Archive for the ‘Childbirth Pregnancy’ Category
Teenage pregnancy is on the rise in the Philippines and women’s groups said it is time to introduce sex education in government schools.
But their proposal has met with stiff resistance from the country’s influential Catholic Church.
According to the World Bank, the Philippines is among the top ten countries where there is an increasing number of teenage mothers (3.6 million) and these statistics often translates to a higher incidence of poverty in the country.
Women’s groups are alarmed by the steady increase in teen pregnancies. Seven out of every 10 women who are pregnant are teenagers, and most of them are younger than 19.
Dr. Junice Melgar, executive director, Likhaan, said: “We need to stress that delaying the age of pregnancies are important for them, not just physically to save their lives because of the risks of early pregnancy, but also economically, because we know that young people who are able to have opportunities are the people who are able to delay sexual engagements, especially having pregnancies. These are the ones that are able to finish school and have a better job.”
Non-governmental organisations are pushing for the enactment of a Reproductive Health bill. That piece of legislation would uphold the use of artificial contraceptives and institutionalise sex education in schools.
But the influential Catholic Church’s opposition to it has put it on hold.
Dr Junice Melgar said: “Unfortunately, even sexuality education is being challenged and opposed by conservative forces in the Philippines. Whether we like it or not, whether parents approve it or not, the young people are getting all source of information from the Internet, from their peers, etc.
“And if there’s no authoritative voice that tells uniformly on a standard basis what’s the harm, what are the risks, how can young people avoid the risk of early pregnancy? Then the risks to young people will stay as is, or could even increase the incidence of teen pregnancies in the country.”
Zimbabwe records about 2,000 maternal deaths annually, UN agencies said in a statement last month.
Apart from the 2,000 women who die as a result of giving birth, “Several thousands more suffer severe or long lasting illness or disabilities. Zimbabwe needs midwives now more than ever,” said the United Nations Population Fund, the United Nations Children’s Fund (UNICEF) and the World Health Organization.
The country’s economic collapse is blamed for the migration of midwifery skills to neighbouring countries and further afield, which is thought to have exacerbated the figures for 2007, the last recorded statistics, when there were 1,068 maternal deaths for every 100,000 live births, and a neonatal rate of 24 deaths in every 1,000 live births.
Between 2005 and 2006, only 68 percent of pregnant women were delivered by a skilled attendant, a situation Zimbabwe’s health ministry attributed to long distances between communities and health centres, poverty, and transport problems, particularly in rural areas.
To mark International Day of the Midwife on May 5, Merlin is launching All Mothers Matter a report outlining why, without urgent investment in health workers in fragile states, the Millennium Development Goal for maternal health will not be reached.
50 per cent of women who die in childbirth every year live in countries caught up in or emerging from crisis.
Yet evidence is clear: 75 per cent of lives could be saved if women had access to a skilled birth attendant or emergency obstetric care. With less than one health worker per 1,000 people, fragile states simply do not have the health workforce or services in place.
Carolyn Miller, Merlin’s Chief Executive comments:
‘Midwives are at the heart of maternal survival. Fragile states carry the greatest burden of maternal deaths – and have the lowest numbers of health workers – yet receive insufficient Overseas Development Aid. We cannot hope to meet global maternal health goals if we don’t reallocate our focus, and funding, to countries in crisis.’
In 2007, fragile states received just 38.4 per cent of Overseas Development Aid despite suffering the highest levels of maternal mortality. All Mothers Matter addresses this disparity calling for targeted investment of Â£2.4bn for health in fragile states, an investment which would ensure countries in crisis are back on track to meet Millennium Development Goal number 5 to reduce death in childbirth by three quarters.
Working out at Â£2.71 per person per year, this additional funding re-allocated from international budgets and into fragile states, could double the health workforce, including rapid scale up of midwifery training to ensure there is one skilled birth attendant for every 175 women. It would also provide all the medical supplies and drugs needed plus incentives for staff working in underserved and rural areas.
Carolyn Miller also said:
‘It is more important than ever to be effective and targeted with aid. Maternal deaths lead to global productivity losses of $7.5billion each year. Reallocating aid to fragile states will not only save hundreds of thousands of lives, it makes clear financial sense.’
All Mothers Matters advocates for an overhaul of how health is currently funded to ensure maternal mortality is tackled effectively. Currently huge amounts of aid are spent tackling diseases such as malaria and TB in isolation; yet such diseases, which contribute to high levels of maternal mortality, cannot be prevented, treated or cured without sufficient numbers of trained health workers. Also such aid loses 40% of its value thanks to donor conditions.
The report prioritises investment in health systems calling for 50 per cent of all global health funding to be channelled into strengthening health systems, with 25 per cent of that to be used to train and retain health workers. Investing in health systems would help deliver regular staff salaries, training, equipment and incentives for health workers, ultimately building the skills base needed to stop mothers dying needlessly in childbirth.
Mama Zeena, a Training Coordinator at Merlin’s midwifery school in Zwedru, Liberia is in the UK to launch the report. She commented:
‘You cannot tackle maternal mortality in isolation’ you need sustained investment in a functioning workforce. You need more midwives. All women should be able to see a trained midwife and get help when they need it, regardless of where they live. A mother should not have to die.’
Read All Mothers Matter http://www.merlin.org.uk/images/libimages/1755.pdf
With China’s rising affluence, increasing numbers of infertile couples have been seeking surrogate mothers to bear them babies.
In recent years, officials have largely turned a blind eye to this underground womb-for-rent industry that defies the country’s strict childbirth laws. Now, there are signs the authorities are starting to crack down by forcing some surrogate mothers to abort their fetuses.
In the southern Chinese city of Guangzhou, three young surrogate first-time mothers were discovered by authorities hiding in a communal flat.
Soon afterwards, district family planning and security officers broke into the flat, bundled them into a van and drove them to a district hospital where they were manhandled into a maternity ward, the mothers recounted to Reuters.
“I was crying ‘I don’t want to do this’,” said a young woman called Xiao Hong, who was pregnant with four-month-old twins. But they still dragged me in and injected my belly with a needle,” the 20-year-old told Reuters of her ordeal which happened in late February.
The woman, who declined to give her full name for fear of reprisals, said the men had forced her thumbprint onto a consent form before carrying out the abortion.
Another of the surrogates, who said she’d come from a village in Sichuan province, recounted how officers made her take pills then surgically removed her three-month-old fetus while she was unconscious. “I was terrified,” the 23-year-old said.
