The Most Vulnerable: Reaching Mothers and Newborns

By virtue of the fact that you’re reading this, you were one of a lucky few who made it through infanthood, chances are, alongside your mother. It is something we often take for granted.

When we imagine our own babies being born, we might think, will my baby come out healthy? Will we know how to keep them safe? Have we bought the right crib, the right food? Will be we good parents? Our worries in the first hours, days and weeks of our child’s life are endless.

Yet, some mothers do not have the luxury of more than one fear, the first and most fundamental: will my baby survive childbirth? 

The world over, mothers and their babies are not so fortunate. The day of birth is the most dangerous day of life, and the provision of quality maternal and newborn healthcare is far from guaranteed.

800 women and 7,400 newborns still die each day from complications during pregnancy, childbirth and shortly after delivery. Another 7,300 women experience a stillbirth.

It’s a problem that plagues countries both rich and poor. For example, babies born in Ward 8 in Washington, DC are 10x more likely to die by their first birthday than babies born in the richest, Ward 3.

Additionally, babies have similarly cruel fates in their first year of life. In a grim statistic, the World Health Organization warns that a child’s risk of dying is highest in the first 28 days of their life – a staggering 44% of the deaths of children under five happen within that period.

It is an enormous and tragic problem, and does not have a simple fix. Poor maternal and newborn health starts long before a woman goes into labor and goes far beyond the delivery room. The worst-case scenario for woman with poor access to healthcare is bleak, and is rife with obstacles.

Living in a crowded, urban slum with little education and few financial resources means she has little control over her own life. Lack of food and cramped, unsanitary living conditions mean she and her unborn child are more susceptible to disease. Fear of assault and robbery in unstable political situations mean she has fewer options when seeking care, and she is dependent on strained public resources which often cannot provide even basic services to all of the population.

maternal and newborn health

Childbirth itself poses a great danger, should she not have access to a hospital or midwife. Hemorrhaging, high blood pressure during pregnancy, complications from delivery and infections are all greater dangers for her. The presence of diseases like HIV/AIDS and malaria also account for a number of maternal deaths. Should the child be born healthy, and she herself survive childbirth, the burden of childcare may fall on her alone.

The number of maternal and newborn deaths is still unacceptably high, but the progress seen under the MDGs, and the continued focus on women’s and newborns’ health in the SDGs mean that countries have recognized there are concrete steps that can be taken to whittle away at the monolith of maternal mortality.

Girls’ Globe is currently in Mexico City at the Global Maternal Newborn Health Conference. Follow @GirlsGlobe on Instagram, Twitter, Facebook and Periscope to receive live updates from the conference and add your voice to the discussions with #GlobalMNH! 

Featured image: Lindsay Mgbor/Department for International Development

Maternal healthcare in Tanzania: Giving thanks for little victories

For those of us passionate about improving access to quality maternal healthcare, thinking about progress towards the MDGs can be disheartening. But this holiday season, as we celebrate Thanksgiving in the United States, we are reminding ourselves to be grateful for the little victories.

A long way to go

It’s a sobering fact that, despite encouraging steps in the right direction, we are very far from reaching our goals (1).

  • The global maternal mortality ratio has dropped by 45% between 1990 and 2013: far short of the 75% target.
  • The maternal mortality ratio in developing regions is 14 times higher than in developed regions.
  • 300,000 women worldwide died in 2013 due to pregnancy or childbirth related causes.
Image c/o Kupona Foundation
CCBRT/Daniel Hayduk/2014

Tanzania: The national context

Kupona Foundation is a non-profit committed to improving access to quality maternal healthcare in Tanzania. If I focus on the Tanzanian context, the picture is still bleak.

  • Every year, 8,000 women die as a result of childbirth or pregnancy related causes (2).
  • For every woman that dies, 20 more will develop an infection, injury or life changing disability (3).
  • There are still significant gaps in the technical skills and critical infrastructure required to enable teams on the ground to save lives.

We have just over 12 months to reduce Tanzania’s maternal mortality rate by 57%. It’s easy to be discouraged about if this is possible.

