• July 24, 2015
    By: Jinny Jung

    “Mothers are a part of a rising African continent, and their health and welfare cannot be separated from the rest of society. For stronger and healthier communities, we need to secure basic rights for African mothers. Maternal mortality remains an enormous challenge, but can be overcome with female empowerment.” – Jinny Jung

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  • After A Mother is Gone

    July 13, 2015
    By: Jinny Jung

    Time and time again, we have focused on the socioeconomic and environmental conditions that ultimately result in the avoidable deaths of many pregnant women in developing countries. However, we have not really considered the implications of a mother’s death –without understanding how the absence of a mother affects her family and community both immediately and in the long run, we cannot fully combat maternal mortality. In regions like sub-Saharan Africa where approximately 179,000 women die each year, maternal mortality is a public health issue that cannot be separated from the overall wellbeing of the population.  

    Mothers are the heart of the family. They act as the bearers of the next generation, giving birth to and raising future workers, leaders, and functioning society members. Education and social statuses of mothers have a great impact on her children’s wellbeing – children of educated mothers are 50 percent more likely to have longer lifespans and make smarter decisions about their health and family planning (The State of the World’s Children 2009 Report, World Health Organization). When the mother is taken out of the picture abruptly and unexpectedly, the family loses a central figure and important household contributor (culturally, emotionally, and financially). Her death also indirectly affects her daughters’ chances of dying when it is their turn to bear children, turning maternal mortality into a familial cycle.

    Without a mother, children suffer. Family structure is greatly disrupted, and poverty becomes a great threat to the family. In many already-impoverished households, the strain of maternal medical bills, the death of the mother, and the funeral costs associated with the mother’s death compel many fathers to take their children out of school and put them to work. For school-aged girls, this robs them of the chance to educate and empower themselves on personal health and independence. Girls also feel more pressured to start families earlier, placing them at higher risk of maternal mortality. Infants whose mothers die during the first six weeks of their lives are far more likely to die in the first two years of life than babies whose mothers survive (WHO). The mother is a key figure in ensuring that her household remain as stable and healthy as possible.

    Acknowledging the importance of women – especially in developing African countries – is an crucial step in gaining rights for women. In the WHO 2009 State of the World’s Children Report, Aslihan Kes, an economist and gender specialist at International Center for Research on Women (ICRW), stated that “women’s contribution to their families’ wellbeing is immeasurable. They contribute as producers, as income earners, farmers, and entrepreneurs, and at the same time take on most, if not all, of the household care work.” If we have improved policies and increased investment in maternal health care, we could lessen the severity of the impact of maternal deaths on families and communities.

    Creating a supportive environment for females, mothers, and newborns is essential in the maternal mortality battle. Maternal mortality is very much a product of the oppressive environment in which women of developing countries live in. Women remain disadvantaged and disempowered at home and in their communities, but if given the tools to empower themselves, they could create a more supportive and healthy environment for themselves and their families. Education is “pivotal to improving maternal and neonatal health, reducing the incidence of child marriage” (WHO 2009 State of the World’s Children Report). Societal female disempowerment propagates the unfortunate maternal mortality trend, but if we educate girls and protect them from discrimination, we could see a further decline in mortality.

    A human-rights based approach toward improving quality of and access to maternal care would include addressing gender discrimination and inequities in society through social and cultural changes.  Granting wider access to family planning and adequate diets are cost-effective measures that women of reproductive age have a right to expect. Currently, the rights of many African mothers are being blatantly neglected, leaving them out to die and condemning their daughters to similar fates. They are marginalized, ignored, and used by a society and healthcare system that does not care about them enough. We can change their fates by focusing on creating a female-friendly environment where young girls and women feel safe coming forward for sexual information, medical care, and personal empowerment.

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  • Ethiopia: Preventing Mother-To-Child HIV Transmission

    June 30, 2015
    By: Jinny Jung

    In Ethiopia, young mothers undergo regular antiretroviral therapy (ART) in order to increase the chances of delivering HIV-free babies. Antiretroviral therapy is nothing new; however, the increased provision of ART is strengthening Ethiopia’s maternal healthcare services and enabling more mothers to live healthier lives with their babies.

    In Ethiopia, 90,000 pregnant women live with HIV and 14,000 HIV-positive births occur annually (World Health Organization). Despite these numbers, only 24% of eligible pregnant women receive ART and other medical services. Without medical intervention, the mother is not the only one at risk – a baby being born in a developing nation is at a 25% to 35% risk of getting HIV from an infected mother (PubMed). HIV is a public health issue that endangers countless lives, including those who haven’t been born yet.

    Ethiopian mothers are being given the chance to break the cycle. According to 33-year-old Sisay Dinku, who offers counseling to HIV-positive women, “There have been a lot of improvements. When I first knew I was HIV positive, we used to go to the hospitals far away because the services weren’t given at the community centers like they are now.”

    For instance, people no longer have to wait as long to receive their CD4 count results. The results gauge how well one’s immune system can fight infections such as HIV, and also determine when a person should begin treatment. Previously, women would have to wait up to two weeks to receive their results, if at all – more often than not, the results would become mixed up, rendering them useless.

    The Pima machine was a revolutionary change. Now, patients can have their blood samples analyzed in twenty minutes, allowing all eligible patients to begin treatment right away, rather than having to wait weeks. When it comes to pregnant women, a difference of mere days can make all the difference in life and death. Sisay was one of nine other women who discovered they were HIV-positive on the same day, but she is the only survivor. The rest, unfortunately, were not able to begin treatment or sustain treatments once they begin due to causes such as lack of transportation to the health center.

    The Pima machines were initially funded and provided by UNITAID, a global health organization, but the Ethiopian government has since chosen to expand and extend the program, due to its success and efficiency. USAID also ran a three-year HIV prevention program for pregnant, HIV-positive mothers. It collaborated with the Ethiopian Ministry of Health to strengthen existing maternal and newborn health services. Community-based measures were also taken. Pathfinder International, another organization focused on sexual and reproductive health, worked closely with health workers, religious leaders, and government structures in order to ease the accessibility and costs of maternal, newborn, and PMTCT services.

