Deborah Maine, an epidemiologist with a background in anthropology and over 30 years of experience working on reproductive health programs in developing countries, developed the three delays framework for understanding maternal mortality—a framework that continues to guide the work of maternal health program implementers and researchers alike.
In recent years, Maine has been working extensively on the issue of cervical cancer. Her May 16th presentation focused on the controversy around priority setting for cervical cancer prevention, screening, and treatment in developing countries.
Maine explains the controversy:
“Even a successful vaccine program won’t help women already sexually active. Focusing only on the vaccine means writing off 2 generations of women who have already been sexually active and have already been exposed but will not benefit from this. And I wonder: Would anybody even propose a child health intervention that would take effect in 20 years? I don’t think so. I think this is something that happens preferentially with women. And I think it is a human rights issue. I really do.”
A few of Maine’s recommendations:
Retire the pap smear. “It is like a horse and buggy. It was great when that was all we had.”
Visual inspection and DNA tests are both more sensitive, cost less, and have lower loss to follow up.
Increase coverage of screening in both developed and developing countries.
Focus on neglected groups.
Focus on women over 30.
Avoid over screening.
Dr. Maine wrapped up her presentation by reminding the crowded room of public health students, researchers, and implementers of a very important point: “I would just like to remind everyone that 5 million women who have already been infected with HPV will die before the vaccine can have effect. Improving screening programs is the first priority in both developed and developing countries.”
The presentation was followed by a lively Q&A session.
The document provides critical insights into the various barriers to access to oxytocin, misoprostol, and magnesium sulfate. Post-partum hemorrhage (PPH) and Pre-Eclampsia/Eclampsia (PE/E) are two of the leading causes of maternal death. PPH can be treated, and often prevented, with uterotonic medicines—such as oxytocin and misoprostol. Similarly, magnesium sulfate is an effective treatment for managing PE/E.
Oxytocin, misoprostol, and magnesium sulfate are all now included on the WHO Model Lists of Essential Medicines—but significant gaps exist between international policies and actual access to medicine in communities, and health facilities around the world.
The document also highlights innovations and best practices for increasing access to essential commodities—exploring the use of mobile technologies to share information about stock outs, solar powered refrigerators, single-dose and disposable injectable medicines, task-shifting, and pooled procurement strategies as tools for expanding the availability of essential maternal health medicines for women in developing countries.
The report concludes that: “While findings differ across countries, one aspect is clear – significantly more research is needed to fully capture the state of maternal health commodities in these countries, and probably others. Building on this initial review, a well-planned series of consultations with in-country stakeholders is a critical next step. A comprehensive understanding of the status and accessibility of these commodities is a necessary component of ensuring access to high quality maternal health services for millions of women around the world.”
New global maternal mortality estimates were released today in a report by the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA) and the World Bank. The report,“Trends in maternal mortality: 1990 to 2010”, shows that the number of women dying of pregnancy and childbirth related complications has almost halved in 20 years. The estimates show that from 1990 to 2010, the annual number of maternal deaths has dropped from more than 543,000 to 287,000–and that a number of countries have already reached the MDG target of 75 per cent reduction in maternal death.
Major highlights from the report:
• In 2010, the global maternal mortality ratio was 210 maternal deaths per 100,000 live births. Sub-Saharan Africa had the highest maternal mortality ratio at 500 maternal deaths per 100,000 live births.
• In sub-Saharan Africa, a woman faces a 1 in 39 lifetime risk of dying due to pregnancy or childbirth-related complications. In South-eastern Asia the risk is 1 in 290 and in developed countries, it is 1 in 3,800.
• Ten countries have 60 per cent of the global maternal deaths: India (56,000), Nigeria (40,000), Democratic Republic of the Congo (15,000), Pakistan (12,000), Sudan (10,000), Indonesia (9,600), Ethiopia (9,000), United Republic of Tanzania (8,500), Bangladesh (7,200) and Afghanistan (6,400).
• Ten countries have already reached the MDG target of a 75 per cent reduction in maternal death: Belarus, Bhutan, Equatorial Guinea, Estonia, Iran, Lithuania, Maldives, Nepal, Romania and Viet Nam.
Over the past few years, the global health community has witnessed and contributed to the publication of more frequent and more technically advanced estimates for maternal mortality than ever before. This report adds to the growing body of evidence that is helping the maternal health community to measure and better understand the scope and trends of the problem. It is an exciting time in the field–and we encourage you to read the new report.
