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Maternal Mortality Rates for Women in Tajikistan Are Dropping

maternal mortality rates tajThe Republic of Tajikistan is a country located in Central Asia. In 1991, when Tajikistan became independent it was the most poverty-stricken country of the Central Asia republics. A civil war hurt Tajikistan’s economic and social growth, which led to a decline in overall health in the region. One of these health issues is that Tajikistan has had a very high maternal mortality rate. However, in the last decade progress has been made and maternal mortality rates for women in Tajikistan are dropping.

Tajikistan currently has a rate of 32 maternal deaths for every 100,000 live births. This number has significantly decreased since 1990 when the rate was 107. There are multiple factors that are responsible for the decline in maternal mortality rates. One of the dangers had been the fact that many women have their babies at home. In fact, at least 15 percent of women still give birth without a doctor or midwife present.

Hospitals and Healthcare Facilities

A project by the name of Feed the Future Tajikistan Health and Nutrition Activity (THNA) is spreading information about the dangers of giving birth at home. They also teach women in the country about the benefits of delivering in a hospital or other health care setting. Funded by USAID, THNA is working alongside hospitals and healthcare centers in different locations throughout the country to talk about the three main factors that lead to increased chances of maternal mortality, also known as the three delays:

  1. Seeking maternity care
  2. Reaching a healthcare facility
  3. Receiving high-quality care once at a healthcare facility

In 2016, THNA partnered with the Ministry of Health and Social Protection of the Population to further understand the problem. The duo conducted 14 in-depth assessments of hospitals in the region. They found out that many healthcare facilities did not have proper medical supplies, lacked adequate equipment and were understaffed. The duo worked together and provided the healthcare centers with new equipment and supplies.

The partnership also taught more than 1,400 people in the community to be health educators. The health educators, in turn, taught women about prenatal care and when they should go to a hospital. These changes are a major reason why maternal mortality rates in Tajikistan are declining.

Midwifery Services

Families in Tajikistan who cannot afford healthcare facilities often turn to alternatives such as midwifery. It is challenging to find a good midwifery service in the country. However, the United Nations Population Fund (UNFPA) is working with the Ministry of Health to increase the quality of midwives in the region. They supply midwives with education, capacity building and medical equipment. Furthermore, the UNFPA trains midwives on effective perinatal care.

UNFPA also provides technical help in improving training curriculums at schools throughout the country. Nargis Rakhimova, the UNFPA National Program Analyst on Reproductive Health in Tajikistan said, “This initiative is considered a breakthrough as it raises educational programmes to the level of internationally agreed standards.” Improved midwifery services are another factor why maternal mortality rates for women in Tajikistan are dropping.

Even though it is easy to recruit young women into midwife training programmes, it is not easy to keep them in the profession. Midwives do not make a lot of money and there is no official certification for midwifery, which may lower the standards of services in the region. Rakhimova said, “Though the midwifery situation in Tajikistan is improving, midwifery needs to be developed as a separate profession complementary to medicine.” Improving compensation for midwives will help continue to lower maternal mortality rates in Tajikistan.

Continuing to Improve

The poverty Tajikistan faced when it gained its independence led to a number of health crises in the region. Maternal mortality rates are one of these issues. Even though the country still faces problems with maternal mortality, the conditions are improving. The combination of advancements in healthcare facilities and midwifery services are a big reason for the improvements. These are the two main contributors as to why maternal mortality rates for women in Tajikistan are dropping.

– Nicolas Bartlett
Photo: Flickr
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Solutions to Infant Mortality in Central African Republic

Infant Mortality in Central African Republic
Newborns remain at high risk in war-torn countries, and in the case of Central African Republic, many women lack adequate resources to ensure a successful pregnancy. This absence has resulted in the nation having one of the largest statistics of infant mortality in the world.

In a report published by the World Health Organization (WHO), the infant mortality rate for Central African Republic in 2016 was 42.3 deaths per every 1,000 births, making Central African Republic one of the riskiest places for a child to be born.

Causes of Infant Mortality

According to a study by UNICEF, the main cause for infant mortality in third-world countries is preterm birth complications, which encompasses 35 percent.

Complications can often result from limited access to medical care. According to the same study by UNICEF, not only was infant mortality in Central African Republic one of the highest in the world, but as of the year 2009, there were only three healthcare professionals to assist with every 10,000 people in the country.

Also, due to the lack of trained medical professionals to assist pregnant women, many mothers decide to have the child at home or end up in labor before they reach a facility. In a 2012 report published by Doctors Without Borders, the report stated that 26 percent of newborn deaths occurred in a hospital, while 74 percent of deaths occurred at home or en route to a hospital.

