Maternal Health Issues Vermont Giving Circle July 2011

Vermont Women’s “Giving Circle”

An intergenerational network of Vermont women with the common goal of supporting sustainable change in the lives of women and children around the world. We are pooling our resources to leverage the power of our donations, to fund existing non-profits whose programs and services address the issues of human rights, safety, health and education for those in need.

Maternal HealthThe Difficult facts:

536,000 maternal deaths, 3 million stillbirths, and 23.7 million newborn deaths each year. Of these, it is expected that 358,000 women and 3.6 million newborn babies die due to largely preventable complications during pregnancy, childbirth and the postnatal period. This does not include the over 3 million babies who are stillborn.

98% of these deaths occur in the developing world.


Worldwide, nearly 1,500 women and more than 10,000 newborns die every day from complications of pregnancy or childbirth that could have been treated or prevented with adequate care . These needless maternal deaths—almost 350,000 per year—have left millions of orphaned children behind. And for every maternal death, another 20 women are injured or disabled as a result of pregnancy or childbirth—at least 10 million women every year.


Maternal mortality is a sensitive indicator of inequality, and current statistics show that the poorest and least educated women have the highest risk of death during pregnancy or childbirth


In developing countries such as Rwanda or Malawi, one woman out of every 35 dies as a result of pregnancy or childbirth. In contrast, in Japan, only one of 12,200 women will die in pregnancy or childbirth .

Some possible solutions:Ensuring free comprehensive health servicesProviding logistical assistance for women to reach health

facilities Training and staffing a strong network of community health

workersStrengthening the quality and quantity of services,

provided through public clinics and district hospitals family planning, comprehensive neonatal care, adequate nutrition, and professional medical attention for childbirth and emergency complications of pregnancy.

The vision is a world in which skilled care at every birth is ensured for all women and their babies, regardless of their social, cultural, ethnic or religious backgrounds.

Some possible solutions:Four focus areas

It is critical to understand the deep-rooted cultural beliefs in families and communities that have a huge impact on a women’s decision to as to whether or not she seeks skilled care during pregnancy and childbirth.

1 Skilled obstetric care for pregnancy and childbirthThroughout the developing world, 52 million births occur without

help from a skilled attendant, and 35 percent of pregnant women have no contact at all with health personnel before delivery.

Yet potentially fatal complications occur in 15 percent of all births.

An estimated 700,000 midwives are needed world wide to ensure universal coverage with maternity care, but there is currently a 50% shortfall. In addition, 47,000 doctors with obstetric skills are required.


2 Family planningFamily planning is among the most effective

tools for reducing maternal mortality. Nevertheless, 50 percent of all pregnancies worldwide are unplanned or unwanted, accounting for nearly 300,000 new pregnancies every day.

These programs we’re talking about tonight mobilize and train health workers trained in sex education and reproductive health counseling, sexually transmitted diseases (inc. HIV) contraceptive methods..


3 Preventing mother-to-child transmission of HIVNinety percent of the 2.5 million children living with HIV

became infected during childbirth . So did the vast majority of more than 300,000 children who die of AIDS each year before reaching the age of 5.

Yet a simple and highly effective treatment for prevention of mother-to-child transmission of HIV (PMTCT) has been available in developed countries since 1994.

This starts in pregnancy with HIV testing, providing antiretroviral therapy, counseling on infant feeding and advising on safer sex practices. In addition, it includes appropriate obstetric practices, to prevent mother-to-child transmission of the virus during childbirth.


4 Postnatal care for mothers and babiesThis includes helping mothers and babies in

breastfeeding, managing complications such as severe postpartum bleeding, infection, and depression. As well as counseling on postnatal contraception.

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Partners in Health Family planning

Family planning is an integral part of the model of comprehensive women’s health care that was developed in their clinic in Haiti.

Each of Haiti’s’s clinical sites has a full-time nurse trained in sex education and reproductive health counseling.

They have been offering free condoms and other contraceptive methods for over 15 years.