    Providing antenatal care has proven to lower HIV prevalence among pregnant women. A study conducted from January 2006 to June 2010 examined 7,887 pregnant women in the Antenatal Care Unit of Bishoftu Hospital. In 2006, the overall prevalence rate was 8.3% but declined to 4.3% in 2010. Due to the remarkable decline in HIV prevalence in the observed five-year period, researchers concluded that the involvement of male partners in HIV counseling, HIV testing, and early interventions targeted at HIV-negative individuals are vital.*

    Prevention of mother-to-child transmission (PMTCT) includes:
    • Antenatal care and testing for HIV
    • For HIV-positive women, antiretroviral treatment
    • For infants, antiretroviral treatment within 72 hours of delivery

    In order to prevent mother-to-child HIV transmission, the mother must stick to a regular regimen of medications while pregnant and breastfeeding.

    Says Ababa**, an HIV-positive mother, “Now I know my daughter doesn’t have it while I have it, I’m very happy. It changes everything for me.”

    *”Trend of HIV prevalence among pregnant women attending Antenatal Care Unit of Bishoftu Hospital, Ethiopia”, PubMed July 2013.
    **Name changed for anonymity.

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  • Algeria: What it’s doing right for its mothers, and what it still needs to do

    June 18, 2015
    By: Jinny Jung

    Every day, 396 African women die due to pregnancy-related complications and causes (WHO). Maternal mortality is an ongoing struggle and it can become easy to be disheartened by the apparent lack of progress being made in maternal health. Regardless, there is still hope. Algeria, a country in North Africa, has reported a 50 percent decrease in maternal mortality in the past few decades. According to the United Populations Fund (UNFPA), maternal deaths have decreased from 523,000 in 1990 to 289,000 in recent years. What did Algeria do differently for its mothers, and why did it work?

    The Algerian government started investing much more money in the health sector and in human resources, greatly easing the strain that overburdened and understaffed health centers and hospitals were experiencing. It spends more than $100 per capita on health – a generous amount compared to Tanzania and Uganda’s $15 per capita (WHO). Investing human resources for the health sector allowed for the establishment of disease detection programs, the improvement of existing healthcare services, and a reform of the healthcare system. How did these help mothers survive? The creation of multiple health services decreased disease incidence rates and put fewer mothers at risk of contracting diseases during pregnancy. As a result, mothers were healthier when giving birth, which greatly improved their survival chances.

    At the 68th General Assembly of the World Health Organization (WHO), the Minister of Health of Geneva, Population and Hospital Reform Abdelmalek Boudiaf praised Algeria’s efforts: “Algeria’s investments in the health sector have allowed meeting many challenges and achieving promising results in terms of health indicators.”

    Algeria might have slashed its maternal mortality rate in half, but the battle isn’t over just yet. Progress in maternal mortality is tracked by the fifth millennium development goal (MDG) established by the United Nations: “To reduce by three quarters, between 1990 and 2015, the maternal mortality ratio” and “[to] achieve, by 2015, universal access to reproductive health” (UN.org). If Algeria is to achieve the fifth MDG, it needs to grant wider access to sexual and reproductive health services for young women, instead of stigmatizing the need for antenatal and postnatal care and education.

    Antenatal and postnatal care are so important in increasing a mother’s chance of survival. A 2009 study found that 95.3% of births are attended in Algeria, yet mortality is still high because of poorly trained healthcare staff and a lack of antenatal care being provided to the mother. Without proper antenatal care, early identification of health risks to the mother can be missed and become life-threatening later on. Eclampsia, one such pregnancy condition, manifests itself as regular pregnancy pains but if not caught in time, can cause uncontrollable bleeding and seizures in the mother. 79% of mothers receive postnatal care in Algeria, but we need to question how often they visit the hospital after delivery, how long they wait to visit the hospital after delivery, and whether they were examined by qualified nurses and doctors.

    The most important thing to consider when it comes to fighting maternal mortality and analyzing what works and what doesn’t, is whether there is a bridge between policy and on-the-ground implementation. There is no doubt that the Algerian government is taking steps to reduce mortality, but the sustained high mortality levels hint that more needs to be done than just throwing money at the problem. Pregnant mothers are dying unnecessarily, and Algeria needs to figure out what it’s still not doing right.

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  • Men can’t get pregnant, but they should care.

    June 10, 2015
    By: Jinny Jung

    Making a baby takes two, and raising a family also takes a strong partnership. However, most African mothers are left trying to handle everything on their own, from the very moment they become pregnant. Africa’s dominant patriarchal society has significant implications for maternal health and family rearing, and if we are to help mothers in Africa, we must also recruit fathers.

    Pregnancy and family rearing are viewed as exclusively women’s affairs. Men are often excluded from the pregnancy process – expecting fathers often are not allowed to remain in the room when antenatal examinations are conducted, and there is a general disconnect between reproductive health knowledge and men. Although men are not actively engaged during pregnancy, they hold an enormous amount of sway over their partner’s reproductive decisions. 87.7 percent of women have husbands who are solely responsible for family planning. Every pregnancy in Africa is affected by men, whether men choose to take responsibility or not.

    The exclusion of men from the maternal process ultimately negatively affects the pregnancy outcome and weakens family bonds. As head of the family, men have a disproportionate amount of sway over when a woman becomes pregnant and what happens afterwards; he can keep her from leaving the house to visit the doctor or subject her to dangerous traditional birth practices. Men can also propagate harmful cultural beliefs about pregnancy and birth which can ultimately endanger the mother’s health and safety.

    Although African men do not realize how helpful their presence can be during their partners’ pregnancies, male involvement can have enormous positive impacts on maternal mortality and family stability. Men can reach out to community elders, leaders, and religious leaders in order to advocate for pregnant women. For this Father’s Day, we should all think about how to include more of Africa’s fathers to create healthier and happier families. Men and women should be viewed as equal partners in pregnancy and childrearing, rather than be separated on the basis of traditional gender roles.

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  • A Shortage of Blood

    June 2, 2015
    By: Jinny Jung

    It is undeniable that far too many pregnant women die unnecessarily, especially in areas of extreme poverty. Nigeria is no exception – in fact, it has one of the highest maternal mortality rates in the world. Every ten minutes, a Nigerian woman dies from pregnancy or childbirth, and many more are left disabled from delivery complications. There is also a hidden culprit driving up maternal mortality – lack of proper blood. 

    A severe blood bank shortage is currently hitting hospitals in Nigeria hard, leaving many unable to provide life-saving blood transfusions for their patients. Blood is one of the most basic and essential resources a hospital needs, but in Nigeria, hospitals are struggling to find enough blood donors who do not have HIV/AIDS. 

