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Maternal Health
Maternal death the most preventable tragedy P6
MATERNITY FOUNDATION: TAKEN IN ETHIOPIA BY PHOTOGRAPHER ANNE PRYTZ SCHALDEMOSE
A committed actor in reduction of health inequalities in particular through its maternal and newborn health programme
It represents: 3.77 million monitored women, including 1.03 million pregnant women
Since 2010, the Sanofi Espoir Foundation has supported 35 maternal and newborn health projects in low- and middle-income countries. Led by international or local organisations, they focus on improving coordination of care, promoting multidisciplinary management, upgrading local skills, mobilising communities and strengthening education. www.fondation-sanofi-espoir.com
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IN THIS ISSUE
ICM’S PRESIDENT With the right support, midwives can serve 87% of the needs of all women and newborns. Why we must invest in midwives .
THE TEN STEPS TO SUCCESSFUL BREASTFEEDING Accordint to WHO and UNICEF.
PHOTO SERIES: Women across Kenya portrayed as they wish to be seen: as individuals not victims.
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Time to accelerate ending preventable maternal and newborn deaths
Maternal and newborn deaths are a protracted public health emergency in need of our immediate attention and action.
Every year, 300,000 women die due to preventable causes of death during pregnancy and childbirth1. In addition to mothers dying prematurely, 5.3 million babies are stillborn or die in their first month of life2,3. These deaths occur in the poorest geographical areas, often go unnoticed, un-registered, and un-investigated by the same health system that should have saved them by simple, evidence-based measures. In a well-developed healthcare system, women survive childbirth and live to see their child survive its fifth birthday and beyond. From a human rights perspective, a normal
life event, such as pregnancy and childbirth, should not be associated with risking death. The World Health Organization (WHO) works closely with Member States and partners to ensure that healthcare systems deliver high quality care, which is universally available and accessible to all, especially the most disadvantaged and vulnerable billions4. Essential components of healthcare include prevention, early detection and treatment of complications during pregnancy, childbirth, and the postnatal period, by health worker with appropriate midwifery skills; and access to family planning to allow women and families time and space any desired pregnancies. Given the under reporting of the true magnitude of deaths of mothers and babies, strengthening health data collection for data driven
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Dr Rajiv Bahl Acting Director, Maternal, Newborn, Child and Adolescent Health Department, WHO
“300,000 women die during pregnancy due to preventable causes of death.”
decision making is essential for tracking results and holding governments accountable for improving the health of their populations. In spite of the 44% reduction of maternal deaths during the Millennium Development Goal period (1990-2015), the annual rate of reduction will need to be doubled or even tripled in order to reach the Sustainable Development Goals by 20305. To achieve the ambitious global goals to which world leaders have committed, financial, geographical, and cultural barriers must be removed. Universal health coverage will only be possible if improvement in access to care is informed by data collected on births, deaths and causes of death, and among the most vulnerable in low- and middle-income countries. Every misclassified and unrecorded death of a mother
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or her baby is a lost opportunity to achieve quality of care for all, and for ending preventable deaths of mothers and their babies. Nathalie Roos and Dr Rajiv Bahl Sources: 1. World Health Organization. Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Populations Division. 2015. 2. Lawn JE, Blencowe H, Waiswa P, et al. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet 2016;387(10018):587-603. doi: 10.1016/S0140-6736(15)00837-5 [published Online First: 2016/01/19] 3. UNICEF W, World Bank Group and United Nations. Levels and Trends in Child Mortality Report 2017, 2017:36. 4. World Health Organization, 13th Global programme of Work (GPW), 2018 5. Every Woman Every Child. 2015. Global Strategy for Women’s, Children’s and Adolescents Health 2016-2030. PLEASE RECYCLE AFTER READING
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Why medicine quality matters for maternal health One reason countries continue to struggle to reduce maternal deaths is the extraordinarily high prevalence of poor quality medicines.
SPONSORED
Poor quality of maternal health medicines contributes to maternal deaths and is holding countries back from achieving development targets. Governments need to take decisive action.
