According to the World Health Organization, 9.2 million children under the age of 5 die every year, many from preventable conditions that could be treated with simple healthcare interventions. The majority of these deaths occur in Sub-Saharan Africa and South Asia, where the child mortality rate is 175 per 1000 (compared to 6 per 1000 in industrialized countries).

Many of the diseases that kill children younger than 5-years-old are caused by lack of access to healthcare facilities, improper hygiene and sanitation, unclean water and not enough food, and low levels of education and information. The top three causes of child mortality are:

1. Pneumonia
About 15 percent of child mortality deaths are caused by pneumonia. In 2013, pneumonia killed an estimated 935,000 children under the age of 5. Pneumonia occurs when the air sacs in the lungs, the alveoli, are filled with pus and fluid. This makes breathing difficult, and does not allow the infected person to intake enough oxygen. Those who are malnourished have weaker immune systems and are therefore at a higher risk of dying from pneumonia. Pneumonia is also more likely to affect those who have pre-existing illnesses such as HIV, who live in an area where levels of indoor air pollution are high because of cooking with biomass fuels like wood or dung, who live in crowded homes, or those who have parents who smoke. While pneumonia can be treated with antibiotics, only one third of the children infected with pneumonia get the antibiotics necessary to cure them.

2. Diarrhoeal Disease
Each year, diarrhea kills 760,000 children under the age of 5. It is caused by unclean drinking water, contaminated food or person-to-person contact and poor hygiene. Malnourished children are more susceptible to diarrhea, and children in developing countries are likely to contract at least three cases of diarrhea each year. Since diarrhea leads to malnourishment, those who are already weakened by the disease are likely to contract it again. Diarrhea then leads to severe dehydration, which leads to death. It can be treated with rehydration zinc supplements. A good method of preventing diarrhea is decreasing levels of malnutrition, therefore making children less likely to be infected with the disease.

3. Malaria
In Africa, a child dies every minute from malaria, a disease caused by parasites. These parasites are transmitted to people from mosquito bites. The symptoms are first expressed as fever, chills and vomiting, and can then progress to severe illness and death if not treated within 24 hours. Malaria is preventable through the use of mosquito nets and levels of deaths caused by malaria are decreasing. Malaria related mortality cases in Africa have fallen 54 percent since 2000.

Child mortality is also high in countries that have a high Maternal Mortality Rate (MMR). More than a third of child mortality deaths occur in the first month of life and are related to pre-term birth, birth asphyxia (suffocation), and infections. In order to reduce Child Mortality, Maternal Mortality rates also have to decrease. This can happen with increased access to healthcare facilities and increased prenatal visits.

Child mortality rates are decreasing, but there is still work to be done. Vaccinations, adequate nutrition and increasing education will all help to decrease the levels of child mortality.

Ashrita Rau

Sources: WHO 1, WHO 2, WHO 3, WHO 4
Photo: Flickr

The earthquakes that shook Nepal in late April and early May were declared the country’s worst natural disaster on record. The quakes claimed the lives of 8,800 people and injured 22,000 others. The mass destruction and death toll continue to have devastating effects on all aspects of the country’s well-being. The Nepalese people are trying to rebuild and reclaim the sense of normalcy that existed before the quakes, but the earthquakes’ effects have presented new challenges.

Before the storm, increasing amounts of Nepalese women were choosing to have their babies in health facilities — a choice that helped Nepal meet the United Nations Millennium Development Goal in the reduction of maternal mortality rates by three-quarters. Another major factor in the massive reduction of such rates is a decade-old decision to distribute misoprostol to women who need it. Misoprostol is a drug designed to treat stomach ulcers, but is also capable of terminating a pregnancy when taken early on, and preventing postpartum hemorrhage — the leading cause of maternal death — when taken after giving birth.

