Child Marriage in Nepal Despite becoming illegal in 1963, child marriage remains a common practice in Nepal. Almost 40 percent of girls in Nepal will be wed before the age of 18, and 10 percent of girls will be married before the age of 15. These statistics place Nepal with the 17th highest prevalence rate of child marriage worldwide. As of 2017, there were 587,000 child brides in the country. The vast majority of these marriages are arranged, sometimes with significant age differences. Furthermore, the brides in child marriages are more likely to experience domestic violence and rape.

Activists claim that prevalence rates are increasing in some districts of the country. This is occurring despite the government announcing in 2014 a target to eradicate child marriage by 2030. However, there are a plethora of organizations working to combat child marriage in Nepal. Many of these organizations are working in tandem with the government to ensure that the 2030 goal is achieved. Keep reading to learn more about the top five organizations fighting child marriage in Nepal.

5 Organizations Fighting Child Marriage in Nepal

  1. UNICEF: The humanitarian branch of the United Nations has been instrumental in both raising awareness and tackling the problem of child marriage in Nepal. In 2016, UNICEF launched the Global Program to Accelerate Action to End Child Marriage, focusing on Nepal and 11 other countries. This program manifests through training community religious leaders to advise against child marriage. In addition, efforts include building health posts that protect child brides by teaching them about reproductive health, as well as mobilizing adolescent girls.

  1. Girls Not Brides: Girls Not Brides and UNICEF worked in tandem to craft Nepal’s National Strategy to End Child Marriage in 2016. The plan includes six components: implementing laws and policies, empowering girls, providing quality education for girls, engaging men, mobilizing families and communities to change norms and providing services. One tangible action taken thus far includes raising the legal marriage age to 20. Another action includes providing cash incentives for families to support their daughters’ educations. Girls Not Brides also works closely with a variety of grassroots organizations that address the issue on the ground including Sakcham Rural Nepal, Loo Niva Child Concern Group and Janaki Women Awareness Society.

  2. Kapilvastu Integrated Development Services (KIDS): A partner organization of Girls Not Brides, KIDS works in Kapilvastu, a district in Nepal, to improve women’s health services. Some of its projects include Safe Motherhood through WASH. WASH targets recent mothers, including child brides, to promote hygiene mothering practices such as hospital deliveries. Another project is the Women’s Health Program, which informs poor adolescent girls about their reproductive health to protect young brides.

  3. Loo Niva Child Concern Group: Another Nepali organization, Loo Niva specializes in children’s rights. The organization protects vulnerable children from exploitative practices, such as arranged child marriages. In particular, the organization has worked in the southern Lalitpur rural area. There, the organization promotes intervention education programs about the dangers of child marriage and how it contributes to issues such as school dropouts.

  4. Human Rights Watch: Although not involved in grassroots and community efforts, Human Rights Watch plays an instrumental role. The organization’s efforts hold the Nepali government accountable for its goal to end child marriage. Additionally, it has consistently surveyed the Nepali government’s actions and reported when, for example, the Nepali government delayed releasing in its strategic plan in 2016. This exposure is necessary to pressure the Nepali government to achieve its target.

Chace Pulley
Photo: Flickr

Maternity Crisis in Sierra Leone
There is a maternity crisis in Sierra Leone. The country has the highest maternal death rate in the world, with one in 17 women dying from pregnancy or birth complications. This number could be even higher, as Sierra Leone’s 2017 Maternal Death and Surveillance Report estimated that seven in 10 maternal deaths go unreported. Below are seven facts about the maternity crisis in Sierra Leone.