While many countries are struggling to reduce maternal mortality to the global target of 70 deaths per 100,000 births, countries like Finland have demonstrated that only in exceptional circumstances should we accept a woman dying while giving birth. Finland’s maternal mortality ratio is just three deaths per 100,000 births. Maternal death is preventable in almost all cases. A number of medicines are identified as essential for ensuring safe childbirth. Postpartum haemorrhage, pre-eclampsia and eclampsia are the main causes of maternal mortality worldwide. The World HealthOrganization (WHO) recommends that every woman receives uterotonics following childbirth to prevent postpartum haemorrhage, all of which can be of poor quality by the time they reach the patient if not manufactured, packaged, transported and stored properly. Magnesium sulfate – a drug used to prevent and treat pre-eclampsia– is a simple, cheap, effective and life-saving drug if the quality is right. However, many women lack access to these safe, effective drugs and die as a result. In the two countries with the highest number of maternal deaths annually, recent studies revealed unacceptably high levels of poor quality maternal health medicines. In 2017, the Government of India published a nation-wide survey of the quality of medicines in which oxytocin was identified as one of the most frequently out-of-specification medicines. 41.3% of the samples tested were out of specification. Even more alarming, are the survey results for the same drug in Nigeria, where a staggering 74.2% of oxytocin samples failed testing standards. This study has sparked a number of actions within the Ministry of
Lester Chinery Director of Programs, Concept Foundation
“High quality maternal health medicines are available for under $1 a small price to save a woman’s life.” Health and the National Agency for Food and Drug Administration and Control in Nigeria. At a recent event in Geneva on incentivising investment in quality medicines, NAFDAC’s recently appointed Director General, Professor Adeyeye, talked of her own personal childbirth experience where the drugs used to induce her labour failed to work. After a prolonged labour, an emergency caesarean section was performed to save hers and her baby’s lives. She also talked of her older sister who died of haemorrhage following childbirth. The poor quality of the medicines is likely to have played a significant role in both of these events. In fact, it is a practice that doctors administer higher doses to effectively induce labor. Professor Adeyeye now uses the experience to energise her mission to drastically improve the quality of medicines in the country.
What can countries do to improve the quality of maternal health medicines? Lester Chinery is the Director of Operations at Concept Foundation. Chinery points out that regulatory control plays a strong role in ensuring that the medicines available in countries are of suitable quality. In Nigeria, where the majority of maternal health medicines are imported, Professor Adeyeye has sought and won long barred access to the ports to ensure that the medicines entering the country are
registered and of appropriate quality. Other countries are working in partnerships such as the EAC/Swissmedic Marketing Authorisation for Global Health Products programme to strengthen the capacity of their regulatory authorities. Improving procurement practices is another critical area where countries can improve the quality of maternal health medicines. Policies must ensure that only quality-assured medicines are procured in order to bring down maternal mortality. Price is too often the only procurement criteria and one that ignores the full costs associated with medicine failure such as unnecessary surgery and the high financial burden of maternal death. Countries also need to prioritise investments in appropriate storage and transport of medicines, according to Chinery. Many maternal health medicines require cold chain from manufacturer to user. Where this cannot be assured, countries need to look to genuine, heat-stable alternatives.
like India, where serious shortages of skilled medical professionals mean that access to lifesaving healthcare services is limited, ANMs have contributed to reducing maternal mortality. On 3rd April 2018, Kamala gave birth to a healthy baby girl by caesarean section in a small private hospital. What started as a day of joy and hope, changed rapidly a few hours later. Kamala’s family noticed she was bleeding heavily. She was rushed back to the operating theatre where the doctors performed hysterectomy surgery to save her life. Having lost a lot of blood, Kamala’s family were told that she required an urgent blood transfusion. As the hospital had no supply of blood, Kamala’s family rushed to purchase five units of blood at a higher-level healthcare facility. Kamala lost so much blood that despite the transfusions, efforts to save her life failed. She passed away late that evening.
