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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

 

Epsom salt
In order to bring attention to the life-threatening pregnancy condition Pre-eclampsia, many health organizations observed World Pre-eclampsia Day on May 22, which allowed PATH the perfect opportunity to share its progress with an innovation that uses Epsom salt to save lives.

The nonprofit global health organization’s new innovation aims to make preventive solutions for pre-eclampsia and eclampsia more accessible in lower-income countries.

Every day about 800 women dies from preventable pregnancy-related causes, like pre-eclampsia and eclampsia, according to the World Health Organization (WHO). The WHO also reported that 99 percent of these maternal deaths take place in low-income countries.

How Is Epsom Salt Used to Save Lives?

Beginning in the 20th century, doctors discovered that Epsom salt worked as a method of treating pre-eclampsia, a condition that results in high-blood pressure and damage to the liver and kidneys, among other symptoms.

Despite its name, Epsom salt is not a salt at all, but rather it is magnesium sulfate and is known to prevent and deter convulsions that are common with pre-eclampsia and eclampsia, according to a historical report published by the National Center for Biotechnology Information (NCBI).

For women in countries with more resources, magnesium sulfate is administered to them through an intravenous (IV) infusion before, during and after childbirth. Women in countries without access to reliable electricity cannot use IVs and must obtain the magnesium sulfate treatment via intramuscular injections which can be more painful, according to PATH.

While nearly 90 percent of the world’s population has access to electricity, stated by the World Bank data, 59 percent of healthcare facilities in low and middle-income countries lack access to reliable electricity, according to a report published on Science Direct. 

What Is PATH Doing About It?

Besides access to electricity, IV infusions can be difficult for low-income countries to access, taking into account the cost of purchasing, training and replacing parts. Knowing this, PATH began to develop a technology that would allow for a more reliable method of injecting medicine without the need for extensive training or electricity.

It took PATH innovators a few years to find the perfect technology that was simultaneously affordable, easy to use and did not need batteries or electricity. Ultimately, the group decided on using a bicycle pump, according to an article written by one of the developers, resulting in RELI Delivery System, or reusable, electricity-free, low-cost infusion delivery system.

The bicycle pump was able to have consistent delivery rates into the patient with just a few manual hand pumps. In 2016, PATH was able to produce a prototype and received two awards: the Saving Lives at Birth seed award and an honorary Peer Choice award.

The next step for the RELI Delivery System is to use the money from the awards and donations to PATH and follow the system in Rwanda and Uganda to see it work in action and gain feedback.

How Effective Is This Treatment?

A 2002 study conducted by The Magpie Trial Collaboration Group found that the use of magnesium sulfate halves the risk of eclampsia in pregnant women with pre-eclampsia. The same results were supported by a 2010 study conducted by several groups including the Centre for Epidemiology and Biostatistics, University of Leeds and Bradford Institute for Health Research.

In 2011, WHO recognized magnesium sulfate as a priority medicine for mothers for major causes of reproductive and sexual health mortality and morbidity.

Although the use of magnesium sulfate can ultimately save women’s lives, there are some side effects that come along with the treatment, including skin flushing (more common with intramuscular injections), nausea and vomiting, drowsiness, confusion, muscle weakness and abscesses.

While something as simple as Epsom salt being used to save lives is innovative in itself, developers, like those at PATH, are continuously working to ensure that everyone has equal access to these health benefits.

Makenna Hall
Photo: Pixabay

10 Scary Facts About the Zika Virus
The Zika virus was first discovered in Uganda in 1947 through a group of diseased monkeys. In 1952, the first infected human was found in Uganda and the United Republic of Tanzania. The Island of Yap is the first location where a large scale outbreak of the Zika virus was recorded. This incident took place in 2007. There are currently no countries facing a sizeable Zika outbreak, however, there may be a risk of contracting the disease in regions where the Aedes species of mosquito is prevalent. This article looks at the top 10 scary facts about the Zika Virus.