Top 7 Facts About the Maternity Crisis in Sierra Leone

  1. The Majority of Maternal Deaths are Preventable: The top causes of maternal death in Sierra Leone are bleeding, pregnancy-induced hypertension, infection and unsafe abortions, all of which are preventable through adequate medical treatment, according to the World Health Organization. Bleeding is a particularly difficult problem for under-served rural areas where mothers do not have access to health care facilities. Another issue facing mothers is infrastructure. People poorly maintain many roads between towns and clinics and these make for a difficult journey for sick and laboring women. Again, road maintenance is a simple problem that can help reduce maternal death in Sierra Leone.
  2. The Majority of Mothers are Under 20: One hundred and twenty-five out of 1,000 mothers in Sierra Leone are under age 20 according to a 2017 United Nations Population Fund (UNFPA) study. Maternity in Sierra Leone is particularly dangerous for adolescent mothers and 20 percent of maternal deaths in Sierra Leone were among teenagers. Beyond maternal death, pregnant teenagers in Sierra Leone lose out on life prospects – a 2015 law banned pregnant girls from attending school, and parents describe teenage pregnancy as the “ultimate shame” for a family.
  3. The 2014-2015 Ebola Crisis Halted Progress: Before 2014, Sierra Leone was making progress in reducing maternal death – from 2000 to 2015, maternal deaths dropped by 4.4 percent. However, the Ebola epidemic caused an immediate increase in maternal death through 2015. Sierra Leone planned to meet many Millennium Development Goals by 2015, but the May 2014 Ebola outbreak reversed progress, particularly in maternal health. Not only did Ebola put a strain on general health care in Sierra Leone, but it also dramatically reduced the number of health care workers in the country. A 2016 World Bank report estimated that maternal death could increase by 74 percent due to the extreme shortage of health care workers in the country.
  4. Programs for Maternity Care Still Need Funding: There is a dearth of doctors in Sierra Leone. For example, in the district of Bonthe, there are nine doctors for 220,000 patients and only 44 percent of births receive support from a nurse or midwife. Unfortunately, between the civil war from 1991 to 2001 and the 2014 to 2015 Ebola outbreak Sierra Leone, the burgeoning health care system in Sierra Leone lost momentum. The E.U., the U.N. and UNICEF have all devoted funds to maternity in Sierra Leone in addition to Partners in Health and other nonprofit organizations. Donations are critical to moving forward with maternal health.
  5. Sierra Leone’s Government has Committed Itself: President Julius Maada Bio announced in October 2019 that Sierra Leone increased its health budget from 8.9 percent to 11.5 percent of the country’s national budget to help combat dangerous maternity in Sierra Leone. On October 18, 2019, Sierra Leone opened a $1.6 billion maternity facility in Freetown to better serve the country’s largest city. Sierra Leone also launched a free health initiative in 2010 to help improve pre- and post-partum care. The government’s goal for maternity in Sierra Leone is to meet Millennium Development Goals by 2030, reducing the global maternal mortality ratio to less than 70 per 100,000 live births.
  6. Nonprofits are Deeply Involved: Multiple nonprofit organizations, including UNICEF, Partners in Health and the Borgen Project have covered issues with maternity in Sierra Leone. Partners in Health has been particularly successful, building a maternal waiting home and opening a health clinic in Kono in 2018. UNICEF provided safer water for mothers to help with illness and sanitation. These nonprofits prove that the crisis is not insurmountable.
  7. Celebrities are also Getting Involved: In October 2019, vlogbrothers, run by Hank and John Green, pledged $6.5 million to Partners in Health as part of his family’s initiative to bring awareness to maternity in Sierra Leone. John Green discussed how he traveled to Sierra Leone and saw first-hand the lack of hospital electricity, medical equipment and transport. He praised the efforts of the Partners in Health in developing a large-scale hospital system and making systematic changes and he asked anyone who can donate to do so. Currently, the vlogbrothers have a goal of $240,000 per month in donations – so far, they have approximately $194,000. The vlogbrothers are also providing updates on their donations and work with Partners in Health in Sierra Leone.

Motherhood should not be a gamble. Families around the world deserve to look forward to pregnancy and birth and not feel distressed. Multiple organizations are pushing for progress, but more is necessary. Support in any form, from awareness to donations, can only help the crisis of maternity in Sierra Leone.

Melanie Rasmussen
Photo: Flickr

The Butterfly iQ

Two-thirds of the world lacks life-saving access to medical imaging. However, new technology — such as portable ultrasound machines — brings modern medicine where it might not otherwise take root. According to the World Health Organization (WHO), up to 70 percent of technology designed in developed countries does not work in still-developing nations. Fully-equipped hospitals can be hours, or days, away from villages, leaving conditions undiagnosed and untreated.

