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The Current State of Global Maternal Health

Global Maternal HealthAccording to a new report released by the United Nations and partners, “approximately 800 women died from preventable causes related to pregnancy and childbirth” daily in 2020. The United Nations Maternal Mortality Estimation Inter-Agency Group studied global trends in maternal mortality between 2000 and 2020. Concerningly, the data shows that maternal deaths rose in several regions over the last few years. However, several organizations are working to improve global maternal health.

The Maternal Mortality Trends Report

Titled “Trends in maternal mortality 2000 to 2020,” the report is the combined effort of several U.N. agencies.  The report covers 185 countries and territories, most of which are WHO member states. It presents comprehensive data about global and regional trends relevant to maternal health over the past two decades.

Several factors can increase the risk of maternal death. According to the WHO, some of the major ones are severe bleeding, infections, high blood pressure during pregnancy, unsafe abortions and delivery-related complications.  Most of these are avoidable through simple health care and medical attention. However, according to Dr. Natalia Kanem, executive director of the UNFPA, the world faces a shortage of 900,000 midwives. Furthermore, the WHO states that “roughly a third of women do not have even four of a recommended eight antenatal checks or receive essential postnatal care.”

The Impact of Poverty on Global Maternal Health

Poverty has a significant impact on global maternal health. Poverty-stricken regions lack the medical resources and qualified personnel to provide women with adequate care during the maternity period. According to the Pan American Health Organization, the prevalence of maternal deaths is highest in countries impacted by poverty and conflict.

Data shows that, in 2020, the maternal mortality rate in low-income countries stood at 430 per 100,00 live births. In contrast, this rate stood at 12 per 100,00 live births in countries that were financially better off. To further demonstrate the devastating impact of poverty, the report stated that despite only 13% of the global population living in the least developed countries, women in these countries accounted for 42% of maternal deaths worldwide in 2020.

Due to the impacts of poverty, 70% of global maternal deaths in 2020 occurred in sub-Saharan Africa. This means that out of 287,000 global maternal deaths, 202,000 occurred in the region. Countries such as South Sudan, Chad and Nigeria have extremely high maternal mortality rates, with Nigeria noting the most maternal deaths in 2020.

Central and Southern Asia is another region with a high maternal mortality rate. In particular, the region had 47,000 maternal deaths in 2020, which is the highest outside of sub-Saharan Africa.

The Progress

Fortunately, the world made a lot of progress toward reducing maternal deaths between 2000 and 2015, during which U.N. member states adopted the Millennium Development Goals. As a result, the global maternal mortality rate fell by 34.3% between 2000 and 2020. The number of global maternal deaths almost halved during the two decades.

Regions with some of the highest numbers of maternal deaths noted the most progress since 2000. The maternal mortality rate dropped by 33.1% in sub-Saharan Africa between 2000 and 2020. Northern Africa and Western Asia saw a drop of 46.8% while Central and Southern Asia saw a massive drop of 67.5%. Even the least developed countries reduced their maternal mortality rate by 47.4%, according to the U.N.’s report.

Current Efforts

U.N. Member States adopted the 17 Sustainable Development Goals in 2015. SDG 3 aims to “ensure healthy lives and promote well-being for all at all ages.” In particular, SDG 3.1 aims to “reduce the global maternal mortality ratio to less than 70 per 100,000 live births” by 2030. Many organizations are working to achieve this target.

The WHO runs a Maternal Health Unit that “provides leadership for improving maternal and perinatal health and well-being and ending preventable maternal mortality” through education, surveillance and advocacy.

The UNFPA, UNICEF, the WHO and the International Confederation of Midwives (ICM) created the Framework for Action to Strengthen Midwifery Education, which launched in 2019 at the 72nd World Health Assembly. It includes a comprehensive blueprint for building high-quality midwifery education systems.

The WHO developed a Midwifery Education Toolkit to provide “midwives with all the training required to care for healthy women and their newborns, prevent unnecessary interventions while ensuring lifesaving actions and enable health professionals to work effectively in a multi-disciplinary team.”