Solutions to Infant Mortality

Due to the high risks that newborns encounter, organizations have provided and proposed solutions to infant mortality in Central African Republic. According to the Population Reference Bureau (PRB), midwives can serve as a substitute for mothers who are unable to make the journey to the nearest healthcare facility.

The organization stated that a midwifery program in Nigeria was able to see a 60 percent increase in the use of prenatal care and almost 50 percent increase in healthy childbirth, when there was the presence of a midwife during pregnancy.

The Importance of Breastfeeding

Another proposed solution is aiding mothers with breastfeeding before and after they give birth. UNICEF has addressed the importance of breastfeeding mothers by stating that, “delaying breastfeeding by 2–23 hours after birth increases the risk that a newborn will die by more than two fifths. Delaying it by 24 hours or more increases the risk by almost 80 percent.”

UNICEF has made efforts over the years to address this statistic and stated that it has supplied thousands of children and mothers in Central African Republic with Vitamin A supplements to aid with breastfeeding.

Safe and Quality Treatment

Furthermore, Doctors Without Borders has established a project in the town of Boguila that includes a hospital which operates and provides secondary health care, an outpatient department and 10 health posts in proximity to the town.

With access to safe and quality healthcare facilities, midwifes and proper nutrition before and after pregnancy, mothers can be in better means of having children that survive after birth — an occurrence that would decrease the alarming rate of infant mortality in Central African Republic.

– Lois Charm
Photo: Flickr

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Liberia Invests in Strengthened Midwifery Programs

midwifery
During the 14-year civil war in Liberia, the health system became increasingly fragile, and a lack of roads and transportation made it difficult for pregnant women to receive necessary emergency care. This issue has created a strong need for strengthened midwifery in Liberia.

As a result, Liberia had one of the highest maternal mortality rates in the world according to a 2015 USAID article, but the country is now trying to change that through investment in midwifery programs.

Currently, 44 percent of Liberian women give birth without a skilled attendant, and nearly one out of 138 mothers die from preventable causes during childbirth. Such issues could be avoided with basic or strengthened midwifery in Liberia, according to the World Health Organization.

Bentoe Tehounge, a trained midwife in Liberia, told WHO, “We need midwives who can ensure a safe pregnancy even before a woman is pregnant. People who can provide advice on family planning, nutrition, physical activity and preventing mother-to-child transmission of HIV.”

There are six midwifery schools in the Liberia, half of which are in rural areas, and less than 200 midwives for over four million people. Most of these midwives work in urban areas. Strengthening these schools, especially the rural ones, will improve access to quality care for women around the country.

Retaining these midwives is one step towards Liberia’s investment in the profession. According to WHO, many health professionals were driven out of the country due to the civil war and the Ebola crisis, and now midwives lack “safe accommodation and transport, are overworked and paid poorly and have limited opportunities for career advancement.”

A new B.S. program addresses a portion of these concerns by providing further professional development. The program graduates 50 to 75 registered midwives per class, which is expected to staff more than 700 health facilities in the country. To develop better teaching methods, Liberia is working with the Danish Midwives Association to pair Liberian and Danish midwives in order to learn more advanced skills, like preventing and treating hemorrhages. It is hoped that this new alliance will result in strengthened midwifery in Liberia.

In the United States, this final element is comparable to the apprenticeships or clinicals that midwives do to obtain a license. Mary Anne Brown, a midwife serving the Great Falls and Helena areas of Montana, said that degree programs require that their students find and work directly with a midwife to gain clinical experience.

Past midwife training in Liberia tried to work within a culture of home birth in Liberia (USAID reported that 63 percent of Liberian women gave birth outside of a health facility) and with the knowledge of traditional midwives.

The goal was to shift the focus to encouraging birth preparedness, recognizing and referring complications and providing appropriate emergency care through what USAID called “home-based life-saving skills.” By utilizing storytelling, case histories, discussion, role-play and demonstrations, midwives, expectant parents and community leaders were able to educate themselves at community meetings.

One of the greatest achievements of the previous midwife training in Liberia was its ability to connect traditional midwives to both health facilities and certified midwives. Certified midwives perform their own visits to discuss problems the traditional midwives are having, replenish supplies and reinforce the training.

The current programs are a part of WHO’s efforts to provide clear guidelines, tools and an evidence base to lead to strengthened midwifery in Liberia and around the world in order to improve care for pregnant women and reduce both maternal and neonatal mortality rates.

– Anastazia Vanisko

Photo: Public Domain Images