Mother’s Day 2012 provides a good occasion to celebrate accomplishments in the field over the past year. The Maternal Health Task Force shares ten exciting developments.
The State of the World’s Midwives report provided the first comprehensive analysis of midwifery services in countries where the needs are greatest.
Direct Relief International, Fistula Foundation, & UNFPA partnered to develop the first-ever Global Fistula Map, outlining the global landscape of the issue.
Save the Children’s 13th State of the World’s Mothers report focused on nutrition during the period from pregnancy through the child’s 2nd birthday, the first 1,000 days
The World Health Organization added Misoprostol to the List of Essential Medicines, a critical step toward preventing post-partum hemorrhage.
Melinda Gates announced plans to help raise $4 billion to dramatically increase access to family planning around the world by 2020.
In a recent article in Nature International Weekly Journal of Science, science writer, Daniel Cressey, wrote about efforts by drug development companies to share intellectual property and expand access to leads on potential drug candidates for malaria and other tropical diseases.
In the hunt for drugs that target diseases in the developing world, ‘open innovation’ is creating a buzz. Pharmaceutical companies are making entire libraries of chemical compounds publicly available, allowing researchers to rifle through them for promising drug candidates.
The latest push for open innovation, unveiled last month as part of a World Health Organization road map to control neglected tropical diseases, will see 11 companies sharing their intellectual property to give researchers around the world a head start on investigating drug leads (see ‘Road map unveiled to tackle neglected diseases‘). It makes for good press, and investors are not worried about giving away potentially blockbuster drugs because the diseases in question are not commercial priorities.
But is it good science? The answer, from the first large-scale initative of this kind, is a cautious ‘yes’.
Written by Rachel Wilson, the senior director of policy and advocacy at PATH and co-chair of the Maternal Health Supplies Working Group
Today could be the beginning of a significant, life-saving shift for maternal health. The United Nations Children’s Fund and the United Nations Population Fund launched a high-level commission to improve access to essential but overlooked health supplies, including medicines that could save the lives of millions of women.
Worldwide, an estimated 350,000 women die during pregnancy and childbirth every year. Most maternal deaths can be prevented with affordable and effective medicines, such as oxytocin, misoprostol, and magnesium sulfate. Together with skilled health workers and strong health systems, these medicines can transform women’s health in developing countries.
“The day of birth is the most dangerous day in the life of a woman and her child,” stated commission co-chair Prime Minister Jens Stoltenberg of Norway in today’s announcement. “The fact that women do not get the care they need during childbirth is the most brutal expression of discrimination against women. To prevent these tragic and unnecessary deaths is not only a humanitarian urgency of highest priority, but a key investment for social and economic development.”
We know what the main barriers and gaps are, including weak logistics and supply chains, inadequate regulatory capacity to protect people from sub-standard or counterfeit medicines, lack of affordable medicines, and confusion about how, why, and when to use them. And we know from other health areas that it is possible to overcome these challenges in even the poorest and most isolated communities. Solving these systemic and structural problems now will help countries strengthen and provide critical obstetric health services well into the future.
“There is no doubt that lives can be saved by increasing access to affordable and effective medicines and health supplies. We must all make a difference and the time is now,” said commission co-chair President Goodluck Jonathan of Nigeria.
With technical and political leadership, the commission can contribute significantly to improving women’s health worldwide by:
Quantifying the unmet need for maternal health medicines so manufacturers can adequately scale up to meet that need and cost estimates to achieve universal coverage can be calculated.
Identifying global and national level expenditures for maternal health medicines so any gaps between necessary and actual funding levels can be determined and filled.
Exploring bulk purchasing mechanisms so that prices remain low while at the same time creating more attractive markets for manufacturers.
Decreasing the prevalence of substandard medicines.
Improving national regulatory capacity to ensure that only quality medicines are available and that new medicines can effectively enter the market.
Promoting the national registration of essential maternal health medicines as identified by the World Health Organization.
Strengthening management information systems to ensure medicine availability and avoid stockouts but not too far in advance to risk expiration.
Monitoring policy implementation so gaps may be addressed.
Improving knowledge and skills of health care providers and supply chain managers.
Building the evidence base and human resource capacity for administration of maternal health medicines by lower-level workers so that women may receive appropriate care when delivering in their community.
With a concentrated and continued focus on high-impact health supplies, the commission’s work could make unprecedented leaps toward the Every Woman Every Child movement’s goal to save 16 million lives by 2015.