That’s not to say that the country isn’t pushing for change. Earlier this year, the President of Tanzania, Dr. Jakaya Mrisho Kikwete, launched the ‘Sharpened One Plan’. Inspired by the country’s laudable achievements in the reduction of child mortality, the plan is designed to accelerate progress towards improving maternal healthcare. In Kikwete’s words

We are still grappling with reducing maternal mortality…we still have a long way to go (4).
~President Dr. Jakaya Mrisho Kikwete

“The one person you save means something.”

It is easy to get lost in the statistics, but one of Comprehensive Community Based Rehabilitation in Tanzania’s (CCBRT) OB/GYNs recently reminded me of the need for perspective. Dr. Fatma Sulieman is one of several district mentors conducting on-the-job training and mentoring at maternity facilities across the region of Dar es Salaam, which has a population of over 4.3 million (5). Dr. Fatma is based at Temeke District Hospital, a facility managing approximately 2,000 deliveries each month with one of the highest maternal mortality rates in the region. (You can learn more about our comprehensive maternal and newborn healthcare program here).

At first, I used to get disappointed when I didn’t get the results I wanted immediately, but then I realized that the one person you save means something.
~Dr. Fatma Sulieman

Image c/o Kupona Foundation
CCBRT/Sala Lewis/2014

Little Victories

Dr. Fatma is right. As we come together this week and give thanks for what we appreciate most, I urge you all to recognize that change is happening.

By taking things one step at a time, Dr. Fatma has seen incredible results at Temeke. The facility reported zero maternal deaths for the month of September. This is remarkable. Thanks to the continued efforts of CCBRT and the Regional Health Management Team to train staff, improve infrastructure and distribute life-saving equipment to maternity facilities in the region of Dar es Salaam, every mother that gave birth at Temeke in the month of September survived. This is huge step forward, and a victory for the families of Dar es Salaam.

We need to step back and celebrate every individual life saved. Step back, and give thanks for the little victories.

Image c/o Kupona Foundation
CCBRT/Mark Tuschman/2014

Of course, not every month is going to be as successful as September. Thousands of women and their babies are still dying in Tanzania every year. We need to build upon this year’s successes and continue to enable the teams on the ground to improve skills of healthcare providers, ensure that they have access to the facilities and the equipment they need to do their job, and decongest health facilities so that they have the time and space to attend to every patient. We need to step back and celebrate every individual life saved, and give thanks for the little victories.

Written by Abbey Kocan
Executive Director, Kupona Foundation

Share this post on social media and remind your followers to give thanks for #littlevictories.

Follow us on Twitter: @KuponaFdn & @CCBRTTanzania

Footnotes:

  1. The Millennium Development Goals Report 2014’, United Nations’
  2.  Tanzania Demographic and Health Survey (TDHS) 2010, National Bureau of Statistics, Tanzania, April 2011, Dar es Salaam
  3. Nanda, Geeta, Kimberly Switlich and Elizabeth Lule, Accelerating progress towards Achieving the MDG to Improve Maternal Health: A Collection of promising Approaches, World Bank, Washington D.C., April 2005, p4.
  4. Putting Mothers of Tanzania First, UNFPA Tanzania, UNFPA.org. August 8, 2014.
  5. Tanzania National Bureau of Statistics Online Census Database, November 2014

India’s Newborn Action Plan

Globally, 2.9 million newborns die within the first month of life. India, with a population totalling 17.5 percent of the global population, accounts for a startling 27 percent of the global newborn mortality rate with over 780,000 newborn deaths every year, the highest newborn mortality rate in the world. On September 17th, India launched its national Newborn Action Plan (INAP) to stop and reverse this disturbing trend.

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Image c/o Gates Foundation

Based on the findings and strategies promoted in The Lancet’s Every Newborn series, INAP aims to reduce India’s newborn mortality rate from its current 29 deaths per 1,000 births to under 10 deaths per 1,000 births by 2030. In order to accomplish this goal, INAP focuses on improving the following six evidence-based, effective strategies:

  1. Preconception and antenatal care
  2. Care during labor and childbirth
  3. Immediate newborn care
  4. Care of healthy newborns
  5. Care of small and sick newborns
  6. Care beyond newborn survival

Additionally, the issue of gendercide does not go ignored. Because a girl’s family traditionally must pay a dowry in order to marry, families – especially in poorer regions – favor having boys over girls. As a result, each month approximately 50,000 female fetuses are aborted or killed at birth, thrown into rivers, or simply left to die. An estimated one million girls in India “disappear” every year. With INAP, the Health Ministry takes this long-standing tradition of gender-bias into account and aims to eliminate gender-based differences in newborn health care.