A Handheld Ultrasound Finds A Wide Variety of Uses in Africa

In recent years, multiple companies have developed portable ultrasound technology, often with these remote areas in mind. The Butterfly Network, a Connecticut-based company, is one such organization, which launched its prototype known as the Butterfly iQ in 2017. The device costs approximately $2,000 and is around the same size as a cell phone. The company’s founder, Jonathan Rothberg, has donated scanners to 13 low-income countries, partnering with organizations like the Canadian Charity Bridge to Health and Uganda-based Kihefo. The organization also has backing from USAID to help further its reach.

Portable ultrasound machines like the Butterfly iQ, are largely being used to test for and treat pneumonia, which causes 15 percent of the deaths of children under 5 years old, killing more than 800,000 children in 2017 alone. The technology has also been used to examine goiters, tumors and other conditions that were otherwise difficult, or impossible, to assess.

In 2014, portable ultrasound machines in Africa took on a new life. Bridge to Health and Kihefo worked to offer women the opportunity to see their unborn children. They brought suitcase-sized ultrasounds to clinics and pulled in six times the normal number of visitors, among them women who had only seen traditional healers before.

In addition to its uses in ruling out tuberculosis and helping to reduce maternal and infant mortality rates, ultrasound technology is also an important diagnostic tool for patients with HIV.

Portable Technology Carries Back Into the Developed World

The Vscan Access from GE Healthcare was originally intended for frontline health care workers in Africa and Southeast Asia. However, the portable ultrasound machine has now found a place in developed countries such as Norway, where it offers an unobtrusive ultrasound in the maternity ward.

Compared to standard ultrasounds, which can not only be uncomfortable but also intimidating to expectant mothers, the Vscan Access is small, deterring worry. Its screen is still large enough to provide a full view of the womb, including the fetal position. Dr. Birgette Kahrs of St. Olav’s Hospital in Norway also notes how easy it is to teach midwives how to operate Vscan’s touchscreen technology.

An App Expands the Reach of the Portable Ultrasound

In 2018, Philips launched Lumify, an app-based portable ultrasound system in Kenya. The new tech was announced at the launch of Beyond Zero Medical Safari, an event hosted by Beyond Zero, an organization founded by the First Lady of the Republic of Kenya that aims at preventing child and maternal deaths.

Lumify unifies portable ultrasounds and mobile devices, creating channels for secure image exchange and processing. It is primarily designed for emergency centers and urgent care centers. The app would, through a subscription service, connect health care professionals around the world. Lumify will additionally offer support, training and IT help.

Lumify is compatible with soft and hard tissue scans. It allows for audio-visual calls, which can connect doctors to remote patients, allowing for diagnosis and treatment across the body and across the globe.

Portable ultrasound technology is still relatively new, so long-term benefits are still unmeasured. Still, portable ultrasounds in Africa, like the Butterfly IQ, already show massive potential in improving the medical status of people without access to first-world medical care. With supporters including the Bill and Melinda Gates Foundation, Butterfly iQ and devices like it, are only just getting started.

Katie Hwang
Photo: Unsplash

Products Tackling Global Poverty
People who live in poverty-stricken communities typically do not have access to simple products that can be the difference between life and death. Below are five products tackling global poverty.