A progress report released this month confirms that in 2010 the world achieved the Millennium Development Goal target of halving, by 2015, the proportion of the population without sustainable access to safe drinking water. More than 2 billion people have received access to an improved water source since 1990.
For an estimated 780 million, however, safe drinking water is still out of reach. Geographically, progress has varied widely: almost half of the 2 billion people who gained access over the past two decades live in Asia— in China and India—while other regions, including sub-Saharan Africa, lag behind, and disparities across economic and rural/urban divides remain.
Health workers are on the frontlines combating the burden of disease caused by unsafe water in their communities, and for too many health workers, access to clean water on the job remains a luxury. In some countries, only about half of all health facilities have regular access to an improved water source. Safe water is not only essential to good health, but to good health care.
This post was originally posted on Impatient Optimists and is reposted here with permission.
The Ministry of Health in Brazil has taken enormous strides to improve maternal and newborn health and adopt a humanized care approach for moms and newborns. They adopted “Kangaroo Care,” also called skin-to-skin contact, the practice of holding a baby close to the skin, as a national policy for low birth weight babies over a decade ago.
And there is one woman in the country who could be called the “Kangaroo Care Champion.”
Brazil’s own Dr. Zeni Carvalho Lamy has engaged in long-term research on this type of care, which demonstrates the extraordinary benefits for newborns—and their parents. Her research has been invaluable to the larger push to get Kangaroo Care adopted worldwide.
Dr. Lamy is working in a variety of ways to improve the chance that small babies have to survive. Though Gary Darmstadt, one of the writers of this post, has written several posts about this deceptively simple practice, Dr. Zeni Carvalho Lamy and her research on this life-saving method inspired him to write another.
A mom with her Kangaroo Care baby at the University Hospital of Federal Maranhão, in Brazil.
Skin-to-skin care has been shown to have incredible benefits. In addition to the fact that it promotes breastfeeding, normalizes the baby’s temperature, increases weight gain, reduces the incidence of infections, and facilitates bonding between baby and parents, Dr. Lamy’s own study at the University Hospital of Federal Maranhão confirms that skin-to-skin care actually reduces pain responses for the newborn.
In fact, Kangaroo care is proven to be one of the most effective means we have to save the lives of preterm (premature) infants.
Kangaroo Care began as an ideal method for low-resource (poor) regions of the world, where technological advances such as incubators, the typical method of treating preterm infants, aren’t available. But what Brazil is showing is that this simple, basic method of care is for all babies—those in the best neonatal intensive care unit available as well as those who may not even have had access to a midwife during delivery.
The University Hospital where Dr. Lamy is based teaches moms and dads how to provide skin-to-skin contact for as much time during the day as possible.
Kangaroo Care allows for the mother and baby to reconnect after an often alarming preterm delivery. Practicing Kangaroo Care while still in the hospital also gives parents a chance to overcome their reservations and fears of caring for a preterm baby while having constant support from health care workers.
Once released from the hospital, parents have more confidence in caring for their child. As a result, these mothers are more likely to exclusively breastfeed (feeding the newborn nothing but breast milk for the first six months of an infant’s life) and are more able to recognize and respond to their baby’s needs.
Seven-year-old former KC babies, celebrating life. The t-shirt says, “I was a Kangaroo Baby.”
For the first several weeks at home, frontline health workers, community health providers including peer counselors, skilled birth attendants, and others, conduct a weekly home visit until the baby reaches an acceptable weight. Routine follow-up for both preterm and full-term babies, including support for the practice of Kangaroo Care, also continues at health care clinics.
The hospital follows-up with these low birth weight babies through the years, until their seventh-year birthday party. Each year, the nurses and doctors get to celebrate with these children and their parents, celebrating both their birthdays, and the enormous benefits of a simple practice that helped them survive the first perilous days and weeks of life.
Kangaroo Care has been adopted across Brazil for preterm and low birth weight babies, thanks in large part to Dr. Zeni Lamy’s amazing research on the practice. It can and should be adopted by all parents all around the world. The benefits are enormous. Every baby deserves a seventh-year birthday celebration.
Maternal health programs often fail to integrate with programs for delivering care to children and then to measure the impact on both newborn and child health outcomes as well as maternal health outcomes. Similarly, child health programs often fail to integrate maternal health care into their plans.
There is reason to be hopeful, however.
