Saving Mothers

Despite lagging in movement towards securing sexual and reproductive health care, targeting syphilis, and monitoring mothers and their babies in the postpartum period, Uruguay has done much to reduce the maternal mortality rate, a major aspect of the fifth Millennium Development Goal. As alerted to by the IPS newswire the country has made significant progress towards lowering the maternal mortality rate, which is now the lowest rate throughout Latin America. Despite these great successes, it remains critical to target lower income communities and rural women as most of the deaths that continue to occur are understood to be avoidable. Additionally, maternal mortality and morbidity relates directly to other issues of women’s health care access, and though the rate is on target, it is important to not only focus on preventing deaths. Uruguay now has secured antenatal care for roughly 90 percent of pregnant women which has helped to lower the death rate from an average of 2.3 per 10,000 live births in the 1990′s, to 1.5 deaths per 10,000 in 2008.

Also significant to the reduction in the death rate is that while abortion remains illegal in Uruguay medical responses to such have shifted. As reported, “In 2001 it was shown that abortions carried out in unsafe conditions were responsible for 28 percent of maternal mortality.” Without changing law to allow for safe abortions, an initiative to reduce the risk of unsafe abortions with counseling and pre and post abortion examinations has enabled many women to guarantee health care access in important, albeit limited, ways. As IPS notes, “According to official statistics, there have been no deaths due to abortion complications in the country in the last two years.”

On California Report, produced by Northern California Public Radio station KQED, there was a wonderful investigation of health care in rural California, where poverty rates are significantly higher than in urban zones and where access to medical care is being threatened. Check out the site and listen to the insightful program for an understanding of how maternal health care is also threatened as hospitals close and as women are often required to travel for upwards of two hours to obtain prenatal care.

Also of interest this week, and as we promised to write further about, is the issue of HIV and distance from medical centers as they negatively affect pregnant women in Swaziland. The IPS newswire reports that midwives that make use of traditional medicine are being urged to “refer all expecting mothers to health facilities for neonatal, delivery and postnatal services.” Yet as the health facilities that women are now told to travel to are often overburdened or in some cases shut down, pregnant women are losing access to care rather than gaining from trained medical providers. The reason for the change in policy was the high maternal mortality rate, yet in forcing pregnant women to travel long distances at great personal risk, perhaps instead local practitioners should gain training to respond appropriately to emergency situations.

And for more news related to the African Union summit focused on women’s health and maternal mortality concerns, the Daily Monitor has a commentary about how many governments continue to disregard the great importance of women’s health and access to health security.

The New York Times reported about advised changes in the ways doctors should respond to the pregnancies of women who had previous Caesarean sections. The news report concluded that in many cases women who previously gave birth via C-section are able to later safely deliver vaginally. The American College of Obstetricians and Gynecologists became interested after a panel was convened to determine why in 2006 only 8.5 percent of women were having vaginal births after previous Caesarean births, down from 24 percent in 1999.

With 1999 guidelines insisting that hospitals have medical teams “immediately available” in case of emergency, many hospitals prevented women from electing to have vaginal births due to fears of malpractice lawsuit and cost, as smaller hospitals were largely unable to staff the required number of doctors to have emergency teams available immediately. Yet C-sections are not without complication, and as the The New York Times notes, “Compared with babies born after a repeat Caesarean, those born vaginally after Caesarean have increased risks of stillbirth (the overall risk is well below 1 percent), but decreased risks of breathing problems and jaundice.”

Back in February, California Watch also reported on the links between maternal mortality and Caesarean section. They note that both C-sections and repeat C-sections contribute to an increased risk of complication associate with increased threat of death. As the NYT states though, for women with “one previous Caesarean, the risk of rupture during a trial of labor is quite low — from 0.7 percent to 0.9 percent. If the same woman has a repeat Caesarean instead, before labor starts, the risk of rupture is even lower — from 0.4 to 0.5 percent.”

The new recommendations seek to allow women to determine their delivery method, though many doctors remain unsure if women will elect for vaginal births due to the continued advisory to have emergency staff “immediately available”. Many hospitals may continue to fear the risk of lawsuit. For more on this topic, reference the Canadian Medical Association Journal (CMAJ).

The International Federation of Gynecology and Obstetrics (FIGO) is reporting that at the 15th Annual African Union Summit in Kampala, Uganda, discussion is focusing on issues of maternal mortality and maternal health. As linked to the underfunding of maternal health campaigns that we first alerted to yesterday, international focus is being placed importantly on methods of reducing maternal deaths, many of which are preventable with adequate care. Quoting news provider Xinhua, FIGO states that “In order to meet the Millennium Development Goals devised by the agency the country has to do more to improve maternal health both pre- and post-pregnancy.”

According to The New Vision, and as we first alerted to yesterday on Facebook, Uganda has just determined that it cannot and will not allocate 15% of the national budget to health and maternal health care as African Union member states had pledged to do in 2003. Instead of the agreed to percentage, Uganda has instead designated 9% of the national budget to the health sector, with maternal and child health care being the lowest priority. At roughly 435 maternal deaths per every 100,000 live births, Uganda needs to take steps in order to meet the the fifth Millennium Development Goal of universal access to maternal health care.

