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Reducing Maternal Mortality in Africa

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

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The Effects of Poverty While Pregnant in Niger

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

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Saving Mothers, Giving Life in Zambia

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

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Utkrisht Bond Aims to Prevent Maternal Mortality in India

Maternal Mortality in India
USAID and its partner organizations implemented the development impact Utkrisht bond in February 2018. Many believe this is an innovative and cost-effective solution to end preventable maternal and child deaths in India.

The Utkrisht bond is targeted to assist the State of Rajasthan, where 80,000 babies die annually from inadequate medical care. But proponents hope the model can be used throughout India, which accounts for 20 percent of maternal and child deaths globally.

The development impact bond was announced in November of 2017 by USAID Administrator Mark Green at the Global Entrepreneurship Summit in India. It is expected to provide 600,000 women with improved healthcare access and potentially save 10,000 moms and newborns.

The bond works as a public-private partnership. Investors grant providers of maternal care with upfront capital. Then, outcome funders pay back the investors their principal plus a return if pre-agreed metrics are achieved. The investor, in this case, is the UBS Optimus Foundation, which has committed about $3 million. The organization works with philanthropists to bring sustainable benefits to vulnerable children.

Up to 440 private health facilities will then be operated with assistance from Population Services International (PSI) and the Hindustan Latex Family Planning Promotion Trust (HLFPPT), which also are co-investors providing 20 percent of the required capital. PSI is a global health nonprofit and the HLFPPT is an Indian nonprofit that works with maternal care.

In order to maximize success, private facilities are the focus of the Utkrisht bond. They host more than 25 percent of institutional deliveries in Rajasthan and are used by women of all socioeconomic backgrounds, yet little has been done to improve their quality of care.

USAID and Merck for Mothers, a nonprofit with the goal to end maternal mortality, have each committed up to $4.5 million that will be paid if the heath facilities meet accreditation standards. This is a highly cost-effective method to save lives according to World Health Organization standards, which is particularly exciting to USAID.

“The pay for success approach ensures appropriate stewardship of U.S. taxpayer dollars, while unlocking both private capital and government resources for health,” USAID states.

While this is the first development impact bond targeted toward health, the future of the Utkrisht bond looks promising. If it is successful, more initiatives can be implemented that involve private-public cooperation and effective use of taxpayer money to save the lives of many women and children around the world.

– Sean Newhouse

Photo: Flickr

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Addressing Disparity Gaps in Women’s Health in Mali

How Emergency Transportation Has Addressed Disparity Gaps in Women's HealthIn September 2017, the United States Agency for International Development’s (USAID) High Impact Health Services Project constructed emergency transport systems in Tienfala, a small community located in Mali, which has allowed for pregnant women to be transported to health facilities in order to give birth. This project was a part of USAID’s efforts to increase health outcomes around the world and close the consistently widening disparity gaps in women’s health.

According to USAID, the completion of the emergency transport systems were in large thanks to a community effort. People from the small Tienfala community worked together in order to help increase the health outcomes of pregnant women in their community. USAID’s project in Tienfala is very promising for the promotion of women and girls in developing countries.

Many other organizations have placed a focus on increasing the health outcomes of women and girls in developing countries in order to address the widening disparity gaps in women’s health around the world. In fact, the aim of the United Nations International Children’s Emergency Fund (UNICEF), in regards to women and girls, is to “promote the equal rights of women and girls and to support their full participation in the political, social and economic development of their communities.”

Like UNICEF, USAID has placed a value on promoting women’s health in developing countries like Mali. Specifically, according to USAID, the focus of the High Impact Health Services Project is to decrease the incidence of maternal and child deaths, and the construction of the emergency transport systems in Tienfala has greatly helped reduce such mortality rates.

Kadia Coulibably, a woman from Tienfala, lacked any sort of prenatal care during her fourth pregnancy, reports USAID. However, the emergency transport systems allowed Coulibably to experience an organized, healthy childbirth. Without the valuable help of U.S. foreign aid through the governmental agency USAID, Coulibaly may have faced complications during her childbirth due to the lack of proper care.

Of course, a focus on the health of women and girls in developing countries is incredibly vital to the empowerment of women in their respective communities. When pregnant women can receive accessible, adequate health care, they can thrive happily and healthily. Thus, the construction of the emergency transport systems for pregnant women in Mali is a step in the right direction for the advancement of women’s health.

– Emily Santora

Photo: Flickr

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Clean Blood Transfusions Impoverished Countries

Hemafuse: Clean Blood Transfusions in Impoverished CountriesIn the U.S., there are many people who are willing and able to donate their blood. With a large blood bank available, the U.S. does not have to use extreme measures to perform a blood transfusion. Unfortunately, this is not the case with many impoverished countries; getting a clean blood transfusion in most of these countries is simply not an option. However, a device called Hemafuse has been developed for doctors to help make these clean blood transfusions possible.