Kamala’s death will leave a permanent impact on her family. After a short stay in hospital, she would have been expected to return to work as an ANM, providing for her family, as her husband had been unable to find work despite his university degree in education. Without her, their baby girl is being brought up by her husband’s sister and 65-year-old mother. Every day, the family worries about how they will survive. Her community also lost the skill and support of an important healthcare provider, which will impact on the lives of many more women and children. Quality medicines could have prevented Kamala’s fatal haemorrhage and saved her life and, in turn, that of many other women dependent on the work of ANMs. Join the #MedsWeCanTrust campaign at medswecantrust.org
The #MedsWeCanTrust campaign #MedsWeCanTrust is a global campaign to drive countries to prioritise access to safe, quality medicines, bringing together political leaders, health advocates, researchers and journalists to create a sense of urgency and ensure action. The campaign will be calling on governments to take action on the quality of all medicines, including those that are essential for maternal health and safe childbirth. It’s time for countries to make a real commitment to ensuring access to quality maternal health medicines.
Kamala’s story Kamala worked as an Auxiliary Nurse Midwife (ANM) in a small rural area in India. Across India, ANMs provide essential maternal health services at the village level, connecting women with health services. Their work covers maternal and child health along with family planning services, health and nutrition education, efforts for maintaining environmental sanitation, immunisation for the control of communicable diseases, treatment of minor injuries, and first aid in emergencies and disasters. In remote areas, such as hilly and tribal areas where transportation is poor, ANMs often assist with home births. In countries
CONCEPT FOUNDATION. PHOTOGRAPHER PAUL JOSEPH BROWN
Kamala’s daughter in the arms of her grandmother shortly after Kamala’s death.
Concept Foundation Is an NGO working with governments, manufacturers and global health stakeholders to improve access to quality reproductive and maternal health medicines. Concept Foundation is supported by funding from MSD, through MSD for Mothers, a 10-year $500 million initiative to help create a world where no woman dies giving life. MSD for Mothers is an initiative of Merck and Co. Inc., Kenilworth, NJ, USA.
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Partnerships, education and economically-benfical communities – the powerful voice of the midwife Midwives need access to quality and complementary training in order to optimise their life-saving potential and ensure a high standard of maternal care globally.
C
ommitment to the midwifery profession is key to achieving universal health coverage (UHC), given the role of midwives as primary caregivers to vulnerable women. The close relationship that midwives have with women and their babies makes investment in midwifery education the single most impactful means to improve maternal and newborn health. Educating midwives to a high standard, to fit the ICM Internationally recognised definition of a midwife, requires work with governments and stakeholders nationally to strengthen midwifery services, monitor their efficiency, and help midwives in their efforts to support women. Investing in midwifery education has a transformative impact on national and regional health. Midwives who are equipped with clearly outlined competencies and working within an enabling environment are able to serve 87% of the needs of all women and newborns. Outlining competencies can also guide the relationship between midwife and mother, fostering a mutual
model curricula by governments, policy-makers, and midwives and midwifery associations alike.
Midwives leading the way
Franka Cadee President, International Confederation of Midwives (ICM)
“Investing in midwifery has a transformative impact on national and regional health.” relationship of trust, dignity and respect between all midwives and all women. The challenge of creating global standards of practice is slowly being overcome through the adoption of essential competencies and
Because midwives can and must lead the way in health advocacy, they require varied and comprehensive training. To foster a culture of leadership in the profession, midwifery education should combine clinical education with training in leadership and research-based policy-making. This is a central way to strengthen the voices of natural visionaries who advocate for maternal needs with unparalleled knowledge. This year, International Day of the Midwife gave midwives a powerful platform through which to vocalise their experiences and shape public understanding of their profession. Our Midwifery Leaders Showcase, which features interviews with midwives themselves, celebrates the growing momentum among midwives leading policy developments, humanitarian efforts, educational structuring, and more as they provide insight into the evolving – but ever women-centred – nature of midwifery. The collaboration between midwives is something we hope to
further share in our 2020 triennial conference in Bali, where midwives from around the world can draw on the unique body of knowledge, technical skills and experience of colleagues for application in their own countries. Bringing midwives together also provides an opportunity for them to embrace the unique ways that they help women and babies not only to survive, but to thrive, through respectful, holistic care.