In the Shivgarh community of Uttar Pradesh, India, the Gates Foundation supported a community-based program centered on promoting preventive newborn care by empowering families and communities. Though the program did not focus on maternal health, what we found was fascinating and pushed us to delve deeper into the connections between maternal and newborn/child health care.
As the “Silicon Valley” of India, Bangalore is often associated with IT customer service and technological innovation. Many people, even those involved in global health, may not consider access to quality health care to be a major issue in such a tech-savvy, rapidly developing city. But with such exponential expansion, it has been impossible for infrastructure to keep up. Bangalore has almost doubled its population in the last 10 years. The government facilities simply do not have enough basic drugs, hospital beds, or health care providers to serve the population they’re responsible for.
This January I’ve been working with the Bangalore Birth Network (BBN), an organization focusing on promoting evidence-based practice to increase the incidence of normal births. They are hoping to improve maternal and neonatal health outcomes through a pilot project at Banashankari Referral Hospital, which serves a large population of women of low socio-economic status. Working with the International MotherBaby Childbirth Organization (IMBCO), the Bangalore Birth Network is implementing staff training programs to improve quality of care by enhancing the use of evidence-based practices.
Staff coming into work at the Banashankari Referral Hospital. Dr. Gangalakshmi, in the green sari, is the hospital's Medical Director and one of only three MDs who rotate shifts at the hospital. Photo by Annie Kearns
Over the past 3 weeks I’ve been helping the Bangalore Birth Network to collect baseline data from the hospital on variables such as Cesarean rate, percent of primiparous women with normal birth who are given episiotomies, and the percent of normal labors which are tracked with a partograph. As many as 40% of births at public facilities across India are Cesarean; things like vaginal birth after Cesarean (VBAC) and allowing laboring women to be accompanied by a companion of her choice are rare. IMBCO and BBN are interested in bringing these indicators more in line with World Health Organization (WHO) guidelines by using IMBCO’s training materials adapted to the local context, taking into account things like the lack of consistently available epidurals and the culture of barring men from the labor and delivery rooms. I’ve also been assisting them in locating funding for the two year project from regional and international sources.
This young woman gave birth at Banashankari a few months before this photo was taken and was returning for follow-up care for her child. Banashankari is often the only medical facility that patients can access for health care. Photo by Annie Kearns
To learn more about the Field Experience in Maternal Health winter session course, visit the course page hereor check out a recent blog post about the course here.
The posts on this blog do not necessarily reflect the views of the Maternal Health Task Force. Our objective is to provide a platform for our Editorial Committee and other experts to post a myriad of data and evidence, as well as opinions/views that exist in the field which will contribute to expanding the maternal health dialogue.
Archive For The GMHC 2010
Archive for the ‘Commentary’ Category
Deborah Maine asks, “Does the HPV vaccine make sense?”
Wednesday, May 23rd, 2012 by KateMitchOn Wednesday, May 16th, the Maternal Health Task Force at the Women and Health Initiative hosted Deborah Maine for a seminar on cervical cancer at Harvard School of Public Health. The seminar was titled, “HPV Vaccine: Does it make sense?”
Deborah Maine, an epidemiologist with a background in anthropology and over 30 years of experience working on reproductive health programs in developing countries, developed the three delays framework for understanding maternal mortality—a framework that continues to guide the work of maternal health program implementers and researchers alike.
In recent years, Maine has been working extensively on the issue of cervical cancer. Her May 16th presentation focused on the controversy around priority setting for cervical cancer prevention, screening, and treatment in developing countries.
Maine explains the controversy:
“Even a successful vaccine program won’t help women already sexually active. Focusing only on the vaccine means writing off 2 generations of women who have already been sexually active and have already been exposed but will not benefit from this. And I wonder: Would anybody even propose a child health intervention that would take effect in 20 years? I don’t think so. I think this is something that happens preferentially with women. And I think it is a human rights issue. I really do.”
A few of Maine’s recommendations:
Dr. Maine wrapped up her presentation by reminding the crowded room of public health students, researchers, and implementers of a very important point: “I would just like to remind everyone that 5 million women who have already been infected with HPV will die before the vaccine can have effect. Improving screening programs is the first priority in both developed and developing countries.”
The presentation was followed by a lively Q&A session.
Watch the video of the presentation here.
Click here to read a recent paper by Maine and colleagues, Cervical Cancer Prevention in the 21st Century: Cost Is Not the Only Issue.
Learn more about Deborah Maine here.
