Ethiopian maternal and child mortalitySince the year 2000, Ethiopia has halved its maternal and child mortality rate. While this statistic seems impressive on the surface, the rate of maternal and child mortality in Ethiopia remains one of the highest in the world. The child mortality rate stands at 67 deaths per 1,000 children. The Ethiopian maternal mortality rate (MMR) per 100,000 live births is 412. This number is 25 times the United States MMR.

The Global Context of Maternal and Child Mortality

The rate of maternal and child mortality in Ethiopia is best understood by examining the larger global context of maternal and child mortality. Globally, neonatal mortality remains significantly high, with 7,000 newborn deaths a day. Neonatal mortality comprises 47% of the deaths of children under 5. This number is up 7% from 1990 when it stood at 40%. Furthermore, the greatest number of neonatal deaths occur in sub-Saharan Africa.

Globally, the MMR has dropped 38% from 2000 to 2017, which is the most recent WHO estimate, but it is important to note that even though the overall global MMR has reduced, some regions still disproportionately experience very high MMR rates. The greatest number of maternal deaths occur in Africa, just as with neonatal mortality. In fact, in 2017, 66% of all maternal deaths occurred in Africa.

A key cause of maternal and newborn mortality is malnutrition. Due to COVID-19, the World Food Programme predicted that the number of food-insecure people in low- and middle-income countries (LMICs) would double to 265 million by the close of 2020. Food insecurity often links to malnutrition or undernutrition. Therefore, this fact has the potential to increase maternal deaths due to a lack of iron and other essential nutrients. The WHO estimates that, as it stands globally, 40% of pregnant women are anemic. Anemia makes these women vulnerable to fatal bleeding and infections during childbirth. Furthermore, while high-income countries have very low anemia figures for pregnant women, in certain LMICs, up to 60% of pregnant women struggle with anemia.

Global Aid Organizations Leading the Battle

Fortunately, during and despite the COVID-19 pandemic, global aid organizations have been collaborating with the Ethiopian Ministry of Health and other regional bureaus to continue to decrease the rate of maternal and child mortality in Ethiopia.

As a major player in combatting maternal and child mortality in Ethiopia, the United States Agency for International Development (USAID) focuses on providing Ethiopian women, children and families, especially those in underserved communities, access to quality healthcare. USAID works with the Ethiopian Ministry of Health and regional bureaus to institute better training so that healthcare workers can improve the care provided at various levels (facility, community and household). USAID ensures access to integrated services such as prenatal checkups, skilled care for labor and delivery, newborn care, preventative care for childhood illnesses and nutritional guidance.

Quality of Care Network

Ethiopia is a member of a 10-country Quality of Care Network created by the WHO, the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA). The Network launched in 2017 with the aim of halving maternal and child mortality by 2022 and improving patient care. In Ethiopia, this commitment involves clinical mentoring and coaching since learning is an essential aspect. Ethiopia chose 17 districts that represent “pastoralist, urban and rural populations” to operate as “learning districts.”

Maternal Mortality Reduction

These coordinated efforts seem to be making headway according to the 2020 Gates Foundation Goalkeepers Report, which tracks progress on SDG goals. In 2019, the Ethiopian MMR was down to 205 deaths per 100,000 live births which would meet the Quality of Care Network goal of halving maternal and child mortality by 2022.

Ethiopian child mortality was down from 66 deaths per 1,000 children under 5 in 2015 to 52 deaths in 2019, which represents more modest progress. However, the Goalkeepers Report warns that COVID-19 could reverse progress made on global goals and asserts that a global collaborative response is essential in all areas.

It is critical to maintain heightened vigilance in coordinating efforts to continue to improve maternal and child mortality rates in Ethiopia despite COVID-19 challenges, so that progress is not lost.

Shelly Saltzman
Photo: Flickr

Progress for Maternal and Child Health Outcomes in Albania Located in the Balkan peninsula and nestled between the Adriatic Sea and Kosovo, Macedonia and Greece is the small country of Albania. Following World War II, the nation was a communist state until its transition to democracy succeeding the 1992 presidential election. The transition from a communist state to a democratic republic disrupted economic growth and the ways of life for many Albanian people. The country’s long-standing policy of isolationism contributed to Albania’s slow development, enduring poverty and lack of economic and political stability.

