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

midwifery
During the 14-year civil war in Liberia, the health system became increasingly fragile, and a lack of roads and transportation made it difficult for pregnant women to receive necessary emergency care. This issue has created a strong need for strengthened midwifery in Liberia.

As a result, Liberia had one of the highest maternal mortality rates in the world according to a 2015 USAID article, but the country is now trying to change that through investment in midwifery programs.

Currently, 44 percent of Liberian women give birth without a skilled attendant, and nearly one out of 138 mothers die from preventable causes during childbirth. Such issues could be avoided with basic or strengthened midwifery in Liberia, according to the World Health Organization.

Bentoe Tehounge, a trained midwife in Liberia, told WHO, “We need midwives who can ensure a safe pregnancy even before a woman is pregnant. People who can provide advice on family planning, nutrition, physical activity and preventing mother-to-child transmission of HIV.”

There are six midwifery schools in the Liberia, half of which are in rural areas, and less than 200 midwives for over four million people. Most of these midwives work in urban areas. Strengthening these schools, especially the rural ones, will improve access to quality care for women around the country.

Retaining these midwives is one step towards Liberia’s investment in the profession. According to WHO, many health professionals were driven out of the country due to the civil war and the Ebola crisis, and now midwives lack “safe accommodation and transport, are overworked and paid poorly and have limited opportunities for career advancement.”

A new B.S. program addresses a portion of these concerns by providing further professional development. The program graduates 50 to 75 registered midwives per class, which is expected to staff more than 700 health facilities in the country. To develop better teaching methods, Liberia is working with the Danish Midwives Association to pair Liberian and Danish midwives in order to learn more advanced skills, like preventing and treating hemorrhages. It is hoped that this new alliance will result in strengthened midwifery in Liberia.

In the United States, this final element is comparable to the apprenticeships or clinicals that midwives do to obtain a license. Mary Anne Brown, a midwife serving the Great Falls and Helena areas of Montana, said that degree programs require that their students find and work directly with a midwife to gain clinical experience.

Past midwife training in Liberia tried to work within a culture of home birth in Liberia (USAID reported that 63 percent of Liberian women gave birth outside of a health facility) and with the knowledge of traditional midwives.

The goal was to shift the focus to encouraging birth preparedness, recognizing and referring complications and providing appropriate emergency care through what USAID called “home-based life-saving skills.” By utilizing storytelling, case histories, discussion, role-play and demonstrations, midwives, expectant parents and community leaders were able to educate themselves at community meetings.

One of the greatest achievements of the previous midwife training in Liberia was its ability to connect traditional midwives to both health facilities and certified midwives. Certified midwives perform their own visits to discuss problems the traditional midwives are having, replenish supplies and reinforce the training.

The current programs are a part of WHO’s efforts to provide clear guidelines, tools and an evidence base to lead to strengthened midwifery in Liberia and around the world in order to improve care for pregnant women and reduce both maternal and neonatal mortality rates.

Anastazia Vanisko

Photo: Public Domain Images

Midwives_in_Chiapas Maternal mortality rates in Mexico have steadily decreased over the past fifteen years. The global maternal mortality rate has decreased by nearly 50 percent between 1990 and 2013. However, the work is far from over.

Ninety-nine percent of maternal deaths happen in underdeveloped countries according to the World Health Organization. Chiapas is the poorest state in Mexico with a poverty level at over 76 percent.

Maternal mortality rates can be significantly lowered with skilled care and supervision throughout the childbirth and traditional birth attendants are being trained to offer this care through workshops and programs in Chiapas.

Traditional midwives are extremely important in communities within Chiapas because of the negative connotation that comes with hospitals and the hesitation that women have toward giving birth in hospitals. Fifty-five or more out of every 100,000 women die in Chiapas during childbirth.

The traditional midwives are receiving training for problems that arise during obstetric emergencies. Understanding the protocol will allow them to act quickly in situations that may cost the mother’s life.

https://www.youtube.com/watch?v=jCuE8Y0d8sk

One such organization is the Global Pediatric Alliance. The alliance has started a training program for midwives in Chiapas. They have programs in four different municipalities in Chiapas. Los Altos de Chiapas is the first community and 88 percent of the population is poor. Fifty-six percent of the population lives in extreme poverty.