    There is widespread misapprehension about donating one’s blood, so most blood supplies come from commercial blood donation. Approximately 60 percent of all blood donations are from commercial sources. Commercial blood is rarely screened properly for viral diseases and the supply usually is not good. In Nigeria, where severe postpartum bleeding can kill even a healthy woman within 48 hours of delivery, the blood bank shortage leaves many women to die.  

    One of the leading causes of maternal mortality in Nigeria is postpartum hemorrhage, which accounts for more than 19% of deaths. As such, having a strong blood bank system would certainly help more pregnant women access the care they need. Says Dr. Oluwarotimi Ireti Akinola, a professor of Obstetrics and Gynecology, “If facilities and blood products are more available, medical professionals will try everything to reduce blood loss in women, take measures to prevent bleeding, and when bleeding happens, they must be skillful enough to know what to do to stop it.”

    Establishing an adequate blood bank is necessary for reducing maternal deaths by hemorrhaging. In 2003, Malawi established the National Blood Transfusion Service and analyzed the efficacy of the program at the Queen Elizabeth Hospital in Blantyre. Results yielded a 50 percent decrease in mortality among pregnant women with severe blood loss. Not only that, the results were directly attributed to the availability of sterile blood, proving the initiative a success. 

    Inadequate blood transfusion services is a major factor fueling maternal deaths. Pregnant women are bleeding to death because hospitals do not have clean blood, and this is absolutely unacceptable and unethical. Hospitals have a responsibility to their patients to have adequate clean blood on supply for emergency cases, and when babies and women start dying because there is no blood left, we have to seriously question the healthcare system of the nation. Hospitals need to be able to collect safe blood donations and maintain blood banks at a high level, because otherwise, more women and babies will continue to suffer.

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  • May: Preeclampsia Awareness Month

    May 26, 2015
    By: Jinny Jung

    Many pregnant mothers are used to regularly tracking the progress of their pregnancies to make sure everything is going smoothly. However, pregnancy is an unpredictable experience and any mother is vulnerable to unexpected complications. Preeclampsia is the most common and one of the most dangerous, complications that can occur. 

    Preeclampsia causes high blood pressure, swelling, sudden weight gain, headaches, and in severe cases, seizures and death. Although it can be easily mistaken for normal pregnancy pains, preeclampsia is a condition that needs to be diagnosed and treated as soon as possible. It affects one in 20 pregnancies and generally arises during the third trimester or later. Most women will deliver successfully but for others, a mild case can quickly become life-threatening, and the only way to resolve it is delivery of the baby. 

    If preeclampsia sets in before 37 weeks, the infant is at higher risk of suffering premature birth complications. Both mother and baby are closely monitored to ensure the baby has enough time to develop without putting the mother’s life at risk. Her kidneys and liver can become impaired and blood clotting problems can also arise.

    Preeclampsia is easily monitored and resolved in developed countries, but this is not the same in developing countries. In some countries in Africa, this is a major problem because hospitals and local health centers suffer from a severe lack of water, electricity, and staff. Dr. Laura Stachel, an obstetrician-gynecologist, said, “I really want a world where women can deliver safely and with dignity, and women don’t have to fear an event that we consider a joy in this country. To see birth associated with death and fear is an outrage.” She spoke with KQED about how she was troubled to see so many pregnant women die in poor countries such as Nigeria because of a lack of basic resources.

    All pregnant women are at risk of developing preeclampsia, but some are more vulnerable than others. Women carrying their first pregnancies have a higher risk of developing the condition, as well as diabetic mothers and mothers carrying twins. All women who develop preeclampsia are at elevated risk of developing end-stage renal disease, heart disease, and chronic hypertension. The more aware people are of preeclampsia and its symptoms, the better – more women and babies can be saved. Especially in poor countries where women do not have the luxury of having nurses and trained midwives monitor their pregnancies and deliveries, women need to be educated on potential complications, such as preeclampsia.

    Our Executive Director, Toyin Idehen, is a severe preeclampsia survivor who lost one of her twin daugthers as a result. This quote is from her experience in the Neonatal Intensive Care Unit (NICU) while she pondered on the survival of her then called ‘Baby Girl Idehen #2′: “Know that I will always be there for you. Know that I have your back. Know that we are in this storm together. Know that tomorrow is a new day and new day’s bring hope and light. – Toyin Idehen.

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  • Fighting maternal mortality in the Gambia

    May 20, 2015
    By: Jinny Jung

    In a tiny barren village somewhere in Gambia, a woman is in labor but there are complications. Although health workers are present, none of them are qualified to provide emergency obstetrics care, meaning the woman will have to be transported to a larger hospital farther away from her location. Although maternal mortality is statistically on the decline, the Gambia remains one of the top ten countries in the world where it is most dangerous to become a mother.

    Women in the Gambia are highly fertile however, many of them live under the national poverty line. Most women give birth to more than five children in their lifetime and lack of sexual education and birth planning makes each subsequent pregnancy more dangerous than the last. Last year alone, maternal mortality rates stood at 433 deaths per 100,000 live births (World Health Organization). CEO of Save the Children Carolyn Miles stresses that “conditions for mothers and their children in the bottom countries are grim, as nations struggle to provide the basic infrastructure for the health and wellness of their citizens”. Women living in remote and rural areas often lack the most basic tools for a medically sound delivery, such as clean water and cotton gauze.

    What then are the main factors behind maternal mortality? Quality of care and availability of health services top the list. The primary cause of maternal deaths are delays in transporting women to health care facilities. In Gambia, a three-tier healthcare system separates rural clinics from basic clinics and major hospitals. The primary level consists of village health services, community health workers, and traditional birth attendants. The secondary level is made up of basic health clinics and facilities, and the tertiary level includes all major health centers and hospitals, as well as special privately-owned institutes or NGO-run institutes. In Gambia, only hospitals are qualified to provide emergency obstetrics care, meaning that women experiencing complications must be transported to a major hospital immediately.

    A decline in health workers has resulted in longer wait times at clinics, further increasing the delay in treatment. Currently, the average wait time at a clinic is 68 minutes, but this wait time only occurs when the clinic is adequately staffed. The ratio of doctors to patients is 1:1964, and the ratio of nurses to patients is 1:5614, which shows the apparent need for medical professionals. Expectant women are denied necessary antenatal and postnatal care, and many women avoid clinics altogether, choosing to give birth at home instead, where they won’t have to wait in line for a doctor.