A spokesman for the Guangdong Provincial Family Planning Commission Zhong Qingcai declined to be formally interviewed by Reuters, but said authorities were investigating.
The official Guangzhou Daily newspaper quoted district family planning officials as saying the women were all unmarried and acting as “illegal” surrogates. It added the three had “agreed” to undergo “remedial measures” in accordance with the law.
But the head of the surrogacy agency caring for the mothers, disputes this version of events.
“It’s an absolute crime,” said Lu Jinfeng, the founder of the “China Surrogate Mother” website (www.aa69.com) which has run for over five years without encountering any problems like this. By forcefully dragging people away like this to undergo an abortion is a savage illegal act that violates human rights.”
Since the incident, a notable vein of officially sanctioned media reports, including one paper describing the profit margins of the surrogacy business as “greater than the narcotics trade,” has led some observers to expect tighter curbs in future.
“When you see this kind of reporting it’s a kind of public education … a sign the government is going to do something,” said Siu Yat-ming, an expert on China’s family planning issues with Hong Kong’s Baptist University. “They’re becoming more aware of the situation … a lot of the (surrogacy) agencies are making a lot of money just like an organized industry,” Siu added.
Underground networks of surrogacy agents, hospitals, and doctors have spread in recent years as infertile Chinese couples with money hire surrogates to produce babies for them.
The surrogates are often confined to secret flats for most of the duration of their pregnancy to avoid detection, while fertility, obstetrics and childbirth procedures for the mothers are often carried out discreetly by medical staff at public hospitals and health clinics with links to agents.
“Under China’s civil law, this (surrogacy) should be prohibited. Intermediary (surrogacy) services are also essentially illegal,” said Zhang Minan, a law professor at Guangzhou’s Sun Yat-sen University and an expert on the issue. “But these cases exist and they cannot possibly be made public or legalized. You cannot legalize such practices,” he added, referring to China’s tight birth planning rules which have restricted couples to just one child since the late 1970’s.
With around one in six couples in the U.S. now estimated to be infertile and with similar rates seen in China as modern urban lifestyles take hold, surrogacy agencies have been recruiting girls, often from poor villages, to have babies on behalf of prospective parents, in ever greater numbers.
Accurate figures on the size of the industry are hard to come by, but a recent report by the respected Southern Metropolis Weekly estimated around 25,000 surrogate children have been born so far in China, citing research into surrogacy agency websites carried out by family planning authorities.
Hundreds of Chinese surrogacy agencies are openly listed on Chinese search engines like Baidu, luring prospective clients with maternal imagery and pop-up windows offering live chats.
Prospective surrogate mothers are openly recruited and paid between 50,000 to 100,000 yuan ($14,650) per pregnancy on some sites, making it a lucrative profession for poor village girls in a country where the average annual per capital income for rural households is around $600.
While emotional, ethical and legal complications make surrogacy a thorny topic in many countries, the trend has been on the rise globally. India, in particular, has become a “surrogate outsourcing” hub for infertile and gay Western couples.
“There are millions of people out there who want to have kids but can’t,” Robert Klitzman, a bio-ethicist at Columbia University’s Medical Center told Reuters by phone from New York.
India has moved to introduce legislation on surrogacy to safeguard the rights and health of impoverished women from exploitation.
In some U.S. states paid surrogacy is outlawed, while weak regulatory oversight in states such as California has led to clients being duped by unscrupulous surrogacy brokers.
“Whenever you have an underground industry you’re going to have problems because there’s no guarantee that they’re going to follow standards of safety, follow standard medical or ethical practice. There’s a lack of transparency,” Klitzman added.
In China, however, with the number of surrogate births still very small compared to the overall birth rate, the prospect of a safe legal framework remains a distant one, leaving open the risk of arbitrary, violent enforcement.
“They (the authorities) do have the right (to force abortions) but it rarely happens because such surrogacy is extremely secretive. And for the authorities it’s difficult to get evidence,” said Zhang, the legal scholar. “Because this problem hasn’t yet sparked widespread social interest, so from this perspective the Chinese government hasn’t really noticed the matter, nor accepted it,” he said. “If this problem does spark widespread social interest, then authorities might start to do something about it,” Zhang added.
Shabnam had dreamed of owning a home for years, but with few prospects for her husband, she followed the lead of many poor women in her town in western India: she signed up to carry a baby for another couple.
At the clinic of Nayna Patel, perhaps India’s best-known “surrogate doctor” who delivered Anand town’s first surrogate baby, more women are signing up to be surrogates, with even nurses and teachers lining up, as their husbands lose their jobs.
“The women who come here usually want the money to buy a home, pay off loans, or for their childrens’ college education,” said Patel in her small clinic, the walls of which are covered With clippings and pictures of Patel with babies and parents.
A surrogate is generally paid about 250,000-400,000 rupees ($4,000-$8,000), a huge sum of money in a country where many live on less than $2 a day.
Doctors with a western education, top-notch facilities and lower prices have already made India an attractive destination for procedures ranging from bypass surgery to liposuction.
Lax legislation and an entrepreneurial streak in Gujarat state have helped make Anand a last stop for many childless couples at home and abroad, after its first surrogate baby five years ago.
In this bustling town known for India’s best-known brand of butter, Patel has delivered more than 100 surrogate babies, 40 percent for Indians living abroad and 20 percent for foreigners.
It all began with a grandmother surrogate for a UK couple five years ago that pitched Anand and Patel into the spotlight.
Following their lead, locals and foreigners began to flock to Patel’s clinic, drawn by the lower costs, relaxed attitude toward surrogates and lack of legislation.
A draft bill on surrogacy is pending before parliament, and meanwhile, hundreds of clinics have mushroomed across the country, with critics saying touts promoting this “reproductive tourism” care little for the health or rights of the surrogates.
Patel, who was featured on a special show on Oprah Winfrey two years ago, raises her voice in defence.
“My argument is: the surrogate is not killing anyone, not committing an illegal or immoral act. And if a surrogate’s child is able to get an education, if one family is able to buy a home — and help a needy couple in the process, where is the harm?”
Not everyone sees it that way.
Patel and the couples, more than half of whom are either non-resident Indians or foreigners, have come under a barrage of criticism for “exploiting” surrogates and for glossing over the ethical debate.
Many surrogates themselves do not tell their parents or in-laws for fear of being ostracised, and several of Patel’s surrogates live in a Surrogate House to ensure they have a proper diet, and are safe from drunken husbands and nosey neighbours.
