CleanBirth - Saving Mothers and Babies in Laos

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Countdown to 2015 report: Look at Laos

Countdown to 2015 released country profiles today.

The 2012 Report, Building a Future for Women and Children, highlights country progress—and obstacles to progress—towards achieving Millennium Development Goals 4 and 5 to reduce child mortality and improve maternal health.

Lao PDR is a mixed bag.  Significant progress has been made in water and sanitation, malaria prevention, and immunizations. However there is much, much more to be done. Two biggies that I see: only 26% of infants <6 are exclusively breastfed (up from 23% in 2000) and only 20% of births have a skilled attendant (up from 19% in 2000).  Antenatal care is still bleak — with 35% attended once in pregancy by a provider — up from 27% in 2000.  Density of doctors, nurses and midwives stands at 12.4 per 10,000 population.

My summary: keep funding clean birth kits, community health workers and midwifery training.

My CBK Project: Introducing Birth Kits for Baby Showers.

Fundraising is officially underway.  I have raised enough money for 60 kits, including shipping and training for community health workers. So excited!

I have also come up with an idea for getting out the word about the kits:  Birth Kits for Baby Showers©.  Instead of a cute favor that is briefly admired and then forgotten about, why not give the gift of life for $5.   Each guest recieves a place card announcing that a donation of a Clean Birth Kit  has been made.  Here are examples of the cards:

Laos: Maternal & Infant Mortality Stats

Why does Laos need Clean Birth Kits?

Here are the stats on Laos and maternal and infant mortality from GFMER – WHO – UNFPA – LAO PDR Training Course in Reproductive Health Research in Vientiane, 22 September 2009.

Health situation ( source census 2005 )
1. Crude Birth rate : 34.7
2. Crude Death rate : 9.8
3. Life expectancy : 61 Female : 63, Male : 59
4. MMR : 405/100.000 LB (MDG=260, US 11 per 100,000)
5. IMR : 70/1000LB  (MDG=45, US 7 per 1,000 — 34 countries better than US, Singapore has 2/1,000)
6.U5MR : 98/1000LB (MDG=55, US 7.5)
7.Total Fertility Rate : 4.5
8. Antenatal Care : 26.7%
9. Delivery at hospital: 10.8%
10. Postnatal care: 6.9%
12.water supply : 67.15 %
13.Sanitation : 45.68 %
14. AIDS prevalence : 0.02%
15. IBN coverage : 60%.

My CBK: Development Laos, PFR and World Bank

The Poverty Reduction Fund (PRF), established in 2003 by the Lao government and funded by the World Bank (check out the great video), is making progress to reduce poverty.

From February 2003 to March 2011…

  • 86 bridges have been constructed;
  • More than 668 villages have received access to clean water systems and 154 irrigation schemes have been developed;
  • 3,042 km of rural access roads have been upgraded;
  • 598 schools and 62 health clinics have been built in remote villages;
  • 681 community members participated in the decision-making process (33 percent women and 95 percent non Lao-Tai speakers);
  • 1,113 training programs were provided for approximately 68,000 community members at village clusters level;
  • 181 training programs were provided for over 310,000 provincial, district, and cluster village facilitators.

Let’s not export our flawed social views on Maternal Health

Today I had a conversation with a friend who is in her 50s about breastfeeding her four children, who were born over approximately a 15 year period.  She said with her first, she didn’t breastfeed at all.  With her second, she breastfed for a month.  And with her third and fourth, born 22 months apart, she breastfed each for a year — and was sad to stop.

What made the difference with her last two?  She said that noone breastfed when she had her first, there was no support.  By the time the last two came, breastfeeding was acceptable if not embraced.  Breastfeeding in the US is increasingly embraced but breast milk substitutes are still being given to almost half of US babies by day 7, according to the CDC.

Thinking about this conversation about social context,  it is clear that society drives what is acceptable/good when it comes to breastfeeding and birth.

In the US C-sections (often scheduled) are de rigeur among celebrities, thus they are regarded by US Weekly fans everywhere as a preferred choice.  The role of midwives is misunderstood, thus they are not sought out.  Birth is seen as dangerous and excruciating and voices opposing this media-driven view are drowned out.  Breast milk and formula are both regarded by many as equally nutritious, with formula having advantages like “baby is more full and sleeps better.”

One of my fears is that our views of maternal health will be exported to the developing world.  It has already begun in the areas of c-section and breastfeeding.

C-section rates in the developing world are on the rise.  One study by Belizan et al comments:

Although the epidemic of caesarean section in Latin America is not new,6 little action is taking place to reduce its use. This is partly because caesarean section is now culturally accepted as a normal way of giving birth.23

Breast milk substitutes are being pushed on populations with neither the money nor the clean water nor the need for them.  Laos is one example where the population has historically had high levels of breastfeeding, but influxes of breast milk substitutes are changing the situation.  This 2010 study by Barennes et al finds:

In Laos, mothers with the highest socio-economic status are showing a tendency to give up breastfeeding. Successful educational strategies and advocacy measures should be urgently developed to promote and sustain breastfeeding in developing countries.

Women in the third world need many things: among them community health workers, midwives, medicine, emergency care and supplies.    However, importing our flawed views of breastfeeding and birthing will not save lives.  Instead, practical solutions need to be found on the ground, where C-sections and milk substitutes are reserved for medically necessary conditions.

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