A golden global standard Encouraging midwives themselves to participate more visibly in advocacy helps governments and stakeholders to better identify midwives’ needs in order to improve midwifery practice globally. Engagement with midwives also provides feedback into which forms of training are most effective. Research has shown that lowdose, high-frequency training modules (where training tools are consistently available for incidental practice during lulls in clinical work) build reflexive ease – and therefore comfort – with using these techniques during high-pressure emergency situations. By ensuring readily-available access to these
training tools in hospitals, birthing centres and the like, midwives who have a few spare minutes can practise their training, which creates a kind of ‘muscle memory’. Providing a supportive training environment for midwives in turn helps them to ensure that pregnancy, birth and postpartum are safe and comfortable experiences for women worldwide. We also believe that, to better identify gaps in practice and to provide skilled and compassionate care to mothers and babies globally, adequate assessment processes are central. This includes enabling midwifery education institutions to showcase their teaching, training and curriculum standards, while also providing them with the opportunity to gain comprehensive feedback on where standards can be improved to attain accreditation. A shared belief in the transformative power of education has the ability to create a positive ripple effect beyond one midwife, one woman and one baby to create healthier, happier, economically-beneficial communities. Read more on globalcause.co.uk
A Sanofi Espoir Foundation’s initiative dedicated to capacity strengthening of midwives. Since 2010, it represents:
7,630 health professionals trained including 3,600 midwives, 9 international projects and 20 local midwives’ initiatives. Innovative mobile apps dedicated to midwives and women can be downloaded for free on: m2025-weobservatory.org
fondation-sanofi-espoir.com
LFAM is a very small, effective and unique organisation which is targeting a reduction in deaths from PPH by supplying medication and opportunities for UK midwives to provide skills sharing workshops. Our health facilities are helping to make medications freely available to mothers and have seen a significant reduction in maternal and newborn deaths. Saving a mum massively improves the chances of her baby surviving. Tel: 0044 (0)2920 343774
Mobile: 07984786103 Email: angela.gorman@lifeforafricanmothers.org Website: lifeforafricanmothers.org
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The TEN STEPS to successful breastfeeding 1
HOSPITAL POLICIES
Hospitals
support mothers to breastfeed by... Not promoting infant formula, bottles or teats
2
Why sexuality education is a life-saving human right
STAFF COMPETENCY
Hospitals
support mothers to breastfeed by...
Training staff on supporting mothers to breastfeed
Assessing health workers’ knowledge and skills
Making breastfeeding care standard practice
Michel Sidibé Executive Director, UNAIDS
Keeping track of support for breastfeeding
3
ANTENATAL CARE
Hospitals
support mothers to breastfeed by... IMPORTANCE OF BREASTFEEDING
Discussing the importance of breastfeeding for babies and mothers
Preparing women in how to feed their baby
4
W
hen adolescent girls and women are denied access to sexual health education and services, they are denied their human rights — with sometimes devastating consequences. Every woman and adolescent girl must be able to equip herself with information about sexual and reproductive health, insists Michel Sidibé, Executive Director of UNAIDS — the Joint United Nations Programme on HIV/AIDS. They should also have unrestricted access to comprehensive sexual health services. These are, after all, basic human rights. Yet, the fact is, these rights are denied to many girls and women across the world, resulting in increased risk of HIV infection, early pregnancy, early marriage, unsafe abortions and missed education. In some places, people below the age of 18 need parental consent to use sexual and reproductive health services, take HIV tests or access HIV treatment.
CARE RIGHT AFTER BIRTH
Hospitals
support mothers to breastfeed by...
Encouraging skin-to-skin contact between mother and baby soon after birth
Helping mothers to put their baby to the breast right away
Sexual education for girls and boys
5
SUPPORT MOTHERS WITH BREASTFEEDING
Hospitals
support mothers to breastfeed by... Checking positioning, attachment and suckling
Giving practical breastfeeding support
Helping mothers with common breastfeeding problems
7
ROOMING-IN
Hospitals
support mothers to breastfeed by...