5 Products Tackling Global Poverty

  1. The Shoe That Grows: The Shoe That Grows produces a shoe for kids living in poverty. It expands up to five sizes and lasts for years. Kenton Lee founded the shoe after he traveled to Nairobi, Kenya. He lived and worked with kids at a small orphanage and noticed that many of the children either had broken, worn shoes or none at all. He came up with the idea of a shoe that expands to prevent soil-transmitted diseases and parasites that can cause children to miss out on their education and even death. As of now, the company has distributed over 200,000 pairs of shoes to 100 different countries. The organization sent 30,000 of those to Ethiopia alone.
  2. NIFTY Cup: The NIFTY Cup is a device that some use to feed premature babies in Malawi and Tanzania who are unable to breastfeed. Unlike the metal cups and spoons that people in poverty-stricken countries often use, the NIFTY Cup contains durable, soft silicone that one can shape to allow all nutrients to reach babies’ mouths without causing them to cough or choke. The cup serves as a life-saving resource for mothers who do not have the necessary medical assistance necessary to keep premature babies healthy. Donors have made it possible to send over 6,000 NIFTY Cups to hospitals in Malawi and Tanzania.
  3. The Lucky Iron Fish: The Lucky Iron Fish is a tool used to fight iron deficiency in developing countries. Families place the iron fish in boiling water before cooking to add proper nutrients to meals. One of these iron fish is equivalent to five years of iron pill bottles. The Lucky Iron Fish company works on a one-to-one donation scale. This means that when people in developed countries buy one of the fish, the company donates another to a family in a developing country. As of 2018, the company impacted 54,000 lives because of the buy-one-give-one system. The impact fund has distributed the fish to Nicaragua, Tanzania, Cambodia, Haiti, Benin and more.
  4. Embrace Warmer: Embrace Warmer is a life-saving tool that developing countries use. In these places, newborn babies often suffer hypothermia due to being premature and low weight. The tool is essentially a sleeping bag that helps regulate the body temperature of newborn babies during their first few days of life. Embrace Warmer began as a class project at Stanford, when students had to design a cost-effective product to help battle neonatal hypothermia. Eventually, the product expanded to rural India and has now helped 200,000 infants in developing countries.
  5. Flo: Flo is a reusable menstrual hygiene kit that Mariko Higaki Iwai designed to provide a solution for women and girls in developing countries to take care of their bodies. The kit allows girls to wash, dry and carry reusable sanitary pads. This kit makes it easier for girls to stay in school, prevent reproductive diseases and illnesses and take care of their menstrual cycle in privacy. Flo is still a prototype but people working in the field in developing countries have been trying to make Flo available for their communities. The team is currently seeking manufacturers to make this possible.

These life-saving products are working at tackling global poverty, while also giving those who live in poverty-stricken communities a better chance at having a healthy lifestyle.

Juliette Lopez
Photo: Flickr

 

Women's Rights in Burundi
Located in Africa’s southeastern region, Burundi, a heart-shaped nation bordering Lake Tanganyika and Rwanda, is one of the poorest countries in the world. With a poverty rate of nearly 75 percent, the nation is largely underdeveloped. In terms of women’s rights, life in Burundi could be better, as many of the country’s citizens cling to discriminatory perspectives that hold their women back. Despite this, the country has made great strides toward cultivating a more equal nation, such as in 2005 when it included gender equality in its reformed Constitution.

Pregnancy and Sexual Health

In Burundi, discussing sex is generally viewed as a taboo subject. Without the occurrence of these necessary conversations, sexual education is often replaced by false information, and many of the country’s citizens fail to understand their own bodies; an issue most dangerous when it comes to young women and girls. Without knowing the way their bodies work, many Burundian women experience unplanned extramarital pregnancies, and because of Burundi’s negative prejudice toward non-marital pregnancy, many of these girls are often ostracized from their communities, kicked out of their homes and forced out of their schools.

Pamella Mubeza, a native to Burundi, fell victim to this system at a young age. Though, after seeing the prevalence of her issue among other Burundian women, she began an organization known as l’Association des mamans célibataires (the Organisation for Single Mums). Through the organization, Mubeza travels to some of the most impoverished places in the city of Bujumbura, such as Kinyankonge and Kinama, and works with young single mothers to not only re-enroll them in school but to rebuild the self esteem their homeland formerly shamed out of them. By 2019, Mubeza’s organization was able to re-enroll 40 young women in schooling and instilled 250 with a newfound desire to learn.

CARE Burundi, a non-profit organization that works to improve the impoverished realities of women and young girls, is also working to help solve the issue. In 2016, the organization launched an initiative known as the Joint Programme, a 4-year-long project that provides Burundian girls with comprehensive sexual and reproductive education through a comprehensive sexuality education (CSE) curriculum called “The World Starts with Me” (WSWM). The program educates young women about their rights and their bodies, and after its first year of implementation, it was taught in 76 Burundian schools and educated 6,007 young women.

Access to female hygiene products is another one of Burundi’s sexual health problems. With sanitary napkins costing up to 2,000 Burundian francs and the country regarding menstrual periods as shameful, many of the nation’s women turn to unhygienic sources, such as grass and plastic bags, during their menstrual cycles. However, the Organisation for Single Mums is working to combat the problem, as they hand out 1,500 free sanitary napkins to Burundian women each month.