The decision to distribute the powerful drug as a means to decrease maternal mortality lacked international support largely because the hegemonic ideology is that the best way to improve maternal mortality rates is to invest in making health facilities more accessible. While the idea of creating hundreds of well-stocked and adequately staffed health centers that are available to all mothers is a good one and would certainly reduce maternal mortality rates, overall it is unrealistic for many developing countries. The reality is that in developing countries where there have been large government expenditures on improving facilities, maternal mortality rates have not improved as significantly as they have in Nepal.

Since the massive earthquake struck, expectant mothers face additional challenges and there is concern that the mortality rates could increase again. With the destruction of roads and many healthcare facilities, giving expectant mothers misoprostol makes even more sense.

Currently, distributing the misoprostol amidst the widespread destruction is a major issue in Nepal. Aid groups, such as Direct Relief, have been working with the International Confederation of Midwives (ICM) and the Midwifery Society of Nepal (MIDSON), to deliver midwife kits, tents and funds. The intervention program focuses on providing midwives and the tools that they require, including misoprostol, to give Nepalese mothers the best chance at having a healthy delivery.

When access to midwives and trained professionals is as severely limited as it is in Nepal, there needs to be a backup plan. Few countries have followed in Nepal’s footsteps but if Nepal’s success has been any indication, misoprostol could be an intermittent solution that could work for many developing countries. In time, we will see how Nepalese maternal mortality rates fare in the aftermath of the horrific disaster. If the low rates are upheld, perhaps the international community will reconsider responsible use of misoprostol to get countries maternal mortality rates down, until the large scale investments in facilities and infrastructure can be made.

– Emma Dowd

Sources: Economist, Foreign Policy, Military Technologies, Reuters
Photo: Women News Network

Fifteen years ago, a summit convened. All member states of the United Nations at the time gathered and agreed on eight international development goals. The Millennium Development Goals (MDG), as they are named, were adopted to better lives in the developing world.

One of the countries highlighted was China, and it has surpassed the world’s expectations, improving health for mothers and their children – ahead of the 2015 target date.

The National Health and Family Planning Commission (NHFPC), an organization within the People’s Republic of China that works at the policy level to improve medical conditions for Chinese families, stated that, as of June 10, 2015, maternal mortality rates have dropped dramatically over the past 25 years. This exceeds the fifth Millennium Goal and has made a powerful impact on the lives of Chinese women.

The maternal death rate in China dropped significantly since 1990. In fact, it has plummeted 75.6 percent. In 1990 death rate among mothers giving birth was 88.8 per 100,000 compared to 21.7 per 100,000 in 2014.

Maternal mortality rates can be an important indication of the health of a nation and China’s success, attributed in part to its growing economy, better funded health care and allowances provided for rural women to give birth in hospitals, suggests extraordinary progress.

The gap between urban and rural pregnancies has always been vast in China with rural care significantly lower, but in past years access to medical services in less populated areas has improved as well. The hospital delivery rate in rural families was merely 36.4 percent in 1990 while in 2014, the rate had increased to 99.6 percent.

Additionally, the NHFPC said that in 2014, seven years ahead of the Millennium Development Goals deadline, infant death rates and mortality for children under 5 dropped to 8.9 per thousand and 11.7 per thousand, respectively.

In Nanning, capital of southwest China’s Guangxi Zhuang Autonomous region, several health vehicles, with the help of two organizations, were put into operation devoted to impoverished rural women in need of maternal care.

All-China Women’s Federation (ACWF) and the China Women’s Development Foundation (CWDF) donated 30 Health Express for Mothers mobile medical units in 2009 and 10 more in August 2011. During the year before the ceremonial departure on August 4, 2011, over 4,000 maternal women and 500 more critical patients were helped by the service.

Medical units such as the ones in Nanning have helped thousands of women, given training to over 17,000 medical workers and have brought health benefits to millions of rural residents.

China has made leaps and bounds in the care for its women and children. Increased healthcare funding and better medical facilities accompanied with the grass roots efforts of tenacious citizens have demonstrated China’s ability to go above and beyond the world’s expectations, improving life for its people.

