IMPROVING MATERNAL HEALTH
Improving the health status of women remains an unmet challenge, with great disparities existing between low- and high-income countries. As we began researching about Goal #5, the facts unearthed were staggering:
“Deaths each year from maternal causes are estimated to range from
507,000 to 585,000 –equating to the death of one woman every minute
of every day. Of these deaths, 99% occur in low-income countries.
Women in sub-Saharan Africa have a one in 16 lifetime risk of dying
from pregnancy or during childbirth as compared to a one in 1,800 lifetime
risk for women in developed countries. Death and disability from maternal causes account for nearly 20% of the total burden of disease for women of reproductive age in developing countries.”
--World Health
Organization
Maternal mortality has been most often attributed to what have been termed the ‘three delays.’ These are delays in recognizing that complications are serious enough to require help; delays in getting to a treatment center equipped for obstetric emergencies due to transportation problems or distance to the treatment center; and delays encountered in starting treatment once having reached a care facility due to lack of available trained
health care personnel.
The leading causes of death for women, primarily affect poor women. Inadequate access to reproductive health services contributes to unwanted pregnancy, unsafe abortion, inadequate antenatal care and lack of skilled attendants at birth.
Leading Causes of Death in Women……..2002
HIV/AIDS………………………………………1.3 million
Malaria……………………………………………665,000
Tuberculosis………………………………………536,000
Maternal conditions……………………………….510,000
Source: World Health Report,
2004, WHO
We found an organization, the American College of Nurse Midwifery, that has a wonderful outreach program called “Home Based Life Saving Skills”. This is a family focused, community based program to reduce maternal and neonatal mortality. It increases access to basic lifesaving care within the home and community. It decreases delays in reaching referral facilities where life-threatening problems can be managed. This is done through supporting birth preparedness and encouraging the involvement of decision makers in making timely decisions.
Home Based LSS represents a critical rethinking of conventional community-based approaches. First, Home Based LSS takes into account the social context of childbirth, focusing on the pregnant woman, her family caregivers and the homebirth attendant as a
team. Secondly, it addresses the challenges inherent in responding to unpredictable life threatening complications, including problem recognition, first aid care, referral decision-making and health seeking. Finally, Home Based LSS works to enhance, rather than replace existing care practices, negotiating safe, feasible and acceptable actions that will be taken in the home setting when life-threatening complications occur.
The overall goal is to develop consensus on practices that are not only safe, but also feasible and acceptable to users in a home setting until they reach a referral facility. Toward this end, the Home Based LSS model emphasizes community involvement at every step and uses the principles of adult education and group process to facilitate the multidirectional transfer of information. HBLSS has been identified as a promising approach in the World Bank Discussion Paper “Accelerating Progress towards Achieving the MDG to Improve Maternal Health: A Collection of Promising Approaches.”
Our MDG collection for today will go the American College of Nurse Midwifery, for their outreach program, Home Based Life-Saving Skills. Most of these deaths are preventable through quality maternity care, improved nutrition, family planning, access to post-abortion care, available transportation and communication, rapid and safe blood services, improved education for women within the culture. The Life Saving Skills program encourages an expanded role for the midwife in recognizing and responding to life-threatening obstetrical and neonatal midwives and other providers to strengthen pre-service emergencies. The program provides didactic training in critical knowledge along with intensive on-the-job, competency-based clinical experience in specific interventions aimed at preventing or minimizing the mortality and morbidity associated with the major causes of maternal and neonatal death.
The LSS Manual has been implemented in Ghana, Uganda, Nigeria, Viet Nam, Indonesia, Cambodia, Bangladesh, Eritrea, Zambia, Russia, Honduras, Tanzania, Rwanda, Ethiopia and Liberia. (http://www.midwife.org/global.cfm)
Your contribution and support can help eradicate the needless death of a woman somewhere, won’t you give generously?
Katie Cathey
World Health Organization
(www.who.int/mediacentre/news/statements/2007)
American College of Nurse Midwives
Global Health Council