10 Scary Facts About the Zika Virus

  1. People are more likely to contract the Zika virus in poor countries. Mosquitoes that carry Zika often breed in stagnant water. These buildups of stagnant water are found in areas where communities lack adequate plumbing and sanitation. According to the United Nations Development Programme, poor households are least equipped to deal with the virus and are most likely to be exposed to the disease.
  2. Women face the biggest consequences during a Zika outbreak. Health ministers throughout Latin America have told women not to get pregnant during a Zika epidemic. In poorer countries, women lack access to sexual education, which leaves them vulnerable to misinformation. Furthermore, women may be blamed for contracting the virus during pregnancy, which carries an unfair social stigma.
  3. Zika poses a threat to unborn children. In some cases, when a pregnant woman is infected by the virus it disrupts the normal development of the fetus. This can cause debilitating side effects like babies being born with abnormally small heads and brains that did not develop properly. This condition is called microcephaly. Symptoms of microcephaly are seizures, decreased ability to learn, feeding problems, and hearing loss.
  4. Even though a mosquito bite may be the most well-known way to contract the Zika virus, it is possible to get the disease through other avenues. It is possible to get the disease during unprotected sex with a partner, who already have been infected by the virus. Individuals can also contract the virus during a blood transfusion or an organ transplant.
  5.  Symptoms of a Zika virus infection may go unnoticed. The symptoms can be described as mild. If symptoms do occur they can present themselves as a fever, rash or arthralgia. This is especially dangerous for pregnant women because they may not know that they have been infected, unknowingly passing it on to their unborn baby. There is no treatment available to cure this disease once it has been contracted.
  6. There are other birth defects associated with the Zika virus. Congenital Zika syndrome includes different birth problems that can occur alongside microcephaly. Some malformations associated with congenital Zika syndrome include limb contractures, high muscle tone, eye abnormalities, and hearing loss. Approximately 5-15 percent of children born to an infected mother have Zika related complications.
  7. The cost of caring for a child born with Zika related complications can be quite expensive. In Brazil, each kid born with the disease could cost $95,000 in medical expenses. It would cost approximately $180,000 in the U.S. to care for the same condition. Some experts believe the numbers are higher when taking into account a parent’s lost income and special education for the child.
  8. Even though there are more than 10 scary facts about the Zika Virus, there are also measures being taken to prevent future outbreaks. Population Services International (PSI) is working with the ministries of health in many different Latin American countries to spread contraception devices. This promotes safe sex practices. This also gives the women the power to decide if and when she wants to become pregnant.
  9.  The World Health Organization (WHO) is also implementing steps to control the Zika virus. Some of these steps include advancing research in the prevention of the virus, developing and implementing surveillance symptoms for Zika virus infection, improving Zika testing laboratories worldwide, supporting global efforts to monitor strategies aimed at limiting the Aedes mosquito populations and improving care to support families and affected children alike.
  10. The good news is that there are currently no major global outbreaks of the Zika virus. This is a sign that steps around the globe have been successful to lower the number of Zika cases. However, this doesn’t mean that precautions shouldn’t be taken when traveling to areas where the Aedes species of mosquito is prevalent. Even though they are no major outbreaks the disease still exists and may cause problems if contracted.

Conclusions

Even though the Zika virus may currently not be a threat worldwide, it is still something that needs to be accounted for. Zika has serious repercussions in poverty-stricken countries where people can’t afford adequate medical care. The Zika virus is also more likely to be contracted in poorer regions. The Zika virus has a strong correlation with poverty.

– Nicholas Bartlett
Photo: Flickr

Maternal Mortality in Africa

Upon learning they are pregnant, most women do not immediately wonder if it’s a fatal diagnosis. However, that is the stark reality for many women in developing countries, particularly in sub-Saharan Africa. Maternal mortality in Africa is a pervasive and devastating issue. Far hospitals, scarce doctors and poor healthcare systems all contribute to maternal mortality. Most maternal deaths are preventable and caused by complications treatable in developed nations. It is important to recognize the causes of maternal death and solutions already in place to further reduce maternal mortality in Africa.

Causes of Maternal Mortality

The most common causes of maternal mortality are severe bleeding, infections, high blood pressure during pregnancy, delivery complications and unsafe abortions. In most cases, these are treatable with access to trained medical staff and proper medication. Access to maternal health care varies around the world. “A 5-year-old girl living in sub-Saharan Africa faces a 1 in 40 risk of dying during pregnancy and childbirth during her lifetime. A girl of the same age living in Europe has a lifetime risk of 1 in 3,300,” according to Dr. Greeta Rao Gupta, deputy executive director of UNICEF. Factors such as “poverty, distance, lack of information, inadequate services, [and] cultural practices” prevent women from having access to the proper medical services they need.

