Mark Tuschman is an award winning photographer who has traveled extensively intentionally for many foundations, NGOs and corporate social responsibility programs. He has a passionate interest in promoting the basic human rights of women and girls and plans to publish a book: Faces of Courage: Intimate Portraits of Women on the Edge documenting the lack of autonomy of women and girls in the developing world and all the efforts being made to empower them. For more info, please see his Facebook and Kickstarter pages.
Much of their work involves making sure that clinics have the medications and vaccinations they need to keep their patients healthy. I was quite impressed by the robustness and size of so many of the infants at the clinics yet there was a downside to it too. Quite a few of the mothers that I photographed near Meru and Embu clinics were no more than 15 or 16 years old. They were unwed, had very little schooling and now at their very young age, they had the responsibility of raising a child, with little hope for any further education or economic opportunities. I was certainly heartened to see how well the babies were taken care of with proper nutrition and vaccinations, but there seems to be a big need for keeping young girls in school and providing them with safe methods of contraception.
Through photography, I want to pay tribute to the women I have met and to the millions of other women who share their lack of autonomy over their own lives and bodies. I hope the photos I take will bring these women and their stories to the forefront of world consciousness. Below are the photos I took while visiting the maternal and infant health clinics in Kisumu and Meru, Kenya. As you will see from the photos- the clinics are providing excellent and necessary care for mothers and their infants, but the age of many of the new mothers shows the urgent need for enhanced access to education and contraceptives in Kenya.
Almost a year ago, I held my beautiful baby boy in my arms for the very first time. I was captivated and mesmerized by his wrinkled skin, his bright eyes and his innate ability to feed from me, taking in all the nourishment he needed in those early hours. As the days and weeks went by, I watched him grow, become more alert and attentive and attempt his first smile. Nothing could have prepared me for this unbelievably wonderful experience.
But, having travelled to, and worked in, some of the poorest countries in the world, there has not been one moment that I have taken the precious life of my baby for granted. I am among the privileged of the world; able to enjoy him free from the worry of death lurking just around the corner.
Newborn deaths now account for at least 44% of deaths among children under the age of five globally, resulting in 2.9 million lives lost each year. Another 2.6 million babies die in the last 3 months of pregnancy or during childbirth (stillbirths).Every Newborn, 2014
These shocking statistics necessitate strong action. Spring boarding from the dialogue and momentum created in recent months by the State of the World’s Mothers and State of the World’s Midwifery reports and The Lancet’s Every Newborn and Midwifery series’, the Every Newborn Action Plan was launched yesterday at the 2014 Partners’ Forum. Recognizing the inherent connection between the health of a mother and her baby, the Plan is a “roadmap and joint action platform for the reduction of preventable newborn mortality”, and is hoped to contribute towards the advancement towards Millennium Development Goal (MDG) 4 – a goal which is seeing slower progress than MDG 5 (associated with maternal health). There are 3 main causes of newborn deaths worldwide; infections (including sepsis/pneumonia, tetanus and diarrhoea), pre-term birth, and birth asphyxia. Low and middle income countries bear the greatest burden of newborn mortality and shockingly, two-thirds of all global newborn deaths occur in sub-Saharan Africa.
1. Strengthen and invest in care during labour, childbirth, and the first day and week of life.
2.Improve the quality of maternal and newborn care.
3. Reach every woman and every newborn to reduce inequalities.
4. Harness the power of parents, families and communities.
5. Count every newborn through measurement, programme tracking and accountability.
There is no doubt that implementation of these strategies will be challenging. The Every Newborn Action Plan highlights the vital role that a wide range of stakeholders have to play – from governments to civil societies and health service providers to the business community, to name but a few. It was good to see that the first guiding principle of the Plan emphasizes the responsibility that countries and communities themselves have for ensuring that the health of their newborns improve. Ultimately, this will result in long-lasting and sustainable change.
