How the Maternal Mortality Rate is Decreasing in Sierra LeoneThe capital of Sierra Leone, Freetown, is historically known for being a home for freed slaves during the transatlantic slave trade, giving Sierra Leone a prominent place in history. However, the small west African country boarding Guinea has faced many adversities. One is the significant increase in adolescent pregnancies and fertility being some of the highest in the world. Women in Sierra Leone have “a one in 17 lifetime chance of dying during pregnancy, delivery or its aftermath.” This article will discuss the main reasons for the decreasing maternal mortality rate in Sierra Leone.

Data Behind the Mortality Rate in Sierra Leone

For the government of Sierra Leone, keeping a consistent record of deaths was nearly nonexistent during the Ebola outbreak. According to an article by Financial Times, Dr. Sesay, who is “the government’s director of reproductive and child health,” conducts the government’s response to the maternal deaths. According to Dr. Sesay, procedures are set out to lower the maternal mortality rate in Sierra Leone. “We’ve put in place a maternal death surveillance and response team, and developed a technical guideline. When a death is reported, they go and confirm.”

Part of the surveillance is ensuring that reporting the deaths is imperative. This requires health workers within communities to report the deaths to major health facilities. Furthermore, this is vital to decreasing the maternal mortality rate in Sierra Leone as it ensures that all families are accounted for and not misrepresented in the sample population. However, the same health workers reporting the data are the same ones attempting to save these expectant mothers’ lives, which stretches on the ground workers.

Looking at the Numbers

Maternal mortality in Sierra Leone had reached 1,070 deaths between January to June of 2020. According to a report by the ministry of health and sanitation in Sierra Leone, from January to March of 2020, there was a total of 581 maternal deaths. And from April to June of 2020, the total was 489 maternal deaths.

Equally as important, the predominant reference of data for maternal deaths is CRVS (Civil Registration and Vital Statistics). The issue is that Sierra Leone doesn’t recognize this system of data reporting. When this occurs, other data systems are created, such as surveys and various studies, which leaves more room for inaccurate information. The organizations the World Health Organization, the United Nations International Children’s Emergency Fund, the United Nations Population Fund and the World Bank Group have collectively concluded that not all deaths can be recorded due to “systematic error.” Meaning the data presented won’t be accurate due to the actual number being lower or higher and this will impact how the maternal mortality rate is decreasing in Sierra Leone.

However, when using CRVS, “records will be systematically lower than the true number because there will always be deaths that go unreported. This is referred to as a systematic error.” Along with systematic error, there is the possibility of “random error,” meaning when a health worker records inaccurate information. This increases the inaccuracy of maternal deaths in Sierra Leone. Considering health workers are underpaid and overworked, random error is present when recording maternal deaths.

How to Improve Maternal Mortality Rate Efforts

There are multiple ways of decreasing the maternal mortality rate in Sierra Leone. However, today’s most beneficial way is by increasing and encouraging education for traditional birth attendants (TBAs). Undergoing childbirth for many women in Sierra Leone in the past meant being at home and having a TBA present. Usually, a TBA is an elderly woman from within the community and is often referred to as “auntie” or “mother.” Although this may sound beneficial and comfortable, such as having a midwife or doula, according to the government, TBAs were the primary reason for the country’s maternal deaths.

If patients were to have any complications during delivery, the TBA would inform the patient that emergency transportation would take too long to arrive and going to the nearest clinic would take too much time. In most cases, patients would bleed out as healthcare officials would arrive too late. The government attempted to resolve this issue by ratifying a law in 2010 forbidding TBAs to assist in deliveries outside of a clinical environment. If a TBA and anyone else taking part in the process, including the expectant mother, were caught defying this law they would face extreme retribution.

Established in 2001, the non-governmental organization IsraAID is working towards providing “emergency and long-term development settings in 50 plus countries.” The organization also has a medical care program that targets “reproductive health,” along with expanding educational opportunities. For the maternal mortality rate to decrease, the government of Sierra Leone has to establish effective maternal mortality reporting data and education for TBAs.

—Montana Moore
Photo: Flickr

Healthcare in Uganda
Uganda continues to have one of the best healthcare systems in Africa. In the 1980s, the nation had a reputation of possessing bottom tier medical management compared to the rest of the world. However, government officials worked tirelessly to provide the necessary medical equipment to combat diseases and curb infection rates. The Ugandan healthcare system eventually became one of the strongest on the continent. Here are 5 ways healthcare in Uganda is continuing to improve.

