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Formative SupervisionWith a population of about 30 million, many Angolans do not have access to adequate healthcare. The limited access to quality healthcare is due to decreased funding due to the Angolan Government’s budget restrictions. The lack of funding affects the quality of public healthcare which people can receive at no cost. The public healthcare sector in Angola does not have enough healthcare providers with proper training and resources. The lack of resources in healthcare reflects in the low ratio of about one health center per 25,000 people and more than 50% of people are without access to healthcare services. In recent years, USAID’s Health for All project, using the Health Network Quality Improvement System (HNQIS), has implemented formative supervision in Angola. Implementing formative supervision in Angola has shown to improve the quality of healthcare by increasing the number of healthcare providers with proper training.

USAID’s Health for All Project

USAID’s Health for All program is a five-year project that began in 2017. It works with the Angolan Government to help improve the quality and access to healthcare in the country. The project’s focus is on addressing the issues of malaria and reproductive health since those are two of the main health concerns affecting the people of Angola. With the current funding being at $63 million, the program has been able to train 1,489 health professionals on how to diagnose and treat malaria and created reproductive health services in 42 health facilities.

The program’s use of formative supervision in Angola has helped in educating and providing healthcare workers with the necessary tools to effectively care for patients. The Health Network Quality Improvement System is the main tool that USAID uses to help improve the quality of healthcare because the system is used to evaluate the performance of individual healthcare providers. By tracking the performance of the healthcare providers in Angola, USAID can more easily determine which areas of the healthcare system need improvement. Under the Health for All program, USAID has been using formative supervision with healthcare providers who specifically tend to cases of malaria and reproductive health.

The Benefits of Formative Supervision

From October 2019 to March 2020, the Health for All project recorded improvements in the quality of healthcare through the use of formative supervision in 276 out of 360 Angolan health facilities with prenatal services. In addition to tracking the performance in maternal and reproductive health, the supervision has also helped in finding the areas in which the management of malaria has been lacking. There are now about 1,026 health providers that have been properly trained in managing malaria cases as a result of the project. This has in turn indirectly improved the quality of care regarding maternity since malaria causes 25% of maternal deaths in Angola.

Besides increasing the amount of funding that goes toward healthcare, the Health for All project has used such funding to be more interactive with healthcare facilities through the use of formative supervision in Angola. Formative supervision has shown to drastically improve the quality of care in the areas of malaria and reproductive health as supervision allows trained health officials to identify and fix integral issues pertaining to healthcare in Angola.

Zahlea Martin
Photo: Flickr

Doctors for MadagascarMore than 75% of people living in Madagascar are living under conditions of extreme poverty. Disease and natural disasters consistently fall upon the country. Madagascar faces a dangerous lack of proper healthcare provisions and a low number of medical professionals to meet the needs of all its inhabitants. The country does not lack hope of improvement though. Doctors for Madagascar carries out projects to help address the issues that Madagascar faces with appropriate medical care.

Doctors for Madagascar

Doctors for Madagascar (DfM) was founded by German doctors in 2011 after they observed the meager amount of healthcare provisions and trained professionals that were available. Its work is concentrated on providing for one of the country’s most poverty-stricken regions, being the remote south of the island.

This organization allocates immediate aid but it also wants to have a lasting impact and work toward sustainable solutions. Therefore, Doctors for Madagascar monitors its projects in the long-term to be sure that each one is reaching its maximum potential in both service and longevity. In keeping with this idea, the organization creates partnerships with doctors that are local to the south of Madagascar to base its aid on what experts in the community believe to be most necessary.

The Obstacles Madagascar Faces

  • Environmental challenges negatively affect the farming fields and threaten agricultural outputs.
  • Tropical storms have forced tens of thousands of people to evacuate their homes.
  • Hunger affects millions. In 2018, Madagascar ranked number six of nations around the world with the highest rate of malnutrition.
  • Diseases such as measles and plague affect thousands, especially due to low vaccination rates.
  • There is no universal health insurance.
  • Lack of consistent electricity.
  • Maternal health is inadequately meeting the needs of poor mothers and is especially complex during a complicated birth where proper facilities could be hours away from the mother’s village. Those who end up delivering without the assistance of medical professionals depend on the oldest women in the village.
  • Insufficient medical supplies along with difficult working conditions are some of the difficulties being faced within Centres de Santé de Base, which are facilities made of stone that provide healthcare in the countryside of Madagascar. Each one generally contains a nurse, midwife and sometimes a doctor.
  • A lack of trained medical professionals, especially in the south of the island.