Shabnam, 26, has not told her two older daughters or her in-laws that she is a surrogate; she lives with a few other surrogates at the hospital with her youngest child, while her husband, who is out of work, cares for the two others at home.
“I don’t think I can ever tell them; I don’t think they’ll understand,” she said, insisting on using just one name. Her husband used to earn less than $1 a day washing dishes.
Some experts say surrogates, who are often barely literate, do not understand all that the process entails, and are putting themselves at physical and emotional risk but have few rights.
“The primary concern is the physical and mental health of the surrogate: there are several risks, including maternal mortality, associated with assisted reproductive technologies,” said Preeti Nayak at Sama Resource Group for Women and Health.
India’s maternal mortality ratio is 301 in 100,000 births, the highest in south Asia after Bangladesh, the World Bank says.
For Chris McDaniel and his wife Shannon, who came to Anand last April from San Diego after having tried every option in the United States, where hiring a surrogate can take months and cost up to $100,000, the decision to go to Patel was clear.
“It wasn’t in our life plan to fly half-way around the world to a country we barely knew about to have our child,” said Chris, who is writing a book on their experience.
It is hard to come by numbers of surrogates in the country, but Patel has a list of nearly 200 and is seeing more women walk in everyday because they are feeling the pinch of the slowdown.
In the absence of legislation, Patel sticks to guidelines of apex body Indian Council of Medical Research, which say a surrogate may only be implanted with the egg and sperm of the couple or anonymous donors, and that she must be below 45 years.
Patel also insists couples seeking surrogates must have a medical condition that makes child bearing impossible or risky, and draws the line at gay couples and single parents.
The surrogate, who must have her husband’s consent, has no rights over the baby, but feels empowered nevertheless, she said. “Until then, they have felt powerless, helpless; now, they feel like they can be of some use to their family,” she said.
Shabnam’s ambition is far more modest.
“I was very scared thinking of our situation, thinking how will we manage?” said Shabnam, who is eight months pregnant with the baby of an Indian couple living in the United States. Now I feel a bit more confident. At least if we can buy a house, then things will get better.” ($1 = 50 rupees)
With only six years left to achieve its Millennium Development Goals (MDG), [see: http://www.mdgmonitor.org/factsheets_00.cfm?c=NPL] Nepal, like many other Asian countries, is lagging behind and must make further efforts, say local and international health experts.
A top priority is the maternal mortality ratio (MMR), which Nepal’s government hopes to reduce to 134 women per 100,000 live births from its current level of 281 per 100,000 live births, according to the government’s Demographic Health Survey 2006. [see: http://www.measuredhs.com/pubs/pdf/FR191/FR191.pdf]
Put another way, this means one woman is dying every four hours (six women a day) due to pregnancy-related complications.
“It will be a big challenge for Nepal to really achieve the maternal health goal,” said reproductive health expert, Ava Darshan Shrestha, vice-president of the Safe Motherhood Network Federation (SMNF). [see: http://www.smnnepal.com.np]
Skilled birth attendants are not present at nearly 81 percent of deliveries, something that is putting thousands of women at risk, according to SMNF.
There is a severe shortage of maternal health services, especially in the hills, where most of the maternal deaths occur.
“In rural areas, most women need to walk for hours. If they travel by bus it’s just as bad because the roads are so rough that women in labour end up in a serious condition even before reaching hospital,” said Sabitri Chettri, a female community health volunteer.
Weak administrative, technical and logistical capacity, inadequate investment and lack of skilled health personnel further hamper effective health services, according to UNICEF’s State of the World’s Children – 2009 report [see: http://www.unicef.org/sowc09/]
Experts are concerned that failure to achieve the MMR goal will also adversely affect other MDGs.
Unless you reduce the MMR, it will be difficult to achieve other MDGs, including a reduction in child mortality [goal 4], as well as gender equality and empowerment [goal 3], Saramma Mathai, a maternal health expert with the UN Population Fund (UNFPA) in Bangkok, told IRIN. We know that unless a mother survives [childbirth], the risk of death of a newborn is much higher,” she said.
She said the maternal health goal was also linked to MDG 1, which relates to both poverty reduction and malnutrition.
“Without a mother, a child’s nutrition is going to suffer. And women contribute a lot to the economy, both in terms of working at home and contributing to the economy,” said Mathai.
Local health experts told IRIN the health of mothers and newborns was closely linked, and preventing deaths required implementing measures like antenatal care, skilled attendance at birth, access to emergency obstetric care, adequate nutrition, post-partum care, newborn care and education to improve health, infant feeding and care, and ensuring good hygiene behaviours.
“To be truly effective and sustainable, however, these interventions must take place within a development framework that strives to strengthen and integrate programmes with health systems, and an environment supportive of women’s rights,” said the State of the World’s Children 2009 report.
The Ministry of Health and Population, with the support of the UK Department for International Development (DFID), has started Ama Surakchhya Karyakram, a national programme offering free childbirth and travel costs to women who come and deliver at a maternal health facility.
The programme is available in all government hospitals and health centres.
“This programme is aimed at improving maternal health and newborn survival, and we are committed to its effective implementation,” said senior government official Girija Mani Pokhrel. “We need to remember that Nepal is the 14th poorest nation in the world,” Sushil Baral, DFID maternal health adviser in Kathmandu, told IRIN, adding that the programme was a “bold initiative”.
The number of women dying in childbirth in Liberia has nearly doubled since the 1980s, according to a recent UN report that has policymakers calling for urgent attention to reproductive healthcare.
While the report shows encouraging trends in infant and child survival, it puts maternal mortality at 994 women per 100,000 live births in 2007 compared to 578 in 1987.
“We need to do something immediately and urgently about maternal mortality,” said John Agbor, head of child survival for the UN Children’s Fund.
The increasing proportion of women dying while giving birth is linked to a drop in the proportion of births attended by skilled health personnel, according to the UN report. In 2006 under half of births were attended by trained personnel versus 91 percent in 1986, according to the report on Liberia’s progress on the Millennium Development Goals. Even fewer deliveries – 37 percent – take place in health facilities, the report says.
Part of the problem is a lack of health personnel. Before civil war broke out in 1989, Liberia had 250 qualified licensed doctors, but now just 50 doctors serve 3.5 million people; many have gone overseas to work, according to government statistics.