Gender-Based Violence

Sexual violence against women is a growing problem in Burundi. With nearly 23 percent of Burundian women experiencing sexual abuse, and 50 percent of these victims being under the age of 13, the prevalence of gender-based violence in Burundi is undeniable.

Due to the nation’s connection between shame and sexuality, many sexual abuse cases often go unreported, so the number of women experiencing them is likely much higher.

However, through the help of UNICEF and NGO partner Caritas Burundi, Burundian sexual violence is being challenged. Through an initiative known as the Giriteka project, UNICEF and Caritas Burundi are bringing together the nation’s doctors, psychologists, nurses, community leaders, local authorities and religious leaders and teaching them how to best care for their nation’s sexually abused women. From training psychologists on how to prevent gender-based violence to working with religious leaders on how to direct victims toward help, thanks to these organizations, women’s rights in Burundi are not only being protected but defended.

Economic Opportunity

When it comes to the workforce, Burundian women make up 90 percent of the country’s food and export jobs and  with 55.2 percent of the nation’s workforce being female, Burundian women are making substantial contributions toward the advancement of their national economy.

However, this same level of equality cannot be seen in the country’s distribution of land.

Access to property ownership is the largest barrier Burundian women face when seeking economic equality. While 80.2 percent of the country’s people own land, women make up only 17.7 percent of them since the country lacks proper legislation that prohibits male succession traditions from overriding women’s rights.

Public opinion may be partly responsible for these discriminatory practices since 57 percent of the nation’s people believe women and men should not have equal land rights when it comes to inheritance.

Despite this prejudicial reality, U.N. Women is making women’s pathway to land ownership easier by providing them with monetary loans.

Also, the Zionist Organization of America has created an initiative meant to advocate for female land rights in Burundi by urging the nation’s women who do own land to register it.

By working at the community level, these organizations are advocating for the economic endeavors of Burundian women, and actively challenging the misogynistic gender norms that have been placed upon these their lives.

While women’s rights in Burundi are far from equal, the good news is that great work is being done to better them. Thanks to organizations like U.N. Women and initiatives such as the Giriteka project, women in Burundi are not only being cared for but heard. By advocating for women’s rights, these organizations are not only providing Burundi’s women with the freedom to hope for a better life but also to live one.

– Candace Fernandez
Photo: Flickr

Effects of Poverty While PregnantWomen represent more than half of the world’s poor and make only a small percentage of the world’s income. This is influenced by various factors, including lack of access to education, abuse and gender inequality. Because women are already at a higher risk of facing the crippling effects of poverty, their situation becomes more precarious when they are pregnant or new mothers. It is estimated that 99 percent of all maternal deaths occur in developing countries.

Furthermore, in food insecure and unstable countries, adolescent pregnancy is the leading cause of death in young women, ages 15-19. Some of the leading causes of maternal death include severe bleeding, infection and delivery complications due to a lack of proper health care facilities.

Physical Effects of Poverty While Pregnant

In developing countries, where there is often little access to high-quality food and water, one of the most common effects of poverty while pregnant is malnutrition. Underweight and malnourished mothers are at an increased risk of mortality, miscarriage and preterm labor. Because they lack proper access to antenatal care, they are prone to infection and morbidity.

The WHO Millennium Goals Progress Report showed that 60 percent of women in Africa give birth without the presence of a skilled attendant. In addition, nearly 50 percent in Africa lack any antenatal care.

As it relates to malnutrition, more than half of all pregnant women in developing countries suffer from anemia. In South Asia, for instance, 75 percent of pregnant women have anemia versus 18 percent in developing countries. Aside from the low energy levels associated with anemia, anemic pregnant women face a heightened risk of death from bleeding during childbirth.

Malnourished mothers are also at risk of developing hypertension. Although hypertension is associated with higher risks of preterm birth and lower child birthweights, the most severe risks include preeclampsia and placental abruption. The former can cause kidney, liver and brain damage for the mother. Although this is a treatable condition if caught early, many women in developing countries have little access to health care that would offer a proper diagnosis or treatment.