Additionally, the WHO is a partner organization in the French Muskoka Fund. Initiated in 2010 by the French government, the fund aims to improve maternal and child health in nine African countries. Besides supporting policies, the fund provides access to essential health care, medicines and professionals. The French government renewed commitments to the fund twice already since 2015 and Denmark pledged support for the fund in 2018. In 2021, the French government announced a commitment of €10 million annually until 2026 for the Muskoka Fund.

In order to achieve the target set by SDG 3.1, a global effort toward improving global maternal health is needed. Investment in health care and facilities along with education and advocacy will help reduce maternal mortality worldwide.

– Siddhant Bhatnagar
Photo: Flickr

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Targeting the Midwifery Shortage: LMIC Midwives

LMIC MidwivesAccording to the World Health Organization (WHO), utilizing well-trained midwives could be a game-changer. Globally, midwives could decrease maternal, newborn and stillborn mortality by 83%. This is why WHO advocates for a midwife or other skilled health professional at every birth globally. Midwives are health professionals trained to manage uncomplicated pregnancies and deliveries and guide the family through the immediate post-natal period. More low-to-middle-income country (LMIC) midwives are needed to reduce maternal mortality rates.

Midwifery

Midwives can deliver 87% of the maternal health service need. However, only 42% of skilled midwives work in the 73 countries with 90% of the maternal, newborn and stillborn deaths. Further, a 2020 University of Dundee study found that midwifery is less effective in low-to-middle-income countries (LMICs). Where it does exist, there is a lack of standardization in education, training and regulation. Fortunately, organizations are focusing on increasing the number of LMIC midwives, midwifery education options and midwifery regulation.

Role of the Midwife

Not only do midwives deliver babies but they also play several other key roles. As members of their communities, they are culturally sensitive. Because they have community trust, they effectively promote strong health measures. Midwives help patients with family planning and breast and cervical screenings. They advocate for female rights and the elimination of genital mutilation practices. Midwives counsel teens on sexual and reproductive health and counsel victims of gender-based violence.

The midwife-led model of care is one in which the midwife is the lead medical provider for childbirth. According to a 2020 study, the holistic midwife-led model leads to more patient satisfaction and fewer unnecessary procedures. The study, however, suggests that the model needs stronger implementation in LMICs.

As the United Nations Population Fund (UNFPA) declares, “The deficits are highest in the areas where needs are greatest.” Luckily, the UNFPA and other programs are pushing to increase the number of LMIC midwives, midwifery education and midwifery regulation.

UNFPA: Supporting LMIC Midwives

Supporting LMIC midwives and building an LMIC midwifery workforce has been the focus of UNFPA since 2008. The organization works with more than 40 global partners and more than 300 national partners. Together they work on strengthening competency-based midwifery training and bringing it to scale. The focus is developing strong regulatory processes to analyze outcomes, supporting midwives in gaining a stronger voice through the creation of midwife organizations and increasing funding for midwife services. As of the end of 2018, the UNFPA trained more than 105,000 midwives and 8,500 midwifery tutors in 650 midwifery schools. This has helped create 250 midwifery associations and branches. The UNFPA’s midwifery support extends to more than 120 countries, including 39 countries with the highest global maternal mortality rates.

Tunza Mama: Midwifery Network in Kenya

While the UNFPA works globally, there are also national programs striving to support LMIC midwives. There is a shortage of midwives in public health facilities in Kenya because the government cannot afford to pay them. The African Medical and Research Foundation (Amref) International University launched the Tunza Mama network in 2018. This provides an alternative option to access midwives and improve the socio-economic status of Kenyan midwives.

Tunza Mama midwives visit women at their homes. Clients pay directly to the Tunza Mama bank account and the midwives get 95% of the fee. Tunza Mama spreads awareness of its existence using social media, which is how 70% of mothers came to know about the program. During the COVID pandemic, Tunza Mama is using mobile and e-learning digital platforms to reduce the need for in-person sessions by 75%. Some challenges include the fact that Tunza Mama is a paid service so only the middle-class can use it. The next steps include subsidizing the system so marginalized women can also gain access.