5 Improvements to Healthcare in Uganda

  1. HIV Reduction: Uganda is one of a small number of countries that was able to reverse the harmful infection rates of the HIV epidemic. At one point during the 1990s, the nation had an infection rate of 18-30% in its population. However, this number slowly went down to as low as 6.5% in 2016. The Government of Uganda worked with multiple organizations, including UNAIDS, to help maintain a low number of infections. Officials also invested in properly educating the people on how to better protect themselves from contracting the virus.
  2. Maternal Mortality Rate (MMR): The nation has started to see a major reduction in MMR over the last several years. This is due to a few factors, including adopting the Saving Mother Giving Life or SMGL model. According to the WHO, Africa has an MMR average of 561 per 100,000 births while Uganda’s rate is only 343 per 100,000 births.
  3. CDC Assistance: The CDC has aided healthcare in Uganda in many ways. In 2018, the organization helped an estimated 608,000 people by providing them with life-saving antiretroviral treatment. Moreover, the CDC’s team helped implement a national biosafety level 3 reference laboratory for viral hemorrhagic fevers. The lab assisted in the detection and providing confirmation about VHF outbreaks in the nation.
  4. Poverty Line Reduction: A lack of resources due to poverty still limits the progression of healthcare in Uganda. The poorest of the country make up a majority of visitations facilities receive because they are more susceptible to diseases. However, Uganda took steps to lower the effects of poverty starting around 2006. Over the next seven years, the poverty rate declined from 31.1% in 2006 to 19.7% in 2013. Moreover, Uganda continues to work on providing healthcare to the poor in rural areas. The country is focused on ensuring medical treatment access to non-Urban Ugandans.
  5. Combating COVID-19: The Ministry of Health in Uganda placed guidelines to prevent COVID-19 from spreading throughout the nation. The country experiences very low numbers in confirmed cases compared to the rest of the world. The officials made several posts on their website about health guidelines they should follow when visiting the hospital to seek treatment if infected.

While Uganda has witnessed improvements to their healthcare system, there remain obstacles. One of the primary ones is the lack of medical resources needed to be placed at the top tier level with countries like the United States in medical advancement. The Government of Uganda continues to seek aid and find other ways to help its people receive the best treatment they can provide. With these efforts, hopefully healthcare in Uganda will continue to improve.

Donovan Baxter
Photo: Flickr

Infant Mortality Rate in HaitiThe infant mortality rate in Haiti is the highest in the Western Hemisphere. While the rate has been decreasing since 2000, recent environmental disasters beginning with the 2010 earthquake have created many setbacks. Here are five facts about Haitian infant mortality:

1-      In 2016 the infant mortality rate in Haiti – deaths of children aged one year or younger – was 52.2 per 1,000 live births, whereas the U.S. rate was 5.6 per 1,000. The main reasons for the high ratio in Haiti come down to crushing poverty, poor health infrastructure and the lack of accessible healthcare.

2-      75 percent of mothers in Haiti give birth at home, without a skilled birth attendant or access to emergency childbirth services. The main reason for this is that much of Haiti is rural and underdeveloped. With 55 percent of Haitians living in rural areas, most mothers do not have access to proper medical facilities, emergency transportation, or skilled midwives. This leaves the majority of mothers in Haiti without the proper support through labor.

3-      The maternal mortality rate of the country was 359 to 100,000 live births in 2015. Most of the maternal deaths in Haiti are preventable as they are mostly caused by eclampsia, sepsis and postpartum hemorrhages. Reducing this ratio is important, as children who have lost their mothers are 10 times more likely to die prematurely than those who are with their mothers.

4-      Only 37 percent of births are delivered with a skilled attendant present. Haiti has one midwife for every 50,000 people according to the United Nations Population Fund. The 2010 Haiti earthquake harshened these conditions as the natural disaster destroyed the main school in Haiti for midwives, took the lives of many healthcare professionals and led to the emigration of other workers.