As a result few women are referred to doctors for obstetric care, according to the same report. Jennie Fallah, who lives in the Monrovia suburb of Paynesville, told IRIN: “When I was about to deliver there was no doctor so I was forced to give birth [without] one…I really did not know what to do as I was in severe pain…there was a health centre near [my home] but there is no doctor or midwife there at night.”
High adolescent pregnancy rates – a third of all babies are born to teenagers – and low literacy rates further compound maternal mortality, said UNICEF’s Agbor.
George Gould, UNDP’s National Policy Analyst in Liberia, told IRIN access to skilled health attendants has declined in rural areas partly because it is so difficult to attract health workers.
“There are no opportunities in the rural areas. There is no piped water or electricity or anything to attract personnel to work in these areas. Rural health workers need higher wages to pull them out of cities.”
Under-five mortality has been cut in half since 1992 to 111 per 1,000 live births, the report says, noting that Liberia is likely to meet the MDG goal to reduce by two thirds the under-five mortality rate by 2015. Infant mortality decreased from 139 per 100,000 live births in 1992 to 72 in 2007.
Infant mortality has dropped partly because vaccination rates vastly improved, according to Agbor. Five diseases – pneumonia, diarrhoea, malaria, measles and AIDS – account for half the deaths among children under five in Liberia, according to the report.
Immunisation rates for measles have risen significantly and Liberia has been polio-free for several years.
Since 1999 vitamin A supplements have also been widely distributed, significantly boosting hundreds of thousands of children’s immunity to common killers such as diarrhoea and measles, UNICEF’s Agbor said.
The UNDP’s Gould said the government must remain vigilant in order to meet the infant mortality MDG. To build on progress already made, the Ministry of Health should continue supporting mass immunisations, providing vitamin supplements and insecticide-treated bed nets, alongside revitalising primary health care, he said.
“Reducing both maternal and infant mortality remain a priority,” Agbor said. “If Liberia continues in this path the infant mortality MDG might be reached.” But he added: “Reaching the maternal mortality MDG would clearly be an uphill task.”
It is a task the government is finally taking on. When maternal death statistics came out in 2007 the Ministry of Health created a reproductive health policy, but it is only now being implemented.
“We have had a sustained period of peace and security,” said Gould. “Health outreach activities can now be regular and planned, which should mean that progress against the MDGs now speeds up.”
Progress will be documented in the country’s next Demographic Health Survey, expected out in 2010.
Pregnancies among girls as young as 12 and women in their early 40s are on the rise in Mali’s rural north, according to health workers, who say cultural mores and economic pressures contribute to the potentially life-threatening pregnancies, which often go untreated due to scant health services.
Bana Nimaga is a midwife at the Bankass health centre – 700km east of the capital Bamako – which sees the most complicated pregnancies from surrounding villages. Most of her patients have never been to a health centre, she told IRIN.
“They arrive to me in a complete state of catastrophe, so tired and worn down at the end of their pregnancy. You find the infant is on the edge of survival. [In these cases], the only legacy women leave for this world are stillborn babies.”
The director of Koulogo health centre almost 40km away, Ousmane Fomba, told IRIN that he has referred “more and more” high-risk pregnancies in these age groups to Bankass. “It is not uncommon to see 35- and 40-year-old women or 12- and 13-year-old girls pregnant.” He said that as more girls travel to work in Bamako or in neighbouring Côte d’Ivoire, early pregnancies have increased.
“And the mature expectant mothers tell us that they do not feel they can say no their husbands who demand intercourse or children,” he said. The medical director said though the centre offers family planning education, “old mentalities endure.”
In 2006 119 babies of every 1,000 live births died by age one, and more than 900 women died for every 100,000 live births in 2005, according to the government. Though the maternal mortality rate decreased by almost half in 2006, lack of access to clean water and health care still put the country in “a state of health emergency” according to the UN Children’s Fund (UNICEF).
According to a government survey, almost one in 10 newborns in 2006 did not live beyond their first year. Half of those deaths occurred during the first week of life. Fewer than half of women who gave birth did so with a trained birthing attendant and 70 percent of infant deaths happened in the home, according to the same survey in 2006.
Even for women who give birth in a health centre the situation is not much better, said the head of the Bankass referral centre, Mamadou Guindo, who told IRIN the health centre does not deserve its designation. “We do not have inpatient facilities or electricity. The only generator we have does not provide enough energy. We do not have enough [medical] materials or anaesthesiologists.”
He said the centre often must refer patients to the hospital in Mopti more than 100km away.
Women ages 17 to 70 sit on vinyl mattresses, drainage bags on the floor next to their hospital beds, catheter tubes stretching from under colourful skirts. Each one has a serene, triumphant look.
The women are recovering from an operation that lasted some two hours and repaired tissue damage that made their urine flow uncontrollably – in one case for 50 years.
“I am beside myself with joy,” one woman told IRIN, talking through an incessant smile. She told IRIN she had lived with the condition for 20 years.
Through a programme run by the UN Population Fund (UNFPA) specialists are training local surgeons and gynaecologists in Korhogo, northern Côte d’Ivoire, in repairing obstetric fistula – a hole in the birth canal caused by complicated labour and a lack of medical intervention, which leaves a woman leaking urine or faeces or both.
When the soft tissues of the pelvis are compressed between the baby’s head and the mother’s pelvic bone, the lack of blood flow causes tissue to die, creating a hole between the vagina and bladder or between the vagina and rectum.
Obstetric fistula is preventable, yet some two million women around the world live with the condition, according to UNFPA. “The persistence of fistula is a signal that health systems are failing to meet the needs of women,” UNFPA says.
For now 16 beds are available for fistula patients at the Korhogo hospital, according to Mansaré Ladji, surgeon, gynaecologist and one of the physicians being trained to perform fistula operations. “There is a waiting list,” he said.
The demand in Korhogo – 630km north of the commercial capital Abidjan – exploded when partner NGOs in surrounding areas began informing communities of the free treatment, Mansaré said. “Women are coming from everywhere.”
Since launching the project in February doctors in Korhogo have performed 25 operations to date.
“We are giving these women a new life,” Mansaré told IRIN, recalling how some women danced as they left the hospital. “It cannot be described, it must be experienced.”
“This operation changed everything,” said Silué Korotoum, a 34-year-old woman who received the treatment. “I can thrive now. I can go where I wish and do as I wish.”
Mansaré said one of the most important goals is long-term training for local health workers to treat obstetric fistula. “We must set up something that will continue after [trainers] are gone.”
