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“Mother’s Health Worth the Investment”

This article comes from Ophelia Dahl, the co-founder of Partners In Health, Paul Farmers org.  The excerpt describes the need for local, life-saving medical care for women and that it’s expensive — but not nearly as expensive as letting them die.

But over 350,000 women still die every year in Haiti, Malawi, and other developing countries, because they can’t afford or can’t reach the care they need. They die because they do not have access to … a network of care that reaches right into the villages where the most vulnerable women live, that ensures they deliver their babies at health centers with the help of a skilled midwife or doctor, and that can refer and transport them to a hospital with surgical facilities in an emergency.

None of this is rocket science. Doing all of it isn’t cheap or easy — except when compared to the cost of inaction.

How do you quantify the cost of more than 350,000 women’s lives a year? Measured in moral and human terms, the value of even a single woman’s life is incalculable, compounded by the fact that when mothers die in childbirth, their babies often die as well, and their older children are left orphaned and at high risk.

For those who prefer to measure costs in dollars and cents, my friend and fellow co-founder of Partners In Health, Paul Farmer, recently co-authored a paper analyzing the costs and benefits of the most expensive piece of the necessary network of care — surgical services to provide Caesarean delivery for obstructed labor. The conclusion: the economic benefits of saving women from death and disabling injuries would be six times greater than the costs of providing surgical care.

Other studies have shown that doubling global investments in family planning and pregnancy-related care — from $11.8 billion to $24.6 billion — would prevent more than 250,000 maternal deaths a year.

If you do the math, the increased investment amounts to the cost of about six weeks of the war in Afghanistan. That seems a small price to pay to make motherhood as much an occasion for celebration in Haiti and Malawi as it is in the United States.

Reducing Maternal Mortality: It Takes a Village and a HUGE grant

I just read A Mother’s Day Lament: Why Has Improving Maternal Health Been So Elusive? by Anne Goddard, President and CEO, ChildFund International, in the Huffington Post.  The lament is that progress toward keeping moms healthy and safe in childbirth and reducing maternal mortality has been the slowest of all the Millennium Development Goals (MDGs).

Her organization is doing huge, meaningful, effective work in Africa, India, Southeast Asia, and Latin America.  She writes of the org’s health work in Senegal:

Thanks to a grant from the U.S. International Development Agency (USAID), and working collaboratively with other partners, ChildFund has implemented a large-scale community health project that we believe will ultimately reach virtually the entire country over the next four years. A network of community-based health huts and outreach sites is being created so that virtually everyone — those in both rural and urban areas — will have convenient access to trained healthcare.

She goes on to write about the important role of education and engaging women themselves in the solutions:

In tandem with the centers themselves are additional educational efforts at the community level, particularly addressing some of the cultural traditions that can impact a woman’s health, such as the practice of female genital cutting. There are other cultural aspects that also are informing our strategy. We understand, for example, the vital role that grandmothers and godmothers play as mentors to the younger women in their communities, and so we are training these community elders as birth attendants and community health volunteers, integrating them into this system of healthcare built at the community level.

Simple Checklist to Prevent Maternal/Infant Deaths

Acording to this article from Impact, http://www.psi.org/impact-magazine/2012/05/can-simple-checklist-make-child-birth-safer, checklists have cut surgical deaths in half.  Makes alot of sense for birth.

PSI/India has joined a team led by the World Health Organization, Harvard School of Public Health, Bill & Melinda Gates Foundation and many others who are asking whether checklists can significantly reduce the nearly 5 million maternal and infant deaths a year associated with childbirth.

PSI/India and partners have assembled a 31-item list of reminders, from the simple – asking the mother’s companion to be present at the birth – to precise clinical signs of infection and hemorrhage. Their aim over the next three years is to test it in India to see whether childbirth-related harm, including death, in institutional deliveries can be significantly reduced through adherence to essential childbirth-related clinical care standards.

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.

“Midwives Matter for Maternal Health and More”

Great post from NotEnoughGood.com (http://notenoughgood.com/2012/04/midwives/).

Midwives are undervalued and overlooked throughout the world.  They could make a difference to maternal and infant health outcomes.  According to the article:

UNFPA outlines the many skills a professional midwife can offer in reducing maternal mortality and morbidity.  For example, before and during pregnancy, midwives can be a source of substantiated advice and information. They can be a source of family planning advice and materials. During pregnancy and labor, a trained midwife can recognize signs of problems in women and their newborns, and can refer a woman to the appropriate facility.  When adequately trained, midwives can also provide emergency care. Through these skills, UNFPA believes that midwives can play a key role in achieving MDGs 4 (reduce child mortality), 5 (improve maternal health) and 6 (combat HIV/AIDS, malaria and other diseases). In some countries, midwives can also provide vaccination services.

The article goes on to talk about success stories in countries that  “have harnessed the power of midwives as frontline maternal health workers”.  Malaysia was able to reduce maternal mortality in this way.

The article concludes:

Investment in midwives, who are part of their communities and able to provide culturally relevant but accurate information is an invaluable resource for many women who would otherwise go without such quality care.  Because qualified midwives are trained to understand infectious disease and issues in the scope of pre- and post-natal care, as well as delivery, they are important assets to countries seeking to improve the lives of women, children, and other vulnerable populations.

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