Why Men’s Involvement in Safeguarding Maternal Health Is Critical!

This post was written by Elman Nsinda, journalist and maternal health advocate, White Ribbon Alliance Uganda (nsindae (at ) gmail.com)

In Uganda, 17 women and 106 newborns die every day due to complications related to pregnancy and child birth. Unfortunately, the causes of these deaths are clearly known and could be averted if each of the parties responsible played their part. The causes of death include: Severe bleeding, sepsis, obstructed labor, Hypertensive Disorders among others, exacerbated by delays at both community and at facility levels.

Pregnancy comes as a result of a moment of enjoyment by a couple; man and woman. This means therefore that the two are equally responsible for the outcome and the results whether negative or positive, should be equally shared by the two. The death of a woman as result of complications related to pregnancy and child birth, leaving the husband to remarry, will justifiably show injustice to the woman.
ewec-sun-event-photo-by-%c2%ac-2016-perry-bindelglass-228I am a father of two, and during pregnancy for the two children, I provided good food for the mother’s nutrition, planned transport to take her to the health facility and accompanied her to hospital for antenatal care and delivery for both of our children. I also saved money to plan for emergencies.
During this process, I witnessed mothers lying on the floor, midwives backing at women, delays and other ill treatment. Mine did not face any of those because it was me leading the way for her. We were given priority because I was around; other women without husbands accompanying them were looking on when we were by-passing them!
The experience gave me a sense of being an active participant in my wife’s pregnancy and birth. My wife also felt safe and cared for. No wonder why she delivered normally to healthy, thriving babies.

In Uganda, it’s known that every pregnant woman with a husband accompanying her is catered for fast. In fact, some women who can afford to hire other men to accompany them, do so in order to get first priority and good health care. Reports show that after women become pregnant, many men keep watching as the pregnancy gestation matures, claiming ownership but doing nothing to support the woman go through the process safely to have a healthy thriving baby! As we encourage men to take more active roles as fathers during pregnancy and childbirth, we also need to strive to change the social norms that place women in a position where they need to be accompanied by men to receive proper healthcare and treatment.

img_2537In sub-Saharan Africa, pregnancy and childbirth is looked at as a responsibility of the woman. Therefore, it is rare to see men accompany women to antenatal care and be present at delivery. When they see fellow men doing it, they consider them to be idle, perhaps unemployed and having a lot of extra time. Even with positive examples they miss, and abdicate their responsibilities.

But men can have a tremendously important role during pregnancy and childbirth for example through proving good nutrition to the pregnant woman, responding to complications, seeking medical help, paying for transport, and providing household needs. Birth preparedness! However, these roles are often overlooked and neglected. Almost all causes of maternal deaths are preventable. By taking more active roles as partners and fathers, men could do their part in preventing unnecessary maternal and newborn deaths in countries like Uganda.

In many nations, men also still make most decisions about family planning, such as when to have a child, how many children are to be born, where to give birth from (home or facility), among other vital decisions. We need to work towards changing this, and ensuring that women have control over their own reproductive decisions and their bodies – and decisions about children are made jointly by men and women, as equal partners and parents.

It’s the responsibility of all of us – you and me – to raise awareness about these critical roles in our societies so that men can understand how important their active participation is and play their part in helping women receive the quality care they deserve. Through this, men can help women ultimately survive childbirth, thrive as women and mothers and transform their lives and the lives of their families. This will remarkably impact on maternal health indicators and eventually contribute to the attainment of the Sustainable Goals, because healthy mothers make for a healthy world.

screen-shot-2016-09-20-at-9-52-24-pmA journalist and advocate for women’s and children’s health and rights, Elman Nsinda has been involved in safe motherhood advocacy campaigns across the Uganda to ensure that needless deaths of mothers and newborns are prevented. Elman is a trained White Ribbon Alliance citizen journalist and volunteer.

Featured image: A couple after birth of their child at Barr Health Center in Lira district, northern Uganda. The midwives at the health center encourage pregnant women to go with their husbands for ANC and delivery. Photo by Denis Okwir/WRA Citizen Journalist.

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.

Maternal Mortality: When Numbers Speak Volumes

The clinical nature of the term ‘maternal mortality’ makes the importance – and the humanity behind the concept – hard to fully grasp. It evokes images of statistics, of numbers and of distant percentage rankings that seem to have little to do with the women we know and meet. Yet, the issue of maternal health has a direct and powerful impact on the most human and personal aspects of our lives: our mothers and our children.

The fact is that in the world today, despite the availability of modern technology and huge medical advances, pregnancy poses significant health risk for many women living in parts of the globe. While in developed countries, easy access to high quality care before, during and after pregnancy makes the process safe for most mothers, childbirth is a far more painful and risky process elsewhere in the world. Most maternal deaths are painfully avoidable: women die from basic and preventable, but potentially agonizing complications like hemorrhaging after childbirth, infections, eclampsia and pre-eclampsia, and complications from unsafe abortion procedures.

maternal health
MDG 5 logo courtesy of the United Nations

The United Nations recognized the importance and gravity of maternal mortality worldwide and made improving maternal health as Goal 5 of their landmark Millennium Development Goals. The effects of maternal deaths are far-reaching. It is not only devastating for the mothers and children who are directly affected, but has profound social and economic impacts. The long term effects on the family are well-documented, including depression, withdrawal, less care for dependents such as the elderly and children, negative effects in patterns of household consumption and a decrease in the quality of health of surviving family members. 