In many cases women are not aware a remedy exists, or if they are, cannot afford it, according to UNFPA. Without subsidies the operation cost about US$300, about 10 times what most people in the region earn in a month, residents said.
In the UNFPA centres – in Korhogo, Man and most recently Bouaké – services are free; the programme will continue as long as funding is available through the agency’s Thematic Fund for Maternal Health, UNFPA gynaecologist Abou Pauline told IRIN. UNFPA is urging the Ministry of Health to maintain free care for women with fistulas.
Simeon N’da, Health Ministry spokesperson, told IRIN the government will study whether obstetric fistula is a condition for which the government will ensure free treatment, as it does for some other illnesses such as Buruli ulcer.
In the Korhogo recovery room were three young women ages 17 to 18, whose fistulas were caused by difficult deliveries.
Doctors told IRIN even more important than providing treatment is eliminating the causes of fistula – including poor general health, lack of maternal health care and practices such as early marriage and childbirth, lack of spacing between births and women’s lack of power to make their own health care decisions.
“Obstetric fistula is a condition resulting from complicated childbirth,” gynecologist Abou told IRIN. “If we reduced complications in childbirth we would reduce fistulas.”
It is essential that people have access to properly equipped medical facilities and qualified medical personnel, she said.
But even when facilities are available, cultural practices weigh on women’s health, medical workers told IRIN.
At the Korhogo hospital a health worker recounted a case in which a woman urgently needed a caesarean section but family members would not consent without the approval of her husband. He was travelling and out of reach.
Benin’s government is in its first week of helping women pay for caesarean operations in an effort to reduce the number of women dying during childbirth every year, estimated at 2,000 according to the government.
As of 1 April, the US$200 caesarean subsidy is offered to women seeking care in more than 40 hospitals in mostly urban areas nationwide.
Market vendor in Benin’s business capital Cotonou, Marie Reine Amouzouvi, told IRIN that when her doctor recently told her she needed a caesarean section to safely deliver her child, she was worried. “I did not know it would be free. If there were not this free operation, I would have died along with my child because I would not have had money to pay for the operation.”
The head of the gynaecology clinic at the state-run National Hospital and University Centre in Cotonou, José de Souza, told IRIN that before the subsidy, the hospital had to absorb costs to perform life-saving caesarean operations. “This [subsidy] helps medical practitioners. We are able to cover our costs, which makes our job easier.”
The government has linked the country’s high level of maternal and infant deaths in childbirth to long hospital waits for caesarean operations as underfunded hospitals scrambled to assemble the necessary equipment.
In launching the subsidies last month Minister of Health Issifou Takpara said in a nationally televised address that women will have a shorter wait time for their operations and instructed hospitals “to take the necessary steps to render [gynaecological] services operational 24 yours a day, seven days a week, every day of the year.”
But hospital director Souza told IRIN that for the subsidies to make a difference, hospitals need more cash. The state has pledged more funds to solve staffing shortages, improve operating rooms and purchase equipment.
As of 2004 Benin fell short of the World Health Organization-recommended minimum of one doctor per 10,000 people to ensure basic care.
In December 2006 President Boni Yayi pledged free health care for pregnant women and all children under five years old, which would cost the state $50 million, according to the Ministry of Health.
Governments and health analysts have considered cutting health fees as one way to improve the health of some cash-strapped patients.
A government health inspector who works with midwives in Cotonou, Adékambi Adjovi, told IRIN that even a steeply-subsidised caesarean operation may not be enough for some women. “The circuit [of health care costs] for women who have caesarean operations should be covered entirely because now they pay post-operative costs themselves.”
Medical director Souza told IRIN it is important to make sure hospitals do not increase their operating costs to take advantage of the subsidy at the state’s – and patients’ – expense.
The Ministry of Health reported 14,000 women giving birth through caesarean in 2008 and has estimated an additional 3,000 mothers will need the operation in 2009, based on population estimates.
Thousands of pregnant women caught up in the fighting between government forces and the Liberation Tigers of Tamil Eelam (LTTE) are in urgent need of healthcare, according to aid workers. “I was scared. I didn’t know if we were going to make it,” 23-year-old Thanusiya told IRIN. At eight months pregnant and after weeks of shelling, she and her husband escaped to the northern, government-controlled town of Vavuniya last month. Given the number of civilians who have fled to government-controlled areas, coupled with those still trapped inside the conflict zone, the numbers of women in the same position as Thanusiya could easily be in the thousands. “Women do not stop getting pregnant or giving birth to their babies even when on the move or when living in camps,” Lene Christiansen, country representative for the UN Population Fund (UNFPA) [see: http://srilanka.unfpa.org/] in Colombo said, expressing concern for the large proportion of high-risk pregnancies among women in displaced persons camps as well as increased teenage pregnancies. According to UNFPA, pregnancy-related disabilities and death often rise in conflict situations when reproductive health services, including pre-natal care, assisted delivery and emergency obstetric care are disrupted and often unavailable. At the same time, many women lose access to family planning services, exposing them to unwanted pregnancies. About 70,000 civilians remain trapped in the conflict area, the government reports, while international agencies place their numbers at up to 150,000.
As of 6 April, some 60,000 Tamil civilians had fled and were now being housed in 29 camps in Vavuniya, Mannar and Jaffna districts, the government reported. Should that influx continue, aid workers addressing the reproductive health needs of women will be stretched. “If 100,000 people come, the number of pregnant women could easily reach 8,000 or more,” Anura Priyaratne, district programme manager of a local NGO, the Family Planning Association of Sri Lanka (FPASL) [see: http://www.fpasl.org/home_eng.php] in Vavuniya, told IRIN. “We need to be prepared,” Priyaratne said, citing the importance of spreading their coverage to other camps in the area through their mobile clinics. With local and regional authorities, and supported by UNFPA, the local NGO provides reproductive health services to IDPs in the Vavuniya District through its two mobile health clinics, which visit the camps weekly. In addition to prenatal and postnatal care, assistance includes basic reproductive health services as well as the distribution of clean delivery kits and hygiene items for women and girls of reproductive age through its LISA (Life saving emergency reproductive health services) project. Women in labour are taken to Vavuniya Hospital, where UNFPA has provided equipment for emergency obstetric care.
In addition, UNFPA supports the FPASL in expanding health awareness, with a specific emphasis on HIV and sexually transmitted diseases.
Women’s rights experts are speaking out against a recent government report that condones limiting health care services for families with too many children and replacing feminist discourse with religious schooling in the southeast of the country.