Letting mothers and babies stay together day and night
6
“It’s critical that we take a human rights approach to maternal health,” says Sidibé. “We have to teach girls — and boys — about sexual health at a very early age, so they know how to protect themselves against disease. We also have to make sure that HIV prevention and treatment options are available to everyone. If young people don’t have access to condoms, for example, they are completely vulnerable to infection, which explains why we see only a 14% decline in new infections among adolescent girls and young women between 10–19 years.”
SUPPLEMENTING
Hospitals
support mothers to breastfeed by...
Giving only breast milk unless there are medical reasons
Prioritizing donor human milk when a supplement is needed
Concerns about stigma and discrimination This issue is more widespread than many realise. On last December’s Human Rights Day, UNAIDS revealed that — according to studies from 19 countries — approximately one in five people living with HIV had been denied healthcare. Data from eight countries, meanwhile, highlighted that 25% of people living with HIV had put off going to hospital because of worries that they would face stigma or discrimination. Being denied sexual health services is bad enough but, in some cases, women face an even more disturbing human rights violation. “In Lesotho, I met a 45-year-old woman who was diagnosed as HIV positive when she was 28,” says Sidibé. “At that time, she was pregnant but forced to have an abortion and undergo sterilisation. She told me: ‘I lost all my reproductive rights.’ That is unacceptable.”
Helping mothers who want to formula feed to do so safely
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RESPONSIVE FEEDING
Hospitals
Making sure that mothers of sick babies can stay near their baby
support mothers to breastfeed by...
Helping mothers know when their baby is hungry
Developing strategies for change Things are changing, says Sidibé. Initiatives are in place to educate girls and young women about sexual health and ensure that effective prevention services are available. A network of two million community health workers is being developed across Africa by 2020 so that health services can reach remote communities, and an agenda for Zero Discrimination in Health Care was launched by UNAIDS and World Health Organization’s Global Health Workforce Alliance in 2016. “We have a major challenge to ensure discrimination is removed from healthcare settings,” says Sidibé. “To get results, we must deal with the problem in a strategic way.”
Not limiting breastfeeding times
BOTTLES, TEATS AND PACIFIERS
Hospitals
support mothers to breastfeed by...
Counsel mothers on the use and risks of feeding bottles, teats, and pacifiers
10 Hospitals
DISCHARGE support mothers to breastfeed by... Referring mothers to community resources for breastfeeding support
Working with communities to improve breastfeeding support services
CREDIT: UNICEF AND WHO
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Empowering women with contraception and knowledge
*PHOTO: UNFPA VIET NAM/VU NGOC DUNG
Dr Natalia Kanem Executive Director, United Nations Population Fund (UNFPA)*
Family planning is preventing the tragedy of girls and women dying in pregnancy and childbirth and transforming lives in developing countries.
Photo credit: Liberia 2017: NOOR/Sanne de Wilde for UNFPA
Dr Natalia Kanem, a passionate champion of women and girls, understands the link between family planning and maternal health. As United Nations Under-Secretary-General and Executive Director of the United Nations Population Fund (UNFPA), she cites the shocking fact that some 830 women die every day from pregnancy or
childbirth complications. That’s more than 300,000 deaths each year. However, there is positive news. The dedicated work of UNFPA is making a dramatic difference in reducing unintended pregnancies and pregnancy/childbirth related death and injuries. Dr Kanem states emphatically: “Family planning saves lives.” Over the last 15 years, the dynamic organisation, headquartered in New York, with offices in more than 150 countries, has succeeded in helping reduce maternal death by more than 40%. She elaborates: “For the first time in history, more than 670 million women and girls in developing countries are able to use modern contraception. More than 300 million unintended pregnancies are now averted every year.” However, there is much work to do. Far too many women continue to die due to preventable and treatable complications of pregnancy and childbirth. She explains that UNFPA’s reproductive health services in developing countries include providing access to voluntary family planning and pre-natal care. At the heart of these services is the personal relationship and guidance provided by local midwives, nurses and doctors who understand the culture. Dr Kanem is enthusiastic about this effective, grassroots strategy. “Midwives save lives. Counselling on available methods of contraception helps a woman make informed choices, avoid unintended pregnancies and space when she has her children. And, when she decides to become pregnant, she already has a relationship with someone who
cares and who can guide her through childbirth and postnatal support.” UNFPA provides 40% of all contraception in developing countries, including the contraceptive pill, hormone implants, condoms, IUDs and other devices, recognising women’s different needs and preferences and respecting and upholding their right to decide freely whether or when to bear children.