 How Doctors for Madagascar Offers a Solution

Doctors for Madagascar does not discriminate against the members of the communities it helps, therefore, the organization takes care of the medical costs for those who cannot afford the treatment they need. Along with covering costs, the organization also provides cost-free maternal healthcare to women. As many women are unlikely to see a doctor throughout their entire pregnancy, DfM provides access to check-ups for women.

Transportation for pregnant women has improved as ambulances are provided and free hotlines have been made accessible for communication between ambulances and Centres de Santé de Base.

DfM builds health facilities and provides construction expertise to help carry out each project. The organization also renovates medical facilities that are necessary to the community’s health, providing medical equipment that is needed in the healthcare facilities and issuing training for its maintenance. Volunteering consists of doctors joining on aid missions. Each doctor that works with the organization must have sufficient experience and have a strong background in the french language to effectively communicate and treat Madagascans as needed. The organization also offers training to local medical professionals by experienced medical professionals that work or volunteer with DfM.

The Onset of COVID-19

As each nation confronts the global COVID-19 pandemic, Madagascar is not facing its first or only crisis. Dengue fever and malaria are killing more people in Madagascar than COVID-19, yet the pandemic is still emphasizing the urgency of improvement needed in medical care and the importance of access to healthcare. In fact, it is even shaping how some of the highest authorities in Madagascar influence this important matter through their advocacy. The Bishops’ Conference of Madagascar (CEM) stated that “The health crisis reveals the importance of an efficient health structure… we believe the time has come to look for ways to improve public health as a whole.”

The Future of Madagascar

The need for medical aid in Madagascar is a pressing issue. Doctors for Madagascar has proven that through awareness, action and understanding, impoverished communities can be helped in both the short and the long term. It is true that the country faces many recurring threats but that does not mean there has been no positive change. These changes can be seen in Madagascar today, which can provide an optimistic outlook on working to reduce poverty in other countries as well.

– Amy Schlagel
Photo: Flickr

Maternal Care in BangladeshBack in 1972, Fazlé Hasan Abed started a small organization called the Bangladesh Rehabilitation Assistance Committee (BRAC). Originally dedicated to helping refugees after Bangladesh’s war for independence against Pakistan, the organization has since grown to serve 11 countries across Asia and Africa. One of the key focuses of BRAC is poverty alleviation and includes categories such as improving maternal care in Bangladesh.

BRAC’s Strategies for Poverty Reduction

BRAC engages several strategies to combat poverty, such as social enterprises. Social enterprises are self-sustaining cause-driven business entities that create social impact by offering solutions to social challenges and reinvesting surplus to sustain and generate greater impact. Some social enterprises include those seeking to promote access to fisheries, give people access to jobs in the silk industry and businesses that give seed access to farmers.

BRAC also prioritizes social development. These initiatives refer to BRAC’s on-the-ground programs. Social development efforts aim to build communities up by attempting to foster long-term development through the promotion of microfinance and gender equality and by eradicating extreme poverty.

The third focus of BRAC is investments. BRAC seeks to invest in local companies in order to create as much social impact as possible. This includes initiatives to expand affordable internet access for all and a range of other financial support services.

Finally, the organization founded a tertiary education institution called Brac University. The University, located in Bangladesh, aims to use its liberal arts curriculum in order to try and advance human capital development and help students develop solutions to local problems.

The BRAC Manoshi Maternal Care Initiative

Founded in 2007, the Manoshi program is specifically tailored to serve mothers and newborns by providing accessible care. There are a couple of unique methods that make this maternal healthcare initiative especially effective in reaching its goals of improving maternal care in Bangladesh.

One-third of people in Bangladesh live under the poverty line and a greater part of this group live in slums, making it difficult to access and afford necessary healthcare. Manoshi focuses primarily on empowering communities, particularly women, in order to develop a system of essential healthcare interventions for mothers and babies.