SWEDD Midwifery Training in the Sahel

In Mali, according to 2016 demographic data, the shortage of midwives and obstetric nurses is severe. There are only 1.4 midwives per 10,000 people versus the WHO recommendation of 23 doctors, nurses or midwives per 10,000 people. Also, according to 2018 data, 36% of teenagers have begun childbearing. Pregnancy and childbirth are the leading cause of death among adolescent girls.

Mali is part of the Sahel, the semi-arid region of north-central and western Africa. The Sahel also includes Benin, Burkina Faso, Chad, Cote d’Ivoire, Mali, Mauritania and Niger. The maternal and neonatal mortality rate in this region is one of the highest rates in the world. In response, in 2016, the World Bank began working with Sahel governments with support from the UNFPA to launch the Sahel Women’s Empowerment and Demographic Dividend (SWEDD) project, which provides midwifery training. Since the launch, more than 6,600 midwives have been trained. In addition to training LMIC midwives, SWEDD’s overarching goal is to achieve the “demographic dividend” by empowering women and girls through education, family planning and more.

Together, global organizations such as the UNFPA, local networks such as Tunza Mama and regional collaborations including SWEDD are pushing to boost the number of LMIC midwives. This will significantly lower maternal and newborn mortality in areas that need it the most.

– Shelly Saltzman
Photo: Flickr

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2020: Year of the Nurse and Midwife

2020: Year of the Nurse and Midwife 
In honor of the 200th anniversary of the birth of Florence Nightingale, the World Health Organization (WHO) designated 2020 to be the International Year of the Nurse and Midwife. Nightingale was a revered nurse and leader and is a symbol of the power of nursing. The overall goal of the campaign is to elevate the role and allow for others to recognize the importance of the roles filled in the healthcare field by nurses and midwives globally.

The WHO, the International Confederation of Midwives (ICM), International Council of Nurses (ICN), Nursing Now and the United Nations Population Fund (UNFPA) began a year-long effort to celebrate the work of nurses and midwives, showcasing the difficult conditions they often face, and advocate for increased funds in the nursing and midwifery workforce called the Nightingale Challenge.

Nurses are often the first and only point of care in many developing communities. They give lifesaving immunizations and health advice while also looking after older people. Both nurses and midwives care for mothers and children after birth. Although nurses and midwives make up more than half of all healthcare workers around the world, the WHO estimates that there is a shortage of approximately nine million nurses.

The Nightingale Challenge strives to develop the next generation of young nurses, midwives, practitioners and advocates for health. The global goal is to have 20,000 nurses and midwives under the age of 35 participating and benefiting from this in 2020 with at least 1,000 organizations already joining.

The Timeline of the Campaign

June- December 2019: Enrollment

  • Employers enroll and accept the challenge
  • Join and listen to newcomer calls
  • Webinars with global leadership experts
  • Low-income employers are matched with funders

January 2020: Launch

  • National and regional launch events
  • Global Media Campaign

January – December 2020: Delivery

  • Employers and participants can exchange stories regarding their experiences through Nursing Now’s global platform.
  • Webinars with participants from around the world by inspiring nurse and midwife leaders.
  • Media campaigns throughout the year to profile global events and articles.
  • Launch of mid-year reports and campaigns on how employers are responding to the challenge.

December 2020: Conclusion

  • Celebrations to mark the end of the Nightingale Challenge and 2020 Year of the Nurse and the Midwife.

Differences Around the World

Nursing is an applied field that varies depending on where it is practiced. Educational preparation is another variance between countries. Australia educates nurses through higher education and entry-level nurses carry a bachelor’s degree. Essential to Australia is universal access to health care with the state and territory running the healthcare system. Japan is a highly modern, yet traditional society that is changing to deal with an aging population. To handle changes, Japan is responding through involvement in policy decisions and service enhancement for the elderly.