The future belongs to a 10-year-old girl Dr Kanem explains that when the UN set the Sustainable Development Goals in 2015, the UNFPA was thinking about the 10-year old girl who will be 25 in 2030. “How do you empower a 10-yearold girl who is impacted by so many global issues? Guess who has to walk further to collect water because of climate change? Guess who is missing school to look after younger children? In some societies she will be eligible for marriage at 14. And she will have undergone female genital mutilation. “Many girls get pregnant without even understanding sex. And then they get blamed and shamed and kicked out of school. “We have a responsibility to give proper information to adolescent girls, so they can grow into their womanhood and avoid unintended pregnancies. “When girls are informed about their bodies, they are better able to avoid teenage pregnancy, stay in school and find better jobs. This can break the cycle of poverty and improve livelihoods and opportunities for successive generations.” Dr Kanem, who has seen the transformational results, says: “Family planning empowers girls and women to seek and keep better jobs. No one should lose their livelihood because of unintended pregnancy. “Giving her choices raises hope for prosperity. A woman should be able to aspire to be the mayor of her town or president of her country.”
Family planning can achieve change for all While UNFPA has made phenomenal progress, there are still 214 million women and girls in developing countries waiting to access modern contraception and life-changing information. Dr Kanem spells it out: “Our
purpose is to advance the right of every individual and couple; men, women, boys and girls to responsibly look after their reproductive and sexual health and have a happy, healthy sexuality. Information and education is part of that human right.” She explains that innovation and partnership are at the heart of UNFPA’s efforts. “One of our projects is to provide menstrual supplies that are sustainable and eco-friendly to take away the embarrassment around what is a lovely part of growing up but can stop girls from going to school at that time of the month. “International solidarity with women helping women across countries and cultures is the key to success. The financial support of our donors in the UK makes a huge difference. “Every pregnancy should be intended, and every childbirth should be safe. The thought of 830 families grieving every single day is unbearable and unacceptable.” Diane Priestley
“Some
830 women die every day from pregnancy or childbirth complications. That’s more than
300,000 deaths
each year.”
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It’s 2018. Why are so many women still dying in childbirth? SPONSORED
For many mothers, babies, and families around the world, giving birth safely isn’t always straightforward. Despite progress, the World Health Organization (WHO) figures show that maternal mortality is still distressingly high - over 800 women die from causes related to pregnancy and childbirth every day.
Today almost all maternal deaths are preventable, thanks to advances in medical care and treatment. Yet every day women across the world are still dying from complications such as excessive bleeding after childbirth, also known as postpartum haemorrhage (PPH). Medicines that prevent PPH are available in many countries but the quality and efficacy of these medicines can be impacted by extreme climates. In low- and lower-middle income countries the cold-chain transport and storage networks which offer medicines protection from the elements are not always
Dr Edith Roset Bahmanyar Senior Medical Director, Obstetrics, Ferring Pharmaceuticals
readily available. It’s also low- and lower-middle income countries which face the highest burden of PPH-related deaths. It must always be the unmet need that drives the healthcare community. The United Nations has set the Sustainable Development Goal of reducing maternal and infant mortality, and this goal must be ours too.
The devastating impact of PPH •
PPH affects 14 million mothers each year, causing 80,000 maternal deaths • Globally, PPH is the leading direct cause of maternal mortality • 99% of deaths from PPH occur in lowand lower-middle income countries In addition to the tragic loss of a woman’s life, the impact of her death is felt by those left behind; surviving children, families
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Jayabi suffered from postpartum haemorrhage, or excessive bleeding, after giving birth. Her life was saved when she was transferred to a hospital where she received emergency care.
and communities all feel the ripple effect through its emotional, social and economic implications. When a mother dies in childbirth, her baby faces a much greater risk of dying, in comparison to those whose mothers survive. Even those women who survive PPH are subject to potentially life-changing implications; serious medical interventions, including hysterectomy, can be necessary to save a woman’s life, and blood transfusions are needed to address severe anaemia. To reduce maternal mortality is an ambitious goal, and certainly one too great to achieve alone - but it is achievable. The challenge must be faced on a united front, with private and public global health partners coming together to bring about change.
