Preventing Haemorrhage and Saving Lives on the Front Lines of Care

Midwives on the front lines of care have made a major impact, ensuring that more women experience a healthy pregnancy and childbirth, and that more newborns survive and thrive. How can we build on progress already made, and strengthen the ability of midwives to ensure even healthier families and communities?

Every year, more than 14 million women around the world experience post-partum haemorrhage. Skilled midwives, trained to deal with complications that arise after childbirth, can intervene to avert many of these deaths, even in low-resource settings.

The Vital Need for Data to Improve Maternal Health

Globally and daily, around 830 women die from causes related to pregnancy and childbirth – equivalent to nearly 35 women an hour. This results in over 300 000 maternal deaths each year – deaths that could be prevented if adequate care was provided. Skilled care before, during and after birth has been identified as one of the key strategies to reducing maternal deaths, a care that 25% of women still do not have access to.

Bernice lives with her father and her four younger siblings in a small rural village in the north of Burundi. Her family, along with eight out of ten Burundians, live below the poverty line, and they depend fully on their household food crop production for their survival. Due to several droughts lately, they are currently facing severe food shortage. Bernice is pregnant with her first child, and even though she’s more than half way through her pregnancy, she hasn’t yet seen a doctor. She is severely malnourished, putting both her and her baby at an elevated risk of complications.

Two years ago, Bernice’s mother Thalia passed away when giving birth to her fifth child, due to a post partum haemorrhage – one of the most common causes of maternal deaths in both developing and developed countries. As with 40% of the deliveries in Burundi, each of Thalia’s childbirths have taken place in their family home – every time without a skilled birth attendant by her side, without both water and electricity.

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Bernice represents a population that is facing numerous challenges that arise from their individual circumstances. Living in extreme poverty in rural Burundi – a country with one of the highest maternal mortality ratios (maternal deaths per 100 000 live births) in the world – makes Bernice and her baby highly vulnerable in regards to surviving pregnancy and birth. In just a couple of months it is her turn to face the difficulties that often come with childbirth in her condition. She fears what is to come, knowing what happened to her mother.

Bernice and her family are fictional characters and fortunately, this time the story is a fictional one. However, based on the latest data on maternal and child health, this is the reality of countless women, adolescent girls and babies around the world, with sub-Saharan African countries facing great challenges in regards of maternal, newborn and child health. In this region, a woman’s lifetime risk of dying during pregnancy or childbirth is an appalling 1 in 36, and the newborn death rate is the highest in the world with 34 deaths per 1000 live births. Compared to a woman in a high-income country, a woman in sub-Saharan Africa faces a 100 times greater risk of dying during pregnancy and childbirth.

The future might look nothing but dark when looking at numbers related to maternal health, but we also need to recognize the improvements that have occurred. Globally, since 1990, the maternal deaths have dropped by 44%, and ¾ of women now have skilled care during their childbirths. Furthermore, at least four antenatal care visits are received by  ⅔ of women worldwide. This increase in maternity services is imperative in showing us that some interventions are successful – hopefully leaving us with a somewhat optimistic mind.

However, in spite of ubiquitous efforts, much is yet to be done. The gap between the countries with the highest and the lowest maternal mortality has grown despite the increased use of maternal health services, resulting in a bigger gap between countries and populations. In other words: millions of pregnant women are left behind from the progress, with minimized opportunities for health gains not only for themselves, but also for their babies.

“We are determined to take the bold and transformative steps which are urgently needed to shift the world onto a sustainable and resilient path. As we embark on this collective journey, we pledge that no one will be left behind.”
The UN 2030 Agenda for Sustainable Development

For us to be able to achieve the Sustainable Development Goals by 2030, and the underlying aim of “leaving no one behind”, accurate, reliable and population-based data on maternal health is essential. It is more crucial today than ever before, and vital to decrease the inequities in care that remains and seem to increase between and within populations.

The percentages in the illustration refer to to following numbers and statistics:

  • 25% of women do not have access to skilled care during birth
  • 99% of all maternal deaths occur in developing countries
  • Between 1990 and 2015, the global maternal mortality dropped by 44%
  • A woman in sub-Saharan Africa is at a 100 times greater risk of dying during childbirth compared to a woman in a developed country
  • Every hour, nearly 35 women die from causes related to pregnancy and childbirth

#12 – Maternal Health Now: New Research from The Lancet

In this episode Julia Wiklander, Felogene Anumo and Zanele Mabaso introduce you to new research that was published just a few weeks ago in The Lancet’s Maternal Health Series. Girls’ Globe was in New York City at the launch of the series and Girls’ Globe blogger Zanele Mabaso from South Africa spoke with one of the authors, Dr. Oona Campbell, from the London School of Hygiene and Tropical Medicine.