[Translate]
Tags: cervical cancer, Deborah Maine, Harvard School of Public Health, HPV, HPV vaccine, Human Rights, three delays, three-delays framework, vaccines, video, Women and Health Initiative
Posted in Commentary, Evidence, News | No Comments »
Maternal Health Commodities: Case Studies from Bangladesh, India, Ethiopia, Nigeria, Tanzania, and Uganda
Tuesday, May 22nd, 2012 by KateMitchLast month, the Maternal Health Task Force was invited by the Secretariat to the UN Commission for Life Saving Commodities for Women and Children to complete a landscaping of maternal health commodities in 6 countries. The MHTF, in collaboration with Global Health Visions, prepared a working document, titled UN Commission on Life Saving Commodities for Women and Children: Country Case Studies, that takes a closer look at the status of 3 maternal health commodities in 6 countries where maternal mortality remains a persistent problem: Bangladesh, India, Ethiopia, Nigeria, Tanzania, and Uganda.
The document provides critical insights into the various barriers to access to oxytocin, misoprostol, and magnesium sulfate. Post-partum hemorrhage (PPH) and Pre-Eclampsia/Eclampsia (PE/E) are two of the leading causes of maternal death. PPH can be treated, and often prevented, with uterotonic medicines—such as oxytocin and misoprostol. Similarly, magnesium sulfate is an effective treatment for managing PE/E.
Oxytocin, misoprostol, and magnesium sulfate are all now included on the WHO Model Lists of Essential Medicines—but significant gaps exist between international policies and actual access to medicine in communities, and health facilities around the world.
The document also highlights innovations and best practices for increasing access to essential commodities—exploring the use of mobile technologies to share information about stock outs, solar powered refrigerators, single-dose and disposable injectable medicines, task-shifting, and pooled procurement strategies as tools for expanding the availability of essential maternal health medicines for women in developing countries.
The report concludes that: “While findings differ across countries, one aspect is clear – significantly more research is needed to fully capture the state of maternal health commodities in these countries, and probably others. Building on this initial review, a well-planned series of consultations with in-country stakeholders is a critical next step. A comprehensive understanding of the status and accessibility of these commodities is a necessary component of ensuring access to high quality maternal health services for millions of women around the world.”
Access the full report here.
[Translate]
Tags: commodities, eclampsia, Global Health Visions, innovation, magnesium sulfate, maternal health commodities, misoprostol, oxytocin, PE/E, post-partum hemorrhage, PPH, pre-eclampsia, UN Commission for Life Saving Commodities for Women and Children, UN Commission on Life Saving Commodities for Women and Children: Country Case Studies, uterotonics, WHO Model Lists of Essential Medicines
Posted in Commentary, Evidence, News | No Comments »
New Estimates Show Major Reduction in Maternal Mortality, But More Progress Needed
Wednesday, May 16th, 2012 by KateMitchNew global maternal mortality estimates were released today in a report by the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA) and the World Bank. The report,“Trends in maternal mortality: 1990 to 2010”, shows that the number of women dying of pregnancy and childbirth related complications has almost halved in 20 years. The estimates show that from 1990 to 2010, the annual number of maternal deaths has dropped from more than 543,000 to 287,000–and that a number of countries have already reached the MDG target of 75 per cent reduction in maternal death.
Major highlights from the report:
Read the full press release here.
Read the full report here.
Join the conversation on Twitter at hashtag: #motherhood #MMR2012
Over the past few years, the global health community has witnessed and contributed to the publication of more frequent and more technically advanced estimates for maternal mortality than ever before. This report adds to the growing body of evidence that is helping the maternal health community to measure and better understand the scope and trends of the problem. It is an exciting time in the field–and we encourage you to read the new report.
[Translate]
Tags: Afghanistan, Bangladesh, Belarus, Bhutan, Democratic Republic of Congo, Equatorial Guinea, Estonia, Ethiopia, global health, India, Indonesia, Iran, Lithuania, Maldives, maternal mortality, MDG5, Nepal, new maternal mortality estimates, Nigeria, Pakistan, Romania, sub-Saharan Africa, Tanzania, UNFPA, UNICEF, WHO, World Bank
Posted in Commentary, Evidence, News, Policy | No Comments »
10 Reasons to Celebrate the Health of Moms—and Those Working to Improve Maternal Health—this Mother’s Day!
Friday, May 11th, 2012 by KateMitchMother’s Day 2012 provides a good occasion to celebrate accomplishments in the field over the past year. The Maternal Health Task Force shares ten exciting developments.