JONI KABANA, KABANA PHOTOGRAPHY/CONCEPT FOUNDATION/FERRING PHARMACEUTICALS/MSD FOR MOTHERS
MEDIAPLANET
Collaborations have the power to save lives Maternal mortality is a deeply complex and multi-faceted issue and if we are to address it, we must share our expertise across the sectors. By bringing together the world’s most committed and influential healthcare providers, research organisations, NGOs, commercial organisations and charities we can facilitate this pooling of knowledge. By doing so, this collaborative, goal-focused approach could help transform the lives of families around the world. Read more on globalcause.co.uk
Healthy mothers, healthy communities Over half the world’s population pay for healthcare out of their pocket. The solution? Universal health coverage and partnerships.
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ast month, President Kagame told the World Health Assembly: “In Rwanda, a combination of community-based health insurance, community health workers, and good external partnerships led to the steepest reductions (a halving) in child and maternal mortality ever recorded.”
More than 40% of children are malnourished or stunted But global progress is patchy. India, one of the world’s fastest growing economies, ranks 129 among 184 nations on maternal mortality and 145 out of 193 on infant mortality. Poverty, malnutrition and poor sanitation lie behind child mortality. More than 40% of children are malnourished or stunted. What can we learn from Rwanda? There, more and more women give birth in the presence of skilled health personnel. Hospitals have developed antenatal, obstetric, and post-natal care and put protocols in place to prevent postpartum haemorrhage. Sadly, in India, a 2010 government scheme to help stem India’s high rates of infant and
its part in Rwanda’s recent success. Following the genocide against the Tutsi, hundreds of thousands of survivors, mostly widows, were infected with HIV via systematic rape. Between 250,000 and 500,000 surviving women and girls were raped and, in 1994, the HIV prevalence rate was estimated at 13%. Thomas B. Cueni Director General, International Federation of Pharmaceutical Manufacturers & Associations (IFPMA)
“Global health is about much more than medicines and vaccine.” maternal mortality will now apply only to first-borns .
HIV prevalence heightened by systematic rape The biopharmaceutical industry has played
Often, individuals cannot afford to pay for their treatment More needs to be done to reach all patients, regardless of economic circumstances. Too often the cost of treatment is pointed to as the main stumbling block, but rarely do people stop to try to understand why – if 95% of the most commonly-used medicines are affordable, generic medicines – do so many people go untreated? Part of the answer is that today, over half of the world’s population have to pay for their medicines and health services out of their own pockets. For somebody who has $2 a day as disposable income, or even less to live on, even 20 cents a day may be too much. In tackling the healthcare challenges of the developing world, we need to leave our own comfort zone and collaborate, be it in engaging in health systems reform or in partnerships to
bring innovative medicines to millions of people in resource-constrained settings.
Partnerships are the only way to achieve universal health coverage Dr Tedros, Director General of the World Health Organization, holds up partnerships as the only way to achieve health for all (universal health coverage or UHC). The pharmaceutical industry knows that global health is about much more than medicines and vaccines – it requires building and supporting strong health systems, delivering education to communities to promote prevention, strengthening standards and regulations and creating innovative finance models. Partnerships are clearly the way forward. But they will come to nothing without nurses, midwives, teachers, community workers, mothers, wives and sisters - women. They are the agents of change for the children of today and tomorrow. They are the real stars of global health progress. For them to really shine, we owe it to them to make UHC truly universal. Read more on globalcause.co.uk
Education | Innovation | Collaboration
safe birth is a human right LIBERIA 2017: NOOR/SANNE DE WILDE FOR UNFPA
together we can make change
NIGER 2017: NOOR/SANNE DE WILDE FOR UNFPA
#safebirth