With regard to placental abruption, the placenta separates from the wall of the uterus and can cause severe bleeding for the mother and prevent the baby from receiving enough oxygen. Like anemia, hypertension is a severe physical side effect directly correlated with higher rates of poverty that puts malnourished mothers and babies at great risk.

Emotional Effects of Poverty While Pregnant

In many developing countries, women do not have equal access to education or career opportunities, making them dependent upon their spouses or families. Such dependency can lead to feelings of helplessness that can affect the health of pregnant women. Evidence suggests that pregnant women who face extreme poverty are more likely to face inequality and develop mental illness.

Furthermore, humanitarian crises, such as conflict and post-conflict situations, can increase the risk of violence against women. It is estimated that 35 percent of women worldwide have experienced physical and emotional violence. In places such as West and Central Africa where child marriage still exists, women are more likely to face violence and domestic abuse.

In sub-Saharan Africa, Intimate Partner Violence (IPV) has a 61 percent prevalence in some areas. Abuse in any form, physical, psychological or sexual, can have dire consequences on women and their health during pregnancy. Victims of abuse often face physical harm and mental health issues, such as depression, post-traumatic stress and anxiety. Some victims turn to alcohol or drugs. In addition, women who suffer abuse often face unwanted pregnancies and unsafe abortions. The stress of abuse can affect many aspects of a person’s life but puts pregnant women at a much greater risk due to their already vulnerable physical state.

Efforts to Lessen the Effects of Poverty While Pregnant

Programs such as the U.N.’s Global Strategy for Women’s, Children’s and Adolescent’s Health, the U.N. Millennium Development Goals and WHO Global Action Plan have made strides in reducing the effects of poverty while pregnant. Between 1990 and 2013, the global maternal mortality rate has decreased by 50 percent.

Although maternal mortality rates remain high in developing countries, programs such as the U.N.’s Agenda for Sustainable Development and numerous nonprofit organizations are working to provide access to antenatal care and technology that would assist in identifying health problems for pregnant women. With increased food security, access to antenatal care and an increase in education and gender equality, the U.N. Agenda For Sustainable Development hopes to decrease the maternal mortality rates by at least two-thirds by 2030.

In keeping with this sustainable development agenda, the Reach Every Mother and Child Act (S.1766) is a bipartisan bill that would allow for mothers and children in these impoverished nations to receive the care they so desperately need while also providing a foundation for them thrive and contribute to the global economy. Because the U.S. already has the expertise in ending preventable maternal and child deaths, we must play a larger role in this global fight to help mothers and their children.

 

Send an email to your Senators today asking them to support the Reach Every Mother and Child Act.

 

In addition to increasing access, a greater focus is being placed on the quality of care for these vulnerable groups led by the WHO and UNICEF. The two organizations recently launched a Network for Improving Quality of Care for Maternal, Newborn and Child Health to “cut preventable maternal and newborn illness and deaths, and to improve every mother’s experience of care.” In 2017-2019, Bangladesh, Côte d’Ivoire, Ethiopia, Ghana, India, Malawi, Nigeria, Tanzania and Uganda signed on as partners and more countries are expected to join this effort in the future.

– Christina Laucello and Kim Thelwell
Photo: Flickr

Urban and Rural Voucher Systems

Each year, millions of pregnant women give birth without access to proper health care services. Countries such as Ethiopia, Laos and Yemen are just a few parts of the world where this is a major problem. For example, in Ethiopia, 59 percent of women do not receive care by a medical professional during pregnancy. In Zimbabwe, however, access to prenatal care has drastically improved since the 2014 implementation of the Urban and Rural Voucher Systems (UVS and RVS, respectively). These systems allow for low-income pregnant women to receive the healthcare that they need. They have already had incredible benefits on thousands of pregnant women. Additionally, they set a great precedent for governments and NGOs to come together to find solutions to pressing maternal health issues.

Qualifications

The UVS and RVS service pregnant women whose incomes place them in the bottom 40 percent of households in Zimbabwe. Consequently, women who cannot afford the required $25 co-pay at many clinics can still receive care. Providing women with this essential health care helps to ensure that these women and their babies stay healthy and safe both during and after pregnancy.