– Jason Zimmerman

Sources: Women of China, Women of China, The Lancet, Women of China,
Photo: MedHealthNet

Nigeria is second only to India in terms of the number of maternal deaths it experiences, and along with five other countries—India, Pakistan, The Democratic Republic of the Congo, China and Ethiopia—Nigeria is part of a group which makes up more than 50 percent of the maternal mortalities that occur in the world.

The Maternal Mortality Rate (MMR) in Nigeria was 560 per 100,000 live births in 2013. As UNICEF states, Nigeria loses 145 women to maternal mortality each day. This high level of maternal mortality is also linked to Nigeria’s high rate of deaths for children under 5—newborns account for a quarter of the under-five deaths which occur in the country.

There are many reasons why maternal mortality in Nigeria is so high, including a lack of access to healthcare, rampant poverty, substandard health care and the prevalence of child marriage.

Urban women have more of an opportunity to receive healthcare than rural women do. As stated in a Global One report about Nigeria, women in urban areas have over twice as many deliveries taking place in public and private health facilitates than women in rural areas. This is because women in rural areas are normally not able to afford the transport to the hospitals in urban areas, and have to settle for midwives or traditional birth attendants—or no help at all—when giving birth. Many of these traditional birth attendants do not have the skills and training necessary for delivering a baby—for example, many are not able to perform C-sections—and for treating complications that can occur during birth.

Rural women do not have the money to travel to hospitals to receive better care. Nigeria has a high poverty rate, with a 2010 report stating that 64.4 percent of the population lived in extreme poverty and 83.9 percent of the population lived in moderate to extreme poverty. The fact that many people cannot afford the healthcare that they need contributes to Nigeria’s high MMR.

Even if women in Nigeria are able to have access to a hospital, they sometimes still end up suffering. This is because some hospitals in Nigeria have substandard care. For example, Global One’s report states that substandard birth techniques in government hospitals in North-Central Nigeria, including poor C-section procedures, accounted for 40 percent of all fistula injuries suffered by women in Nigeria.

A fistula, according to the World Health Organization, is a hole in the birth canal. Fistulas are directly connected to obstructed labor, a problem that contributes to high levels of maternal mortality. Even if women survive labor, many of them still have to live with the fistula. Approximately two million women live with an untreated obstetric fistula in Sub-Saharan Africa and in Asia, and women with fistulas suffer incontinence, social segregation and health issues.

Fistulas are more common in women who give birth at a young age. These women’s bodies are not ready for childbirth, leading to many health problems, including obstetric fistulas. Nigeria has an extremely high rate of child marriage—43 percent of girls get married before the age of eighteen—and many of those girls are not given the option of whether or not they want to get pregnant. Contraceptive use is slowly becoming more widespread and acceptable, but in 2008, only 10 percent of women used contraceptives.

Since contraceptive use is still stigmatized, many brides under the age of 18 are forced to give birth, and their bodies are very vulnerable to complications, therefore contributing to a high maternal mortality rate. Nigeria also has a high fertility rate—five children per woman in 2014—which also impacts the MMR.

If Nigeria wants to reduce its high levels of maternal mortality, it has to make sure that access to healthcare is more widespread. It also needs to improve the quality of healthcare available, reduce the number of child marriages and de-stigmatize contraceptive use.

– Ashrita Rau

Sources: UNICEF, WHO 1 WHO 2, WHO 3WHO 3, Global One Girls not Brides, IRIN News CIA World Factbook
Photo: Healthy Newborn Network

Sierra Leone, a small country on the West African coast, gained independence from Britain in 1961. Ranked as the least developed country in the world in 2007, poverty and maternal mortality are some of the main problems that Sierra Leone faces today.

As of 2010, Sierra Leone had a maternal mortality rate (MMR) of 857 per 100,000 live births, making it one of the most dangerous countries in the world for women to give birth. This high maternal mortality rate was mainly due to hemorrhages, a cause of 26 percent of maternal deaths in sub-Saharan Africa. Since Sierra Leone only collects annually one-forth of the blood it needs for transfusions, hemorrhages are a major danger during childbirth. Other contributors to the high MMR are obstructed labor, anemia and toxemia during pregnancy.