Though there was note made of the ways that money has been funneled into providing all children, regardless of gender, the ability to go to school free of cost, a move which has enabled greater numbers of girls to gain an education, it is note worthy that maternal mortality funding is often discussed alongside educational costs, HIV funding, and other health related issues as way of validating defunding actions.

Configuring the funding of universal primary and secondary education as a valid reason for underfunding maternal health care results in a skewed conversation about which peoples deserve governmental rights and protections. Importantly, these discussions that configure the funding of one sector against another serve to create and maintain socially held opinions about which bodies are valuable and which are not. The lives of women and pregnant women are just as important for the future of developing Uganda, and the funding children’s education should not serve to function as an acceptable reason for the lack of important ambulatory services, trained midwives, access to clean clinics and sexual education.

The risk of death is greatest amongst the poor and in focusing on education as empowerment alone, the poor remain largely isolated from the health services that are more easily accessed by wealthier groups. The debate needs to be shifted to enable an understanding of the multiple and intersecting concerns of youth education and maternal health care access in order for all peoples to gain safety and security.

As reported by The News International, Pakistan has asked for $78 million in financial support to enable Pakistani women to increase the time between pregnancies. Makhdoom Shahabuddin, Pakistani Health Minister, explained to a delegation of U.S. governmental officials that this birth spacing endeavor is critical for meeting the Millennium Development Goal to reduce the maternal mortality rate. Saying that spacing related not merely to the health of mothers and their babies, Shahabuddin noted that Pakistan recognizes fertility reduction to “also (be) a right of women who want to postpone their next child but are unable to find the means to do so.” As roughly one-third of the births in the country occur within 24 months or less of a previous pregnancy results in greater risk of disease and death to the mother. Both a health and human rights issue, the discussions occurring around fertility reduction are obviously important and necessary.

Yet as Pakistan is one of the six countries with the highest maternal mortality rates, this focus on lengthening the time between pregnancies is certainly only one important step that needs to be made towards increasing safety. Though focus is being invested on widening the time between pregnancies, so very much money is being negotiated to this task alone, and thus it becomes critical to recognize that there needs to also be other attempts at reducing death rates. A major component of fertility reduction is provisioning the nation with birth control methods and educating the populace about the proper use of such devices, but also critical is an expansion of the wider health care system and training midwives and nurses to assist with pregnancies and births in both urban and rural zones.

As the article even notes, the birth spacing policy will likely account for 100,000 lives saved, but is not in itself the singular method capable of bringing the nation to the target goal of 40 deaths per 1,000 live births. Hopefully discussion between the Pakistani Health Ministry and the U.S. delegation will engage the need for a diversified program that recognizes that other social services are required to provide all mothers with the security and care necessary to really meet the Millennium goals.

The IPS News wire discusses the multitude of ways mothers in Brazil identify meaningfully with pregnancy, labor, and motherhood depending on cultural expectations and traditional considerations. Attending importantly to the ways that there is never a single way of being a mother, the state National Health Foundation’s (FUNASA) Department of Indigenous Health works to respect how different communities regard the importance of where someone is born, how the placenta is handled, and what body markings an infant and mother should be bestowed with.

Dealing with community midwives and natural medicine providers from 215 different indigenous ethnic communities certainly has produced challenges, yet as the Department is focused most specifically on respecting communities while also assisting mothers has resulted in innovative methods for reducing the maternal mortality rate. For instance, the building of birthing houses enables entire families to remain nearby their homes and wider communities during assisted labor. The important recognition of the diversity of mothering possibilities reveals a deep care on the part of the Brazilian government and in turn the maternal mortality rate has fallen from 140 deaths per 100,000 live births in 1990, to 75 per 100,000 live births in 2007.

In other news, the New York Times is reporting that the maternal mortality rate in New York has been negatively affected by obesity, poverty, and lack of health insurance. As we first commented on yesterday via Twitter, city health officials have determined that 49 percent of the 161 women that died between 2001 and 2005 were obese. The death rate was also recognized to be highest amongst women of color and women from poorer neighborhoods, attesting to the disparity in health access that occurs along racial and economic lines in the United States. Women without health insurance were reported to be four times as likely to die due to pregnancy related complications.

IPS News is also reporting that in Zwedru, Liberia, men have begun to work as midwives despite cultural unease around men performing such tasks. Yet with a shortage of qualified female candidates for the recently reopened midwifery program in Liberia’s rural southeast, male students are recognized as being able to fill important positions within the community. Understanding that men are also deeply affected by the high maternal mortality rate through the loss of mothers, children, and sisters, has allowed some to recognize the need for male participation while others still shy away from challenging the gendered nature of maternal health care. In order to meet Millennium Development Goals however, and to combat the 1 in 12 lifetime risk of maternal mortality, it will be greatly interesting to witness the ways increased male involvement will be received.