Additionally, warfare in developing countries causes the breakdown of healthcare systems. This further prevents women from accessing life-saving medical care. For example, when the 11-year civil war in Sierra Leone ended in 2002, it left less than 300 trained doctors and three obstetricians to treat the country’s 6 million people.

Solutions to Reduce Maternal Mortality

Many NGOs work throughout the region to combat maternal mortality in Africa. In fact, the United Nations initiated the Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016-2030. Their goal is to “reduce the global maternal mortality ratio to less than 70 per 100,000 live births” by 2030.

According to a study by the World Health Organization, there needs to be better documentation of maternal mortality in Africa to create more effective policy solutions. Currently, less than 40 percent of countries have a registration system documenting the causes of maternal mortality. Hence, this lack of information makes it difficult for the U.N. and NGOs to create effective solutions.

An unexpected yet effective way maternal mortality in Africa has been combated is through photography. Pulitzer-prize winning war correspondent Lynsey Addario took her camera to the region to document maternal mortality. Addario documented the experiences of many women, including 18-year-old Mamma Sessay in Sierra Leone. Sessay traveled for hours by canoe and ambulance while in excruciating labor to reach her nearest hospital. Addario stayed with Sessay for the entire experience, from the birth of her child to her subsequent hemorrhage and death. Addario even traveled with Sessay’s family back to their village to document Sessay’s funeral and her family’s grief.

Ultimately, TIME published Addario’s photographs. And as a result, Merck launched Merck for Mothers, giving $500 million to reduce maternal mortality rates worldwide. Addario stated, “I just couldn’t believe how unnecessary her death seemed, and it inspired me to continue documenting maternal health and death to try to turn these statistics around.”

The Bottom Line

The international community must continue to address maternal mortality, a preventable tragedy. No woman should have to fear for her own life or the life of her unborn child upon discovering she is pregnant. Through documentation, reporting and care, the international community can fight to reduce maternal mortality in Africa.

Alina Patrick
Photo: Flickr

In parts of the world where midwives and doctors are few and far between, traditional birth attendants (TBAs) play a critical though often controversial role in maternal healthcare. Though untrained, they function as medical leaders in their communities, sometimes delivering more babies than midwives. But as health experts reassess the functionality of untrained workers in the modern healthcare model, TBAs are at risk of being banned from assisting with births completely. Some African countries, such as Zambia and Sierra Leone, have already banned TBAs, although not without backlash. These bans have raised a very important and highly disputed question: are TBAs important or detrimental to the reduction of maternal mortality rates throughout the developing world?

TBAs, also known as traditional or community midwives, help pregnant mothers through delivery and the pre- and post-birth periods in areas where viable healthcare facilities are scarce or unreachable. They are typically older women who hold respect in their communities and often have children of their own. Unlike midwives and obstetricians, TBAs lack formal medical training and instead learn about the birthing process through oral tradition and delivery experience.

TBAs today work with mothers and their infants all over the world and are deeply rooted in the birthing cultures of many communities. TBAs are especially in demand in poor rural areas, where as few as 20 percent of births may be serviced by a skilled health worker. Much of their appeal comes from their accessibility, since TBAs offer their services at relatively low costs. TBAs are usually easier to reach than formal health professionals since they work within their communities, whereas bad roads, long distances and lack of transportation can deter women from seeking hospitalization. Women are especially unlikely to attempt the journey to a hospital if the care offered there is inadequate.

Some countries have attempted to make it easier for women to reach hospitals and receive inexpensive or free care, yet many women still seek out TBAs. This can most likely be attributed to the fear that is associated with clinics and hospitals, since many women are wary of facilities outside their communities, especially when surgery is involved. While there can be much trepidation and distrust surrounding doctors and hospitals, TBAs are well established and liked within their communities.