Communities’ participation in the planning, implementation and monitoring of policies and programmes that affect them is a central feature of such leadership and one of the most effective transformational mechanisms for action and accountability for newborn health.Every Newborn Action Plan, 2014
The platform for implementation of the Plan will be maternal and child health services, with a particular focus around care during birth and care of the small or sick newborn, in the context of universal coverage and quality care. Newborn mortality was not mentioned explicitly in the Millennium Development Goals and there is a risk that this may also be omitted from the Sustainable Development Goals for the Post-2015 agenda. In light of that, a strong commitment to achieve a reduction in newborn mortality is required, with key stakeholders working together to overcome bottlenecks to progress at every stage of the way. It is all too easy to shift our attention onto the statistics, plans, strategies and goals themselves. But let’s continue to remember what this is all about; to mothers, families and communities around the world, the life of Every Newborn matters immensely.
In many developing countries, a woman’s chance of dying in childbirth can at times surpass her chance of surviving it. While the global maternal mortality rate has decreased 45% since 1990, around 800 women continue to die every day as a result of pregnancy and childbirth related complications. Most of these deaths are preventable, and many could be avoided through simple and often very low cost solutions and interventions. For millions of women, the lack of availability of basic medical services, such as trained nurses and midwives, and the lack of accessible clinics and cheap basic medicine such as antibiotics can lead to grave consequences, sometimes for both mother and the baby. The first day of a newborn’s life – a day that should be marked with sheer joy and happiness – has also been identified as the most dangerous day for both mother and the baby. For millions of mothers and babies, pregnancy and childbirth are shadowed by immense risk and danger, and what should be a start of a new life too often is the end of one.
In the meantime, in other countries like the United States, pregnant women and newborns are facing other types of problems – almost the opposite than women in developing countries. While women in developing countries lack access to the most basic maternal healthcare services, women in America face an increasingly medicalized birthing experience. Approximately 1 in 3 babies born in the US is delivered via c-section, compared to 1 in 5 in 1996. While a c-section can be lifesaving to both the mother and the baby in certain situations, medical necessity does not explain the sudden and drastic increase in c-section rates – nor does it explain the dramatically different rates of c-sections between individual hospitals. Other medical interventions such as episiotomies are commonplace, and while the rate of midwife-assisted births is rising int the US, a vast majority of births – near 90% – are still handled by OBs, even though in most other developed countries normal births are routinely handled by trained midwives. On the other hand, as pregnancy and childbirth in the US and other western countries is becoming more and more medicalized, the cost of childbirth is also rising to the point of unaffordable. The US has been ranked as the country with the highest cost of childbirth in the world, with an average cost of vaginal birth hovering around $30,000 and c-section around $50,000 – pricing many couples out of safe, healthy pregnancy and childbirth experience. While maternal mortality rates are declining in every other western country, they are on the rise in the United States, which ranks behind every other industrialized nation in terms of maternal mortality. This is despite the fact that the US spends more than any other industrialized country on maternal health related costs.
The challenges faced by women in countries like India or Kenya differ drastically compared to the challenges faced by women in America – and the dangers related to pregnancy and childbirth might stem from different reasons – but the bottom line is that women in developing countries and women in America continue to die during pregnancy and childbirth at alarming rates, mostly from preventable causes. Accessibility of maternal care isn’t only a question of a health clinic or hospital existing nearby – it includes affordability, quality and nature of available health care as well. There are huge disparities in terms of quality of care in the United States, and health care is becoming a luxury good only available to those who can afford to pay hefty insurance fees. In developing countries, something as simple as lack of a trained midwife can become a question of life or death for pregnant women, who too often end up giving birth in dangerous settings with no trained health care workers available for support.
There is a divide between the North and the South in terms of maternal health and maternal mortality – but unfortunately, right now this divide is being bridged from the wrong direction, where the situation in certain western countries seems to be worsening while the situation in developing countries is not showing adequate signs of improvement. One thing is clear across the world – women and children cannot afford to wait any longer for proper, quality maternal and newborn health care services to become available to them. Business as usual is simply not enough, because every day that passes without change means hundreds of lives lost for preventable causes. A life of a mother and a life of a child must be valued the same everywhere in the world. It’s time to commit to action, and time to commit to deliver – there should be no agenda more important than that of saving the lives of mothers and their children.