The plan is to train at least 120 Tzeltal and Tzotzil-speaking midwives between 2014 and 2017. An estimated 100,000 people will be impacted by the project. The second municipality is Las Margaritas, a highly marginalized area with extremely low Human Development Index rankings.

The isolated communities in the area particularly suffer from the lack of care adequate obstetric care. The program with GPA has already held five trainings for 29 traditional birth attendants in the area.

The training of midwives is changing the maternal mortality rates and the risks of home births in Chiapas.

Iona Brannon

Sources: Arizona State University, Global Pediatric Alliance, New York Times, Reuters, World Health Organization 1, World Health Organization 2
Photo: nyt

maternal_mortality
The earthquakes that shook Nepal in late April and early May were declared the country’s worst natural disaster on record. The quakes claimed the lives of 8,800 people and injured 22,000 others. The mass destruction and death toll continue to have devastating effects on all aspects of the country’s well-being. The Nepalese people are trying to rebuild and reclaim the sense of normalcy that existed before the quakes, but the earthquakes’ effects have presented new challenges.

Before the storm, increasing amounts of Nepalese women were choosing to have their babies in health facilities — a choice that helped Nepal meet the United Nations Millennium Development Goal in the reduction of maternal mortality rates by three-quarters. Another major factor in the massive reduction of such rates is a decade-old decision to distribute misoprostol to women who need it. Misoprostol is a drug designed to treat stomach ulcers, but is also capable of terminating a pregnancy when taken early on, and preventing postpartum hemorrhage — the leading cause of maternal death — when taken after giving birth.

The decision to distribute the powerful drug as a means to decrease maternal mortality lacked international support largely because the hegemonic ideology is that the best way to improve maternal mortality rates is to invest in making health facilities more accessible. While the idea of creating hundreds of well-stocked and adequately staffed health centers that are available to all mothers is a good one and would certainly reduce maternal mortality rates, overall it is unrealistic for many developing countries. The reality is that in developing countries where there have been large government expenditures on improving facilities, maternal mortality rates have not improved as significantly as they have in Nepal.

Since the massive earthquake struck, expectant mothers face additional challenges and there is concern that the mortality rates could increase again. With the destruction of roads and many healthcare facilities, giving expectant mothers misoprostol makes even more sense.

Currently, distributing the misoprostol amidst the widespread destruction is a major issue in Nepal. Aid groups, such as Direct Relief, have been working with the International Confederation of Midwives (ICM) and the Midwifery Society of Nepal (MIDSON), to deliver midwife kits, tents and funds. The intervention program focuses on providing midwives and the tools that they require, including misoprostol, to give Nepalese mothers the best chance at having a healthy delivery.

When access to midwives and trained professionals is as severely limited as it is in Nepal, there needs to be a backup plan. Few countries have followed in Nepal’s footsteps but if Nepal’s success has been any indication, misoprostol could be an intermittent solution that could work for many developing countries. In time, we will see how Nepalese maternal mortality rates fare in the aftermath of the horrific disaster. If the low rates are upheld, perhaps the international community will reconsider responsible use of misoprostol to get countries maternal mortality rates down, until the large scale investments in facilities and infrastructure can be made.

– Emma Dowd

Sources: Economist, Foreign Policy, Military Technologies, Reuters
Photo: Women News Network

Maternal_Mortality
In 2000, the U.N. agreed on eight Millennium Development Goals that it hoped to reach by 2015. Included among these goals: promoting gender equality and empowering women, reducing child mortality and improving maternal health. For the Philippines, improving maternal health is an extremely important goal since the maternal mortality rate of the Philippines was high—209 deaths per 100,000 live births as of 1993. The target for the Philippines is the reduction of the MMR to 52 deaths per 100,000 live births by 2015. However, while maternal mortality has been decreasing in the Philippines, it has not been falling at a fast enough rate.

Maternal deaths are still a huge concern for the Philippines. By 2006, the maternal mortality rate decreased to a rate of 162 per 100,000 live births and currently, the MMR is 120 deaths per 100,000 live births—still nowhere near the target that the MDGs established.