Approximately 73 percent of births in Sierra Leone occur in rural areas, where access to health care during pregnancy is normally limited and maternal healthcare does not have as many beneficial outcomes compared to healthcare in urban areas. Many women who need cesarean sections do not receive them, due to the fact that even if a birth attendant is present, many birth attendants are actually aides who do not have the qualifications to perform a cesarean section or to do other tasks that are necessary to help the mothers survive.

Maternal mortality is also prevalent because of a lack of sanitation. Traditional practices also play a cause, since many communities choose home-births instead of modern health care facilities.

Another cause of maternal mortality in Sierra Leone is the high rate of adolescent marriages. Forty-four percent of girls in Sierra Leone marry before they reach the age of 18. Adolescents are more likely to suffer during pregnancy and childbirth, as their bodies are normally not developed enough to carry a baby and deliver safely.

Contraceptive use is also not widespread in Sierra Leone, contributing to Sierra Leone’s high MMR. Only about 7 percent of women use contraceptives, leading to a high fertility rate of 5 children per woman. This contributes to more children and more pregnancy related complications.

In 2010, in order to reduce the MMR and the high rate of children’s deaths in Sierra Leone—almost one-third of children died before they reached their fifth birthday as of 2007—the government of Sierra Leone implemented a policy that would provide free healthcare for pregnant and lactating women and for children under the age of five. This policy led to increased amounts of antenatal care visits immediately after it was introduced, but antenatal care visits decreased once again a few months later, and the policy was not as impactful as hoped.

Therefore, despite the 2010 healthcare act, Sierra Leone is still facing high rates of maternal mortality and a high rate of deaths among children under 5. However, there is hope. Thanks to a now thriving mining industry and a GDP that is growing, Sierra Leone’s economy is looking up. Hopefully, these economic benefits can be invested in the healthcare industry and can help contribute to the supplies and care that pregnant women and their children need.

– Ashrita Rau

Sources: The Borgen Project 1, The Borgen Project 2, Amnesty International, UNFPA, WHO 1, WHO 2, The Guardian, ICRW
Photo: Flickr

merck for mothers
Merck for Mothers is a 10-year, $500 million initiative that envisions, and works toward, a world where no woman dies giving life. Currently, an estimated 800 women die per day, primarily in developing nations. Merck’s global mission is to bring better healthcare and innovative health solutions to millions of people across the developing world; a commitment that has been in standing for more than 150 years. Working closely with its program leadership, advisory board, healthcare workers, maternal health experts and policy makers, the Merck for Mothers initiative has already served in more than 30 countries across the world.

As stated on its website, “Women are the cornerstone of a healthy and prosperous world. When a mother survives pregnancy and childbirth, her family, community, and nation thrive.”

Merck for Mothers aims to see nations thrive by saving as many lives as possible, and it does this by tackling the two leading causes of maternal mortality: excessive bleeding after labor and high blood pressure disorders during pregnancy and childbirth.

For example, in Uganda, where a woman faces a one in 49 chance of dying during pregnancy and childbirth, many of the private healthcare providers, such as independent midwives and local pharmacies, offer services that are not always regulated and can vary in quality. As a result, Merck for Mothers explores the ability of these local private providers and health businesses to deliver affordable and high-quality maternal healthcare. This is a program that has estimated to reach more than 150 thousand pregnant women over the span of three years.

Each of the 30 country programs is different and tailored to that country, yet they all strive for the same goal: giving mothers a better chance at surviving pregnancy and childbirth. In addition, Merck for Mothers focuses on family planning, which is known to play a key role in reducing maternal mortality. Merck for Mothers explains this through the Ripple Effect. When a mother dies, the ripple effect begins with her child who is more likely to die before the age of two. If she has other children, they are also up to 10 times more likely to leave school and suffer from poor health. But a mother’s death affects more than just her family.

Merck for Mothers believes that a woman’s death also impairs her community. Representing as much as one-third of the world’s gross national product, a woman’s unpaid work contributes to a community’s economic prosperity. In the end, this becomes a global economic issue. For these reasons, Merck for Mothers focuses on three key areas: innovation, access and advocacy.