Please add to the list in the comments!
[Translate]
Tags: Born Too Soon, commodities, Direct Relief International, family planning, Fistula Foundation, Global Fistula Map, Joyce Banda, List of Essential Medicines, Malawi, Melinda Gates, MHTF, misoprostol, Mother's Day, Mother's Day 2012, PLoS, post-partum hemorrhage, Respectful Maternity Care Charter, State of the World's Midwives report, State of the World's Mothers Report, UNFPA, UNICEF, White Ribbon Alliance, WHO, World Health Organization, WRA
Posted in Commentary, News, Resources | No Comments »
How might data-sharing aid in the fight against malaria?
Thursday, April 5th, 2012 by KateMitchIn a recent article in Nature International Weekly Journal of Science, science writer, Daniel Cressey, wrote about efforts by drug development companies to share intellectual property and expand access to leads on potential drug candidates for malaria and other tropical diseases.
Read the full story here.
More on malaria from the MHTF, here.
[Translate]
Tags: Daniel Cressey, data-sharing, malaria, Nature, neglected tropical diseases, open access, open innovation, pharmaceutical companies, World Health Organizations
Posted in Commentary, News | No Comments »
A Closer Look at Lifesaving Maternal Health Medicines
Friday, March 23rd, 2012 by KateMitchWritten by Rachel Wilson, the senior director of policy and advocacy at PATH and co-chair of the Maternal Health Supplies Working Group
Today could be the beginning of a significant, life-saving shift for maternal health. The United Nations Children’s Fund and the United Nations Population Fund launched a high-level commission to improve access to essential but overlooked health supplies, including medicines that could save the lives of millions of women.
Worldwide, an estimated 350,000 women die during pregnancy and childbirth every year. Most maternal deaths can be prevented with affordable and effective medicines, such as oxytocin, misoprostol, and magnesium sulfate. Together with skilled health workers and strong health systems, these medicines can transform women’s health in developing countries.
“The day of birth is the most dangerous day in the life of a woman and her child,” stated commission co-chair Prime Minister Jens Stoltenberg of Norway in today’s announcement. “The fact that women do not get the care they need during childbirth is the most brutal expression of discrimination against women. To prevent these tragic and unnecessary deaths is not only a humanitarian urgency of highest priority, but a key investment for social and economic development.”
We know what the main barriers and gaps are, including weak logistics and supply chains, inadequate regulatory capacity to protect people from sub-standard or counterfeit medicines, lack of affordable medicines, and confusion about how, why, and when to use them. And we know from other health areas that it is possible to overcome these challenges in even the poorest and most isolated communities. Solving these systemic and structural problems now will help countries strengthen and provide critical obstetric health services well into the future.
“There is no doubt that lives can be saved by increasing access to affordable and effective medicines and health supplies. We must all make a difference and the time is now,” said commission co-chair President Goodluck Jonathan of Nigeria.
With technical and political leadership, the commission can contribute significantly to improving women’s health worldwide by:
With a concentrated and continued focus on high-impact health supplies, the commission’s work could make unprecedented leaps toward the Every Woman Every Child movement’s goal to save 16 million lives by 2015.
To learn more about the UN Commission on Life-Saving Commodities for Women and Children, visit http://www.everywomaneverychild.org/resources/un-commission-on-life-saving-commodities.
[Translate]
Tags: Every Woman Every Child, Jens Stoltenberg, magnesium sulfate, maternal health medicines, Maternal Health Supplies Working Group, misoprostol, Nigeria, oxytocin, PATH, President Goodluck Jonathan, Rachel Wilson, supply chain management, UN Commission on Life-Saving Commodities for Women and Children, UNFPA, UNICEF, World Health Organization
Posted in Announcements, Commentary, News | No Comments »
World Water Day 2012: Clean Water is Essential for Good Health–and Good Health Care
Thursday, March 22nd, 2012 by KateMitchIn honor of World Water Day, our colleagues at IntraHealth have written a blog post about the links between access to clean water and quality health care. Be sure to check out IntraHealth’s World Water Day quiz too.
From our colleagues at IntraHealth:
Read the full post here.
Be sure to take a look at the MHTF’s blog series on water and sanitation here.