Manoshi’s Focal Areas for Community Development

  • Providing basic healthcare for pregnant and lactating women, newborns and children under 5
  • Building a referral system to connect women with quality health facilities when complications arise
  • Creating women’s groups to drive community empowerment
  • Skills development and capacity building for healthcare workers and birth attendants
  • Connecting community organizations with governmental and non-governmental organizations to further their goals

The main methods used in the Manoshi project to achieve desired outcomes are social mapping, census taking and community engagement.

Manoshi’s Impact on Maternal Care in Bangladesh

BRAC projected that improvement in healthcare access would cause neonatal mortality to decline by 40-50% and the most recent data from the Manoshi program shows just that. Manoshi’s data shows that from 2008 to 2013, both the maternal and neonatal death rates dropped by more than half. From 2007 to 2011, the percentage of births at health facilities increased from 15% to 59%, while national averages only increased from 25% to 28%, suggesting that mothers served by Manoshi have more access to resources and facilities for safe deliveries. Prenatal care also increased from 27% to 52% in the same years.

With the substantial impact of organizational programs like Manoshi prioritizing the wellbeing of women and children, advancements with regard to maternal care in Bangladesh will hopefully only continue upward.

– Thomas Gill
Photo: Flickr

empowering women improvesIn recent years, great strides have been made in improving women’s and children’s health. Fertility rates in both low and middle-income countries have significantly declined and life expectancy has increased by more than 10 years. Despite this progress, the WHO reports that a vast majority of maternal deaths (94%) occur in low-resource settings and most could have been prevented through adequate maternal care and other factors. Political and societal efforts to mitigate these disparities as well as ground-level health interventions are key to guarantee enduring improvements in women’s and children’s health. Empowering women improves maternal and child health outcomes in several ways.

Empowering Women Improves Maternal Health

Although the role of women’s empowerment as a social determinant of maternal and child health outcomes has not been as widely acknowledged as other social determinants such as education, it is a leading opportunity to improve the well-being of women and children around the world. Women’s empowerment is positively associated with an array of positive maternal and child health outcomes,  such as improved antenatal care, contraceptive use, child mortality and nutrition levels.

Improved Maternal Health in Guinea and India

Another facet of maternal health that is linked with women’s empowerment is increased access to quality maternity care. The Republic of Guinea has committed to alleviating maternal and child health disparities by increasing women’s liberty. According to the 2018 Guinea Demographic Health Surveys, mothers who received higher quality antenatal care (ANC) also exhibited several aspects of women’s empowerment, such as having a proactive role in healthcare decisions and being employed.

In Varanasi, India, women’s autonomy and empowerment were also found to positively influence maternal health. A study of 300 women found that women with greater autonomy were more likely to deliver their baby in a clinic and employ higher levels of antenatal care.

Improved Maternal Health in Africa

Uniformly, a regional analysis of Africa revealed that dimensions of women’s empowerment impacted maternal health and utilization of health services. Researchers found that having greater control over money or household decisions correlated with higher Body Mass Index (BMI) in the Democratic Republic of Congo, Ghana, Uganda and Zambia. This is important because low maternal weight is a risk factor for low birth weight babies and adverse infant outcomes. Additionally, facility delivery was significantly associated with positive attitudes toward gender roles in Nigeria. Delivering in a clinic plays a large role in reducing maternal mortality as the majority of fatal pregnancy complications can be prevented if intervened by a skilled clinician.

Empowering Women Improves Child Health

In addition to improving maternal health, empowering women improves and enriches the health of their children. Studies have found a nexus between women’s empowerment and good child health outcomes, including higher utilization of health care services and immunizations, improved nutritional status and lower child mortality.

Women in Nepal who own land are significantly more likely to have authority over household decisions,and similarly, children of mothers who own land are significantly more likely to be a healthy weight. The connection between land ownership and feelings of empowerment mean women are more likely to use income to contribute to the well-being of the children and the family overall.

Organizations for Women’s Empowerment

Mending educational and economic inequalities and disadvantages that women and girls face are fundamental in empowering women and marking long-term and sustained improvements in women’s health. Offering scholarships, making schools a safe environment for girls and transforming beliefs and gender-biased social norms that perpetuate discrimination and inequality are avenues to create equal education opportunities. Additionally, governments and policymakers are pertinent to allocate resources necessary for gender equity and improving female health.