Girls’ Globe will be at the Third Partners Forum in Johannesburg for the Partnership for Maternal, Newborn and Child Health, taking place on 30 June – 1 July 2014. Follow the discussion on Twitter via #PMNCHLive and @PMNCH and sign up for the Daily Delivery for up-to-date news from Johannesburg!
Yesterday, the Lancet released its Every Newborn series, presenting the most up-to-date picture on progress and remaining challenges on decreasing newborn and maternal deaths around the world. The series continues from Lancet’s Neonatal Survival series, which was released in 2005, and is comprised of five papers:
The Series lays out the grim reality of newborn and maternal health and survival. Progress has been achieved – since 1990, under-5 and maternal deaths have been halved globally largely due to the Millennium Development Goals – but despite the progress, 2.9 million newborn babies die and 2.6 million are stillborn every year. Though maternal mortality rates have declined 45% since 1990, there still were an estimated 289,000 maternal deaths in 2013 – nearly 800 per day. The issue of newborn and maternal mortality remains a largely unfinished agenda, and an issue that deserves and gravely needs more global attention and prioritization urgently.
According to the data presented in the Series, preterm births continue to rise, and while under-5 mortality has received notable attention globally, the issue of stillbirths remains largely ignored and invisible. In addition, as highlighted in the series,
Most newborns and nearly all stillborn babies enter and leave the world without a record of their existence
This means that most of the babies who lose their lives within the first 28 days after birth and almost all stillborn babies are never registered, and never receive birth certificates. Additionally, preterm babies are less likely to be counted or registered, even in wealthy countries. This points to low expectations towards the babies’ survival, and social acceptance towards neonatal and stillborn deaths as something that is inevitable and maybe even a natural part of life. Women’s and babies’ lives are too often viewed as expendable, and these deaths treated as unpreventable – but, as stated by Professor Bhutta, one of the Series’ authors:
Our research shows that three million lives can be saved by 2025 if achievable interventions are scaled up to nearly universal coverage, and improving care at the time of birth gives a triple return on investment saving mothers, newborns and stillbirths.
The Series presents several concrete suggestions for dramatically improving the health and survival of mothers and newborns around the world, drawing also from the Every Newborn Action Plan. The fifth paper in the Series presents a path towards action, underlining the importance of the following shifts that need to take place at global, national and local levels:
Intensification of political attention and leadership
Promotion of parent voice, supporting women, families, and communities to speak up for their newborn babies and to challenge social norms that accept these deaths as inevitable
Investment for effect on mortality outcome as well as harmonisation of funding
Implementation at scale, with particular attention to increasing of health worker numbers and skills with attention to high-quality childbirth care for newborn babies as well as mothers and children
Evaluation, tracking coverage of priority interventions and packages of care with clear accountability to accelerate progress and reach the poorest groups
The fact that a vast majority of these [stillbirths and newborn] deaths – which have a huge effect on the women and families involved – are never formally included in a country’s health registration systems signifies acceptance that these deaths are inevitable, and ultimately links to inaction.
There’s simply no more time for inaction, because every day that passes means hundreds of women lost to preventable maternal deaths, and thousands of newborn deaths and stillbirths that could have been avoided. Research shows that the day of the birth is often the most dangerous for both the mother and the baby. The day of a child’s birth should be the happiest, most joyous and miraculous day for the mother, the baby and the other parent – and it should never, ever end in the untimely death of the mother or child.
Without healthy mothers and healthy babies, we cannot build healthy and prosperous societies. If protecting and saving the lives of mothers and babies isn’t worth all of our energy, time and attention – I really don’t know what is.
I want to tell you about Carol Perks, an Australian nurse who has transformed maternal and child healthcare in northern Laos. She has inspired my maternal heath work in Laos and shown me the importance of generously sharing knowledge.
The Encouragement I Needed
When I started CleanBirth.org, my maternal-infant health project in southern Laos, some said, “Are you qualified to do that? You’re not a midwife” or “Can Clean Birth Kits have a real impact?”