[Translate]
Tags: China, health workers, India, Intrahealth, safe drinking water, water and sanitation, World Water Day
Posted in Commentary, News | No Comments »
A “Kangaroo Care Champion” in Brazil
Thursday, March 22nd, 2012 by KateMitchWritten by Gary Darmstadt and Wendy Prosser
This post was originally posted on Impatient Optimists and is reposted here with permission.
The Ministry of Health in Brazil has taken enormous strides to improve maternal and newborn health and adopt a humanized care approach for moms and newborns. They adopted “Kangaroo Care,” also called skin-to-skin contact, the practice of holding a baby close to the skin, as a national policy for low birth weight babies over a decade ago.
And there is one woman in the country who could be called the “Kangaroo Care Champion.”
Brazil’s own Dr. Zeni Carvalho Lamy has engaged in long-term research on this type of care, which demonstrates the extraordinary benefits for newborns—and their parents. Her research has been invaluable to the larger push to get Kangaroo Care adopted worldwide.
Dr. Lamy is working in a variety of ways to improve the chance that small babies have to survive. Though Gary Darmstadt, one of the writers of this post, has written several posts about this deceptively simple practice, Dr. Zeni Carvalho Lamy and her research on this life-saving method inspired him to write another.
A mom with her Kangaroo Care baby at the University Hospital of Federal Maranhão, in Brazil.
Skin-to-skin care has been shown to have incredible benefits. In addition to the fact that it promotes breastfeeding, normalizes the baby’s temperature, increases weight gain, reduces the incidence of infections, and facilitates bonding between baby and parents, Dr. Lamy’s own study at the University Hospital of Federal Maranhão confirms that skin-to-skin care actually reduces pain responses for the newborn.
It’s a force of nature that can save lives.
In fact, Kangaroo care is proven to be one of the most effective means we have to save the lives of preterm (premature) infants.
Kangaroo Care began as an ideal method for low-resource (poor) regions of the world, where technological advances such as incubators, the typical method of treating preterm infants, aren’t available. But what Brazil is showing is that this simple, basic method of care is for all babies—those in the best neonatal intensive care unit available as well as those who may not even have had access to a midwife during delivery.
The University Hospital where Dr. Lamy is based teaches moms and dads how to provide skin-to-skin contact for as much time during the day as possible.
Kangaroo Care allows for the mother and baby to reconnect after an often alarming preterm delivery. Practicing Kangaroo Care while still in the hospital also gives parents a chance to overcome their reservations and fears of caring for a preterm baby while having constant support from health care workers.
Once released from the hospital, parents have more confidence in caring for their child. As a result, these mothers are more likely to exclusively breastfeed (feeding the newborn nothing but breast milk for the first six months of an infant’s life) and are more able to recognize and respond to their baby’s needs.
Seven-year-old former KC babies, celebrating life. The t-shirt says, “I was a Kangaroo Baby.”
For the first several weeks at home, frontline health workers, community health providers including peer counselors, skilled birth attendants, and others, conduct a weekly home visit until the baby reaches an acceptable weight. Routine follow-up for both preterm and full-term babies, including support for the practice of Kangaroo Care, also continues at health care clinics.
The hospital follows-up with these low birth weight babies through the years, until their seventh-year birthday party. Each year, the nurses and doctors get to celebrate with these children and their parents, celebrating both their birthdays, and the enormous benefits of a simple practice that helped them survive the first perilous days and weeks of life.
Kangaroo Care has been adopted across Brazil for preterm and low birth weight babies, thanks in large part to Dr. Zeni Lamy’s amazing research on the practice. It can and should be adopted by all parents all around the world. The benefits are enormous. Every baby deserves a seventh-year birthday celebration.
Interested in learning more about Kangaroo Care and what you can do to help spread the word and raise awareness? In December 2011, the first Kangaroo Care Conference for Latin America and the Caribbean was hosted by USAID. The United States was there as well. Information was shared with the goal to learn about and connect across borders to promote Kangaroo Care as a life-saving tool. Read up about this amazing practice on Impatient Optimists, or on the Healthy Newborn Network. Read the stories of families who have adopted this practice, watch this video, and spread the word about the benefits. And if you have a story to share, please do so in the comments.
Continue the conversation on Twitter with Gary Darmstadt (@gdarmsta), MCHIP (@mchipnet), the Healthy Newborn Network (@HealthyNewborns), Unicef (@UNICEF), and the MHTF (@MHTF).