Self Help Groups (SHGs) are a great example of a simple yet effective solution to empower women who live in lower-income communities. Find Your Feet is an organization based in the U.K. that is working in Malawi and rural India to end rural poverty. The organization works with families in remote areas of Asia and Africa by helping them earn incomes and expand access to vital services. A key facet of its work is geared toward women’s empowerment and it has created SHGs throughout the poorest districts in India.

The Way Forward

Empowering women is a catalyst for not only better maternal and child health outcomes, but investing in a woman’s health and empowerment has a ripple effect, helping families, communities and countries to rise out of poverty.

– Samantha Johnson
Photo: Flickr

healthcare in peruPeru carries a heavy history of periodic instability that has made the establishment of an accessible healthcare system perilous. The country suffers from an inequitable distribution of healthcare workers. It also struggles with the partition between private and governmentally-sponsored healthcare, the provisions of which skew inequitably toward the wealthy. Peru’s wealth gap shows the richest 20% in the nation controlling nearly half of its income and the poorest 20% earning less than 5%. This inequality is quite literally killing Peruvians. According to the 2007 National Census of Indigenous Peoples conducted by the Peruvian government, over 50% of census-interviewed communities did not have access to any form of health care facility.

Healthcare in Peru by the Numbers

  • The life expectancy in Peru is 74 years, landing the country at 126 out of 224 countries.
  • The probability of a child in Peru dying before the age of five is 1.4%, compared to 0.1% in the United States.
  • Peru spends 5.5% of its GDP on healthcare, compared to the U.S.’s 17.1%, ranking the country at 128 out of 224 countries.
  • In Peru, there are one and a half hospital beds available per 1,000 individuals. This is a number that is especially dire during the coronavirus pandemic.
  • Peru clocks in at just under one and one-quarter of a physician per every 1,000 Peruvians in need of medical care.

Structure of Healthcare in Peru

Due in part to fluctuating governmental structures and rulers, Peru currently operates with a decentralized health care system administered by five entities. Two of these entities provide 90% of the nation’s healthcare services publicly, while three provide 10% of the nation’s healthcare in the private sector. This distribution results in considerable overlap and little coordination, depleting the healthcare system of resources and providers. In fact, many healthcare providers in Peru work an assortment of jobs across different subsectors.

As healthcare is a necessary sector of the economy, Peru’s healthcare worker density is increasing, even as health worker outmigration also increases. But since these workers are not equitably distributed, coastal and urban areas monopolize the majority of these providers. Lima and tourist coasts boast the highest distribution of healthcare workers, while rural and remote areas such as Piura and Loreto are home to few health providers.

Impact of the Healthcare Structure on Women

The detrimental effects of inequitable healthcare distribution are most visible in the country’s astonishing maternal mortality rate. The World Bank’s 2017 data showed that 88 out of 100,000 mothers in Peru die from pregnancy-related causes. However, Peru’s efforts have substantially reduced the number from 10 years before when the maternal mortality rate in Peru was 112 per 100,000 mothers in 2007.

The burden of maternal mortality rests squarely upon the shoulders of poor, rural, and Indigenous women. They are dying from largely preventable causes in a massive breach of human rights. These women disproportionately face countless barriers to pregnancy wellness and birth healthcare, including a dearth of emergency obstetric and neonatal services, language barriers and a lack of information regarding maternal health. Peru has implemented policies in recent years to reduce the rate of maternal mortality, such as the increase of maternal waiting houses for rural pregnant women to reside in as they approach birth.

The only cause of premature death that precedes neonatal disorders as a result of inadequate neonatal obstetrics is lower respiratory infections. This type of infection is the most likely cause of premature death, and it has remained so since 2007. This illness, too, disproportionately impacts women and children. They are the most likely groups to die from household air pollution, a type of pollution caused by the burning of solid fuels for cooking and heating purposes. In Peru, 429 out of an estimated 1,110 yearly childhood deaths are caused by acute lower respiratory infections resulting from household air pollution. Combined, neonatal disorders and lower respiratory infections cause more death and disability than any other factor in Peru. These are shortening the lives of Peruvian women and children by almost 20%.

Moving Forward with Healthcare in Peru

The healthcare system in Peru is one that suffers many flaws. It is straining to support its people, especially in the midst of a worldwide pandemic. While the going is slow, the country is striving to reform its healthcare system. Peru is doing this by reforming its healthcare system in the direction of universal coverage – an achievable but certainly strenuous goal. Since vigorously implementing healthcare reform in the late 90s, Peru reports coverage of 80% of its population with some form of health services. While this number is far from ideal, it is evidence that the Peruvian government is not only cognizant of but concerned about its healthcare failures, and it is striving for a fuller coverage future.