Due to the lack of blood donors in poverty-stricken countries, doctors use autologous transfusions to give the patients the blood they needed; this involves using the patient’s own blood for the transfusion. It could be obtained during hemothorax – a condition where the patient’s blood has pooled up in an open cavity, or, alternatively, they could also use the blood resulting from hemorrhaging during an ectopic pregnancy – pregnancy which occurs outside the uterus.

Originally, doctors had to scoop up the patient’s pooled blood with nothing but a soup ladle. They then took the blood collected from the soup ladle and poured it through a filtration system to make the blood cleaner for transfusion. Not only is this unsanitary, but it is a highly complicated process that takes many doctors to perform. It has saved a few lives in the past, but it is inadequate as a permanent solution.

The Hemafuse looks to alleviate all of those problems and make clean blood transfusions in impoverished countries happen. To operate the Hemafuse, doctors need to put the suction inlet into the pooled blood and then pull the pump. Blood is then filtered through the filtration system, removing clots and impurities. After the blood is collected, the doctor then pushes the pump and the blood is then moved into a separate blood bag that is connected to the side of the device. Once there, the blood can be used in a blood transfusion back to the patient the blood originally came from.

This is much safer and cleaner than using a soup ladle. The patient’s blood stays within a closed and sterile system rather than it being exposed to the elements. Not only that, it requires only one or two doctors to use rather than the eight or nine that were previously required. It also costs about $60 per patient use, which is much more affordable than the $250 a normal blood bag would cost.

The Hemafuse device has been backed by many prominent organizations such as USAID, UKAID and the Gates Foundation, among many others. Doctors want clean blood transfusions in impoverished countries to become widespread, so they are willingly coming around to performing clinical trials using Hemafuse. With this device, the soup ladle transfusion will hopefully become a procedure of the past and patients will finally be able to receive the – clean – lifesaving blood that they need.

– Daniel Borjas
Photo: Flickr

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Top Five Diseases Infecting Pregnant Women in Poverty

Women in Poverty
While the disease Maternal and Neonatal Tetanus affects newborns, there are other diseases that can be harsher to pregnant women in poverty, since their bodies work harder to provide health to two individuals. Because of a lack of healthcare and nutrition, these women can be more susceptible to diseases that could be easily managed in countries with accessible healthcare. Here are the top five diseases affecting pregnant women in poverty:

Hepatitis E

Pregnant women in the second or third trimester are more likely to experience liver failure when they contract Hepatitis E. When contracted in the third trimester, the fatality rate is as high as 25 percent. An epidemic in India resulted in high mortality rates of pregnant women. To decrease the risk of spreading Hepatitis E, it is important to maintain hygienic practices and proper handling of public water supplies, since the infection can spread through contaminated drinking water.

Measles

Due to vaccinations, measles is fairly rare in developed countries. However, this is not the case in developing countries. While measles is severe to a baby, it can be even worse for women during pregnancy. A study from Saudi Arabia found that 80 percent of pregnant women in poverty with measles were hospitalized. Measles can infect the fetus and increase the risk of prematurity and miscarriage.

Malaria

Though preventable through vaccination, malaria remains prevalent in Africa. There are about 200,000 newborn deaths each year as a result of malaria in pregnancy, and 30 million women in areas infected by malaria become pregnant each year. When pregnant, the woman’s immunity to diseases decreases, so exposure to malaria increases the risk of illness, severe anemia and death. However, there have been interventions to decrease the risk of contracting malaria. In 2000, the first African Summit on Malaria was held in Abuja, Nigeria. Here, heads of state committed to providing effective malaria interventions to at least 60 percent of pregnant women. Also, there have been efforts to bring malaria interventions through antenatal clinics in Africa.

HIV/AIDS

Globally, HIV/AIDS is the leading cause of death among women between the ages of 15-24, the age women are most likely to become pregnant. Women are twice as likely as men to contract the virus. Antiretroviral therapy has been used to treat pregnant women.

Tuberculosis

This airborne disease is 10 times more likely to infect pregnant women who test positive for HIV. According to the WHO, every year about 700,000 women die from tuberculosis, and more than 3 million women contract the disease. Tuberculosis is the third leading cause of death among women between the ages of 15 to 44. When pregnant, the disease is harder to diagnose since the symptoms (fatigue, tiredness, and shortness of breath) are similar to typical symptoms of pregnancy.

If the U.S. Congress passed the Reach Every Mother and Child Act, pregnant women in poverty who are diagnosed with treatable diseases could receive the necessary treatment. If passed, the U.S. government will provide agencies to expand interventions for maternal health, to provide treatments and assistance to afflicted women and children.

– Emma Majewski

Photo: Flickr

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SUN Movement’s Campaign for Fighting Malnutrition

SUN Movement
Malnutrition accounts for nearly half of all deaths among children under five. While the majority of these deaths occur in Africa and Asia, the loss of human life due to hunger and malnutrition is a global burden. Malnourished children are more likely to get sick, suffer from abnormally severe symptoms of common illnesses and die from otherwise preventable illnesses. Thankfully, organizations such as the SUN Movement work to reduce this hunger-related child mortality rate.