    There are needless and life-threatening delays in Gambia’s healthcare system that transform the process of birth into a fatal, feared one. Considering the great shortage in trained medical professionals at the smaller regional healthcare centers, increased spending on training healthcare workers would yield long-term benefits for women. Establishing a healthcare system that functions adequately in rural areas as well as urban areas, would decrease treatment delays and grant more women access to lifesaving prenatal and postnatal care.

  • What African Mothers Really Want for Mother’s Day

    May 12, 2015
    By: Jinny Jung

    All mothers dream of witnessing and celebrating milestones of their children’s lives, of living long and healthy lives with family. These simple, pleasant ideas of family life are robbed from far too many women in Africa due to the harsh reality. Poor healthcare, unpaid labor, inadequate women’s rights and equality, poor education, and sexual violence are all factors that affect African girls and women every day. When we discuss maternal health, we cannot have the dialogue without including women’s empowerment. So, in honor of this year’s Mother’s Day, let us talk about girls and women.

    The African Union (AU) called 2015 the “Year of Women’s Empowerment,” but what does that truly mean? African women have made considerable progress in political, social, and economic positions, but a vast majority is still marginalized by their government. If we want true empowerment for females, that means making a political effort to secure basic rights and privileges. Currently, too many policies and cultural beliefs put females at an enormous disadvantage.

    Females are one of Africa’s greatest untapped resources, but their government does not see them as such, and instead makes it harder for them to survive in society. Nyaradzayi Gumbonzvanda said, the AU Goodwill Ambassador for Ending Child Marriage, “The leaders need to know that the young women and girls are here and they are not a statistic… This is part of Africa rising. Africa will not rise as long as its daughters are bleeding and Africa will never be prosperous or at peace with itself if the whole generation is losing opportunities.” Females of all ages make up nearly half the agricultural workforce, but sexist laws restrict their access to property, land, money, credit, and decision-making powers. In addition to this, they are expected to manage their families and care for the children, all forms of unpaid labor. Gender violence, coupled with sexual and reproductive health issues, only worsen the plight of the African female.

    When it comes to healthcare and gender equality, African females suffer some of the worst statistics on the planet. Childbirth is the second leading cause of death for adolescent girls. Every day, more than 400 African females die by pregnancy and childbirth-related complications. Far too many girls and women die in the prime of their lives, and their deaths have lasting consequences for the communities they leave. Those who do not die often suffer from life-lasting aftereffects of childbirth that take a toll on their health.

    Women’s health and education in Africa is so important and we can never stop talking about it for as long as healthcare and accessibility issues remain present, because the existence of these issues affects all other aspects of society. Economic development is slowed, and government funds are wasted on health issues that could be otherwise eradicated entirely if women were given more access to stronger healthcare and sexual education.

    For this Mother’s Day, we need to continue pressuring African leaders to view girls and women as important members of society. If females are enabled to participate in their community politically, socially, and economically, we can expect lasting strides in women’s health and equality. Working toward a vision where women live in a world that offers them social justice, equality, and respect can result in healthy, lively communities.

  • Gestational Diabetes and Pregnancy

    May 5, 2015
    By: Jinny Jung

    We’ve been talking about maternal mortality for so long and employing so many strategies in the fight against mortality, so why is Africa still plagued by high mortality rates? Medicine and technology have evolved to the point where we can provide relatively inexpensive supplies and treatment for pregnant women across Africa, but still pregnant women suffer from an enormous lack of education on health risks during pregnancy.

    Gestational diabetes mellitus (GDM) is one such health risk that is widespread yet not very well known. Diabetes is a chronic disease where the affected patient cannot produce or use insulin, resulting in symptoms such as thirst, hunger, weight loss, changes in vision, and fatigue. It reduces blood flow, damages nerves in the feet, and increases the risk of heart disease and stroke. In people with diabetes, heart disease is responsible for 50-80% of deaths (World Health Organization).

    Worldwide, GDM affects up to 15% of pregnant women (International Diabetes Foundation). In pregnant women, GDM increases the risk of eclampsia, miscarriage, labor complications, hemorrhage, and stillbirths. These same women are also at higher risk of developing Type 2 diabetes within the next ten years. Their infants are also born with a higher prevalence of obesity and Type 2 diabetes later on. Despite the short-term and long-term health impacts of GDM, it remains an overlooked maternal health issue.

    In many low-income African countries such as Ethiopia, diabetes is not a part of the regular screening offered during prenatal care. As a result, many cases of gestational diabetes go unnoticed. Management Sciences for Health (MSH) estimates that as few as two in ten cases are diagnosed. In a study of 1,242 pregnant Ethiopian women, 11% of all screened were positive for GDM. Hidden but high rates of gestational diabetes are credited as the reason maternal mortality rates remain elevated in the face of improving basic health services. In the past 25 years, maternal mortality rates have dropped 45% globally, but few African countries have experienced a similar drop in mortality rates – likely due to hidden diseases and risks such as GDM.

    The high prevalence of missed GDM during pregnancy is worrying, but treatment is surprisingly both inexpensive and effective. In the same study mentioned before, 79% of the pregnant women with GDM responded positively to simple interventions such as changes in diet and increased exercise. Pregnant women were recommended to maintain a healthy body weight, eat a healthy diet with decreased sugar, salt, and saturated fat intake, avoid smoking, and receive regular blood sugar tests.

    There is no reason why we should not increase screening for GDM when treatment is so basic and inexpensive. Katie Dain, executive director of NCD Alliance, emphasizes interventions on GDM: “Concerted action on gestational diabetes has the potential to accelerate progress toward the MDGs, and simultaneously curb the growing burden of noncommunicable diseases (NCDs). It is a win-win situation.” Thus, screening for and managing GDM is a crucial factor in lowering maternal mortality rates.

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  • Malaria Matters

    April 30, 2015
    By: Jinny Jung

    A buzzing mosquito is annoying enough on its own, but what are the effects on a pregnant woman? That mosquito could mean life or death for you and your unborn child. The WHO estimates that annually, 30 million African women living in malaria-endemic areas become pregnant. Malaria is responsible for 20% of maternal deaths, making it a more lethal killer of pregnant women than HIV/AIDS. Undoubtedly, malaria is an important culprit we must pay attention to in the battle against maternal mortality.

    Malaria is a life-threatening but entirely preventable disease that spreads through mosquito bites. Caused by the parasite Plasmodium falciparum, malaria thrives in tropical and subtropical regions. A bitten victim will experience a fever, headache, and joint aches as the P. falciparum parasites attack the red blood cells. Annually, the disease kills more than one million a year, the majority of deaths being concentrated in sub-Saharan Africa in children under the age of five.