The Albanian Refugee Crisis

In the late 1990s, Albania became host to hundreds of thousands of people seeking asylum from violence and political unrest in the neighboring country of Kosovo. The rapid influx of refugees resulted in many Albanian regions becoming overcrowded and under-resourced. The country, already struggling to support its own people, barely coped with the increasingly dire refugee situation. During this time, Albania was recognized as one of the poorest countries in Europe. The percentage of the population living below the poverty line was estimated to be between 30% and 50%. Crime rates were high and social unrest pervaded.

Albania applied for membership in the European Union in 2009 and joined NATO later that same year. In response, the European Union invested $11 million dollars in emergency aid for Albanians, refugees from Kosovo and surrounding countries. Organizations such as the International Committee of the Red Cross and the United Nations Children’s Fund further worked to improve conditions for all people affected by the crisis.

The effects of political upheavals and the refugee crisis impacted many aspects of life for Albanians. Specifically affected were Albania’s healthcare system and the state of maternal and child health in Albania.

Healthcare in Albania

Historically, Albanians have had limited access to healthcare and health services. Prior to World War II, Albania had few foreign-trained physicians and a small number of hospitals and health clinics based predominantly in urban regions. When the country shifted to a communist state, the Soviet model of health was adapted. Health institutions and hospitals were erected but the quality of medical care was poor.

Investments in the health sector decreased in the 1970s. Recurring political upheavals throughout the 1990s and early 2000s resulted in the destruction of numerous healthcare facilities and the loss of valuable medical equipment. Immunization programs halted and the quality of basic sanitation services decreased drastically in rural and urban areas of Albania.

Maternal and Child Health in Albania

As a result of inadequate health services, health outcomes are poor in Albania. Mortality rates for communicable, infectious diseases are high. Cardiovascular disease is the leading cause of death in the region. Albania has also faced ongoing outbreaks of cholera, tuberculosis and hepatitis.

Health outcomes for women and children in Albania are similarly poor. Albania’s maternal and infant mortality rates are high. Analysis of mortality trends in Albania between 1989 and 1993 revealed that the infant mortality rate decreased from 9.8% in 1970 to 2.8% in 1990. Infant mortality rates subsequently began to rise steadily following the 1992 transition to democracy.

In rural areas, infant mortality rates are twice as high as those in urban regions of the country. Maternal mortality rates in Albania are four times as high as those in other parts of Europe as a result of poor prenatal care and abortion-related complications. Family planning practices are uncommon, as well as forms of birth control alternative to abortion.

Addressing the Issue

However, Albania has shown significant progress in improving its healthcare system as well as the state of maternal and child health outcomes. Albania’s government has shown initiative in restructuring the existing healthcare system to focus on addressing the leading causes of death and disease. The country has also adopted a progressive approach to improving the standards for the protection of women and children’s right to healthcare.

Albania has focused on increasing the accessibility and quality of neonatal and pediatric primary health care in an effort to reduce maternal and infant mortality rates. The nation has implemented additional staffing within women’s and children’s counseling centers and health centers. Albania’s government has partnered with the Ministry of Health to create innovative national health policies that address the needs of the healthcare system, health professionals and Albania’s population. Additional funding and resources have also been allocated to the nation’s health sector.

Further action taken by the Albanian government to improve the state of maternal and child health in Albania includes:

  • Albania signed and ratified the United Nations’ Convention on the Rights of the Child, a treaty outlining the cultural and health rights of children.
  • Albania has begun decentralizing the healthcare system and is ensuring that each village has access to updated and equipped health centers.
  • Albania’s government has adopted a new system of family planning that has improved women’s access to necessary reproductive services.
  • Albania implemented the National Action Plan for Children that increases access to essential health care for mothers and children, works to prevent malnutrition and weight-related disorders, stems the spread of preventable infectious diseases and reduces infection rates of HIV/AIDS and other sexually transmitted diseases.

Moving Forward Amid the COVID-19 Pandemic

The current COVID-19 pandemic further puts pressure on Albania’s government and budget to continue ongoing efforts to improve the nation’s healthcare system. International partners as well as Albania’s government continue to work to improve the country’s healthcare system and advocate for the promotion of the rights of women and children. In doing so, the health outcomes of Albanian women and children will progress and the quality of life for all of Albania’s population will better in the years to come.