The education of nurses is a graduate position, and nursing as a science is still developing. Zimbabwe’s National Health Strategy outlines its health care system. Meanwhile, the Zimbabwe Patient Charter provides the overall framework for the health care delivery system. The system views nurses as critical to the backbone of the primary care approach. Zimbabwe Health Professions Council accredits most nursing programs. However, since access to clinical specialization at the post-baccalaureate level is nonexistent in the country, degree holders are educated in either the United States or the United Kingdom.

Nurses make a difference every day for patients. The Nightingale Challenge encourages and seeks to develop the next generation of nurses and midwives. Given the current pandemic, people now see healthcare workers in a new light and with renewed respect. With the recognition of 2020 as the International Year of the Nurse and Midwife, the Nightingale Challenge and the COVID-19 pandemic, all factors to encourage nursing, the awareness fosters growth in the nursing positions around the world.

– Anna Brewer
Photo: Flickr

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4 Facts About Maternal Health in Nepal

Maternal health in Nepal Nepal, a landlocked country bordering India and China, has a population of approximately 30 million. In 2015, close to 41 percent of births occurred at home in Nepal. Of those home births, just under half were carried out without a trained professional. Due to the alarming rate of maternal deaths seen in the early 2000s, maternal health in Nepal has been a focal point for many years. Even though complications during births at health centers still occur, the presence of trained professionals during birth remains the best way to avoid preventable deaths. Many organizations have partnered with the Nepalese government and are working hard to bring these numbers down even further every year.

4 Facts About Maternal Health in Nepal

  1. Nepal’s maternal mortality rate decreased about 71 percent between 1990 and 2015. The decline is attributed to free delivery services and transport in rural areas, access to safe delivery services and medicines that prevent hemorrhaging. In rural parts of Nepal, it has historically been much more difficult to receive proper healthcare. Through the combined efforts of various organizations and the Nepalese government, the number of facilities in remote areas has increased. Additionally, the incentive to travel to these facilities has risen. In 2005, the government began giving stipends to pay for transportation costs. Four years later, the government passed the Safe Motherhood Programme, which allowed free delivery services to pregnant women. In 2011, the government continued to promote safe pregnancies by adding another incentive of $5 for attending antenatal checkups. Through these efforts, the government has had an enormous impact on the development of maternal health in Nepal.
  2. Midwifery is one of the most important services for maternal health in Nepal. Fast intervention and postnatal suggestions from a skilled midwife allows for better postnatal care for both mother and child. In Nepal, only about 27 percent of women receive care within 24 hours of giving birth. This increases risk of hemorrhaging and heavy-lifting related injuries shortly after giving birth. It also increases risk of possible complications for the baby during and directly after birth.
  3. Midwifery education ensures that midwives are up to date on the most current practices and procedures for successful pregnancy and birthing. Institutions have partnered with the United Nations Fund for Population Activities (UNFPA) to offer combined education for nursing and midwifery. In 2011, Nepal and the UNFPA committed to training 10,000 birthing attendants. However, in a report about midwifery authored by the UNFPA, midwives do not have specific legislation for their work. Midwives are not completely recognized under the law nor are they regulated, which results in issues with proper training and resources. Therefore, greater recognition and accessibility will allow midwives the resources, training and encouragement that they need for success.
  4. Women of lower socioeconomic status have more complications surrounding maternal health. The National Medical College Teaching Hospital in Nepal published an extensive report of the challenges surrounding maternal health in Nepal. A specific challenge mentioned in this report includes the socioeconomic influencers of maternal health. Due to poor nutritional health in women of lower economic status, issues such as anemia can cause mortalities. Additionally, rural areas record about 280 birth complications per day. Although there has been significant work since then to expand access to cesarean sections and birthing centers in rural areas, there are still around 258 women dying per 100,000 live births.

As maternal health in Nepal becomes more of a focus in the healthcare system, there are certain policies and programs that must be expanded upon. Midwifery education and access to services are the most important programs for successful maternal health in Nepal. Many experts in the field continue to push for individual programs that focus primarily on methods for successful midwifery education and overall increased care for maternal health in Nepal.