    Malaria-infected pregnant women experience more pregnancy and birth complications than healthy pregnant women; their infants are also adversely affected. If bitten by an infected mosquito, a pregnant woman will be at higher risk for anemia, miscarriages, premature births, and delivering underweight babies. The babies are put at greater risk once born because they are usually premature and underdeveloped, lacking the vitality they need in order to survive.

    A three-step approach has been taken toward malaria prevention among pregnant women. This approach includes treatment with antimalarial drugs, insecticide-treated bed nets to protect pregnant women from mosquito bites, and the management of malaria among pregnant women. The effectiveness of this treatment stems from the fact that many pregnant women do not know if they are infected and can be asymptomatic. By providing all pregnant women with antimalarial drugs and preventative measures, healthcare workers are able to lower the incidence of malaria.

    Malaria in pregnancy often has devastating consequences to mother and child; addressing this issue would simultaneously address maternal mortality. Sam Kutesa, president of the UN General Assembly, is heartened by the progress being made in malaria prevention but cautions the world to stay aware. “To reach our goals, we must have sustained investments and political commitments for malaria control and elimination,” he said in a statement to Leadership. We, along with international leaders, need to commit ourselves to women’s health and lowering maternal mortality so every household, rich or poor, urban or rural, has access to healthcare.

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  • Why are pregnant women still dying?

    April 22, 2015
    By: Jinny Jung

    In Africa, at least 125,000 women and 870,000 newborns die in the first week after birth every year. We know that skilled care, clean water, and sanitation before, during, and after childbirth saves lives. We have all this information available, so why are so many mothers and children still dying?

    The bulk of maternal mortality cases consists of impoverished women, isolated in rural areas of developing countries. A pregnant woman in sub-Saharan Africa has a 1 in 16 chance of dying from maternal causes, compared to a 1 in 4,000 risk in a developed country (UNICEF). Evidently, the quality of maternal care is very different in poor and rich countries. For one, disadvantaged women lack the security of a functioning basic infrastructure – clean water still is one of the biggest concerns for pregnant women. Additionally, distant healthcare facilities paired with lack of transportation drives up the number of unattended births at home. In the developing world, pregnant women need to worry about every little detail.

    Pregnant women living in poverty often forgo prenatal and postnatal care, as well as skilled medical assistance during delivery. Without medical care, these pregnant women are at greater risk of overlooking pregnancy and birth complications, putting themselves and their unborn babies at risk. Prenatal care provides expecting mothers with the opportunity to educate themselves on maternal health, breastfeeding, sexual planning, and the importance of postnatal care. Postnatal care is just as lifesaving, if not more, as prenatal care because the time period right after the baby is born is crucial for mother and infant. Half of all postnatal maternal deaths occur during the first week, usually in the first 24 hours of childbirth. These deaths could be avoided if more mothers were encouraged to stay in the hospital after delivery, under proper medical supervision and care.

    The impact of providing prenatal and postnatal care cannot be ignored – if 90% of African mothers and infants had access to such care, there would be 310,000 fewer newborn deaths and many maternal lives would be saved. Emphasizing maternal care empowers and educates pregnant mothers, in addition to saving their lives. Currently, pregnant women of the developing world are neglected by their healthcare systems. If we know that the most important intervention in maternal health is adequate medical attention, then why are we still denying these women the care they need?
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  • Keeping mothers alive with clean water

    April 14, 2015
    By: Jinny Jung

    When labor pains hit, most women aren’t concerned with clean water or access to care – all they care about is the fact that their babies are finally on the way after months of preparation and close partnerships with their obstetricians. However, women living in the poorest areas of the world do not even have clean water for the birth process. For mothers and their newborns, clean water is a matter of life and death.

    Healthcare facilities in rural areas of the developing world have abysmal water supply and sanitation, heavily affecting the wellbeing of mothers and their infants. A 2015 World Health Organization report assessed water sanitation and supply in 66,101 facilities across 54 low- and middle-income countries. Out of these facilities, 38% have inadequate water supplies, 19% lack sanitation, and 35% do not have proper sanitary materials. If hospitals and clinics do not have water, one of the most basic resources in the world, how can they properly care for pregnant women and newborns?

    At Lubwe Mission Hospital in Luapula Province of Zambia, there is often no clean water available for labor and delivery. Mary Mwape, a midwife at Lubwe, sees far too many cases where mothers and babies suffer from lack of clean water. “If a newborn child with a fresh umbilical cord is washed using water from shallow, open wells or unsafe water, the child is likely to be infected with diseases like neonatal tetanus or neonatal sepsis which may lead to death,” Mary explains. Without sufficient clean water, Mary is unable to follow demonstrate hygienic practices for her patients.

    There are many drawbacks of delivering a baby in an environment without safe drinking water or sanitation, and sepsis is one of them. Sepsis is a condition triggered when the body is fighting a bacterial infection so serious it puts the body in shock. When in shock, the immune system weakens and blood pressure decreases, putting individuals at higher risk of death. From 2000-2013, sepsis was responsible for 16% of newborn deaths and 11% of maternal deaths worldwide. For such a serious disease, however, sepsis can easily be prevented with clean instruments, soap, and water.

    Insufficient hygienic conditions in developing areas of the world are an enormous problem when it comes to giving birth and creating sterile environments for pregnant women. More often than not, unsanitary facilities and contaminated water sources drive up maternal and infant mortality rates. No woman should ever have to give birth in an environment without access to clean water, working toilets, and soap. No baby should be born in conditions that threaten their lives before they even have a chance to take their first breath.

  • Babies having babies: Teenage pregnancy

    April 8, 2015
    By: Jinny Jung

    Teenage pregnancy is never glamorous, and especially not when you’re lying, nauseous and alone, in a mud hut with flies buzzing around you. For the 20,000 girls under the age of 18 who give birth in developing, low-income countries annually, childbirth is dangerous and stressful. In South Africa, nearly one-third of all adolescent girls fall pregnant – a clear sign that something is horribly wrong.

    Adolescent pregnancy is driven up by gender violence, poor sex education, transactional sex practices, and female sexual repression. In Sierra Leone, where the economy was ravaged by the Ebola epidemic, girls are under enormous pressure to have sex for money. Eighteen-year-old Marie Koroma fell pregnant after having transactional sex with a man twice her age. He abandoned her upon discovering her pregnancy, leaving her to fend for herself and her unborn child alone. Other girls are raped or denied proper sexual contraceptives and education at hospitals, due to an overwhelming belief that “boys will be boys” and girls should not give in to them and be sexually active.