– Annie Iezzi
Photo: NeedPix

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

Women’s Health in IndiaWomen’s health in India is still vulnerable to several risks such as high maternal mortality rates, lack of preventative care and misinformation about family planning and contraception. Despite this, India has proven itself a pioneer in technological innovation among developing countries and it is putting its new innovations towards improving women’s healthcare. 

Maternal Health and Newborn Development

Although maternal mortality rates in India have declined substantially in the last decade, the number of recorded deaths related to pregnancy complications in the country is still remarkably high. A report by UNICEF estimates that 44,000 women die due to preventable pregnancy-complications in India yearly. These complications often stem from a lack of knowledge and inherently the inability to understand that their baby isn’t developing correctly. This lack of knowledge results in fewer women seeking treatment that could save their lives. To combat this, organizations are developing innovative mobile apps to help women stay proactive and educated about the health of their babies and the status of their pregnancies. 

For example, in 2014, MAMA (Mobile Alliance for Maternal Action), an organization dedicated to women’s maternal health in developing countries, developed a digital service called mMitra. The service sends recordings and SMS messages to new and expectant mothers with crucial information about the early stages of pregnancy and child development within the first year of life. The app, which collected 50,000 subscribers within months of its launch, sends educational content to women in their native languages and at times of their choosing. The app,  mMitra ultimately aims to help women pick up on pregnancy and child development issues early and seek treatment before symptoms escalate or endanger the mother and child. 

Breast Exams and Preventative Care

Mammograms are an essential part of preventative care for women globally. Despite this, it is estimated that over 90 percent of women in the developing world go without this essential screening examination. Particularly, in India, high-costs, unsustainable electricity and lack of properly trained radiologists are major causes for the inaccessibility to mammograms and other procedures like it. More women die of breast cancer in the country than anywhere else in the world (around 70,000 women annually). While these high death rates due to inaccessibility to preventive care are tragic, they’ve inspired innovative medical devices that have revolutionized women’s health in India. 

One such device, known as iBreastExam was invented by computer engineer Mihir Shah. Shah invented the device to ensure that women in even the most rural parts of India could get affordable, accurate breast exams and seek treatments as needed. The battery-operated wireless machine is designed to record variations in breast elasticity and performs full examinations in five minutes, posting and recording results through a mobile app. Not only that, the exams are painless, radiation-free and are extremely affordable at $1 to $4 per exam.

Family Planning and Contraceptive Options

Lack of family planning and knowledge of contraceptive options is another challenge in improving women’s health in India. Many Indian women shy away from modern family planning and contraception due to things like familial expectations, cultural influence and a general fear stemming from misinformation from disreputable resources. Family planning and the use of contraception could reduce India’s high maternal mortality rates. However, without proper education on these matters, it is difficult for young Indian women to make informed decisions about what options are best for them. But, in the midst of India’s technological revolution, an increase in accessibility to mobile devices is steadily transforming the way women are gaining health awareness in India. 

There is a particular mobile app that is playing a huge role in improving women’s health awareness in India. Known as Gyan Jyoti, the mobile app provides credible information through educational films, TV advertisements and expert testimonials from doctors. It also acts as a counseling tool for ASHAS (appointed health counselors). The app allows ASHAS to expand their knowledge of family planning through an e-learning feature, customize their counseling plan according to the needs of clients and monitor and store client activity in order to provide the best information possible. 

Overall, while there are still many challenges in improving women’s health in India, the country has proven itself to be a pioneer in technological innovation. Just as well, it’s proven that transformation is possible by putting its innovations towards women’s health awareness through mobile apps, life-saving hand-held devices, and educational platforms that can be accessed at the click of a button. 

Ashlyn Jensen
Photo: Flickr

 

Maternal Health in the Gambia

Maternal health continues to be a concern in developing countries around the world. Although overall maternal mortality decreased by 44 percent from 1990 to 2015, many nations still have a long way to go if the goal of fewer than 70 deaths per 100,000 live births is to be reached by 2030. Of note, despite improvements, the maternal mortality in The Gambia remains one of the highest in the world, with 706 maternal deaths per 100,000 live births.