Various factors are responsible for the high rate of maternal mortality that the Philippines face. According to the IRIN, some of the main causes of maternal deaths are hemorrhages, sepsis, obstructed labor, hypertensive disorders during pregnancy and complications associated with unsafe abortions. Having a physician, nurse or midwife who has had formal training present during the birth can decrease the maternal mortality rate, but currently, these skilled birthing attendants supervise only 60 percent of births in the Philippines. Others rely on traditional birthing attendants who do not have formal training and therefore are often unable to deal with complications.

Poor women and women in rural areas are at a disadvantage. Around 75 percent of the poorest quintile do not have a skilled birth attendant to help them through their pregnancy. Rural areas also have higher maternal mortality rates because many women in rural areas begin having children at a young age. Since adolescent women are normally not developed enough for childbirth, these young mothers face many complications during and after pregnancy and contribute to the high maternal mortality rate.

Another problem that adds to the high maternal mortality rate in the Philippines is the low level of contraceptive use. The Philippines is 80 percent Catholic, so birth control pills, condoms and other forms are contraceptive use are considered to be similar to abortion. This has led to limited access to contraceptives, since contraceptives were previously not widely available at health care clinics.

This limited access to contraceptives has negative effects. In 2006, there were three million pregnancies in the Philippines. Half of those pregnancies were unplanned, and one third of the unplanned pregnancies resulted in abortions. A higher rate of contraceptive use will prevent this from happening and will consequently decrease the maternal mortality rate.

While rates of contraceptive use have not risen much from 2006 to 2014, there is hope that contraceptive use will now increase dramatically due to a birth control law that the Philippine Supreme court approved in April 2014. The law requires the government’s health centers to have free condoms and contraceptive pills. It may be too soon to tell whether that law has a significant effect on maternal mortality. However, the law will hopefully help the Philippines to reach its MDG by the end of 2015. Other ways to help reduce maternal mortality are providing more antenatal care and more widespread access to health facilities.

– Ashrita Rau

Sources: UNDP, IRIN News, Philstar, WHO, Huffington Post, United Nations, BBC
Photo: Flickr

merck for mothers
Merck for Mothers is a 10-year, $500 million initiative that envisions, and works toward, a world where no woman dies giving life. Currently, an estimated 800 women die per day, primarily in developing nations. Merck’s global mission is to bring better healthcare and innovative health solutions to millions of people across the developing world; a commitment that has been in standing for more than 150 years. Working closely with its program leadership, advisory board, healthcare workers, maternal health experts and policy makers, the Merck for Mothers initiative has already served in more than 30 countries across the world.

As stated on its website, “Women are the cornerstone of a healthy and prosperous world. When a mother survives pregnancy and childbirth, her family, community, and nation thrive.”

Merck for Mothers aims to see nations thrive by saving as many lives as possible, and it does this by tackling the two leading causes of maternal mortality: excessive bleeding after labor and high blood pressure disorders during pregnancy and childbirth.

For example, in Uganda, where a woman faces a one in 49 chance of dying during pregnancy and childbirth, many of the private healthcare providers, such as independent midwives and local pharmacies, offer services that are not always regulated and can vary in quality. As a result, Merck for Mothers explores the ability of these local private providers and health businesses to deliver affordable and high-quality maternal healthcare. This is a program that has estimated to reach more than 150 thousand pregnant women over the span of three years.

Each of the 30 country programs is different and tailored to that country, yet they all strive for the same goal: giving mothers a better chance at surviving pregnancy and childbirth. In addition, Merck for Mothers focuses on family planning, which is known to play a key role in reducing maternal mortality. Merck for Mothers explains this through the Ripple Effect. When a mother dies, the ripple effect begins with her child who is more likely to die before the age of two. If she has other children, they are also up to 10 times more likely to leave school and suffer from poor health. But a mother’s death affects more than just her family.

Merck for Mothers believes that a woman’s death also impairs her community. Representing as much as one-third of the world’s gross national product, a woman’s unpaid work contributes to a community’s economic prosperity. In the end, this becomes a global economic issue. For these reasons, Merck for Mothers focuses on three key areas: innovation, access and advocacy.

At Merck, corporate responsibility is the cornerstone of its daily commitment to tackle global health challenges, such as river blindness, HIV/AIDS and cervical cancer. It has been a 150-year commitment, but that has not stopped Merck from making new additions.

With Merck for Mothers, it can now expand its scope and save the lives of millions of mothers across the globe, so that every day 800 more lives of women are spared.