Carol Perks, a true expert in this field, never asked me those questions. Her first words to me via email were:
Good to hear from you and congratulations on trying to help the situation for women and children in Salavan. I’d be happy to help you in any way that I can…
Into the Unknown
When Carol arrived in Sayaboury Province in 1991, on a 2-year Save the Children contract, there were no other foreigners, “virtually no transport, no electricity, no water.” In this video, she explains with a laugh, Sayaboury was “very wild in those days.”
The health situation was dire: the infant and maternal mortality rate were abysmal, with only 18% of women receiving antenatal care and just 7% having a skilled attendant at their births.
Carol’s planned two years turned into more than twenty. During this time, she worked with district and provincial officials to develop a comprehensive model for providing healthcare in rural communities, with a strong focus on maternal and child health.
The model mandates building clinics, renovating hospitals, training health staff and volunteers, improving water and sanitation and more. Importantly, with technical assistance from Save the Children, the Lao government implements and manages their own health departments.
By 2007, all districts of Sayaboury Province had successfully implemented the model. So, Carol and Save the Children moved on to neighboring Luang Prabang Province.
Carol retired in 2013. Yet, her work continues in Laos’ north and will inspire my own in the south. She has shown me what one woman can do to improve maternal and infant health.
She also showed me how to support other women. Even when my organization was in its infancy, she honored the work I was doing. She took time out of her demanding days to answer my questions and share best practices. That meant so much to me and I will try to emulate her example when others seek my help.
Thank you Carol Perks for your work in Laos and for your generosity of spirit!
Who is the woman that most inspires you to work harder and be better? Post a shout out to your hero below and share with a tweet using #WomenInspire.
By Haile Gebrselassie, Save the Children Child Ambassador, two-time Olympic Champion and four-time World Champion.
Ethiopia, my country, is the cradle of humanity. The first stone tools were found here and Lucy, a 3 million year old skeleton and the first Homo sapiens, was found in the village of Hadar, on the southern edge of the Afar triangle.
Our history is ancient and continuous. We are fiercely proud of the fact that we are the only African nation never to have been colonised. But like every nation our history is chequered and we have suffered.
In 1983, when I was ten years old, the first flames of hunger were flickering throughout Ethiopia. It was that year my mother died due to birth related complications. In those days, in my village, this was not very unusual.
My mother died following birth complications. The women of the village tried to help, but when I think back I realise that none of them really knew what they were doing.
In so many ways, we have made progress in saving the lives of mothers and their newborns since then. Today, the number of children dying before their fifth birthday has been halved since 1990.
The number of women who die in childbirth has declined by almost a third – that’s millions of kids who get to grow up with a mother and millions more getting a chance at life.
What we have achieved so far must be celebrated. The actions of our governments over the last fifteen years have brought about the greatest leap in children’s wellbeing survival in history. This change has been brought about by bold political leadership at the highest levels.
But even today, half of all women giving birth in sub-Saharan Africa give birth without any skilled help. Globally, 2 million women also give birth completely alone. A direct result of this lack of skilled health workers, as Save the Children has shown in a new report today, a million newborn babies die on their first day of life. A single baby’s death is one death too many.
The good news is that we know what needs to change: ensuring every birth is supported by quality trained health care workers who have the expertise to help premature babies survive, deal with birth complications and prevent newborn infections can, with some wider steps, help prevent as many as two-thirds of these newborn deaths.
Every country in the world must ensure that all mothers-to-be have access to a midwife with life-saving medicines and equipment.
Africa is finally a continent on the rise – and children are the key to our continuing success. I want them to grow up to be the doctors, lawyers, teachers and even athletes that they are meant to be. The race for survival is a marathon, not a sprint. We are in this for the long haul. Like long distance running, this will take endurance, commitment and conviction. We have seen the incredible results when we put our minds to it.
The prize for these children is much greater than an Olympic medal. They get a fair chance at life, regardless of how poor their parents are, where they live or whether they are a boy or a girl. This is a race that we can win.