5-      With this said, there are nonprofit organizations that are working together to reduce the infant mortality rate in Haiti. Every Mother Counts is an organization based in New York that dedicates its resources to making pregnancy and childbirth safe for mothers around the world. This organization supports Midwives for Haiti in order to train newly skilled birth attendants with the goal to improve the quality of care and access to skilled delivery care in Haiti. Since 2012, Every Mother Counts has funded the training of 69 midwives in Haiti, who continue to deliver around 200 babies every year.

Midwives for Haiti is a grassroots nonprofit organization working in Haiti to reduce both maternal and infant mortality rates. The organization runs educational programs to train Haitian nurses in the skills necessary for deliveries, and then empowers these individuals to reach rural mothers that need care. The resources they have collected provide mobile prenatal clinics, reaching women across 23 rural villages. These efforts are crucial in reducing the infant mortality rate, as the World Health Organization has identified the investment in health workers as being the critical building block for healthier deliveries around the world.

With the support of these organizations, every year the infant mortality rate is estimated to be falling by about 3 percent and since 1990, the maternal mortality rate in Haiti has declined by 43 percent.

While there have been great health improvements in Haiti for pregnancy and childbirth, there is more that can be done. The U.S. can improve the odds further by passing the Reach Every Child and Mother Act. The bill would create reforms to increase the impact and effectiveness of The United States Agency for International Development (USAID) for maternal and child survival programs. Additionally, the bill would provide USAID the right to implement new and innovative financial tools that are already helping countries in need. By supporting and passing this piece of legislation, USAID will be given another tool to save the lives of mothers and infants in Haiti and around the rest of the world.

Tess Hinteregger

maternal mortalityIn 2000, the U.N. agreed on eight Millennium Development Goals that it hoped to reach by 2015. Included among these goals: promoting gender equality and empowering women, reducing child mortality and improving maternal health. For the Philippines, improving maternal health is an extremely important goal since the maternal mortality rate of the Philippines was high—209 deaths per 100,000 live births as of 1993. The target for the Philippines is the reduction of the MMR to 52 deaths per 100,000 live births by 2015. However, while maternal mortality has been decreasing in the Philippines, it has not been falling at a fast enough rate.

Maternal deaths are still a huge concern for the Philippines. By 2006, the maternal mortality rate decreased to a rate of 162 per 100,000 live births and currently, the MMR is 120 deaths per 100,000 live births—still nowhere near the target that the MDGs established.

Various factors are responsible for the high rate of maternal mortality that the Philippines face. According to the IRIN, some of the main causes of maternal deaths are hemorrhages, sepsis, obstructed labor, hypertensive disorders during pregnancy and complications associated with unsafe abortions. Having a physician, nurse or midwife who has had formal training present during the birth can decrease the maternal mortality rate, but currently, these skilled birthing attendants supervise only 60 percent of births in the Philippines. Others rely on traditional birthing attendants who do not have formal training and therefore are often unable to deal with complications.

Poor women and women in rural areas are at a disadvantage. Around 75 percent of the poorest quintile do not have a skilled birth attendant to help them through their pregnancy. Rural areas also have higher maternal mortality rates because many women in rural areas begin having children at a young age. Since adolescent women are normally not developed enough for childbirth, these young mothers face many complications during and after pregnancy and contribute to the high maternal mortality rate.

Another problem that adds to the high maternal mortality rate in the Philippines is the low level of contraceptive use. The Philippines is 80 percent Catholic, so birth control pills, condoms and other forms are contraceptive use are considered to be similar to abortion. This has led to limited access to contraceptives, since contraceptives were previously not widely available at health care clinics.

This limited access to contraceptives has negative effects. In 2006, there were three million pregnancies in the Philippines. Half of those pregnancies were unplanned, and one third of the unplanned pregnancies resulted in abortions. A higher rate of contraceptive use will prevent this from happening and will consequently decrease the maternal mortality rate.

While rates of contraceptive use have not risen much from 2006 to 2014, there is hope that contraceptive use will now increase dramatically due to a birth control law that the Philippine Supreme court approved in April 2014. The law requires the government’s health centers to have free condoms and contraceptive pills. It may be too soon to tell whether that law has a significant effect on maternal mortality. However, the law will hopefully help the Philippines to reach its MDG by the end of 2015. Other ways to help reduce maternal mortality are providing more antenatal care and more widespread access to health facilities.