Mbarikit Eno of Nigeria was among the scores of pregnant women who feared hospitals when she was deciding where to deliver. “Two of my friends died in hospital during childbirth and I don’t want to die too,” Eno told the Global Health Next Generation Network in 2016. “Besides, those midwives in the hospital are very harsh; they shout at you and scold you as if you don’t know anything. They never use kind words on the woman despite the pain she experiences during labour. I know the traditional birth attendant that will deliver me. She is from within my community, she has delivered several women and they are all alive.”

Because there are both benefits and drawbacks to TBA-based care, health experts are divided on TBAs’ place in the modern healthcare model. TBA advocates claim that banning TBAs hurts mothers in disadvantaged communities, since TBAs are sometimes the only health workers available in these areas. This negative effect was demonstrated by a 2007 TBA ban in Malawi, which actually caused Malawi’s maternal mortality rate to rise. The country has since reversed the ban.

Experts also propose training and monitoring TBAs to ensure safe birthing practices. Organizations like the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) have taken steps in this direction by increasing regulations on TBAs in recent years to integrate them into the modern healthcare model. These groups have implemented programs to improve TBA education and forge stronger links between health professionals and TBAs, among other measures.

On the other hand, many researchers argue that TBAs should be eliminated from today’s health system completely. Proponents of the TBA ban claim that TBAs are “untrainable” and too set in their ways to adapt to new healthcare methods. They also warn that TBAs cannot address the main causes of maternal death, such as eclampsia and hemorrhage, and that their often-characteristic illiteracy makes it difficult to keep records.

“It stands to reason that decisions must be made with an eye to the future and not just with a mind for the present,” said former Finnish obstetrician and gynecologist Kelsey A. Harrison in an article for the British Medical Journal. “Traditional birth attendants have no place in this future.”

As modern medicine progresses and new medical technologies enter the mainstream, health experts will need to further re-evaluate the role of more traditional workers in today’s healthcare model. While the best course of action currently remains unclear, banning TBAs and other unskilled workers is only a temporary fix for the low utilization of hospitals and clinics in developing areas. Until the underlying causes that send women to TBAs in the first place are addressed, women around the world will continue to turn to TBAs instead of trained health professionals.

Sabine Poux

Photo: Flickr

Cost of Giving Birth
For something as common and essential as the creation of life, delivering a child can come at quite the cost. Though the United States holds some of the steepest delivery-related costs in the world, many countries around the globe offer maternal healthcare at astronomical prices. These services cater to wealthier families and leave the poor and uninsured to struggle. In rural and low-income communities especially, the high cost of giving birth is very risky for women and newborns.

In many countries, there is a large quality gap between public and private hospitals. Even though there are public hospitals in South Africa, for example, that offer free healthcare services, these facilities often lack adequate equipment and accommodations for mothers and their newborns. One hospital outside of Johannesburg lost six infants around three years ago because it had run out of antiseptic soaps.

Private health facilities typically offer higher-quality healthcare services but at much steeper prices. On average, it costs a woman $2,000 to give birth at a private healthcare facility in South Africa. This is a cost that less than half of South Africa’s population can afford due to a large income inequality problem and a widespread lack of health insurance coverage. Families instead settle for menial care or, in some cases, forgo care altogether.

As an alternative to formal care, women commonly hire traditional birth attendants (TBAs) to help with deliveries in rural areas of developing countries like Ethiopia. TBAs lack official training but are more affordable than midwives, who can cost upwards of 2,000 Ethiopian birr, about $90, or even more if a Caesarean-section is necessary. The result is a population that is underserved when it comes to delivery-side medical attention. Only 2% of deliveries in rural Ethiopia are administered by a health professional.

Tadelech Kesale, a 32-year-old mother from Ethiopia’s Wolayta province, has suffered due to insufficient care and the exorbitant cost of giving birth. Kesale had her first baby when she was 18 and has since lost three of her six children, one of whom was stillborn. Kesale typically earns two to three birr, equivalent to a tenth of a dollar, each week and was unable to hire a qualified professional for any of her deliveries.

“I gave birth at home with a traditional birth attendant,” Kesale said. “If I could afford it, I would go into a clinic. One of my friends, Zenebexh, died in labor – she just started bleeding after breakfast and fell down dead. A healer came but couldn’t do anything.”