“These are preventable deaths and now we have an action plan for preventing them.” – Harsh Vardhan, India Health Minister

Although India as a whole is on track to achieve Millennium Development Goals (MDGs) 4 and 5 (reducing child mortality and maternal mortality by two-thirds and three-quarters respectively), MDG success is not consistent across the country. For example, the state of Kerala already has a neonatal mortality rate of seven deaths per 1,000 births, yet the poorer states of Bihar, UP, Madhya Pradesh and Rajasthan are far behind, with a combined neonatal mortality rate amounting to 56 percent of such deaths nationwide.

“Healthy mothers and healthy children are crucial for India to realize the demographic dividend.” – Melinda Gates

It is important to emphasize that India’s efforts to reduce the newborn mortality rate are not limited to merely survival. With the launch of INAP, the Health Ministry will focus increased attention on improving the health and lives of both healthy and sick newborns. In a country where shunning those with disabilities, neuro-developmental delays, and birth defects is not uncommon, recognizing the value of all newborns, both sick and healthy, is a major step in the right direction.

With support from the Bill & Melinda Gates Foundation, the World Health Organization and UNICEF, India’s Health Ministry is confident in its ability to reduce newborn deaths nationwide – and if India’s INAP efforts echo the success of its anti-polio campaign, the future for India’s newborns looks promising.

 

When Disaster Strikes, Mothers and Newborns Are the Most Vulnerable

Originally published on The Huffington Post.

UNHCR / F. Noy
European Commission / UNHCR / F. Noy via Flickr

What would you do if disaster struck? What would be the first thing you would think about if you found out that your family had to flee from your home? What would be on your mind as you struggle to stay hidden amongst air raids and bombed streets?

If disaster struck today — if a natural disaster swept away my entire community or if internal unrest escalated to a civil war — I know that I would think about how to stay safe, how to ensure that my family and friends could stay safe and how to keep my unborn baby alive and healthy.

For expecting mothers around the globe, this happens daily. Disaster does hit and they remain pregnant, with a growing baby in their womb that needs care, rest and nutrition. Yet, when we speak of disasters and conflict, we speak about who is to blame, we talk about peace-keeping and humanitarian operations, or we debate asylum for refugees — as a burden for the receiving countries.

What we often forget to speak about are the hundreds of thousands of women and girls who still need maternal health care. We forget to speak about the women and girls who risk giving birth in refugee camps, in evacuated villages or even on the road. Yesterday marked the 500 Day milestone until the deadline to achieve the Millennium Development Goals, and unfortunately, mothers and newborns — especially those in conflict and disaster — have not yet seen the sufficient progress, especially with regard to MDGs 4 and 5, related to newborn and maternal health.

This year’s State of the World’s Mothers Report, released by Save the Children, shows that mothers and children face the greatest risk of death during emergencies.

In 2014, an estimated 80 million people will be in need of humanitarian assistance due to conflict, persecution or natural disasters. The majority of these people are deeply impoverished and over three-quarters are women and children. Furthermore, for those who survive, their lives have been completely altered. Save the Children estimates that the average refugee situation lasts 17 years!

The civil war in Syria is now in its 4th year. It is estimated that 1,000 women and children have been killed in conflict every month. Yet, several hundreds (if not thousands) more have died due to food shortages and the lack of medical care. Women in Syria no longer have a reliable health-care system to access essential maternal, antenatal and neonatal services. Prior to the conflict, Syria was on track to meet the Millennium Development Goals related to maternal and child health, yet the conflict threatens to set back several decades of progress.

Around the world, mothers and their babies need us. The countries with the highest rates of maternal mortality are countries with internal conflict or other emergencies. Thus, we cannot discuss maternal, newborn and child health without speaking about peace and security.

As we discuss the situation in occupied Palestine, the horrific persecution of Christians in Northern Iraq, the ongoing conflicts in the Democratic Republic of Congo and Somalia, and the heinous crimes of Boko Haram in Nigeria and beyond — we must remember the mothers and the children who are hit the hardest.