The International Federation of Gynecology and Obstetrics reported today that Pastor Charles and Mai Olivia Charamba have composed a song to assist the spread of information regarding maternal mortality rates in Africa. The aim of this musical collaboration is to help reduce the too high rate and with the assistance of the United Nations Population Fund the song is to become the theme for the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA). Through alerting the wider public of the need to address maternal mortality rates, many hope that the song functions as an educating device that can spread important information in ways that more conventional educational campaigns have not been able to. Indeed this creative approach to an incredibly important issue serves to remind about how high the mortality rates are throughout much of Africa. Other creative steps that can be made to address the maternal mortality rates include donating to the Saving Mothers Causes campaign on Facebook to allow Doctors and Nurses trained and supported by Saving Mothers to provide gynecological and obstetric education and training under the POWHER program in Liberia.

According to The Washington Post, the promise of monetary assistance is the newest social motivator to reduce India’s high maternal mortality rate. With one of the worlds worst rates of pregnancy related death, India is confronting the tensions between an ever growing economy and the lack of health related services available to many citizens. With cash incentive programs now in place rural women are becoming motivated to give birth in hospitals rather than at home where critical and educated assistance is often lacking. The promise of thirty dollars for agreeing to have a hospital delivery is convincing many mothers to have hospital delivers as they are able to gain an amount of money that for many people equals several weeks worth of wages.

Understanding that the loss of mothers in pregnancy impairs the ability of the nation to secure the care of its citizenry, India has also adopted this new incentive program to continue battling the high rate of maternal mortality that plagues the nation and configures it as one of the most dangerous countries in terms of maternal mortality. Though the rate has indeed fallen in the last twenty years, the loss of life related to pregnancy remains quite high. For every 100,000 live births, 254 lives are lost. Indeed, as the article notes, more than half of maternal deaths in 2008 came from six countries: Nigeria, Pakistan, Afghanistan, Ethiopia, the Democratic Republic of Congo, and India. Most at risk are those that live in rural spaces, and in some regions of India statistics demonstrate that a woman dies in labor every hour.

Often a significant factor in decreasing high mortality rates is the training of qualified nurses and midwives who can assist pregnant women in rural zones where access to hospitals is limited. Yet with the support of UNICEF two of the poorest states in India – Bihar and Uttar Pradesh – have witnessed a great increase in the number of women giving birth in medical facilities from less than 20 percent in 2005 to nearly 50 percent in 2008, revealing an increased investment in physically bringing pregnant women to locations with hospitals. Though the result has been greatly positive, and as the training of Ashas (local health assistants) has assisted low income and under-educated couples understand the real dangers of unassisted births, the shift to bringing women to hospitals has resulted in an overburdening of an already overtaxed medical system. Thankfully the government continues to take steps towards increasing access to health care throughout the nation.

The Unites Nations Millennium Development Goals (MDGs) to secure community health and environmental rights and access have not been achieved throughout much of East and Southeast Asia, including the Philippines, new UN reports indicate. Proclaiming the moves made by many nations to be “unacceptable” the UN and the Asian Development Bank (ADB) now consider the health security of many women to be threatened. The Philippines was specifically recognized for not improving maternal health, which is the 5th Goal of the MDG. In seeking to reduce maternal mortality rates by 75% of current rates, the goal states that, “1- most maternal deaths could be avoided, 2- giving birth is especially risky in Southern Asia and sub-Saharan Africa, where most women deliver without skilled care, and 3- the rural-urban gap in skilled care during childbirth has narrowed.” Yet the Philippine Legislators’ Committee on Population and Development Foundation Inc. has just reported that the maternal mortality ratio actually continues to worsen.

Presently 162 maternal deaths occur for every 100,000 live births. As BusinessMirror states, “around 11 Filipino women die every 24 hours from pregnancy and childbirth complications.” Though many of the other MDG goals are being met, it is critical to improve upon maternal health access to also improve infant mortality rates and negotiate for increased access to education. The work of Saving Mothers is dedicated to this task and to educating about the variety of ways maternal mortality rates can be lowered through attention, education, and care. For more information on the findings reported please refer to Business Mirror and the United Nations Millennium Development Maternal Health Goals.

In the six months following the disastrous 7.0 earthquake that hit Haiti, maternal and neonatal health services have largely been secured again for many of the displaced women and girls throughout the nation. Working alongside the UNFPA, the United Nations Population Fund, the Haitian government has met the variety of health needs with mobile and temporary clinics. UNFPA and the Haitian government have prioritized the dissemination of pertinent health related information and now seek to reopen the National School of Nurses and Midwives to meet the needs of expectant mothers. In alliance with UNICEF and the World Health Organization focus is being placed on reducing maternal mortality rates through focusing specifically on improving the quality of reproductive health services in a number of hospitals and clinics.

As stated in the UNFPA press release, “The reproductive health needs of the population are often forgotten in the aftermath of a disaster,” said UNFPA Representative in Haiti, Igor Bosc. “Our job now is to assist Haiti in rebuilding its health sector so that it can provide better reproductive health services and social protection than ever before.” Integral to the very functioning of Haiti is making health care secure for all citizens, including women and mothers. It is significant that women have not been forgotten amidst this tragedy and it is important to champion the moves made by Haiti and the United Nations to continue improving women’s access to maternal health care.

For more on this breaking news refer to UNFPA: http://www.unfpa.org/public/home/news/pid/6238