The cost of giving birth in private hospitals in India is similarly prohibitive. Although government facilities hospitalize women and assist with delivery for free, many expecting mothers opt for private facilities for the higher quality of care. These facilities typically charge around $1,165 for basic delivery services $3,100 for Caesarean-section deliveries.

The costliness of Caesarean-sections and other procedures can be deterrents for poorer mothers who are faced with complications during labor or pregnancy. The Guttmacher Institute estimates that only 35% of women in developing countries receive the care they need when faced with complications. When such needs go unmet, both mothers and their babies face life-threatening medical risks.

The costs of transport to and from health centers can also be discouraging for expecting mothers, forcing them to deliver at home or in other unsterilized spaces. In rural areas especially, transportation is necessary to travel the long distances to health centers, though it is not always readily available. Aside from being expensive, it can also be scarce; as a result, many women deliver in their houses. When complications arise during delivery, this can be especially perilous.

Though there is no one way to remedy the astronomical cost of giving birth in countries around the globe, organizations like Oxfam are calling on the U.S. and other developed nations to send increased aid to countries with high rates of maternal and infant mortality. This aid can serve mothers and their babies in a myriad of ways, from covering basic health care costs to making it more possible for new moms to take time off from work after delivery. Ultimately, it will mitigate the steep costs many families must meet during and after pregnancy, providing mothers with the assistance they need to have safe, successful deliveries.

Sabine Poux

Photo: Flickr

Women in Poverty
While the disease Maternal and Neonatal Tetanus affects newborns, there are other diseases that can be harsher to pregnant women in poverty, since their bodies work harder to provide health to two individuals. Because of a lack of healthcare and nutrition, these women can be more susceptible to diseases that could be easily managed in countries with accessible healthcare. Here are the top five diseases affecting pregnant women in poverty:

Hepatitis E

Pregnant women in the second or third trimester are more likely to experience liver failure when they contract Hepatitis E. When contracted in the third trimester, the fatality rate is as high as 25 percent. An epidemic in India resulted in high mortality rates of pregnant women. To decrease the risk of spreading Hepatitis E, it is important to maintain hygienic practices and proper handling of public water supplies, since the infection can spread through contaminated drinking water.

Measles

Due to vaccinations, measles is fairly rare in developed countries. However, this is not the case in developing countries. While measles is severe to a baby, it can be even worse for women during pregnancy. A study from Saudi Arabia found that 80 percent of pregnant women in poverty with measles were hospitalized. Measles can infect the fetus and increase the risk of prematurity and miscarriage.

Malaria

Though preventable through vaccination, malaria remains prevalent in Africa. There are about 200,000 newborn deaths each year as a result of malaria in pregnancy, and 30 million women in areas infected by malaria become pregnant each year. When pregnant, the woman’s immunity to diseases decreases, so exposure to malaria increases the risk of illness, severe anemia and death. However, there have been interventions to decrease the risk of contracting malaria. In 2000, the first African Summit on Malaria was held in Abuja, Nigeria. Here, heads of state committed to providing effective malaria interventions to at least 60 percent of pregnant women. Also, there have been efforts to bring malaria interventions through antenatal clinics in Africa.

HIV/AIDS

Globally, HIV/AIDS is the leading cause of death among women between the ages of 15-24, the age women are most likely to become pregnant. Women are twice as likely as men to contract the virus. Antiretroviral therapy has been used to treat pregnant women.

Tuberculosis

This airborne disease is 10 times more likely to infect pregnant women who test positive for HIV. According to the WHO, every year about 700,000 women die from tuberculosis, and more than 3 million women contract the disease. Tuberculosis is the third leading cause of death among women between the ages of 15 to 44. When pregnant, the disease is harder to diagnose since the symptoms (fatigue, tiredness, and shortness of breath) are similar to typical symptoms of pregnancy.

If the U.S. Congress passed the Reach Every Mother and Child Act, pregnant women in poverty who are diagnosed with treatable diseases could receive the necessary treatment. If passed, the U.S. government will provide agencies to expand interventions for maternal health, to provide treatments and assistance to afflicted women and children.

