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Breastfeeding Education for Laos

We all know breast is best.  In Laos, where I will be distributing and training women in the use of clean birth kits, breast should be the only choice.  The reasons are clear: lack of clean water access, inability to adequately clean bottles and the expense of breast milk substitutes (formula).

OK so assuming that breastfeeding is the only choice and it is a natural thing, why would women need information about it?  Because not everyone in Laos is exclusively breastfeeding.  According to the UN:

Although at least 90% of mothers are reported to breastfeed in Laos, only about 26% of babies are breast-fed exclusively to six months, according to the Ministry of Health.

…“Most mothers in Laos are actually already breastfeeding their children to six months and beyond,” said Dr Khamseng Philavong, Exclusive Breastfeeding Coordinator and pediatrician at the Centre of Mother and Child Health. “So the challenge is not to convince mothers to begin breastfeeding, but to encourage them to do it exclusively to six months. We’re reminding mothers that adding anything else to their children’s diet – formula, rice, juice, even water – is unnecessary and can be dangerous.”

Here’s what they had done to as of September 2008:

It has already involved the training and activation of some 3,000 village-level volunteers, known as ‘breast milk messengers’, who work directly with mothers and local caregivers to provide information and counseling. Trainings and orientations have also been conducted for health staff and officials in an initial nine target provinces.

I will be interested to see how this campaign initiated by the Lao government and “international partners” (including the UN), has played out three years on in the remote areas of Laos where I will be training and distributing clean birth kits.

Preventing Maternal Hemorrhage in Laos

I was reading an article today “Uganda’s maternal mortality ratio reduces” and began to think again about hemorrhage, the leading birth-related killer of mothers.

I don’t want to get ahead of myself, but as I get closer to bringing the clean birth kits to Laos, I am constantly thinking about how the kits will be used and to what effect.  The kits specifically target infection which is certainly a step toward lowering mortality of moms and babies.  But Active Management of the Third Stage of Labour is so important to maternal survival…and very very unlikely to be well-known in a home birthing environment in rural Laos.

On the maternova site, I have read about an aerosol Oxytocin that is in development that would eliminate the need for sterile injections and refrigeration. Another device being developed by Arsenal Medical, Inc. can be inserted in the uterus after childbirth and expands to control bleeding (funded by the Gates Foundation).

One step at a time…

Here is an excerpt from the article that talks about Active Management of the Third Stage of Labour:

 major cause of death for pregnant mothers in the region (East Africa) is postpartum haemorrhage which is over-bleeding after childbirth. It accounts for 36% of the deaths.  [The doctor interviewed] said that despite this, an assessment carried out in Uganda, Tanzania and Ethiopia in 2007 on whether health workers in the health facilities in these countries could correctly use the Active Management of Third Stage of Labour to prevent bleeding, only 5.7% of the health workers were correctly using the technique.

Active Management of the Third Stage of Labour is a technique used to prevent and treat mothers for over bleeding after delivery and is recommended for all natural deliveries.

The procedure requires a midwife to give a mother drugs to prevent bleeding within one minute of giving birth; to gently tag at the cord during delivery of the placenta and massage the mother’s uterus after delivery of the placenta.

50 Clean Birth Kits Sent to Laos

The maiden voyage of 50 kits has begun.  The kits are being sourced from AYZH in India (more about my collaboration with AYZH here).  They will travel to Lao PDR (Laos), hopefully make it over the border without a hassle from customs and will arrive at CleanBirth.org’s partner organization in Laos.

The object of this first mailing is twofold: 1.  to ensure that mailing them is possible (they don’t get lost and are permitted allowed in by customs) 2.  to get the kits into the hands of health ministers so that they are approved for use.

I have no control over either so I now wait.  Fingers crossed.

Study Low Birth Weight Babies in Lao PDR

This study (Nagoya J. Med. Sci.  72. 51 ~ 58, 2010) shows that mother’s health and nutrition are factors in babies being born with low birth rates.

Mothers who demonstrated a good grasp of nutrition and health delivered LBW infants 10.1 less frequently than mothers who showed more limited knowledge…

While considering the health status of mothers, it was found that those in poor health had LBW infants 3.4 times more often than healthy mothers.

Other issues like family support also play a role:

…In the traditional society of Lao PDR, women have little independence to decide their own future. For a pregnant mother to get medical support, she must wait for the decision of her husband or other family members before consulting a medical doctor for a check-up of her pregnancy status. The necessity of a nutritious diet and the extent of its availability is, except in some rare situations, again dependent on the wishes of the family.

“Hypertension and proteinuria leading to pre-eclampsia” was found in the study to be the cause of 20-25% of prenatal mortalities.