The Prime Ministry has suffered a backlash of criticism after releasing a report that would encourage cutting health care services for families with many children and implementing religious education to help solve women’s problems in Southeast Turkey.
In an effort to find solution to problems faced by families in eastern and southeastern Turkey, the Prime Ministry’s General Directorate of Family and Social Research held two consultation meetings in Diyarbakır in 2008 with nongovernmental organizations in the region, Radikal daily reported yesterday.
Supervised by Nimet Çubukçu, state minister in charge of women and family affairs, the meeting’s outcomes were compiled in a 15-page report. Of the solutions, the most striking was the proposal for a new law that would hinder women from having an excessive number of children and cut health services to those families that exceed a certain number of children. The feminist language adopted by the media in news about honor killings should also be changed, and accurate religious information should take place in the media, according to the report. The move came shortly after Prime Minister Recep Tayyip Erdoğan called for Turkish families to have at least three children.
“What is displayed in the report is very racist and ideological. Instead of dealing with the feminist discourse, they should find solutions to the structural problems in the region, such as establishing women’s centers,” Hülya Gülbahar, head of the Association of Education and Supporting Women Candidates, or Ka-Der, told the Hürriyet Daily News & Economic Review.
“It doesn’t find a solution but rather creates a problem by punishing women who have an excessive number of children [and depriving them of health services] in a region that suffers deep economic problems and rising unemployment,” she said.
Gülbahar said the government policies confined women to their role at home and valued the woman solely as a mother. “The ruling party [Justice and Development Party, or AKP] has unfortunately long been in a bitter battle with feminism,” said Gülbahar. “They have a prejudice against feminism because they can’t bear the image of an independent woman. The party should reconcile with feminism.”
Nebahat Akkoç is the head of the Women’s Center, or Ka-Mer, in Diyarbakır. The organization has many branches in other provinces of eastern and southeastern Anatolia and produced numerous works on honor killings and violence against women since it was founded in 1997. As the head of an old institution specializing in women’s problems in the region, Akkoç reacted to the organizers for not inviting them to the meeting.
“It is a consultation meeting with NGOs but we knew nothing about such an event nor were we invited to the meeting. We have done much work on women’s issues here. I think [Çubukçu] owes us an explanation. We will demonstrate a collective reaction to the situation with the women’s organizations here,” Akkoç said.
She said the official policies have played the most crucial role in the rising number of women-related problems, urging the government to deal with the region’s more urgent problems such as poverty, migration from villages to cities, women’s education, integration of those who come to the cities and communication problems stemming from language and the multi-cultural structure of the region.
“Releasing such a report is useless toward eliminating such problems in a region where the disparities are so big,” Akkoç said.
Nilüfer Narlı, a sociologist form Bahçeşehir University, meanwhile, said punishment cannot solve the problem and that what is suggested in the report is not in line with women’s reproductive rights. “It is not humane to deprive people of health services and it isn’t a long-term solution to the problem. The governmental policies already anticipate the participation of religious authorities and institutions in raising awareness activities targeted women and people [on such issues],” Narlı said.
Each year, more than half a million women die from causes related to pregnancy and childbirth, and nearly 4 million newborns die within twenty-eight days of birth. Millions more suffer from disability, disease, infections and injury. Cost-effective solutions are available that could bring rapid improvements, but urgency and commitment are required to implement them and to meet the Millennium Development Goals related to maternal and child health. The first chapter of the state of the world’s children 2009 examines trends and levels of maternal and neonatal health in each of the major regions using mortality ratios as benchmark indicators.
UNICEF this year has narrowed the reasons behind children’s deaths, and has gone deep to the core of the problem in order to help reduce the number of newborns who die soon after birth.
Women in the world’s least developed countries are 300 times more likely to die during childbirth, or from pregnancy-related complications than women in developed countries, according to UNICEF’s latest State of the World’s Children report, released today.
At the same time, a child born in a developing country is almost 14 times more likely to die during the first month of life than a child born in a developed one. The health and survival of mothers and their newborns are linked, and many of the interventions that save new mothers’ lives also benefit their infants. The 2009 edition of UNICEF’s flagship publication, The State of the World’s Children, highlights the link between maternal and neonatal survival, and suggests opportunities to close the gap between rich and poor countries.
“Every year, more than half a million women die as a result of pregnancy or childbirth complications, including about 70,000 girls and young women aged 15 to 19,” said Ann M. Veneman, UNICEF Executive Director, at the Johannesburg launch. “Since 1990, complications related to pregnancy and childbirth have killed an estimated 10 million women.”
Both mothers and infants are vulnerable in the days and weeks after birth – a critical time for life-saving interventions, such as post-natal visits, proper hygiene, and counseling about the danger signs of maternal and newborn health.
While many developing countries have made excellent progress improving their child survival rate in recent years, there has been less headway in reducing maternal mortality.
Niger and Malawi, for example, nearly cut their under-five death rates in half between 1990 and 2007, and in Angola the child mortality rate fell from 258 to 158 per 100,000 live births in the same time period. In Indonesia, under-five death rates fell to nearly a third of what they were in 1990, and in Bangladesh they fell by more than a half.
The same progress has not been made in addressing health risks for mothers, who are most vulnerable during delivery and in the first days after birth. And while the rate of survival for children less than five years of age is improving globally, the risks faced by infants in the first 28 days remain at unacceptably high levels in many countries.
In the developing world, a woman has a 1 in 76 lifetime risk of maternal death, compared with a probability of 1 in 8,000 for women in developed countries. Approximately 99 percent of global deaths arising from pregnancy and complications occur in the developing world, where having a child remains among the most serious health risks for women. The vast majority occur in Africa and Asia, where high fertility rates, a shortage of trained personnel and weak health systems spell tragedy for many young women.
The ten countries with the highest lifetime risk of maternal death are Niger, Afghanistan, Sierra Leone, Chad, Angola, Liberia, Somalia, the Democratic Republic of Congo, Guinea-Bissau, and Mali. A woman’s lifetime risk of maternal death in these countries ranges from 1 in 7 in Niger to 1 in 15 in Mali. And for every woman who dies, another 20 suffer illnesses or injury, often with severe and lasting consequences.
To lower maternal and infant mortality, the report recommends essential services be provided through health systems that integrate a continuum of home, community, outreach and facility-based care.
This continuum of care concept transcends the traditional emphasis on single, disease-specific interventions, calling instead for a model of primary health care that embraces every stage of maternal, newborn and child health.