Emma Majewski

Photo: Flickr

Pregnant Woman's Journey Made EasierIn some developing countries, giving birth does not mean simply rushing to the hospital in pursuit of a doctor. In fact, most women with low-risk pregnancies deliver their baby at home with a trained midwife or trained birth attendant. But for women experiencing high-risk pregnancies, rushing to the hospital could mean traveling 15 miles or more in stressful and unpredictable conditions, which is quite a distance for a woman in labor to travel.

The journey toward emergency care includes many obstacles such as rough, unpaved terrain and unreliable transportation. The harsh conditions of the road serve as a catalyst for the 2.8 million deaths of newborns every year. Similarly, on average, one woman per minute dies due to pregnancy and childbirth.

Fortunately, pregnant women’s journeys are being made easier through the use of maternity waiting homes. The World Health Organization (WHO) defines maternity waiting homes as residential facilities located near a qualified medical facility, where women defined as “high risk” can await their child’s birth and be transferred to a nearby facility shortly before delivery or earlier should complications arise.

These waiting homes serve as a crucial component in closing the geographical gap between rural areas with poor access to equipped facilities and urban areas with available obstetric care. Their main function is to link communities with the health system in a continuum of care.

However, recent studies show that an increasing number of women do not want to stay in maternal waiting homes because of poor, unsafe and unclean conditions. In response, Merck for Mothers, the Bill and Melinda Gates Foundation, Africare in partnership with Michigan and Boston University intervened and encouraged local communities to build and upgrade their waiting home facilities.

In an attempt to improve the waiting home conditions, many facilities have started selling produce and handmade goods to generate income, turning the facility into a community managed enterprise. Once the waiting homes acquire the proper funds, they can begin adequately supporting pregnant women.

Without the acceptance and participation of the entire community, waiting homes are unlikely to succeed. The satisfaction of women staying in the home is an essential part of the facility’s success or failure. The credibility of a waiting home determines whether or not it is worth the trip.

Health services generally benefit from favorable reports and the best way to spread these is by word of mouth, according to WHO. Also, the more a community talks about the provided services, the easier it becomes to identify the services that need to be improved and additional ones that need to be created. If implemented and promoted correctly, these maternity waiting homes have the potential to save lives.

Megan Hadley

Sources: Impatient Optimists, WHO, Africare
Photo: Flickr

NEMA
Nigeria’s National Emergency Management Agency (NEMA), issued 410 delivery kits to internally displaced pregnant women housed at camps in Maiduguri, Borno State. Among the delivery kits were a wax print and infant feeding bottles along with a mattress, a blanket and a net for the expected newborns.

The kits also included a baby bag, diapers, a basket, a towel, baby soap, and supplements for the mother such as milk and cocoa drink. The supplies come at a vital time since some of these women are due to give birth in late August or September.

The north-eastern Nigerian Borno State has been the worst affected in the conflict against the Boko Haram insurgency which began in 2009. Sani-Sidi, NEMA’s director general, says insurgent attacks have displaced many people, leading to the creation of 23 IDP camps in Borno State.

“In all the camps in the state, 60 percent of the IDPs are women and children classified as vulnerable and needing more support,” he said. “As a result, 410 pregnant women were selected [to receive delivery kits] out of 1,980 identified pregnant women in 13 female IDP camps in Maiduguri.”

Aid from NEMA comes a month after a July donation by Deluxe Childbirth Services coordinated in partnership with U.S. Agency for International Development (USAID), the United Nations Population Fund, and two USAID projects – THE Expanded Social Marketing Project in Nigeria and the Targeted States High Impact Project.

During this donation, UNFPA’s Ratidzai Ndhlovu underlined an expected high in births among Nigerian IDPs, stating that there would be an expected 60,000 births by the end of 2015.

According to UNICEF, a Nigerian woman’s chances of death during pregnancy and childbirth are 1 in 13. Additionally, newborn Nigerian mortalities, which occur among the first week of life, make up about one-fourth of total deaths of children under five years of age.

A majority of these deaths arise from complications during birthing or pregnancy, which serves to highlight the importance of maternal and newborn health care access, especially within vulnerable and displaced populations.

Jaime Longoria

Sources: Premium Times 1, Premium Times 2, UNICEF