– Chelsee Yee

Sources: Merck for Mothers, Poughkeepsie Journal, Mobi Health News
Photo: Modern Mom

physicians for peace
“If you don’t have your health, you don’t have anything,” the old saying goes. Nowhere is this truer than countries where coughs and colds are lethal. People in the developing world experience 90 percent of the world’s disease but have access to only 10 percent of its healthcare. Medical professionals are forced to rely on the sometimes inadequate knowledge they have been armed with.

Physicians for Peace steps in only at the request of an institution in a developing country. After determining whether or not they can fill the need described, Physicians for Peace sends in a team to start their work.

A team is comprised of four healthcare specialists called International Medical Educators. The specialists discuss and develop the training curriculum to be taught on their 5-10 day stay. By keeping smaller numbers, members can cooperate effectively, and host communities are better able to provide for the volunteers.

As listed on their website, teams work in five main areas of healthcare: Burn care, maternal and child health, surgical care, vision care and prosthetic and orthotic care. The cornerstone of their efforts, though, is not the care itself. It is the training.

Healthcare professionals in developing nations are saving lives, but gaps in knowledge are responsible for harming many. Burn victims, for example, are often treated fro their wounds and sent home. With no one to mind the psychological effects of the experience, they are left to deal with the trauma alone. To get newborns to breathe, midwives in Nigeria will shake the child or turn him or her upside down. The effects can be severely damaging, even fatal.

The organization maintains that a little training will go a very long way. They are responsible for a lot of training. In 2013, more than 3,500 professionals attended Physicians for Peace lectures. Additionally, over 1,000 professionals received hands on training.

Though the Physicians for Peace headquarters is located in Virginia, it is truly an international effort. The organization has offices in both the Philippines and the Dominican Republic. Teams have worked in over 60 countries across Europe, the Middle East, Asia, Africa and Central America.

Programs are funded entirely by donations, so transparency is maintained in all business transactions. Over 91 percent of money received goes directly to field programs. Financial reports are published and posted annually.

The educational approach taken by Physicians for Peace to the healthcare shortage is necessary and brilliant. By helping one doctor, one nurse or one midwife, they are helping a great number of patients.

-Olivia Kostreva

Sources: Physicians for Peace 1, Physicians for Peace 2, Physicians for Peace 3, Charity Navigator, Youtube

WinSenga_Sengahorn_Microsoft_Neonatal_Health
At Makerere University in Uganda, three students designed WinSenga, a mobile phone software that can monitor fetal heartbeats and movements. The Microsoft East and Southern Africa Imagine cup of 2012 was awarded to Josiah Kavuma, Aaron Tushabe and Joshua Okello for their invention.

WinSenga runs on Windows-operated smartphones, and is attached to a Sengahorn, a horn midwives have used to listen to fetuses for decades. The horn is fitted with a miniature microphone that sends the sounds to the software. The software then analyzes the retrieved sounds and produces an English read-out that inexperienced birth attendants and midwives can read and apply to monitor the baby’s position, breathing pattern and heartbeats more effectively. The Pinard horn, which is currently used in many developing countries is a very primitive device, and often doesn’t provide very reliable signals.

Depending on the smart phone price, WinSenga will be 80 percent cheaper than an ultrasound scan machine, making it widely available to poorer facilities. Even if ultrasounds were available in some hospitals, few mothers could afford the $10 fee to obtain the scan. “We thought of something we can do to change the world through the mothers,” said Kavuma, adding that the team wanted to help achieve the Millennium Development Goal of reducing maternal mortality by 2015.

The WinSenga software will hopefully bring a promising future in childbirth to developing countries. According to the United Nations, a woman dies from complication in childbirth every minute. The device is cheaper, more portable and easily accessible to hospitals and midwives all over the world. It also represents a new age in technology, one during which phone applications will have prominent effects on society and induce greater change. “The use of mobile technology is a relative new intervention to improving health services,” said Dr. Davis Musinguzi, medic and UNICEF advisor. WinSenga and other devices and apps, he says, will have something to prove to healthcare and medical professionals by “reducing the burden of doing what they have always done.”

– Sonia Aviv

Sources: BBC News, Africa Health IT News, Discovery News
Photo: FotoVisura