– Ashrita Rau

Sources: UNDP, IRIN News, Philstar, WHO, Huffington Post, United Nations, BBC
Photo: Flickr

As the 2015 deadline for the Millennium Development Goals quickly approaches, the UN is encouraging governments around the world to intensify their efforts on the goals that have seen little or no progress since 2000. The main goals that still require significant attention are reducing maternal and child deaths and increasing access to improved sanitation facilities.

There have been several successes in these areas so far. In the past 20 years, the number of children dying before the age of five has dropped by nearly 50 percent. The global maternal mortality ratio has dropped by about 45 percent. It is estimated that 3.3 million deaths due to malaria have been prevented. Additionally, the goal of improving access to safe water globally has been met.

The 2014 report put out by the UN, which is based on data from 2010 to 2014, claims that many other goals are still attainable if current trends and efforts continue.

However, there are some goals that do not seem feasible any longer. Only half of pregnant women in developing countries are getting the appropriate number of prenatal checkups. Diarrhea and pneumonia are still prevalent in many countries and are the main causes of death in children under five. In the past four years, 162 million children were not receiving proper nutrition. Finally, sanitation facilities are not as available as they should be, even in middle-income countries; more than one billion people are still required to resort to open defecation.

Andy Haines, a public health expert and the London School of Hygiene & Tropical Medicine in the United Kingdom, said that the results of these goals are a “mixed picture of major advances towards some goals and worrying shortfalls in progress in the case of others.”

The Millennium Development Goals that are furthest from completion are the ones relating to women: gender equality and reducing maternal and child deaths. Last year, UNICEF claimed that at the current rate, the goal of reducing maternal and child deaths by two-thirds will not be achieved until 2028.

Seven out of the nine regions throughout the world that are participating in the MDG have not reached the goal of reducing maternal and child deaths. Three of them, Oceania, Southern Asia and Sub-Saharan Africa, are not expected to achieve this particular goal, and others may fall short as 2015 approaches.

UN Secretary General Ban Ki-moon recognizes the progress made thus far, but also the need for continued efforts. He said, “The concerted efforts of national governments, the international community, civil society and the private sector have helped expand hope and opportunity for people around the world. But more needs to be done to accelerate progress. We need bolder and focused action where significant gaps and disparities exist.”

By learning from the flaws of the Millennium Development Goals, the UN and fellow organizations have already begun work on the next set of goals called the Sustainable Development Goals. These goals will incorporate a wider span of topics that were not in the MDG, such as economic and environmental issues.

– Hannah Cleveland 

Sources: The Guardian, Science Development Network
Photo: Unicef

More Midwives Needed in NepalNepal’s maternal mortality rate (MMR), or the ratio of maternal deaths per 100,000 live births for reasons related to pregnancy or birth, has declined in Nepal over the last fifteen years. It is estimated that between 1996 and 2005, Nepal reduced its MMR from 539 deaths to 281. It was estimated in 2010 to be around 170.

These declines, similar to those seen in countries such as Bangladesh, Malaysia, and Thailand, are cause for hope. However, health care experts say the gains in Nepal are unsustainable if the country does not address its need for more health care professionals, especially midwives, to prevent women from dying in childbirth.

Declines in maternal mortality rate are attributable to a number of factors other than improved health care access or services. Nepal’s paradox is that even though the MMR is decreasing, access to skilled birth care is still very low. In general, improved health care positively correlates with reduced MMR, but sub-Saharan Africa and Asia have not demonstrated a strong correlation so far due to lack of skilled birth care.

Experts in maternal health do not have the data necessary to determine the exact causes of the decline, but there are multiple factors involved. The top reasons are the social empowerment of women, reduced fertility, and government health care programs. Nepalese women are now having fewer children on average, and have more access to contraception and family planning tools. Women’s life expectancies and literacy rates have increased as MMR has declined. Women are now also offered financial incentives to seek medical care during pregnancy and have more access to affordable, life-saving health care such as blood transfusions.

Nepal is on track to meet its Millennium Development Goal of reducing MMR by 75 percent, to 134 deaths per 100,000 live births. When it reaches that point, the country will require the help of more midwives and health care workers trained in birthing to further reduce maternal mortality. A 2012 UN study found that a midwife in attendance during birth can reduce up to 90 percent of maternal deaths.

– Kat Henrichs

Source: IRIN
Photo: Midwife Ramilla