Maternal mortality is a reflection of the disparities between the rich and the poor, with 94 percent of all maternal deaths occurring in developing countries. The fact that 50 percent of The Gambia’s population lives below the poverty line contributes to the high rates of maternal mortality in the nation.

A majority of the complications that lead to maternal deaths are preventable or treatable. However, either because the mother is giving birth outside of a health care facility or due to a lack of supplies or expertise, the necessary care is not always provided.

The main causes of maternal deaths are severe bleeding, infections, high blood pressure and delivery complications. Other deaths are caused by malaria, AIDS and other diseases.

Contributing Factors

In The Gambia, the national maternal mortality ratio decreased by 46 percent between 1995 and 2015. This can, in part, be attributed to an increase in antenatal care coverage, as 86.2 percent of Gambian women now receive antenatal care from a skilled health professional.

For deliveries, however, only 57.2 percent take place in the presence of a skilled health professional. Most women deliver at home with a traditional birth attendant; the main barriers to giving birth in a health care facility being insufficient time to travel and lack of transportation.

Maternal health in The Gambia is further complicated by social and cultural factors that contribute to pregnancy complications and the low percentage of women who give birth at a health facility or with a health professional. A study done in rural Gambia found that there were four interrelated factors that impacted maternal health:

  • Pregnant women’s heavy workload
  • The gendered division of labor
  • Women’s inferior status in the household
  • Limited access to and utilization of health care

Women in rural Gambia generally work alongside their husbands on farms, a fact that does not change even with pregnancy. Gambian women described being physically and emotionally exhausted from physical labor in the field and the house, noting that they did not get sufficient rest at any point during their pregnancy.

This is connected to the way labor is divided between men and women, as women often work longer hours than their husbands, regardless of whether they are pregnant or not. Social practices prevent men from doing certain household chores while their wives are pregnant to allow them to get more rest, which contributes to poor maternal health in The Gambia.

The activities that women continue to perform can also have negative impacts. Women noted that they had to fetch and carry water from long distances, pick groundnuts and cook with firewood, all of which are health risks for pregnant women.

Additionally, women have less control than their husbands, largely because they are economically dependent on them. Despite doing equal work in the field and more work in the house, women receive no financial benefits. This keeps them from becoming economically independent and forces them to rely on their husbands, giving their husbands more power.

As a result, many women who wanted to stop working could not unless their husbands allowed it. They also could not make certain decisions, including where to give birth, without the oversight of their husbands, contributing to a lack of utilization of health care facilities. As women are often required to work up until they give birth, their workload prevents them from being able to travel to a health care facility in time for delivery.

Improving maternal health in The Gambia, therefore, is connected to women’s autonomy. In addition to improving access to health care facilities and ensuring adequate supplies are available, work needs to be done to ensure that families are educated about the dangers of working during pregnancy and that women have the ability to make decisions for themselves about where to give birth.

Improvement Efforts

Other efforts are also important to decreasing maternal mortality in The Gambia. Within the last decade, the Horizons Trust Gambia and The Gambian Ministry of Health partnered with an organization called Soapbox to launch the Maternal Cleanliness Champions Initiative aimed at reducing infections from childbirth.

One of the main projects of this initiative is the distribution of Clean Birth Kits, which include soap, a clean blade and a clean plastic sheet to help ensure that expectant mothers have sanitary materials regardless of whether they are giving birth at a hospital or at home.

The Maternal Cleanliness Champions Initiative also worked to create a manual for cleanliness standards at health care facilities in The Gambia, adapting the manual to work with the local context of each hospital. The program also supported the training of facility staff to ensure that they knew how to adequately clean to prevent infections and other health complications.

These important efforts need to be combined with others to form a holistic approach to improving maternal health in The Gambia. Only coordinated efforts that are adapted to cultural and social contexts will be successful in significantly reducing maternal mortality in the nation.

– Sara Olk
Photo: Flickr

 

India Doubles
The Indian Parliament has recently passed a bill that more than doubles the nationally mandated paid maternity leave from 12 weeks to 26 weeks. The policy change makes India the country with the third-longest paid leave for mothers in the world, trailing behind only Norway and Canada. The new requirements for paid maternity leave in India will expand opportunities for many women.