Funding

The government of Zimbabwe, the World Bank and Codaid are the main sources of funding for the UVS and RVS. Cordaid is a local NGO that has assisted with much of the program’s implementation. Clinics are subsidized based on their performance. They measure performance on overall range and quality of coverage. This supply-side solution works to help promote jobs and economic growth in local communities, which contributes to the program’s long-term sustainability.

Impact on the Poor

Access to proper care during pregnancy is essential to ensure the health of expectant mothers and their child. In many countries around the world, women do not have access to this care. As a result, the consequences have been horrific.

For instance, there are roughly 3.3 million neonatal deaths recorded per year. Neonatal refers to the first four weeks of a baby’s life. Proper prenatal care can prevent these fatalities. A woman who receives such care is far less likely to give birth to a child with fatal health issues. Proper prenatal care can help identify and fix possible health issues before they become too serious. In addition, receiving prenatal care can offer educational resources. The care can educate a woman about the ways in which they should go about raising a healthy child.

Conclusion

Zimbabwe’s Urban and Rural Voucher Systems have had immense benefits since their implementation. The thousands of women that they have helped to serve reflect such benefits. The programs provide an affordable and accessible option for pregnant mothers to receive the care that they need to ensure both their health and the health of their babies. Also, the UVP and RVP supply-side design ensure that the programs are helping to stimulate local economies and bring communities together. All in all, while much progress must still be made towards increasing access to prenatal care for pregnant women around the world, Zimbabwe has taken an important first step with its Urban and Rural Voucher Systems.

– Kiran Matthias
Photo: Flickr

Maternal Mortality in Africa

Upon learning they are pregnant, most women do not immediately wonder if it’s a fatal diagnosis. However, that is the stark reality for many women in developing countries, particularly in sub-Saharan Africa. Maternal mortality in Africa is a pervasive and devastating issue. Far hospitals, scarce doctors and poor healthcare systems all contribute to maternal mortality. Most maternal deaths are preventable and caused by complications treatable in developed nations. It is important to recognize the causes of maternal death and solutions already in place to further reduce maternal mortality in Africa.

Causes of Maternal Mortality

The most common causes of maternal mortality are severe bleeding, infections, high blood pressure during pregnancy, delivery complications and unsafe abortions. In most cases, these are treatable with access to trained medical staff and proper medication. Access to maternal health care varies around the world. “A 5-year-old girl living in sub-Saharan Africa faces a 1 in 40 risk of dying during pregnancy and childbirth during her lifetime. A girl of the same age living in Europe has a lifetime risk of 1 in 3,300,” according to Dr. Greeta Rao Gupta, deputy executive director of UNICEF. Factors such as “poverty, distance, lack of information, inadequate services, [and] cultural practices” prevent women from having access to the proper medical services they need.

Additionally, warfare in developing countries causes the breakdown of healthcare systems. This further prevents women from accessing life-saving medical care. For example, when the 11-year civil war in Sierra Leone ended in 2002, it left less than 300 trained doctors and three obstetricians to treat the country’s 6 million people.

Solutions to Reduce Maternal Mortality

Many NGOs work throughout the region to combat maternal mortality in Africa. In fact, the United Nations initiated the Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016-2030. Their goal is to “reduce the global maternal mortality ratio to less than 70 per 100,000 live births” by 2030.

According to a study by the World Health Organization, there needs to be better documentation of maternal mortality in Africa to create more effective policy solutions. Currently, less than 40 percent of countries have a registration system documenting the causes of maternal mortality. Hence, this lack of information makes it difficult for the U.N. and NGOs to create effective solutions.

An unexpected yet effective way maternal mortality in Africa has been combated is through photography. Pulitzer-prize winning war correspondent Lynsey Addario took her camera to the region to document maternal mortality. Addario documented the experiences of many women, including 18-year-old Mamma Sessay in Sierra Leone. Sessay traveled for hours by canoe and ambulance while in excruciating labor to reach her nearest hospital. Addario stayed with Sessay for the entire experience, from the birth of her child to her subsequent hemorrhage and death. Addario even traveled with Sessay’s family back to their village to document Sessay’s funeral and her family’s grief.