“Saving the lives of mothers and their newborns requires more than just medical intervention,” said Veneman. “Educating girls is pivotal to improving maternal and neonatal health and also benefits families and societies.”
The report finds that health services are most effective in an environment supportive of women’s empowerment, protection, and education.
The Over all State of the World’s Children’s messages are to save children’s lives, we need to address the health of their mothers; there is an inextricable link between maternal and infant survival; women in developing countries are 300 times more likely to die from pregnancy and childbirth complications than women living in the industrialized world. Progress in maternal and neonatal health has fallen far behind advances in child survival; maternal mortality ratios mirror the overall effectiveness of health systems; to thrive, women and their children must have access to essential timely services at home, in the community, and at health facilities. Saving the lives of mothers and their newborns requires more than just medical intervention; it requires an environment that empowers women and respects their rights.
According to the report, what is needed to prevent maternal and neonatal deaths is rapid progress through sound strategies, political commitment, adequate resources and collaborative efforts, applied in support of the health of both mothers and newborns.
This is in addition to the continuum of care, which embraces every stage of maternal, newborn and child health, and which differs from the traditional disease-specific approach. These essential services for mothers, newborns and children are most effective when they are delivered in a timely fashion at critical points in the life cycle of mothers and children: adolescence, pre-pregnancy, pregnancy, birth, post-partum, neonatal, infancy and childhood. Post-natal care urgently needs to be expanded during the first 24-48 hours after birth, when the risks of maternal and newborn death are greatest.
The interrelated health needs of women, newborns and children require integrated solutions. Essential services must be provided at key points in the life cycle through dynamic health systems that integrate a continuum of home, community, outreach and facility-based care. An integrated approach reaps more dividends than myriad separate initiatives. Linking interventions in packages not only increases their efficiency and cost-effectiveness, but it provides greater incentive for people to use them and greater opportunity to extend and enhance coverage.
The essential services required to support a Continuum of Maternal and Neonatal Care include: enhanced nutrition, safe water, sanitation and hygiene practices, disease prevention and treatment; quality reproductive health services; adequate antenatal care; skilled attendance at delivery, emergency obstetric and newborn care; post-natal care; neonatal care; and Integrated Management of Neonatal and Childhood Illness.
The report states the main causes of maternal and neonatal mortality, dividing them into direct medical causes, reproductive health and family planning, indirect factors influencing maternal and neonatal health, weak health systems and lack of access to facility-based care.
Three quarters of all maternal deaths occur from complications either during delivery or in the immediate post-partum period. These complications include: hemorrhaging, (25 percent of maternal deaths); infections (15%); unsafe abortion (13 %); eclampsia or hypertensive disorders (12 %); and obstructed labour (8%). Mortality risks for mothers and newborns are particularly elevated within the first two days after birth.
Studies show that involuntary pregnancies carry a greater risk than those that are wanted; women with unwanted pregnancies are less likely to receive early antenatal care or give birth under medical supervision. Such pregnancies may also risk unsafe abortions – a significant cause of maternal death.
There is growing consensus that improving access to reproductive health – especially among young people – can have a positive impact on maternal and newborn health. In 2005, the United Nations added universal access to reproductive health as a specific target of the Millennium Development Goal on maternal health.
Linking Maternal and Newborn Health:
The health and survival of mothers and their newborns are intrinsically linked, and many of the same interventions that save maternal lives also benefit their infants.
Regions with high maternal death rates show correspondingly high rates of neonatal mortality. Lowering a mother’s risk of mortality directly improves a child’s prospects for survival. Babies whose mothers die during the first six weeks of their lives are far more likely to die before their second birthday than babies whose mothers survive. Like maternal deaths, the vast majority of neonatal deaths occur in the developing world, and have received far too little attention. A child born in a poor country is almost 14 times more likely to die during the first 28 days of life than one born in an industrialized country. Almost 40 percent of all under 5 deaths occur in the first 28 days of life, three-quarters of which take place in the first seven days. During this early neonatal period, babies and mothers are most vulnerable.
II) Maternal Mortality: The General Picture
While many developing countries and several regions have managed to make significant advances in child survival, several of these same countries have failed to make any serious progress in reducing maternal mortality rates. At the same time, the proportion of under-five deaths occurring in the early neonatal period have risen dramatically. Between 1980 and 2000, deaths in the first week of life have risen from 23 to 28 per cent of overall under-five mortality rates.
Millions of women who survive childbirth suffer from pregnancy-related injuries, infections, diseases and disabilities. For every maternal death, some 20 women – or 10 million a year – suffer complications with severe consequences.
If women had access to essential maternity and basic health-care services, up to eighty percent of all maternal deaths and injuries could be avoided.
Progress on diminishing maternal mortality ratios has been virtually non-existent in sub-Saharan Africa, where half of all maternal deaths take place.
Maternal mortality ratios are particularly staggering in sub-Saharan Africa. Within this region, Sierra Leone – with 2100 maternal deaths per 100,000 live births – has the highest maternal mortality ratio in the world, followed closely by Niger, with an MMR of 1800 deaths per 100,000 live births. In comparison, Tunisia and Egypt have maternal mortality ratios of 100 and 130, respectively.
India accounts for 22 per cent of the global total of maternal deaths; an estimated 117,000 women died from maternal causes in 2005.
Elevated fertility rates, combined with weak access to basic health care and maternity services can have life-long implications for women’s survival. In the developing world as a whole, a woman has a 1 in 76 lifetime risk of maternal death, compared with a probability of just 1 in 8000 for women in industrialized countries. In Niger, the country with the highest lifetime risk, her chance of dying skyrockets to 1 in 7, in contrast to 1 in 47,600 in Ireland.
With the exception of sub-Saharan Africa, all regions have made progress improving access to life-saving maternity services, particularly in regard to skilled attendance at delivery. Yet the global community is not on target to reach the Millennium Development Goal on maternal mortality, which will require a 70 percent reduction in maternal deaths between 2005 and 2015.
In the Gaza Strip, women gave first-person accounts of the ordeals they suffered in the 22-day war that ended Jan. 17. One woman’s baby was born to the sounds of missiles.
There may be a ceasefire here, but no there’s no cessation to the suffering of women who survived this month’s 22-day war.
“We’ve seen horror movies before but nothing looked more real than this one,” Kawther Abed Rabo, who lives in the northern city of Ezbet Abed Rabo, said shortly before the end of the war.