The bill requires implementation in businesses with more than 10 employees. In a country that has been previously criticized for its lack of gender equality, the bill is revolutionary to the growing economy. The new legislation also requires businesses with more than 50 employees to provide nurseries for childcare in close proximity to their offices.

The months following the birth of a child often call for a reassessment of finances and economic security. Families in developing communities can be hit especially hard by new expenses.

In the U.S., no federal law requires employers to provide paid leave for new parents. Only a few U.S. states have legislation that addresses the issue. This lack of legislation is often harmful, and the Census Bureau reported in 2011 that more than 40 percent of new mothers are forced to take unpaid leave. Human Rights Watch has also conducted studies on the impact of a lack of paid leave for new parents in the U.S. After conducting in-depth interviews with 64 American couples, the organization found that just over a third of the families had gone into debt in the months following the birth of a child.

Positive Social Impacts of the Bill

Activists have stated that the extension of paid maternity leave in India will encourage women to more deeply explore potential economic opportunities. A survey that was released last year by the Associated Chambers of Commerce and Industry of India brought to light the fact that a quarter of Indian women in urban areas quit their jobs after having their first child. Hopefully, the new bill will help lower this number.

The Indian Prime Minister, Narendra Modi, expressed on social media that the new bill is a “landmark moment in our efforts towards women-led development.” The Minister of Women and Child Development, Maneka Gandhi, says that the law will “help thousands of women and produce much healthier children.”

In terms of social norms and gender stereotypes, India has a long way to go before women are on the same playing field as men. The extension of paid maternity leave in India has the potential to encourage economic participation from women across the country, and hopefully, it will do just that.

Not only will the law help women in India, many are optimistic that it will inspire other countries to follow suit.

Peyton Jacobsen

Photo: Flickr

Maternal Health in Haiti a Concern For UNFPA
The U.N. Population Fund has expressed concern over the effects that Hurricane Matthew will have on the more than 8,400 pregnant women in the country and those who will need cesarean sections or other maternal care. It has pledged to make maternal health in Haiti a key aspect of its response to Hurricane Matthew.

The organization has pledged to send 252 emergency reproductive health kits to 450,000 people in the next three months. These kits will include resources such as medicine and supplies for safe deliveries, rape treatment and voluntary family planning. The organization also plans to certify local midwives through their own UNFPA supported schools and to open clinics that these midwives will staff. In total, UNFPA hopes to raise $5 million for this project.

UNFPA Executive Director Dr. Babatunde Osotimehin explained the necessity for the project, stating, “Hurricane Matthew delivered a severe blow to Haiti’s health facilities, whether by flooding these centers or blowing off their roofs and putting them out of service. Our urgent task is to protect the health and rights of women and girls and to ensure that their basic needs, which are often overlooked in humanitarian situations, are quickly met. We will work to help women give birth and live, despite this tragedy.”

Maternal health in Haiti has been an issue in the country since well before Hurricane Matthew. Haiti has the highest maternal and infant death rates in the western hemisphere and, in light of Matthew’s aftermath, these rates are expected to rise. UNFPA warned in a press release that an estimated 13,650 women are expected to give birth in the next three months, and the storm’s destruction of many healthcare facilities on the island has raised serious concern among human rights groups.

According to the World Health Organization, approximately 830 women die each day from causes related to pregnancy and childbirth, and 99 percent of these deaths occur in the developing world.

Adolescent pregnancies are very common in Haiti, and since family planning has been interrupted by the storm, such pregnancies are expected to rise in the next few months. According to a 2012 survey, approximately 11 percent of adolescent girls in the country have at least one child.

Magdala Bourdeau, a midwife in Haiti told UNFPA, “Since November 3, we have carried out several deliveries and received several types of pathologies, such as pre-eclampsia, severe anemia, high blood pressure and premature pregnancies.”

Dr. Joanne Liu, the international president of Médecins Sans Frontières, reports that the five main causes of maternal death include hemorrhage, sepsis (infection), complications resulting from unsafe abortion, hypertensive disorders and obstructed labor. Such conditions are usually preventable with access to medical care, but maternal death rates remain high in areas where disaster or conflict has limited access to such care.

The U.N. Population Fund aims to protect maternal health in Haiti and hopes to raise the $5 million that it needs in time to do so.

Eva Kennedy

Photo: Flickr