At Merck, corporate responsibility is the cornerstone of its daily commitment to tackle global health challenges, such as river blindness, HIV/AIDS and cervical cancer. It has been a 150-year commitment, but that has not stopped Merck from making new additions.

With Merck for Mothers, it can now expand its scope and save the lives of millions of mothers across the globe, so that every day 800 more lives of women are spared.

– Chelsee Yee

Sources: Merck for Mothers, Poughkeepsie Journal, Mobi Health News
Photo: Modern Mom

With the second highest maternal mortality rates, Chad falls drastically behind the fifth United Nation Millennium Development Goal in diminishing the mortality ratio by three quarters. There are approximately 1,100 maternal deaths for every 100,000 live births, illustrating a dire need for solutions.

The nature of the problem varies, with deaths ranging from hemorrhage, HIV/AIDS, limited access to health care and obstructive labor. There is also a high Total Fertility Rate in Chad, with women averaging about 5 children.

Many disparities exist between Chadian women who live in urban and rural areas, where the latter averages a much higher TFR. This is partially due to the lack of access to antenatal care as well as limited availability of contraceptives.

Similar to many other patriarchal societies, men play a big role in hindering women from receiving family planning services, consequently endangering their spouse.

High maternal mortality rates pose serious social and economic repercussions for Chadians, further sinking affected families in poverty and decreasing the nation’s economic growth.

A mother is the foundation of a family and research has shown that when a mother passes, there is a greater likelihood for a child to drop out of school, in addition to becoming malnourished.

To address the problem at hand, the Chadian government should focus on increasing access to health facilities, strengthening family planning services and educating young mothers on proper antenatal care. Establishing clinics with trained health professionals  increases the rate of women with medical supervision during childbirth.

Chad has witnessed inadequate human resources for health; thus, more midwives and physicians are in need of proper training. In addition, 20 percent of women have an unmet need for contraceptives, indicating that family size is out of their control.

Better access to family planning allows births to be spaced out and reduces unwanted pregnancy. Furthermore, education is key in developing countries. Teaching Chadian women about reproductive health will ensure that women are making choices that are best for their bodies and will give them a sense of empowerment.

– Leeda Jewayni

Sources: CIA, Safer Birth in Chad, World Bank
Photo: The Guardian

Maternal Mortality in Afghanistan
In recent years, Afghan women have achieved significant social, economic, political and cultural gains that affect their quality of life. Despite these improvements, the country is still burdened with one of the highest maternal mortality rates in the world. According to UNICEF, 1,800 women die for every 100,000 births; most of these deaths are highly preventable, making it a serious public health concern.

The most common complication resulting in the death of the mother is post-partum hemorrhaging. Most Afghan women give birth in their homes, whether by choice or because of rural location. The differences in maternal mortality rates by region reflect the lack of resources and lack of access to health facilities. Most of the rural home-births are done without the presence of a skilled birthing attendant, increasing the risk for the mother.

UNICEF estimated that only 7 percent of women who died used a birthing attendant. Another challenge Afghan women face is access to hemorrhaging preventing drugs. Inexpensive drugs that simply don’t reach parts of rural Afghanistan where it is needed the most, due to conflict or allocation complications.

Afghanistan’s shortage of midwives and antihemorrhagic drugs are not the only two factors contributing to the high mortality rate. Lack of education, political participation, social and cultural practices also play large roles.

Women forced into marriages at a young age is not uncommon. Since contraception is not widely used, women also get pregnant at very young ages. When a woman is 14 or 15, the body is usually not developed enough to naturally carry a child. Women having children at a young age is arguably the greatest biological danger for a mother and her child. High maternal mortality rates directly effect infant mortality rates. When the mother of a newborn dies, the child only has a 1 in 4 chance of surviving the first year of  its life.