The suffering will only end once we collectively speak up, make our voices heard and in solidarity chime in with their suffering to hold our leaders accountable.

Now is the time to ensure that global and national action is taken, not only to accelerate progress to meet the Millennium Development Goals that are due in exactly 500 days, but to ensure that the goals and targets that are set up in the post-2015 agenda include specific attention to the women and children in conflict settings.

Here are a few things you can do to make a difference:

  • Join the online conversation using #MDGMomentum
  • Contact your government officials to see what your country is doing to support women and children in conflict and emergency settings
  • Read the recommendations in Save the Children’s State of the World’s Mothers Report
  • Read the recommendations in the Every Newborn Action Plan
  • Tell the world what you will do to #Commit2Deliver for women and children
  • Foremost, raise your voice and let others know that you will not stay silent about the women and children affected by conflict and emergencies.

Newborn survival: the Every Newborn Action Plan

every newborn header
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.

Photo by Albert Gonzalez Farran - UNAMID
Photo by Albert Gonzalez Farran – UNAMID

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.

Infographic by Save the Children
Infographic by Save the Children

The Every Newborn Action Plan sets out 5 key strategies to tackling newborn mortality:

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.

Additional Resources:

Every Newborn Toolkit

Featured image courtesy of The Gates Foundation

Making the Case to Policy-Makers: We Need to Invest in Midwives

This week the State of the World’s Midwifery 2014 (SOWMY 2014) Report was launched, showing the current challenges and needs of scaling up midwifery services around the world. The report outlines the situation in 73 countries (these countries account for 92% of global maternal and newborn deaths and stillbirths), investigating whether the midwifery workforce is sufficient to meet the universal need for sexual, reproductive, maternal and newborn health.

Only four of these countries are on track, showing the great need to invest in midwives to meet global goals and targets of ending preventable maternal mortality and preventable newborn deaths.

Student midwives in Nigeria. Photo Credit: Lindsay Mgbor/Department for International Development
Student midwives in Nigeria. Photo Credit: Lindsay Mgbor/Department for International Development

How do we make the point to policy-makers?

At the International Confederation of Midwives Congress, Jim Campbell, Director at Integrare and one of the authors of the SOWMY 2014 Report, held a workshop where midwives, health professionals and academia gathered to discuss ways in which to make the case to policy-makers of the need to invest in midwives.

“You need to show the data and the numbers,” explained Campbell, as policy-makers will look at the costs and the benefits. He further encouraged the group to understand the best way to collect data. Various methods of calculating the need of midwives were investigated, including the sensitivity of the method to account for the needs: geographical distribution, fertility rates, roles of other health workers, and more.

In Afghanistan, for example, there is a good basic healthcare system, however, due to the system not taking into account variations in demand across the country, midwives are overworked, overwhelmed and burned out. An Afghani participant in the workshop explained that there is a 35% drop out rate, 12 months after a midwife has graduated. Therefore, the retention and education of the midwifery workforce must be taken into account when making policy recommendations.

The SOWMY 2014 Report is a great tool to start making recommendations based on data. For countries to plan efficiently, the report states that the following data on the midwifery workforce should be collected: headcount, percentage of time spent on key interventions within sexual, reproductive, maternal and newborn health, roles, age distribution, retirement age, length of education, enrollments into, attrition and graduation from education, and voluntary attrition from the workforce.

What are the recommendations?

There is not a one-size fits all. Instead the recommendations need to be linked to context-specific data with a needs-based approach. Countries need different kinds of investments to meet the targets, as the needs of each country is different. It is important to ensure that recommendations are grounded in the needs of each setting.

The SOWMY 2014 Report does provide some general key messages regarding the investment in midwives.

To assist with these policy recommendations, Family Care International has created a toolkit for using evidence from the State of the World’s Midwifery 2014 Report to create policy change at the country level. Download the toolkit in English, French and Spanish!

Investing in midwifery is more than human resources

To ensure that midwives are able to provide women-centered care, have access to appropriate skills, resources and support, the investment must go beyond midwifery education. To ensure that the policies are implemented and that the commitments are prioritised, women have to be included in policy-making. The rights of women must be strengthend in society as a whole and needs to be a priority throughout sectors to ensure the targets of ending preventable maternal and newborn deaths are met.

Stay tuned!