– Alana Castle
Photo: Flickr

Improvements in Maternal Health in Sierra Leone
The life expectancy of women in Sierra Leone is just 61 years old. The country leads in the world in maternal mortality ratio, ranking in 1,360 deaths per 100,000 live births — nearly 500 more than the next nation and three times higher than the average for sub-Saharan Africa. Lack of clean water and well equipped sanitary equipment has unsurprisingly come with generally high maternal health risks. Maternal health in Sierra Leone is improving (albeit with further necessary upgrades) despite its numerous impediments.

Sierra Leone’s Economic and Political State

In 2010, the government in Sierra Leone announced an ambitious program — the Free Health Care Initiative — to provide free care in public facilities for pregnant and lactating women and young children. Still, mothers felt care to be inadequate as little transportation assistance, sociocultural barriers and poor quality still remain difficult years later.

In addition, a devastating 2014 outbreak of Ebola further stunted improvements in health conditions in the nation. In fact, according to a 2015 paper, the reduced number of health personal after the epidemic may have forced maternal mortality to increase by 74 percent in Sierra Leone. But workers are on the ground making progress — individuals from as close as neighboring communities, to as far as a dozen time zones away in Asia, are dedicated to creating improvements in maternal health in Sierra Leone.

Impact of Aid Organizations

A UNICEF partner, Sierra Leone Social Aid Volunteers, built modern toilets, a laundromat, incinerator, placenta pit, water well and water supply system in the nation. And that’s not all — UNICEF and other humanitarian aid organizations have offered aid to over 150 facilities across Sierra Leone.

Fatmata Conteh, midwife at the Konta Line Community Health Center, stated that as a result of these efforts, people in Sierra Leone “can easily clean the health facility and wash all our equipment here. Mothers have access to convenient toilets and water in the bathroom to have a bath after delivery.”

The health center where Conteh is employed provides service to over 7,000 individuals across nearly 30 cities in which nearly one half of patients are under the age of five. In December 2015, UNICEF, funded by the European Union, oversaw 16 separate construction and rehabilitation projects started across the country. All theses projects aimed to improve basic health infrastructure, including maternal facilities.

In November 2017, the World Health Organization (WHO) launched a new five-year strategy for Reproductive, Maternal, Newborn, Child and Adolescent Health in Sierra Leone. The strategy highlights several focus areas, including emergency obstetric and neonatal care, management of newborn and childhood illnesses and prevention of teenage pregnancy. This strategy will hope to launch off the recent progress of late — the females’ increased attendance (at least four checkups) during pregnancy and malaria treatment.

“WHO is proud to have supported the country in developing this strategy together with our partners, but we are also aware that this is just the beginning,” said Alexander Chimbaru, Officer-in-Charge of WHO Sierra Leone.

External Influencers

China has also been an influential partner in the region through its support of aid programs in Sierra Leone. In early June, a group of Chinese health workers touched down in Freetown and joined other medical technicians at the Jui China Sierra Leone Friendship hospital. The hospital provides medical care to children, pregnant and mothers free of charge.

To accompany such dutiful care, the first lady of Sierra Leone, Fatima Bio, officially launched the China-Sierra Leone Maternal and Child Health Care Innovation Project. At a launch event, Bio highlighted the importance of a strong education system and health network, as well as the negative effects of teenage pregnancy.

Closer to home, individuals make substantial sacrifices to assist mothers in giving healthy births. Health Poverty Action has featured Mary Turoy, a successful Maternal Health Promoter in the Kamalo village in the Northern Bombali District of the country. To mitigate the difficulties women face in just traveling to medical centers, Turoy and others in her community offer housing, pregnancy information and much-needed advice.

Maternal Health in Sierra Leone

One of the Sustainable Development Goal health targets is to decrease from 216 maternal deaths per 100,000 in 2015, to less than 70 maternal deaths. The United Nations (U.N.) holds that maternal deaths can be largely prevented if programs bolster the level of care during delivery. And improvements around the globe are, in fact, being made — infectious diseases and adolescent childbearing are down worldwide.

However, conditions remain the most concerning in sub-Saharan Africa. Improvements in maternal health in Sierra Leone are happening, but change is still necessary. Healthcare and maternal conditions in this coastal, west African nation are still an area of concern that could do with continued care today and in the future.

– Isabel Bysiewicz
Photo: Flickr