UNICEF and the Center for Disease Control make several recommendations aimed at improving the lives of women and reducing the maternal mortality rates: establishing health care services in rural areas that are equipped with essential drugs and able to perform cesarean sections, assisted deliveries and safe blood transfusions as necessary; increasing the number of trained birth attendants, midwives and nurses; providing education programs on recognizing pregnancy complications; and building and repairing roads to make health care facilities more easily accessible.

Maris Brummel

Sources: New Security Beat, Huffington Post, UNICEF

The birth of George Alexander Louis, the heir to the British throne is exciting news in itself, but also provides an opportunity to reflect on the women around the world for whom childbirth is a dangerous, often fatal experience.

Every year in sub Saharan Africa, 162,000 mothers die from complications during childbirth and pregnancy, representing an alarming 56% of the global total. The saddest part of this high statistic is that many of these deaths could be avoided if more was done to prevent them.

Due to a combination of insufficient resources, lack of transportation to health care centers, inadequate labor forces, and information gaps, maternal care in sub-Saharan Africa lags far behind the rest of the developing and developed world. Although the U.N.’s Millennium Development Goals have increased maternal health standards as one of their many goals, most experts on the region agree that sub-Saharan Africa has a long way to go if it is to meet its MDG goals by 2015. Though the 2001 Abuja Declaration set countries on the path towards assigning 15% of their national budgets towards healthcare, true progress has been slow.

Though the bad news may seem overwhelming, it has certainly inspired global organizations to take action towards improving the quality of maternal health care in the most neglected regions. AMREF, for example, has launched its Stand Up for African Mothers Campaign, which aims to train 15,000 midwives by 2015 as a way to bridge the labor, information, and access gap prevalent in most sub-Saharan regions.

By ensuring the safety and health of the world’s mothers, these organizations take a much-needed step towards ensuring that every new mother is treated like a “queen” by her regional health care services, and lives to see her own little prince or princess grow up.

– Alexandra Bruschi

Sources : CNN, United Nations Population Fund United Nations AMREF USA AMREF UK
Photo : Notorious

On the afternoon of July 22nd, the British commonwealth grew excited in anticipation for the arrival of the Royal baby, but what if baby George, the Prince of Cambridge, never arrived? What if complications had severed his chances of survival? Despite the joy the Royal baby received on his safe arrival, what would this baby and his mother would have done if they lived in a Third World country?

In the developing world, childbirth complications contribute to high maternal and infant mortality rates. The highest infant mortality rate comes from Afghanistan with more than 1 in every 10 newborns dying during childbirth. Around the world, nearly 3 million newborn infants die, with an additional 2.6 million born stillborn every year.

Yet, we must remember that such high figure does not take into account the mother in these events. An estimated 800 women die each day from pregnancy related causes. As it stands, 99% of these maternal deaths come from developing countries.

The greatest causes of maternal mortality include severe bleeding, infections, contaminated delivery rooms, high blood pressure, high risk abortions, and harmful diseases. Fortunately, these deaths are preventable. Unfortunately, there is much to be done in order to reduce these numbers.

Along with health issues, other challenges include “delays in seeking care, inability to act on medical advice, and failure of the health system to provide adequate or timely care” according to the WHO’s 2005 World Health Report.

However, there is a bright side; maternal deaths have been nearly halved since 1990. This improvement is due, in large part to an increase in social acceptance of midwives, adequate training of attendants, and proper implementation of health expert strategies. With a 2.4% annual rate of decline in maternal mortality, many experts agree that it proves the success of strategies and more resources must be committed.

Health experts point to success stories, such as in Rwanda. Despite genocide and destroyed infrastructure, maternal mortality has been reduced by more than half since 1990. Even more, women in Rwanda have doubled their access to skilled attendants, up to 52%. Many attribute this success to the government’s commitment to women’s health with proper planning.

But Rwanda is not the only country cutting their maternal mortality rate. Progress is being made around the world. However, more must be done in order to continue this progress. Although current strategies are proving successful, the developing and developed countries must continue committing themselves to the development of international health sectors.

– Michael Carney

Sources: AlertNet Climate, CIA World Factbook, UNFPA, WHO
Photo: US Weekly