The Maternal Health Series by the Lancet shines a light on the causes, trends, and prospects for maternal health in the current era of rapid demographic, epidemiological, and socioeconomic transition. It includes analysis of experiences from the past 25 years and shows us the growing threat to progress caused by poor quality care and inequity of access.

The Lancet Maternal Health Series reveals great disparities in quality of care for women during pregnancy and childbirth. In the past 16 years we have seen amazing progress – where maternal deaths have fallen by nearly half (44%) since 1990, yet some countries and some groups of women saw very little – if any – progress. Despite a lot of political attention on maternal health before the Millennium Development Goals were due to be achieved – they fell short on achievement in maternal health. The global goals for 2030 include a 68% reduction in maternal deaths – which will require tremendous action.

In sub-Saharan Africa, a woman’s lifetime risk of dying in pregnancy or childbirth remains at the horrifically high rates of 1 in 36 compared with 1 in 4900 in high income countries. Since 1990, the gap between the group of countries with the highest level of maternal mortality and those with the lowest has doubled in size!

Now, this is urgent business and an urgent human rights issue – because 210 million women become pregnant and 140 million newborns are delivered every year. Quality of care must be increased and disparities must be decreased.

The Lancet Maternal Health Series unveils two extremes that far too many women experience when accessing maternal health services: too little, too late or too much, too soon. And other women receive no care at all. These extremes show that far too much of maternal health care is not grounded in evidence.

Listen to the episode:

 

If you want to get involved, here’s what you can do:

  • Read the evidence from the The Lancet’s Maternal Health Series yourself
  • Read more about maternal health on Girls’ Globe
  • Watch this video interview about the problems of overmedicalization of childbirth with Professor Cecily Begley
  • FInd out what groups are vulnerable in your community and country. What are politicians, civil society groups or others are doing about it?
  • Get in touch with us at The Mom Pod by email – themompod@girlsglobe.org – to get involved with blogging or advocating at the international level.

Cover Photo Credit: Federico Mena Quintero (CC/Flickr)

Maternal Mortality and Me: I Beat the Odds, But Many Women Don’t

This post was written by Denise Dunning, Founder and Executive Director of Rise Up – pictured here with Rise Up staff. 

“Your blood pressure is running high, but we’ll watch it to make sure you don’t develop preeclampsia. You should be fine,” my doctor told me when I was 30 weeks pregnant with my third child. As I sat on the examining table, my palms started to sweat.

This pregnancy had been a rough ride already – first trimester genetic testing showed that my baby had elevated risk of Down syndrome and I developed gestational diabetes during my second trimester. I lay awake worrying most nights, and still started most mornings with my head in the toilet. But all that, I had a feeling, would seem easy compared to the road ahead.

My first two children were born without medical intervention, and now the prospect of an induction and related complications now loomed large in my mind. Working in the field of women’s health, I already knew all too well that the most dangerous thing many women will ever do is have a baby.

The following weeks were a scary blur of doctors and medical exams. Twice a week, I attended stressful antepartum testing appointments where the nurses performed sonograms, monitored my baby’s heartbeat, checked my amniotic fluids, and tested my urine for proteins. I had appointments with dieticians who reviewed weekly logs tracking everything I ate, monitored my blood sugar levels after each meal, and adjusted my insulin dosage accordingly. I also continued my regular appointments, where my obstetrician measured my baby’s growth and ran blood tests to check my liver functions and platelet levels. I held my breath every time, wondering if something terrible had gone wrong.

Sitting through a seemingly endless series of medical appointments, I couldn’t help but think of Joyce and Lizzie. Early in my pregnancy, I was in New York with my Malawian colleague Joyce, advocating for the health of women and girls at the United Nations. While we were in New York together, Joyce learned that her 20 year old sister Lizzie had died when her baby boy was born. After having a normal pregnancy, Lizzie began to hemorrhage during childbirth and was not able to get a blood transfusion. So, like too many women around the world, Lizzie died while giving life.

As the weeks passed, my blood pressure continued to slowly climb, but remained low enough that my doctor reassured me that I would carry my baby to term. I continued my weekly battery of tests, occasionally requesting additional bloodwork as reassurance that both my baby and I were fine.