– Ashleigh Litcofsky
Photo: Flickr

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Maternal Mortality Rate in Guatemala: The Indigenous Story

Maternal Mortality Rate in GuatemalaAs of 2015, the maternal mortality rate in Guatemala was 88, and three-quarters of these maternal deaths occurred in women of indigenous ancestry. The maternal mortality rate among indigenous women is thought to be more than 200. Since midwives or comadronas primarily care for pregnant indigenous women in Guatemala, investments from the World Bank and UNFPA have been focused on training midwives and connecting them with hospital services when necessary. More than six million indigenous people inhabit Guatemala and comprise a large portion–estimated at 45 to 60 percent–of the population. Further, 21.8 percent of the indigenous population live in extreme poverty compared to only 7.4 percent of the non-indigenous population.

Improving Mortality through Training

In 2006, UNFPA, a U.N. agency focused on sexual and reproductive health, began to offer obstetrical emergency training to local comadronas and family planning methods. The agency also teaches the importance of a skilled attendant being present during births in order to improve the maternal mortality rate in Guatemala. Estimates suggest that a well-trained midwifery service “could avert roughly two-thirds of all maternal and newborn deaths.” Statistics show that from 2009 to 2016, UNFPA has trained more than 35,000 midwives.

The Department of Sololá in the western highlands of Guatemala is home to more than 300,000 people, most of whom are indigenous Maya. Only one in four rural births occurs in a hospital, compared with over two-thirds of urban births. In Sololá, comadronas attend more than 63 percent of births mainly outside of a hospital. Some estimates put this figure at more than 90 percent.

The Improving Maternal and Neo-Natal Health Initiative has a three-pronged approach and funding from the World Bank’s Youth Innovation Fund in 2017. The initiative has established a visually-based curriculum to help comadronas recognize dangers and risks during delivery, two-week long training workshops conducted in local healthcare posts, and endowment of “safe birthing kits” for all comadronas containing tools such as latex gloves and gauze pads. Unlike previous initiatives, these trainings have been conducted in local languages rather than solely Spanish. Rosa, a comadrona in the city of Santiago, said this simple change made her “feel more respected” and gave her an increased desire to participate because she felt empowered to save “more lives in her community.”

In collaboration with the Ministry of Public Health and the government of Guatemala, the Maternal Child Survival Program (MCSP), an international program with national and subnational branches, implemented a Midwifery Training Program in February 2018 to improve the maternal mortality rate in Guatemala. Their model uses a competency-based skills training approach. Working with the University of San Martin Porres, MCSP established a coursework protocol for certification.

Discrimination Against Indigenous Peoples

Maternal mortality rates among indigenous populations in Guatemala face particular hurdles. In addition to access to care and infrastructure challenges, indigenous populations face heavy discrimination. They are often evicted from their ancestral lands only to face abuse within the criminal justice system. One young indigenous man reported abuse at the hands of a local gang to police. He believed that “the police don’t listen to us as indigenous people–they do not care about us.” A U.N. Special Rapporteur on the rights of indigenous peoples, Victoria Tauli-Corpuz, says she is very worried about “the grave situation of indigenous peoples” in Guatemala.

Guatemala has made consistent strides in reducing the national maternal mortality rate from more than 200 in 1990 to less than 100 today. However, the maternal mortality rate among indigenous populations remains high. Indigenous populations should be heartened by these improvements, but their unique struggles must not be lost in the larger narrative of maternal mortality in Guatemala.

– Sarah Boyer
Photo: Flickr

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Top 5 Facts About Women’s Health Care in Cambodia

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

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Maternal Mortality Rates for Women in Tajikistan Are Dropping

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
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Liberia Invests in Strengthened Midwifery Programs

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

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Midwives in Chiapas: Lowering Maternal Mortality Rates

quotes about humanity

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

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Fighting Maternal Mortality in Nepal with Misoprostol

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