    When girls fall pregnant at a young age, they suffer lifelong consequences. Additionally, the elevated risks of falling pregnant before becoming fully physically developed drives up maternal mortality rates. Every year, there are 70,000 adolescent maternal deaths and almost all of them are entirely preventable (WHO). High blood pressure in pregnant teens also contributes to preeclampsia, which harms both mother and infant. Babies born to teenage mothers are at higher risk of low birth weight, making it difficult for the fetus to survive outside of the womb without ICU care. Adolescents are not as mindful of their health as older women are, and will not pay as much attention to physical symptoms of any pregnancy complications.

    Another enormous issue with teenage pregnancy is that it takes girls out of schools. Education is vital toward decreasing fertility rates and empowering girls and women. However, in Sierra Leone, pregnant students are not being allowed to take their primary and secondary exams. This essentially robs them of their right to graduate. Established by the Education Minister Minkailu Bah, the new mandate stems from a long-standing, unspoken cultural belief: if you have sex and fall pregnant, you are unfit to associate with your classmates who are not pregnant and therefore more “virtuous”.

    Forbidding pregnant girls from attending school, however, violates the United Nations’ Convention on the Elimination of All Forms of Discrimination against Women (CEDAW). Created as an international bill of rights for all females, CEDAW is the only human rights treaty that protects the reproductive rights of women and tries to overcome cultural beliefs that perpetuate harmful gender roles. Denying pregnant girls from attending classes is tantamount to denying their right to education – it is a violation of human rights. Safeguarding girls’ educations can delay pregnancy, reduce family size, and help girls realize their own autonomy.

    Young women in developing countries, trapped in rural and impoverished areas, experience extremely high rates of pregnancy because they are not given the tools to sexually educate themselves or support themselves without men. Gender disparities between girls and boys disadvantage girls at every turn; girls carry the unjust burden of enduring pregnancy with no emotional or physical support from their male partners. Teenage pregnancy is an enormous issue that robs girls of their futures and physical health.

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  • Hungry mothers, hungry infants

    March 31, 2015
    By: Jinny Jung

    There is enough food on the planet to feed every human being, yet still 13.1 percent of the world’s population is hungry. Of these hungry people, 60 percent are women. Africa is the continent with the second-largest number of undernourished people, the majority of them living in the sub-Saharan region. Hunger disproportionately affects women, a worrisome trend considering they are primarily responsible for the wellbeing of future generations.

    Women face hunger more often than men due to socioeconomic disparities and dominant patriarchal structures that suppress the ability to fend for themselves. During times of extreme famine, they voluntarily go without food so their children have enough to eat. Pregnant women become exhausted by malnutrition due to anemia. Angelina, a malnourished mother in Fashoda, South Sudan, said, “It’s like I’m sick, but I’m not sick. Talking is not easy. When I start to move to work, my head spins. I can even fall down.” She eats only one “meal” a day of porridge, and that meal is usually two spoonfuls after her entire family has finished eating. In addition to this starvation, women are expected to take over work that men are not expected to do, which further robs their bodies of vital nutrients.

    Most women are so malnourished that it puts them at additional risk for pregnancy complications. The leading cause of maternal mortality is postpartum hemorrhage (PPH), which is excessive bleeding during and after the delivery of the infant. PPH is caused by anemia, which is subsequently caused by poor nutrition during pregnancy. Iron deficiencies cause low hemoglobin levels, which cause heavy bleeding. In addition to PPH, malnourished pregnant women are unable to produce enough breast milk for their infants, which in turn affects their infant’s health.

    When mothers aren’t properly nourished, the long-term development of their babies is seriously stunted. In the first thousand days of an infant’s life – from the start of pregnancy to the child’s second birthday – proper nutrition is essential in ensuring strong physical and mental development later on in life. Early breastfeeding promotes growth of a strong immune system, protecting babies against diseases. However, when the mother is malnourished, the baby loses all these vital nutrients and vitamins it needs to survive. The baby is also more likely to be underweight and 20 percent more likely to die before the age of five. Proper nutrition is important for mothers to survive childbirth and for children to grow strong and healthy.

    Women, especially pregnant women, suffer greatly from food shortages. Even when food is ample, pregnant women do not have enough nutrition education to feed themselves properly. When pregnant women are malnourished, they are unable to care for themselves or their infants, and are at higher risk of dying during delivery. Babies need healthy mothers, and we can increase food education to help mothers become more nourished. Changing the way pregnant women approach food during pregnancy could help save the lives of both mother and child.

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  • HIV & Mothers

    March 24, 2015
    By: Jinny Jung

    An African proverb says that every woman who gives birth has one foot in her grave. Dark as it may sound, it is the grim reality for thousands of pregnant women in sub-Saharan Africa. Besides the rampant poverty and lack of development in sub-Saharan Africa, this region is the world’s epicenter of the HIV epidemic. How do pregnant women fare in these conditions?

    Pregnant women with HIV have higher mortality rates than women with HIV because, HIV severely weakens the body. Compared to HIV-negative women, HIV-positive women are six to eight times more likely to die from pregnancy and birth-related causes. In sub-Saharan Africa, 24% of maternal deaths are caused by HIV (WHO). Most maternal mortality from HIV occurs directly from the viral disease itself, although other indirect causes such as sepsis and anemia contribute to mortality because the disease compromises the mother’s immune system. Lack of awareness about the importance of early HIV detection and treatment also contributes to high rates of HIV among girls and women.

    Women are disproportionately at risk for HIV due to sexual and social inequality. Many women are not given the power to make decisions about safe sex, which often leads to HIV transmission and unplanned pregnancies. Social stigmas associated with being HIV-positive also drive many women to hide their status when at clinics, thus losing access to antiretroviral treatment. When talking with Amnesty International, a woman said, “[I]f I go for antiretroviral, my line is that side. All the people in this line, they know these people are HIV. That’s why people are afraid to come to the clinic.” Other women forgo medical treatment altogether, afraid of the potential humiliation that may result if their HIV status is revealed.

    When we stop to reflect on the situation of thousands of women in sub-Saharan Africa who do not survive pregnancy, maternal mortality becomes a very sobering issue. In the context of the HIV/AIDS epidemic, giving birth in sub-Saharan Africa is vastly different from giving birth in the United States, but it does not mean that women in sub-Saharan Africa don’t deserve the same quality of care. The epidemic has far-reaching consequences for pregnant women and their unborn babies, as it causes a plethora of additional health issues. The special needs of HIV-infected pregnant and postpartum women must be addressed in the fight against maternal mortality.