Ultimately, TIME published Addario’s photographs. And as a result, Merck launched Merck for Mothers, giving $500 million to reduce maternal mortality rates worldwide. Addario stated, “I just couldn’t believe how unnecessary her death seemed, and it inspired me to continue documenting maternal health and death to try to turn these statistics around.”

The Bottom Line

The international community must continue to address maternal mortality, a preventable tragedy. No woman should have to fear for her own life or the life of her unborn child upon discovering she is pregnant. Through documentation, reporting and care, the international community can fight to reduce maternal mortality in Africa.

Alina Patrick
Photo: Flickr

Pregnant in Niger
Pregnancy can be challenging anywhere, but being pregnant in Niger is often life-threatening. Around 14,000 women in Niger die every year as a result of pregnancy-related complications, with only 29 percent of births attended by skilled medical professionals. Because giving birth at home is a deeply ingrained cultural tradition in Niger, only 17 percent of women give birth in health facilities.

Challenges in Being Pregnant in Niger

The difficulties of being pregnant in Niger are exacerbated by the persistence of gender inequality. Women are often treated as property, with girls being married or even sold off before reaching puberty. Violence against girls and women remains a huge problem, especially because victims have often been conditioned to expect and tolerate these abuses.

Due to limited national resources and inadequate funding, the health care system in Niger is unequal to the task of providing universal care for all Nigeriens and relies heavily on assistance from charitable organizations. In 2015, an evaluation of Niger’s national health policy, led by the World Health Organization, revealed that only minimal progress had been made in the area of maternal health. To address this need, nonprofit groups such as Nutrition International are taking action.

Nutrition International

Nutrition International is an organization “helping more pregnant women and their newborns receive access to essential health care services, medicines and other commodities, including vitamins and minerals.” This initiative includes assessing the prenatal and antenatal care as well as pregnancy outcomes and evaluating the potential barriers to care for Nigerien women. These barriers range from a lack of confidence that prenatal and antenatal care is as important as they are being told to more practical concerns such as being able to afford transportation to medical appointments.

The period of time during and shortly after birth is a crucial one for both mother and newborn child. Unforeseen complications can arise, and without adequately trained health providers as well as the proper medicine and equipment, too many mothers and babies needlessly die. Nutrition International is also making materials available to facilities in Niger to provide care to pregnant and postpartum women as well as to train health personnel to give improved care and counseling to their patients. Furthermore, they are utilizing volunteers within the community to impart to pregnant women and their families the importance of antenatal care.

UNICEF and UNFPA

In 2017 alone, 81 out of every 1,000 live births resulted in the death of the infant before reaching one year of age. UNICEF provides support to the government of Niger to ensure that mothers and their babies receive a “continuum of care,” from prenatal to antenatal and promotes the education of girls, which can decrease the odds of childhood or adolescent pregnancy.

The United Nations Population Fund (UNFPA) implemented a program in 2014 called Action for Adolescent Girls. This has played an important role in helping to improve conditions for women who are pregnant in Niger. One important mission of the organization is to ensure that the women, and not young girls, are entering into marriages of their own volition and not being impregnated before they are physically and emotionally ready.

UNFPA sought out and trained local women to serve as mentors to young Nigerien girls, teaching them the basics of female hygiene, reproductive health, literacy and the basics of how to manage money. They were taught that child marriage is illegal and were informed of their other rights as citizens and human beings. Within the first eight-month cycle of the program, this initiative had already resulted in an increase of contraceptive use from 19 percent to 34 percent.

Looking Ahead

The government of Niger continues to work with global organizations to improve the health of prospective and new mothers as well as their children. USAID contributes to this effort with development and humanitarian programs in Niger, all of which are aimed at making the country more self-sufficient. The more financially solvent the country is, the better educated its population will be, ensuring that fertility rates continue to decline while the Nigerien economy continues to improve. With assistance from the U.S. and other wealthy nations, Niger can fulfill its potential and all of its citizens can thrive.

Raquel Ramos
Photo: Unsplash

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

The Initiative

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

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

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

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

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

Seeking Care

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

Reaching Care

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

Receiving Care

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

Results and Impact

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

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

– Anne-Marie Maher

Photo: Flickr