In 2003, they began training and mobilizing community health workers who specifically promote family planning and women’s health. These ajans fanm (women's health agents) travel throughout the countryside, teaching women and men about sexually transmitted infections (including HIV) and contraceptive methods, distributing condoms and oral contraceptives, and referring pregnant women and others to the clinics. This successful model is being replicated at PIH sites in Rwanda, Malawi and Lesotho.

New Maternity Clinic in Rwanda

Partners in HealthSkilled obstetric care for pregnancy and childbirth training specialized community health

workers

In Haiti each Clinic site has a fully-functioning women’s health clinic staffed by a professional midwife and six full-time obstetrician/gynecologists cover all of PIH’s clinical sites. PIH also works with matrons, traditional birth attendants, to refer women to prenatal services and hospitals for delivery.

in Rwanda, rapid scale-up of obstetric and comprehensive women’s health care has been facilitated by the support of clinicians with years of experience in rural Haiti. The nursing staff at the women’s health clinic at Rwinkwavu Hospital includes specialists trained in prenatal counseling and delivery as well as family planning. The number of women receiving prenatal care continues to grow.

In Lesotho in June 2009, PIH began training specialized community health workers to educate and accompany pregnant women to the health center and ensure that they receive care from skilled health professionals.

As of January 2011, 203 women had been trained to serve as Maternal Mortality Reduction Program Assistants (MMRPAs), many of whom are former traditional birth attendants.

Establishing “mothers’ waiting houses” for 1-2 weeks before due dates so that all deliveries occur at the clinic; giving new baby care packages that include blankets, clothing and hygiene items to women who attend all ANC appointments, are tested for HIV, and deliver at the health center; and providing ART or PMTCT prophylaxis to HIV-positive pregnant women.

The MMRP has dramatically increased women’s access to health care. In 2010, 70% of reported deliveries in Bobete Health Center in Losotho catchment area occurred at the Health Center, constituting a 350% increase in facility-based deliveries. Furthermore, the number of pregnant women seeking prenatal care, HIV testing and other health services through the Bobete Health Center continues to rise.

Partners in Health Preventing mother-to-child transmission of HIV

90% of the 2.5 million children living with HIV became infected during childbirth.

So did the vast majority of more than 300,000 children who die of AIDS each year before reaching the age of 5.

PIH programs continue to demonstrate that even in low-resource settings, virtual elimination of mother-to-child transmission of HIV is both necessary and possible.

In 1995, the clinic in Haiti began providing antiretroviral treatment for PMTCT to HIV-positive pregnant women in rural Haiti. ZL continues to offer free HIV counseling and testing to every pregnant woman seen, and recorded nearly 90,000 visits with pregnant women in the past year alone. Since the PMTCT program was introduced, the HIV infection rate of newborns has fallen to levels rivaling those in developed countries.

The model for preventing mother-to-child transmission developed in rural Haiti has become an essential and standard component of PIH's model of HIV prevention and care wherever we work. In Rwanda, Malawi and Lesotho, PMTCT programs are integrated into comprehensive care for both mother and child. After giving birth, mothers living with HIV receive counseling and a small monthly stipend to cover basic nutritional needs and monthly travel costs to the clinic. They are also paired with an accompagnateur, a community health worker who will deliver and observe antiretroviral therapy twice daily.

Summary of Partners in healthEnhancing the rights, power, and opportunities for

women is critical to addressing the underlying causes of maternal mortality.

PIH seeks to increase women’s right to healthcare by: ensuring free comprehensive health services, providing cash transfers and logistical assistance for women to reach health facilities, training and staffing a strong network of community health workers, strengthening the quality and quantity of services provided through public clinics and district hospitals, and pursuing scholarship and advocacy for global policy change.

Partners in HealthWhat our donation can buy

$5000 Provides 10 specialty beds for safe labor and delivery

$1000 Hire and train a maternal health worker for one year

$500 Purchase a fetal monitor$250 Provide a surgical kit for cesarean

section$100 Stock birthing kits for five deliveries$50 Supply blood pressure cuffs for every

prenatal visit

The Rwanda Women’s Health Initiatives of the Albert Einstein College of Medicine

COMMUNITY-BASED INITIATIVES Are serving 50 villages and 29,000 people, and include:

COMMUNITY HEALTH WORKER TRAINING: These are volunteer village members who are charged with the responsibility of overseeing the health of their fellow community members. Lectures are provided on topics including pregnancy, normal labor, and emergency recognition and complication readiness. Upon completion, over 200 Community Health Workers in fifty villages will have been trained.