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  • Men need to join the battle against maternal mortality too

    March 17, 2015
    By: Jinny Jung

    Maternal health has declined since the 1990s, but still, pregnant women are needless victims of an entirely preventable public health issue. The majority of maternal mortality stems from birth complications and the immediate postpartum period, and it is crucial that pregnant women receive the support they need in order to survive. Maternal mortality is addressed with strong health care systems, but a neglected factor in the battle against mortality is male involvement. 

    Male involvement in decreasing maternal mortality is surprisingly important, especially in African countries where males exert a tremendous amount of control over their wives and girlfriends. Cultural myths and misperceptions about pregnancy are reinforced by men who have little to no sexual education whatsoever, worsening the mortality trend. A predominant belief is that sexual health is a women’s only domain, and men are generally not engaged to become responsible sexual partners and caretakers. In Zulu culture, it used to be that men were prohibited from seeing their partners and newborns for three months after birth. People believed that men wouldn’t be as masculine if they became involved in the care of either mother or child after birth. Excluding men from the birth process is damaging for mother and child, and results in more needless deaths. 

    There are a variety of ways in which men can become involved in maternal health; they can provide birth control, educate themselves on danger signs of pregnancy, arrange for medical care during delivery, and be responsible partners and fathers for women and their newborns. If men are more educated and involved in the process, women will feel more comfortable seeking out help. A 2010 study among Zambian mothers found that women were less likely to seek out family planning services if their husbands were present at the time the services were offered. Women need emotional support and attentive partners during pregnancy – when asked her opinion on involving men in the pregnancy and birth process, one woman said, “Men will learn how to treat us. They will treat us like ladies.”

    Although maternal health greatly depends on the health sector, male involvement in decreasing maternal mortality is crucial. Boyfriends and husbands should emotionally support their partners at this time and educate themselves on women’s health, because male attitudes have an enormous impact on women’s wellbeing in African societies. Including men in maternal care will improve sexual health and pregnancy outcomes. Involving men in their partner’s maternity care is important because men influence the health outcomes of women and newborns.

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  • Mosquitos and Mothers

    March 11, 2015
    By: Jinny Jung

    In Africa, pregnancy means death. Unacceptably high rates of maternal mortality plague Africa, making maternal health one of the worst public health issues of the 21st century. Sadly, it does not get the attention it deserves from developed countries because maternal mortality has been all but eradicated by strong healthcare systems and high quality of care. Maternal mortality is an issue greatly impacted by poverty and disease, and many African mothers are struggling to stay alive.

    Maternal mortality is driven by many factors such as the increasing burden of non-communicable diseases, but one disease stands out: malaria. In sub-Saharan Africa, malaria is responsible for 10,000 maternal deaths a year. More than 25 million pregnant women are at risk of contracting malaria annually. These numbers may not capture the true impact of malaria on pregnant women, as a study in Mozambique found that 10% of maternal deaths were caused by malaria. In parts of the world where malaria is endemic, it can be responsible for up to 25% of deaths. 

    Malaria’s enormous impact on maternal mortality makes it clear that treating malaria in conjunction to adequate pregnancy care is vital in ensuring the survival of mothers and newborns. Pregnant women with malaria usually experience more severe symptoms and worse birth outcomes. Rather than having healthy births, these malaria-infected mothers often experience miscarriage, premature delivery, and high neonatal death rates. Malaria is responsible for 25% of severe anemia during pregnancy, and anemia puts women at higher risk of hemorrhaging during delivery.

    Malaria prevention in pregnancy is surprisingly simple, but not many pregnant women have access to anti-preventative care. To reduce mosquito bites, pregnant women are provided with insecticide-treated bed nets (ITNs). Intermittent presumptive treatment (IPT) with antimalarial medications administered at least twice during pregnancy is recommended by the WHO. However, a recent survey among postpartum women in rural Uganda found that only 31% of women used an ITN during pregnancy, and only 36% had received two doses of IPT. Jhipego, a non-governmental organization, is gathering data on maternal mortality in Nigeria. Says Emmanuel Otolorin, the County Director of Jhipiego, “Every pregnant woman should take an anti-malaria drug at least twice in pregnancy, whether or not she has symptoms of malaria, because we know that when they don’ thave symptoms of malaria, they have malaria parasite in their blood.” Clearly, there is a great deal of pregnant women not receiving the treatment they need.

    Malaria is one of the most challenging diseases we face in Africa, but it is important to realize its enormous impact on maternal wellbeing. It is the most common cause of maternal mortality in sub-Saharan Africa but we can easily prevent it. This problem has been long neglected but commitment toward reducing the impact of malaria in pregnancy will improve the health of mothers and newborns.

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  • Liberia’s obstacles toward better maternal care

    March 2, 2015
    By: Jinny Jung

    A woman’s wellbeing during pregnancy and childbirth should not be dependent on her economic status. Sadly, poverty fuels many maternal deaths in impoverished African regions. In Liberia, there are more than 1,200 maternal deaths annually, most of which are preventable with proper medical attention. With a broken healthcare system, Liberian women of childbearing age are left to fend for themselves and their vulnerable newborns. For women living in rural areas, pregnancy is life-threatening and terrifying – a far cry from the special experience it should be.

    Most maternal deaths are attributed to preventable and treatable pregnancy complications; however, the real issue is that many women do not have access to emergency obstetric care. In all of Liberia, there are only three qualified obstetricians and 412 midwives available to treat nearly two million women of childbearing age. A study by UNFPA estimates that 74% of global maternal deaths could have been averted if all women had access to obstetric care. Women should have a right to emergency obstetric care, skilled birth attendants, sexual education, family planning services, and primary health care services. At John F. Kennedy Hospital in Monrovia, one of Liberia’s biggest hospitals, beds are in high demand and short supply. In an interview with IRIN, Dr. John Mulbah, head of the maternity center, pointed out the hospital’s limited resources. “We have only five staff trained to conduct fistula treatment. The unit has only 30 beds. . . Our facility is overwhelmed with patients and some have to wait for a long time before being attended to.” Liberia’s severely overwhelmed and understaffed maternal healthcare system deprives women of their right to basic health services.

