delivering in a hospital or other health care setting. Funded by USAID, THNA is working alongside hospitals and healthcare centers in different locations throughout the country to talk about the three main factors that lead to increased chances of maternal mortality, also known as the three delays:

  1. Seeking maternity care
  2. Reaching a healthcare facility
  3. Receiving high-quality care once at a healthcare facility

In 2016, THNA partnered with the Ministry of Health and Social Protection of the Population to further understand the problem. The duo conducted 14 in-depth assessments of hospitals in the region. They found out that many healthcare facilities did not have proper medical supplies, lacked adequate equipment and were understaffed. The duo worked together and provided the healthcare centers with new equipment and supplies.

The partnership also taught more than 1,400 people in the community to be health educators. The health educators, in turn, taught women about prenatal care and when they should go to a hospital. These changes are a major reason why maternal mortality rates in Tajikistan are declining.

Midwifery Services

Families in Tajikistan who cannot afford healthcare facilities often turn to alternatives such as midwifery. It is challenging to find a good midwifery service in the country. However, the United Nations Population Fund (UNFPA) is working with the Ministry of Health to increase the quality of midwives in the region. They supply midwives with education, capacity building and medical equipment. Furthermore, the UNFPA trains midwives on effective perinatal care.

UNFPA also provides technical help in improving training curriculums at schools throughout the country. Nargis Rakhimova, the UNFPA National Program Analyst on Reproductive Health in Tajikistan said, “This initiative is considered a breakthrough as it raises educational programmes to the level of internationally agreed standards.” Improved midwifery services are another factor why maternal mortality rates for women in Tajikistan are dropping.

Even though it is easy to recruit young women into midwife training programmes, it is not easy to keep them in the profession. Midwives do not make a lot of money and there is no official certification for midwifery, which may lower the standards of services in the region. Rakhimova said, “Though the midwifery situation in Tajikistan is improving, midwifery needs to be developed as a separate profession complementary to medicine.” Improving compensation for midwives will help continue to lower maternal mortality rates in Tajikistan.

Continuing to Improve

The poverty Tajikistan faced when it gained its independence led to a number of health crises in the region. Maternal mortality rates are one of these issues. Even though the country still faces problems with maternal mortality, the conditions are improving. The combination of advancements in healthcare facilities and midwifery services are a big reason for the improvements. These are the two main contributors as to why maternal mortality rates for women in Tajikistan are dropping.

Nicolas Bartlett
Photo: Flickr

antenatal care in IndiaIndia is home to one-fifth of all births but has no monitoring systems for basic maternal health and nutrition. A research brief published by the rice institute finds that India has far worse maternal nutrition rates than sub-Saharan Africa – a region much poorer with higher fertility rates. With improper antenatal care being linked with long term effects on the height, weight, cognition and productivity of a child, global attention has been brought to the antenatal care inequalities found in India.

Antenatal Care in India Today

Access to antenatal care in India depends strongly upon the geographic location and socioeconomic status of expectant mothers. Between 50 and 74 percent of expectant mothers in India receive prenatal care services – with a large gap in the distribution of these services.

According to a study done in 2011, 357,777 women in Delhi received at least three antenatal care check-ups, more than the entire state of Uttarakhand which had 153,202 women receive the same level of care.

Further studies showed that  “some states, such as Kerala and Goa, more than 93 percent of women used ANC [Antenatal Care] four times or more, while in Bihar and Nagaland, this figure was less than 17percent,” highlighting the substantial inequalities of access to antenatal care in India.

Current Government Initiatives

Currently, several government programs are in place to increase access to antenatal care services throughout India but have not shown largely promising results. India’s largest program for improving neonatal health, Janani Suraksha Yojana (JSY), uses cash incentives to encourage birthing in hospitals.

However, a study done in 2014 found that the cash transferred to new mothers is much less than advertised, due to how much of it goes towards paying for delivery services – which are meant to be free. In addition, this program only encourages women to give birth in hospitals, rather than address pressing maternal health problems in India – such as maternal nutrition and low birthweight.

Meanwhile, the Pradhan Mantri Matru Vandana Yojana (PMMVY) government program dispenses 5,000 rupees for expecting and lactating mothers. However, this is only available to first-time mothers.

The Integrated Child Development Services (ICDS) is intended to give food to expectant mothers and their children but is poorly implemented – with less than 30 percent of women having received food the ICDS program during their last pregnancy.

Looking Ahead

In order to improve access to antenatal care in India, studies suggest “policy and programme managers should shift from improving the ‘average figures’ to the ‘distribution’ of programme/health care indicators across the sub-groups of populations which need them most.”

The rice institute also notes that rather than rely on outdated surveys for indicators of maternal health, the government finally establish a national monitoring system allowing policymakers to view changes in maternal health over time.

With proper government oversight, the future of antenatal care in India looks promising, as suggested by a study published in The Lancet found that mortality rates for neonates declined by 3.3 percent annually between 2000 and 2015 due to government intervention.

– Shreya Gaddipati
Photo: Unsplash

Healthcare system in Angola

The Republic of Angola is a large country in Central Africa with a continuously growing population of 31 million people. Angola is on the west coast of Sub-Saharan Africa and is one of the continent’s largest countries with 1.2 million square kilometers. As a comparison, it is a little less than twice the size of the state of Texas. With the current growth, Angola‘s population will triple in less than 50 years. This could pose a problem for the healthcare system in Angola as overpopulation is already becoming an issue.

Overpopulation

Angola has one of the world’s highest fertility rates as the average woman will have more than five children in her lifetime. However, the country also has the highest child mortality rate in the world with 187 per 1,000 live births. For those who do survive infancy, one in five children will die before reaching their fifth birthday. Angola ranks 23rd in the world due to its high maternal mortality rates with 477 deaths per 100,000 births.

But how exactly does the mortality rate result in overpopulation? It is all about the odds. Since one in five children on average die before they reach the age of five, families are more inclined to have more children so they have a higher chance to have at least one child reaching adulthood. A number of causes are responsible for the deaths in Angola. Among them are malaria, acute respiratory and diarrhoeal diseases, tetanus, malnutrition and more. More than just because of these initial causes, the mortality rate is so high due to the inadequate health system still being rebuilt.

A weak healthcare system

The healthcare system in Angola is split into two parts: private and public. A majority of the hospitals and clinics are close to the capital, Luanda, and very few are located in other parts of the country. Although treatment at the public level is free, the majority of the population is still limited when it comes to medical care. Due to the understaffed, underfunded and underprepared personnel, often times locals and visitors alike choose to receive treatment at the private level instead. While private clinics are considered to be better than public clinics, there is still much to improve. Pharmacies are mostly in the capital and are often extremely understocked. Hospitals will sometimes lack the necessary equipment or funds for important procedures. Angola also faces a significant shortage of physicians, with only 2,000 in the entire country.

By improving the healthcare system in Angola, the mortality rate would decrease enough to stabilize the fertility rates. Vaccines can heavily improve the current health of Angola’s population and prevent diseases from spreading. Currently, 929 health facilities out of 2409 perform routine vaccination activities. With access to sustainable clinics that provide vaccines throughout the country, the healthcare system in Angola would start to improve the lives of the citizens and lower the mortality rates.

Through strategic planning and patience, the healthcare system in Angola will be able to stabilize the current health status of its residents and help slow the overpopulation process in the country.

– Madeline Oden
Photo: Wikimedia Commons