[Translate]
Tags: Brazil, Dr. Zeni Carvalho Lamy, frontline health workers, Gary Darmstadt, Healthy Newborn Network, Impatient Optimists, Kangaroo Care, Kangaroo Care Conference for Latin American and the Caribbean, low birth weight, MCHIP, UNICEF, University Hospital of Federal Maranhão, USAID, Wendy Prosser
Posted in Commentary, News, Policy | No Comments »
Maternal and Newborn Health, Exploring Shared Solutions for Common Goals
Friday, February 10th, 2012 by KateMitchA New Mother Holds her Newborn in Rural India. Photo by Kate Mitchell
A recent post on Impatient Optimists by Gary Darmstadt and Vishwajeet Kumar addressed the question, “Can newborn health care help mothers, too?” They wrote about a recent study, Community-driven impact of a newborn-focused behavioral intervention on maternal health in Shivgarh, India, that aimed to assess the effect on maternal health outcomes of a community-based essential newborn care behavior change intervention.
Maternal health programs often fail to integrate with programs for delivering care to children and then to measure the impact on both newborn and child health outcomes as well as maternal health outcomes. Similarly, child health programs often fail to integrate maternal health care into their plans.
There is reason to be hopeful, however.
In the Shivgarh community of Uttar Pradesh, India, the Gates Foundation supported a community-based program centered on promoting preventive newborn care by empowering families and communities. Though the program did not focus on maternal health, what we found was fascinating and pushed us to delve deeper into the connections between maternal and newborn/child health care.
Read the full post here.
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Tags: Gary Darmstadt, India, integration, maternal and newborn health, maternal health, newborn health, Uttar Pradesh, Vishwajeet Kumar
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Field Experience in Maternal Health: Annie Kearns Shares her Experience with the Bangalore Birth Network in India
Monday, February 6th, 2012 by KateMitchOver the first three weeks of January, several Harvard School of Public Health graduate students took part in the Field Experience in Maternal Health winter session, organized by the Women and Health Initiative and the Maternal Health Task Force. In this blog post, Annie Kearns writes about her field experience with the International MotherBaby Childbirth Organization and the Bangalore Birth Network in India.
Written by: Annie Kearns
As the “Silicon Valley” of India, Bangalore is often associated with IT customer service and technological innovation. Many people, even those involved in global health, may not consider access to quality health care to be a major issue in such a tech-savvy, rapidly developing city. But with such exponential expansion, it has been impossible for infrastructure to keep up. Bangalore has almost doubled its population in the last 10 years. The government facilities simply do not have enough basic drugs, hospital beds, or health care providers to serve the population they’re responsible for.
This January I’ve been working with the Bangalore Birth Network (BBN), an organization focusing on promoting evidence-based practice to increase the incidence of normal births. They are hoping to improve maternal and neonatal health outcomes through a pilot project at Banashankari Referral Hospital, which serves a large population of women of low socio-economic status. Working with the International MotherBaby Childbirth Organization (IMBCO), the Bangalore Birth Network is implementing staff training programs to improve quality of care by enhancing the use of evidence-based practices.
Staff coming into work at the Banashankari Referral Hospital. Dr. Gangalakshmi, in the green sari, is the hospital's Medical Director and one of only three MDs who rotate shifts at the hospital. Photo by Annie Kearns
Over the past 3 weeks I’ve been helping the Bangalore Birth Network to collect baseline data from the hospital on variables such as Cesarean rate, percent of primiparous women with normal birth who are given episiotomies, and the percent of normal labors which are tracked with a partograph. As many as 40% of births at public facilities across India are Cesarean; things like vaginal birth after Cesarean (VBAC) and allowing laboring women to be accompanied by a companion of her choice are rare. IMBCO and BBN are interested in bringing these indicators more in line with World Health Organization (WHO) guidelines by using IMBCO’s training materials adapted to the local context, taking into account things like the lack of consistently available epidurals and the culture of barring men from the labor and delivery rooms. I’ve also been assisting them in locating funding for the two year project from regional and international sources.
This young woman gave birth at Banashankari a few months before this photo was taken and was returning for follow-up care for her child. Banashankari is often the only medical facility that patients can access for health care. Photo by Annie Kearns
To learn more about the Field Experience in Maternal Health winter session course, visit the course page here or check out a recent blog post about the course here.
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Tags: Annie Kearns, Banashankari Referral Hospital, Bangalore, Bangalore Birth Network, field experience, HSPH Winter Session, India, International MotherBaby Childbirth Organization, maternal health, neonatal health, vaginal birth after cesarean (VBAC)
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