Studies done on the effect of maternal mortality in Africa show a direct link between mortality rates and GDP. Women, even when not directly involved in the labor force, enable the generation of income through providing food, ensuring schooling for children and sharing the domestic workload, thereby boosting worker productivity. The results of a 2006 study done in Africa show that the death of a single person reduced GDP by as much as USD $0.36 per year, making bolstering healthcare for expectant mothers as much as financial issue as a social one.

While maternal mortality rates have dropped since the introduction of the MDGs, they still remain unacceptably high. An estimated 800 women die every day because of a lack of access to proper healthcare. Some eye-opening facts from the World Health Organization reveal the alarming truth of childbearing in 2013:

  • The maternal mortality rate as a result of pregnancy related complications is 240 for every 100,000 live births in the developing world (standing in stark contrast to 16 per 100,000 live births in the developed world.)
  • The probability that a 15 year old woman will eventually die from a maternal cause: 1 in 3800 in developed countries, versus 1 in 150 in developing countries.
  • 99% of all maternal deaths occur in developing countries.

Maternal mortality rates around the world are still unacceptable, especially given the preventability of the conditions which contribute to it. No woman should have to risk her life to bear a child, and no child should be born with such a high likelihood of being raised without their mother. These are basic rights that are being trampled on through a lack of awareness and engagement with the issue of maternal mortality. To learn more, visit the United Nations’ Millennium Development Goals page, or the World Health Organization.

Featured image courtesy of Arne Hoel / World Bank

More than just welfare: Why Finnish family benefits support the entire society

Photo source: www.kela.fi

The Finnish “Baby Box” has made headlines in the news since BBC published a comprehensive article about the history of this peculiar and yet envied Finnish maternity perk. The “baby box” – or as it is referred to in Finland, the maternity package – is a box filled with essential baby and maternity items, such as cloth nappies, baby clothes, toys, baby books, and the box itself, which can be used as a crib for a baby, and comes with a fitted mattress. The “baby box” is only a small part of a broad package of benefits offered to families in Finland, including around 3-4 months of paid maternity leave for the mother, additional 5-6 months of paid parental leave which can be taken by either mother or a father, and 54 days of paid paternity leave specifically for the father.

I don’t have personal experience with Finnish maternity benefits, but a close friend of mine, Outi Vierola, does. She had her firstborn child, Fiona, in December last year. She notes that the original reason behind the “baby box” was to encourage mothers to get health checks done during pregnancy, and the maternity package contributed notably to the decline in child mortality in Finland. Even today, a requirement for receiving the maternity package is for the mother  to see a doctor for a check-up before giving birth.

Photo by Antti Vierola
Photo by Antti Vierola

Outi considers the “Baby Box” absolutely wonderful. She remembered asking a nurse in the earlier stages of her pregnancy what basic items they should get before the baby arrives, and the nurse told them that there really wasn’t anything else they absolutely needed in addition to what is in the “baby box” – the package has everything essential for the first 6-12 months of the baby’s life. Every child born in Finland receives it – and therefore gets an equal start to life, regardless of the socio-economic situation of their parents.

Outi also noted that the Finnish “neuvola” system is a crucial part of the Finnish welfare model. In Finnish, the word “neuvo” means advice, and “neuvola” translates to “a place for advice”. These maternity and child health clinics form a specific branch of the Finnish public health care system for maternity, family and children’s health services. Finnish mothers usually visit neuvola between 8-10 times during a pregnancy. The visits are free, and include two ultrasounds. In addition to health care services, nurses in neuvola offer information and advice, organize family support groups, and help parents with the baby-parent interaction once the child has been born. Outi noted that her experience with her local neuvola was purely positive – she felt she could access the services easily and with short notice, she could always get a hold of someone for advice, and information was easily available. She doesn’t consider these services, nor the other maternity and family benefits, as welfare or handouts, but believes it is the responsibility of the state to provide certain basic services for its citizens in an affordable and accessible manner.

Outi plans to return to work in August, when Fiona is around 9 months old. At this point, Antti, the father, will stay home on his paternity leave for a few additional months. Outi noted that the Finnish model not only supports healthy pregnancies and deliveries, but also makes it easier for women to combine career and family if they wish to do so. It is also becoming easier for fathers to take on stronger roles as caregivers and remain home with their babies. Ensuring that fathers are included in parental benefits is important for supporting the bond between the father and the baby, but also essential for gender equality. If nothing changes with traditional parenting roles, mothers will end up double- and triple-burdened by their work and domestic responsibilities, and fathers may end up feeling left out as caregivers. Encouraging women to return to work after having children is useless as long as the support services offered for families are inadequate – a situation that remains a reality for majority of families around the world, both in developing and developed countries.

Photo by Antti Vierola
Photo by Antti Vierola

The Finnish model is not about charity or giveaways, but about supporting entire families so that mothers can experience safe pregnancies and deliveries, and parents have the means and knowledge to raise their children with confidence and with support. Healthy mothers give birth to healthy babies, and informed parents raise happy, healthy children. These support systems and benefits are not handouts, nor are they just for the mothers – they benefit the entire society.

Photos of Outi and Fiona by the happy and talented photographer-father, Antti Vierola.