vaginal_ringThe World Health Organization has included the progesterone contraceptive vaginal ring (CVR) on its 2015 Essential Medicines List.

Developed by the Population Council, this contraception method is unique because it is safe and effective for lactating women after they have given birth. It can be used as early as four weeks after childbirth for up to one year in order to space out potential future births.

Birth spacing is important for the health of mother and child. Maternal death and other health complications are more likely to arise with short intervals between births. In addition, family planning can help parents to plan finances related to family expansion. Family planning is critical to poverty reduction. When families do not have the knowledge or ability to space births, particularly in developing countries, they may also lack the resources to support these children.

The vaginal ring is 98.5 percent effective in preventing pregnancy with proper use. The ring can be inserted and removed by the mother. This translates to less doctor visits, which are known to strain family resources, such as time and money, in developing countries.

The ring releases progesterone, but does not interfere with breast milk production. In this way, it is unlike oral contraceptives, which contain estrogen and cannot be used by lactating women.

This method is currently used in Bolivia, Chile, Dominican Republic, Ecuador, El Salvador, Guatemala, Panama, and Peru. Currently, studies in India and Sub-Saharan Africa are underway in order to determine if it could be effective in these regions as well.

The inclusion of this method on the list from the World Health Organization’s list suggests that it is likely to be more accessible to communities in the near future. The CVR is effective, safe, and inexpensive. Medical services can be difficult to reach in developing countries, but the CVR places very few demands on doctors.

The Population Council is currently developing another vaginal ring that will not have to be replaced every 3 months. It would last for one year. This would make this contraceptive method even more appropriate for the developing world.

In the future, we may even see vaginal rings that can protect against HIV and other sexually transmitted diseases, in addition to its contraceptive function. This exciting new technology has the potential to address many of the global health problems our world faces today.

Iliana Lang

Sources: WHO, Population Council, Impatient Optimists
Photo: Impatient Optimists

Maternal Mortality
Earlier this year, the World Health Organization (WHO) published a report containing new data about maternal mortality. It revealed that maternal mortality has dramatically decreased by 45 percent since 1990. Many organizations have made decreasing maternal deaths an international priority.

Improving maternal health is the United Nation’s fifth Millennium Development Goal (MDG), one of eight goals related to decreasing global poverty set forth by the international community in 2000. The fifth goal is lofty, intending to reduce the maternal mortality rate (MMR) by 75 percent before 2015.

Nineteen countries, including Nepal, Rwanda and Cambodia, have already achieved over a 75 percent decrease in their MMR. However, over 100 other countries analyzed in the report have much more progress to make before next year’s target date. Unfortunately, it is unlikely that each country will meet this goal.

Still, enormous strides have been made in the maternal health arena on a global scale in the last two decades that deserve to be celebrated. It is estimated that 234,000 fewer women died from pregnancy complications and childbirth in 2013 than in 1990. This number represents a real change that has affected the lives of people across the globe.

The number of maternal deaths isn’t the only thing that is changing. Another recent WHO study shows that the causes behind maternal deaths have evolved over the last 20 years. Data about the actual causes of death during pregnancy and childbirth, though difficult to collect in some areas, is essential if further progress toward decreasing MMR is to be made.

The WHO’s study found that pre-existing medical conditions such as diabetes and obesity, worsened by pregnancy, were the cause of 28 percent of maternal deaths, followed by severe bleeding during childbirth, pregnancy-induced high blood pressure and infections.

Dr. Marleen Temmermen, a co-author of the study, notes, “The new data show a changing profile in the conditions that cause maternal deaths; reflecting the increasing burden of noncommunicable diseases in women throughout the world. Ending preventable maternal deaths will require both continued efforts to reduce complications directly related to pregnancy, and more of a focus on noncommunicable diseases and their effect in pregnancy.”

The new findings about the ways in which maternal health has evolved since 1990 have produced two noteworthy conclusions. The first outcome is the insight that countries all around the world have made much more progress than many ever expected in decreasing the number of maternal deaths. The second is the realization that maternal mortality must be tackled differently as the world of maternal health has changed significantly since the inception of the MDGs in 2000. The causes of maternal deaths have changed, and so must the strategy used to battle them.

Although this progress merits celebration, there is still much to be done to improve maternal health for women everywhere. Fortunately, the new data emerging from the WHO can be used to form more effective strategies in the fight against maternal mortality and global poverty.

— Emily Jablonski

Sources: The Guardian, The Lancet, WHO
Photo: Gallery Hip