Dr. Lisa Nathan conducting community health worker training at Nyamasheke Health Center


COMMUNITY LEVEL MATERNITY CENTER: Health Posts provide the foundation of the health care service delivery in Rwanda. Health Posts can be found at the village level, and provide basic ambulatory services to vast numbers of people. The services of the Health Post in Gako have effectively been expanded by starting birthing services at the site. A new building with running water and solar-powered electricity provides an accessible destination for rural mothers in labor to have uncomplicated vaginal deliveries.


TRANSPORTATION ASSOCIATIONS: Transportation is one of the major obstacles to accessible birthing services for women in rural Rwanda. A hilly terrain without developed infrastructure makes traveling even short distances difficult and dangerous for pregnant women.Volunteer associations have been mobilized in each village and supplied with a traditional ambulance to help transport women in labor to the nearest birthing facility.


MOBILE REPRODUCTIVE HEALTH CARE DELIVERY: Prenatal care, family planning, birth planning, and prevention of mother-to-child transmission of HIV are provided as a mobile service to the 14 villages within the Nyamasheke District. These services are provided by a nurse who visits one village per day, meeting with patients in a central location to each village population.


Project Coordinator conducting community sensitization in Shara cellule for the mobile reproductive health services


HOSPITAL-BASED INITIATIVES at the Kibogora District Hospital, one of two District Hospitals in Nyamasheke District, that serve approximately 588 Villages, include:

PATIENT SAFETY MEASURES: Various measures have been initiated on the maternity ward to decrease error and improve overall patient safety. Protocols and checklists have been developed and implemented with the local staff. Hemorrhage kits have been made readily available in the delivery room and operating theater.

Leadership capacity building activities have been initiated, including identification of a Chief and Assistant Chief of Maternity among the generalist physicians working at the hospital. These two doctors now work solely on the maternity ward, and work closely with the head maternity nurse to provide continuity of care for all patients on the maternity ward.


PHYSICIAN AND NURSE EDUCATION:

Recognizing the lack of specialty training among the physicians working at Kibogora, a curriculum that includes hands-on training, has been developed to cover basic labor management, obstetric emergencies, and basic gynecology. Lectures and hands-on training in labor management is also being provided to the maternity ward nurses and midwives at the hospital as well as at the Nyamasheke Health Center (a main referral site.)

To further enhance skills and education, physicians are provided an opportunity to participate in an intensive five-week training at The Albert Einstein College of Medicine. The Bronx, NY labor floor provides an ideal learning environment. The physicians participate in an observership on the labor floor combined with an intensive obstetric emergency simulation-based training program.


What our donation can buy$20 Pays for an entire box of Magnesium Sulfate

(to prevent Eclampsia, one of the leading causes of maternal mortality)

$20 Pays for 100 tablets of Cytotec/Misoprostol (for postpartum hemorrhage, the leading cause of maternal mortality in Africa. Approximately five tablets are used to treat a case of postpartum hemorrhage)

$400 Purchases a Labor and Delivery Bed$300 Purchases a Postpartum Bed$100 Provides a Delivery Kit (Contains essential materials used to deliver a baby)

$233 Funds a nurse’s salary for a month$700 Funds a nurse for an entire quarter$300 Pays for the mobile services program for one month$900 Pays for the mobile program for an entire quarter$615 Funds all maternity center operation costs for a month$1,850 Funds for the maternity center for an entire quarter

Future Meeting Dates The first Wednesdays of each month

August 3, 2011September 7, 2011October 5, 2011November 2, 2011December 7, 2011January 4, 2012February 1, 2012March 7, 2012April 4, 2012May 2, 2012June 6, 2012

Maternal Health Issues Vermont Giving Circle July 2011

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Transcript of Maternal Health Issues Vermont Giving Circle July 2011