Malnutrition and Infection

The link between malnutrition and infection can create a cycle wherein poorly nourished children have a weaker immune system, which in turn deteriorates their nutritional status. Malnutrition can also stunt a child’s growth, predisposing them to cognitive disabilities.

Hunger and malnutrition take a particularly severe toll on the developing world, where one out of six children (about 100 million) are underweight, one in three children are stunted and 66 million children go to school hungry.

The SUN Movement

Scaling Up Nutrition, or SUN Movement, is a worldwide campaign to alleviate hunger and malnutrition. SUN aims to unite governments, the United Nations, civil society, researchers, donors and business into a cohesive movement to improve global nutrition.

Focusing on the goals established at the 2012 World Health Assembly, SUN movement identifies four strategic processes as the major institutional changes needed for scaling up nutrition worldwide:

  1. Endorsement of National Nutrition Policies that Incorporate Best Practices. Newly enacted laws and policies should reflect proven interventions while paying special attention to women and their role in society.
  2. Sustained Political Commitment and Establishment of Functioning Multi-stakeholder Platforms. Improving nutrition requires a political environment grounded in multi-stakeholder platforms. The dialogue around hunger and nutrition should be open, for different groups to share the responsibility of scaling up nutrition throughout the entire world.
  3. Alignment of Actions Across Sectors and among Stakeholders. The country plans to improve nutrition should reflect frameworks of mutual responsibility and accountability among stakeholders.
  4. Increased Resources for Nutrition and Demonstration of Results. Multiple sectors and stakeholders should increase financial resources for the implementation of plans to improve nutrition.

Each participating country is required to meet state-specific goals and objectives for scaling up nutrition before they can partake in SUN Movement events, like the Annual Global Gathering. This event is where government leaders and multi-stakeholder groups meet to collaborate, share progress, learn from each other and offer new practices for improving nutrition.

SUN Movement has several mechanisms for maintaining oversight and staying on track to achieve its goals. The SUN Networks align resources and foster collaboration, the lead group provides strategic oversight and enforces accountability and the executive committee represents SUN Movement at the international political level. There is also a secretariat and multi-partnered trust fund.

SUN Movement acts like the United Nations for Hunger and Nutrition, with clear guiding principles to achieve goals through cooperation and collaboration. The multifaceted structure of SUN Movement accurately confronts the varied nature of hunger and malnutrition, making the organization an important player in the fight to improve nutrition worldwide.

– Jessica Levitan

Photo: Flickr

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How to Prevent the Zika Virus

Prevent the Zika Virus

According to the Center for Disease Control (CDC), the “Zika virus disease (Zika) is a disease caused by the Zika virus which is spread to people primarily through the bite of an infected Aedes species mosquito.” The disease can cause symptoms like fever, rash and joint pain, although most symptoms go unnoticed. Learning to prevent the Zika virus, then, is imperative.

The most severe symptom is microcephaly, which is a birth defect that causes babies to be born with smaller than average-sized heads. This is of grave concern to pregnant women or women who are trying to become pregnant who have traveled or have partners who have traveled to countries where the disease is present.

Although there are currently no vaccines for the disease, there are five easy steps you can take to prevent the Zika virus from reaching you or your loved ones:

  1. Wear the right repellant. The CDC recommends wearing repellant registered by the Environmental Protection Agency because it contains ingredients such as lemon eucalyptus oil and DEET. Repellants registered with EPA are also evaluated for effectiveness.
  2. Use clothing as a repellant. Wearing long sleeves and pants in a place where mosquitos present can also reduce your risk of a Zika virus infection. It is even more effective if the clothes are treated with permethrin.
  3. Avoid exercising outdoors. Mosquitoes are attracted to carbon dioxide and heat, both of which are heavily emitted when exercising. To avoid being swarmed by mosquitoes, it is best to exercise indoors in an air-conditioned room.
  4. Properly secure buildings. Residing in buildings that have screens over its doors and windows and are properly ventilated with air-conditioning can prevent mosquitoes from entering and protect you while you sleep. Placing netting over cribs and strollers can help protect babies as well, especially since they may be too young to safely use mosquito repellant.
  5. Practice safe sex. The Zika virus disease can be transferred from men during unprotected sex. To prevent transferring the disease, using condoms and abstaining from sex are the best methods after or during visitation to a country with the Zika virus. This information is crucial for women who are trying to become pregnant.

The fight to eliminate the Zika virus has skyrocketed, resulting in incredible scientific innovations. For instance, scientists from the U.K. have released genetically modified male mosquitoes who cause populations of local mosquitoes to fall.

Another technique includes inserting a gene drive into mosquitoes to make them unable to host the Zika virus within their bodies.

Researchers are also utilizing cellphones to track and record people’s movements and use this data for documenting Zika hotspots throughout the world.

As more techniques on how to prevent the Zika virus are discovered, all hope that the spread of the disease can be contained effectively.

– Julia Hettiger

Photo: Flickr