Conclusions:

The results of this study showed that the maternal factors significantly associated with LBW infants included the mother’s age and occupation, her knowledge and health status, and the family’s income. It may not be possible to address all these issues at once, but early and regular antenatal visits by prospective mothers and conducting awareness programs through the mass
media focusing on proper care during pregnancy could alleviate many of these problems.

Lao PDR celebrates the month of midwives

Great article about the Month of Midwives in Laos (Lao PDR).  I am so pleased to see the commitment to increased midwifery training!
Date: 15/06/2012

Every day in Lao PDR, more than two women die because of complications during pregnancy and childbirth. For every woman who dies many more suffer from illness or disability from complications during pregnancy or childbirth. Most of these deaths and illnesses can be prevented when mothers have access to skilled care at birth.

As part of the strategy to reduce maternal mortality in Lao PDR, the Ministry of Health (MoH) with support from the United Nations Population Fund, (UNFPA) and other development partners, specifically UNICEF WHO and the World Bank, is implementing the National Skilled Birth Attendance (SBA) plan that supports the delivery of the national Integrated Package of Maternal, Neonatal and Child Health Services. Specifically the SBA plan includes production and deployment at community level (Health Centre and Hospital Type-B) of trained professional Midwives that are currently being produced in 7 Provincial health schools all over the country.

Normally, all over the world, the International day of the Midwives is celebrated on 5th May each year, but in Laos, in order to ensure that all provinces can take part in the celebrations, MoH have designated the whole month of June as the “Month of Midwives”, because in June the country will see the graduation of the second batch of community midwives. Over the whole month, MoH in collaboration with UNFPA and other development partners is organizing a number of events, the first of which was in Luang Namtha on June 7th, where a health promotion day for mothers and babies in Viengphouka District was held. Two other events are in Savannaketh on 15th and Oudomxay 22nd June, where MOH will present the graduating midwives from the south and north respectively, their certificate of licence to practice as a midwife.

All activities are focused on keeping mothers and babies safe and healthy through access to birth spacing, use of professional midwives before, during and after pregnancy and childbirth and ready access to emergency obstetric care. To make this possible, it is acknowledged that midwives working at the community level must have an unbroken supply of essential supplies and medicines, and must work closely with the community, especially village leaders, in order to promote the key messages and to encourage more men to take proactive action to save the lives of their wives, mothers and daughters.

The main event of the month was the celebration in Savannaketh. The High-level event in Savannaketh on 15th June, saw MoH award the national midwifery certificates of accreditation of competences to the 80 midwives in second batch trained in Khammouane, Champasack and Vientiane Province. The event brought together senior level officials from MOH at central and Provincial level, including the Vice Minister, Associate Prof. Dr. Som Ock Kingsada, as well as representatives from key line ministries such as the Ministry of Planning and Investment (MPI) and the Ministry of Education and Sports, as well as the Lao Women’s Union and government officials from UN supported districts.

“Midwives can provide much more than family planning and skilled care at birth. They can be the link between the community and the health services. They can work together with local leaders to plan and implement actions to improve the quality of life in the community. They can save mothers and babies lives. If people make use of their services, if communities provide them with support and information and local leaders involve them in the planning and decision-making, Midwives can help to make healthier and more productive communities. The work of midwives is the foundation for healthy families, healthy communities and a prosperous nation” said Dr. Esther Muia, UNFPA Representative.

The Vice Minister of Health, Associate Prof. Dr. Kingsada said “In many parts of the world, and now in Lao PDR, midwifery is seen as a very important and gratifying profession. This is why we would like to encourage educated girls and women from the community to consider becoming midwives. We would also like to ask the community and its leaders to identify and encourage girls in particular to become midwives. Every community needs to have its own professional midwife to work with community leaders, families and individual women and adolescent girls to improve knowledge of safe pregnancy, childbirth and care of mothers and babies after birth, but also to provide quality services”

During the event a 15 minutes documentary about the Community Midwives Programme in remote areas of Lao PDR was presented. The video, recorded in Xiengkouang Province and produced by UNFPA’s Asia Pacific Regional Office in collaboration with the Country Office Lao PDR, shows how having skilled birth attendants is helping to improve the health of mothers and babies in these communities.

The training of community midwives is part of the Joint Maternal, Neonatal, Child Health and Nutrition (MNCHN) programme developed and implemented by the MoH and the United Nations. This programme combines the skills and expertise of UNFPA, UNICEF, WFP and WHO and is made possible through a co-financing agreement of more than 8-million euros over five years between 2011-2015, signed between the Grand Duchy of Luxembourg, MoH and the UN.

Contact information:
Diego De La Rosa, Tel.: (+856 21) 315547, Mobile: (+856) 20 59936509, drosa@unfpa.org

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