This pattern continued until the 37th week of my pregnancy, when my six year old came running into my bedroom one Monday morning at 7am. I had hardly slept the night before, and struggled to open my eyes as my daughter put my cellphone to my ear. I heard my doctor’s voice on the other end of the line telling me that my recent bloodwork showed that I had developed HELLP syndrome and that I needed to go to the hospital immediately to be induced. So much for my plans for another natural childbirth.

As we drove to the hospital, I tried to stay calm and positive, resisting the urge to look up HELLP syndrome – and it’s a good thing I did. What I learned later is that HELLP syndrome is a form of preeclampsia that stands for Hemolysis, Elevated Liver enzymes, and Low Platelet count. Or as my labor and delivery nurse put it – really bad news. Put simply, your major organs start to shut down, and if you don’t deliver the baby right away, you most likely will have a stroke or liver failure. Globally, one out of four women who develop HELLP syndrome die.

My husband and I got to the hospital by 9am, the induction started at 10am, and I delivered a healthy baby boy just before 4pm. In the end, I was incredibly lucky – unlike Lizzie, I had an excellent doctor, a team of top rate specialists, great health insurance to cover the exorbitant costs, the ability to advocate for myself within the medical system, and access to blood transfusions and other emergency interventions if I needed them.

And the odds were on my side – the majority of maternal deaths are preventable. Women who have access to quality prenatal care, skilled birth attendants, and postpartum care have exponentially better odds of surviving pregnancy and childbirth, and of delivering healthy babies.

But far too many women and their babies don’t beat the odds. Every year, more than 300,000 women die during pregnancy and childbirth. Every single day, 800 women die while giving birth – which means that two women will die by the time you finish reading this article. And beyond maternal deaths, 2.6 million newborn babies die every year and an additional 2.7 million babies are stillborn.

Like Lizzie, the vast majority of these deaths could be avoided. Hemorrhage, infection, unsafe abortion, and preeclampsia lead to 75% of maternal deaths – all conditions that are fully preventable. Preventable, that is, if we as a global community make the choice to prioritize the health and wellbeing of women and children.

But the sad reality is that we don’t. Women’s health remains one of the least funded issues worldwide – even though it is the bedrock of global health, development, and security. Without healthy mothers, we can’t have healthy families. And without healthy families, we can’t have a safe or sustainable world. But in the year 2016, the health of marginalized women like Lizzie is still, far too often, our last priority.

Working to transform these devastating realities is the mission of Rise Up, an organization I started to advance health, education, and equity for girls, youth, and women everywhere. We invest in the vision, priorities, and strategies of local leaders to achieve large scale change for girls, youth, and women. Rise Up has advocated successfully for 124 laws and policies impacting over 115 million girls, youth, and women in Africa, South Asia, Latin America, and the US.

We invest in advocates like Francesca Adeola Abiola, a Nigerian leader who is working to save the lives of young mothers and their babies through Rise Up’s Champions for Change Initiative. Maternal mortality is one of the leading causes of death for 15-19 year-old girls globally, and the reality for girls in Nigeria – where one in 13 Nigerian women dies during pregnancy or childbirth – is no different. With support and funding from Rise Up, Francesca has advocated for implementation of a national policy that increases access to youth-friendly health services in the slums of Lagos. Francesca has successfully convinced decision-makers to provide funding so that young women can access the services they need to stay healthy.

We also support leaders like Monica Atkins, a young leader in Mississippi who is increasing youth access to comprehensive sexuality education through Rise Up’s Youth Champions Initiative. The United States is one of only eight countries – including Afghanistan and South Sudan – where maternal mortality is actually increasing. So in a part of the US where maternal death rates for women of color are higher than many sub-Saharan African countries, Monica is working to ensure that all young people can avoid unwanted pregnancy and HIV/AIDS. Using art and poetry, Monica is building a movement of young people who speak out for their rights and demand access to the comprehensive sexuality education they need and deserve.

Saving the lives of women like Lizzie – and millions more women like her – takes political will, financial commitment, and savvy advocates who have the resources they need fight for better laws, policies, funding, and health services. That’s why Rise Up has built a network of 370 amazing leaders like Francesca and Monica, investing millions of dollars to support their vision to create large-scale sustainable change for their communities and countries.

Because in the end, the truth is devastatingly simple. Women and their babies will continue to die until we decide that they have the right to live. And without healthy women, we can’t have healthy families, resilient communities, or a sustainable world. The choice is ours to make.