    Further, many women cannot access their healthcare system because they are poor and have no means to travel to the nearest clinic, outside of their rural settings. Because of the lack of roads, some pregnant women are forced to walk three hours or more to the nearest clinic for prenatal care – now imagine undergoing the same ordeal while in labor. Ellen David, a 17 year old resident of Monrovia, knows this all too well. Her baby died because she had no money for maternity bills, clinics weren’t open at night when she went into labor, and the curfew imposed in the light of the recent Ebola outbreak meant she couldn’t have gone to a hospital even if she had the means to. “It’s an awful pain. You look to cuddle your bundle of joy and it dies. You want the ground to swallow you up,” explained Deddeh Howard, neighbor of David. In order to address this issue, Africare was established as a nongovernment health organization targeting traditional midwives. Africare developed a program that trains traditional midwives how to identify and treat potentially life-threatening pregnancy complications. Since traditional midwives are so commonplace in rural communities, educating these midwives goes a long way in countering the dangers associated with traditional birth delivery.

    Why is it important to talk about maternal care in countries like Liberia? In Liberia, women are a vital part of society. They account for roughly 55% of the economy, making up 80% of trade, 60% of agricultural output, and the vast majority of household chores. Additionally, they are entrusted with caring for children and therefore, are socially responsible for fostering the next generation of healthy, able-minded citizens. Despite the woman’s important contributions toward society, she remains disadvantaged and disenfranchised by the government. Many maternal care interventions are highly effective in reducing maternal deaths, cost-effective, and ultimately cost-saving. They yield return investments of over 100% in the long term run because healthy women are able to contribute to society. Preventable maternal mortality is not only an issue of development, but also of human rights. By empowering women through health, governments can ensure additional economic benefit as a direct result of their survival and ability to become a productive member of the workforce.

    There are no simple solutions – we cannot wait for poverty to disappear in the background and expect maternal mortality to decrease; small steps must be taken toward the ultimate goal of creating a sustainable maternal care system. Some of the biggest challenges faced are government accountability and fiscal responsibility. We need to encourage governments to take initiative to support their citizens with public programs such as education, health, water, and transportation. These very basic services we take for granted in Western countries go a long way toward creating a healthier, more productive society. If we want to tackle maternal mortality, we need to build up pressure for government accountability and encourage sustainable reformations in the health sector and infrastructure. These changes will require an enormous amount of work and funds, but ultimately will result in better maternal care in developing countries.

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  • A Road Map for Maternal Care: Malawi

    February 23, 2015
    By: Jinny Jung

    Every year, hundreds of thousands of women’s lives are put at risk to give birth, but this ordinarily beautiful and transformative experience is especially terrifying in sub-Saharan Africa. Malawi, a small country in this part of the world, is overwhelmed by poverty and disease, which impact maternal and infant mortality rates. With a high fertility rate of 5.47 births per women, Malawi is seeing too many of its mothers suffer the dangerous process of pregnancy and birth. In fact, it is considered unlucky to tell people that you are pregnant because child-bearing is viewed as such a serious health risk. However, prospects for expecting mothers in Malawi have improved greatly ever since the country developed a maternal and newborn health program. Examining Malawi’s approach toward reducing mortality rates can offer invaluable ideas for other impoverished country struggling with poverty and disease.

    Malawi is one of the first African countries to have developed a road map for maternal and neonatal health, which helps to focus and implement ways to improve health services. Written in 2005, the Road Map for Accelerating the Reduction of Maternal and Neonatal Mortality and Morbidity in Malawi contains nine key strategies to guide the fiscally-responsible toward attaining the UN Millennium Development Goals for maternal and neonatal health. It aims to increase the availability, accessibility, and quality of skilled obstetric care during pregnancy, childbirth, and after delivery. Another key point of the document is its emphasis on empowering individuals, families, communities, and the government to improve maternal and neonatal health at different levels, thus increasing participation and involvement. Usually, countries with extremely high mortality rates have governments that neglect maternal and child healthcare or divert designated funds for corrupt purposes. Malawi’s road map makes it stand out from other sub-Saharan countries because it commits a larger part of its fiscal budget to healthcare, prioritizes maternal care, and focuses on delivering healthcare to rural areas.

    Poor Malawian mothers and their newborns are more likely to survive because of the government’s commitment to maternal care. In order to stop death during childbirth, more women give birth under the supervision of skilled health providers that are equipped to recognize and handle complications. Trained birth attendants have replaced traditional birth attendants; even in the poorest areas of the country, 63% of births are attended by a qualified birth attendant. The rural areas also receive additional focus in maternal care, as many rural women of child-bearing age live far away from equipped clinics and hospitals. The Malawian government pledged to build as many as 150 maternal waiting homes where rural women can be under medical supervision as their delivery dates come closer. As a result, institutional delivery from 2009 to 2013 was around 73%. In the same time period, 95% of women had at least one antenatal checkup, 46% of women had at least four antenatal checkups, and 84% of women receive postnatal care within two weeks after delivery. The amount of coverage in maternal care is astounding considering Malawi is a predominantly rural country.

    MaiKhanda, translated into “Mother and Baby”, is a program that mobilizes communities to improve quality of maternal care and increase awareness about maternal health. It has a proven success rate – in areas where MaiKhanda worked with communities and health facilities simultaneously, more than 1,000 newborn lives were saved. Part of the lasting success of MaiKhanda is attributed to its focus on reaching out to traditional community leaders and men. As explained by Ros Davis, Chief Executive of one of MaiKhanda’s partner for community outreach, “If there isn’t buy-in from the traditional leaders within the villages, then it’s very hard to get things going.” It manages to defy ingrained cultural assumptions and religious beliefs about pregnancy and giving birth while still respecting a heavily-patriarchal society. Most husbands are apprehensive about letting their wives travel far distances and be gone for a long time in order to give birth in a hospital because they are mistrustful and suspect that she may be seeing others. Another damaging assumption about birth is that only God will protect them, and the hospital can’t help in any way. By mobilizing traditional community leaders and educating men, MaiKhanda empowers women to make safer decisions about childbearing and gives them more confidence to seek out quality maternal care.

    Malawi had one of the worst maternal mortality rates worldwide just a few years ago, but a coordinated dedication to maternal care has helped to reverse the trend and make Malawi a safer place for women to give birth. Although Malawi is still a long way from reaching globally-acceptable maternal mortality rates, it has outpaced its sub-Saharan counterparts in reducing maternal mortality. The emerging vibrant maternal health system in Malawi offers hope for other countries – if Malawi can do it, other countries can, no matter how insurmountable the obstacles may seem.

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