Rabo is the mother of three young girls, two of whom she says are now dead, killed by Israeli soldiers.
She spoke to Women’s eNews near the rubble of her destroyed house.
She says that when the Israeli land operation started, she and her husband and mother-in-law were in their house, looking for a safe room in which to take cover.
Then a voice on a loud speaker coming from a tank outside ordered them to evacuate.
“They asked us to line up in front of the doorstep. I was helping my mother-in-law to walk while Khaled was holding the girls’ hands: Amal, 2 years old; Sua’ad, 7 years old; and Samar, 4 years old.”
She said two soldiers were staring at them eating chips and chocolate. “Suddenly a third one got out of the tank with an M16 and began shooting my girls. Sua’ad and Amal fell dead immediately. I didn’t know about Samar so I just grabbed her and Amal and went back to the house. Khaled was supposed to get Sua’ad but his mother got injured. It was madness and I really can’t understand what happened. What did I do to get my angels killed in front of my eyes? Khaled lost his mind and went back out asking them to shoot him but they didn’t.”
Khadra Abed Rabo, Kawther’s neighbor, confirms the account, saying she witnessed the shootings from her balcony window.
On Jan. 23 the United Nations Relief and Works Agency in Gaza called for an independent international investigation into alleged war crimes committed by both sides during the war.
International rights groups, including Human Rights Watch and Amnesty International, have called for an independent investigation for possible war crimes of both Israel and Hamas, the militant group that controls the Gaza Strip. The Gaza-based Palestinian Center for Human Rights and B’tselem, the Israeli Center for Human Rights in the Occupied Territories, have also called for investigations.
On Wednesday, Richard Falk, an independent investigator with the United Nations, announced that he believed there was evidence of war crimes committed by Israeli troops during the 22-day siege on Gaza and called for additional inquiry.
Israel has appointed a team of international-law experts to defend its soldiers against any war-crime charges.
The women interviewed for this article did not seem aware of any such investigations. They appeared to be suffering from shock.
They were all interviewed during the last week of the war and the week following the Jan. 17 ceasefire, while Women’s eNews traveled to various parts of the country with a group of photographers. Most of those interviewed had taken shelter in U.N. schools. But some spoke as they stood beside houses that had been reduced to rubble.
Manal Al Samoni, 39, lives in Al Zaiton, an area in the eastern part of the Gaza Strip. She spoke with Women’s eNews three days after the truce, while checking on her family’s damaged house. She said she gave birth on Jan. 8, two months early, while listening to tank fire and missiles exploding.
She said her mother–who lived with a son a few houses away–left her home to come to her daughter’s after she told her she was going into early labor. “My daughter-in-law Sana’a kept calling the hospital to send us an ambulance, but no ambulances could make it to our area since it was too dangerous and the Israeli army was opening fire on everything moving.”
Sana’a Al Samoni, Manal’s daughter-in-law, confirmed the account. She said the premature baby wound up being delivered in a large room in the house with dozens of other family members crammed in, all of them trapped inside the house.
“We were forced to deliver the baby, depending on our poor skills in these issues,” said Sana’a Al Samoni. “About 60 men and women were trapped with us in the same room where Manal was having her baby. We covered her with a blanket and began urging her to push. At last, when we succeeded to deliver the baby, Manal started to get cold and so did her newborn daughter. The battery of the cell phone ran out and I couldn’t know what to do other than pray. I remember my hands shaking when I had to cut the umbilical cord.”
Not far from Sana’a sat the new mother’s own mother, Majeda Al Samoni, 67. She was mourning over a wide spot of blood left by the body of a son, with whom she lived. She said he had been brought there by another son who found him shot to death in their living room, killed by tank fire. She had been with him hours earlier, when he was still alive.
“He is really gone! If I knew they would shoot my only son while I’m helping my daughter to deliver I swear I would never have left him. I thought he ran away with his family not knowing he was bleeding for four hours screaming for help . . . Oh, my beloved son!”
Medical workers from the Al Shifa Hospital in Gaza City confirmed on Jan. 18 that he bled to death after he was injured by a tank bullet in different parts of his body.
In one of the U.N. schools serving as a temporary shelter in the Al Atatra area of Jabalia, in the northern Gaza Strip, Sieda Al-Atar spoke to Women’s eNews on Jan. 19, describing how she and her family fled their home on Jan. 7 as rocket fire from a tank began hitting the house.
She was carrying her newborn baby. Her brother was shot and was bleeding but she kept running, leaving him behind.
“It had been 20 days but I still remember it as it was yesterday. I couldn’t turn my head back in fear that I might get shot or my baby will. I only took a look back for a second and was shocked to see my brother Omar lying there, motionless and bleeding. It took me a minute to realize that I can’t go back to rescue him. So I just continued running in tears for hours till I found myself in the middle of the city near one of the hospitals.”
Sieda Al-Atar said she waited at the hospital for hours to see if any ambulance would come from the north with her brother’s body. “I waited till night in the E.R. for my brother to come, but he didn’t. I still wake up at night, hearing his cries for me to help him. I couldn’t breastfeed my baby anymore. My health and hers aren’t good, but it all seems meaningless now anyway.”
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* 170 British MPs criticise BBC’s Gaza appeal ban
UNICEF’s 2009 Humanitarian Action Report (HAR) highlights the plight of children and women around the globe in humanitarian emergencies.
The Humanitarian Action Report is UNICEF’s annual funding appeal for protracted emergencies and is seeking just over $1 billion to assist children and women in 36 countries. The amount sought is some 17 per cent higher than UNICEF’s 2008 appeal, largely because of increased needs in eastern and southern Africa.
“Many countries featured in the report are silent or forgotten emergencies,” said UNICEF Executive Director, Ann M. Veneman. “Women and children are dying every day due to disease, poverty and hunger, but sadly their deaths go largely unnoticed.”
The report notes that over half the funds are to continue UNICEF support to victims of the five largest global humanitarian operations: in the Democratic Republic of Congo, Somalia, Sudan, Uganda and Zimbabwe.
“I have recently returned from Zimbabwe where the economy is crumbling and the cholera outbreak is not yet controlled,” said Veneman, the first head of a UN agency to visit the country in over two years. “Over half the population is receiving food aid and basic social services are collapsing.”
In recent decades, the number and severity of natural disasters has increased significantly. The emergencies included in the Humanitarian Action Report represent only a small fraction of UNICEF’s emergency response activities. Between 2005 and 2007, UNICEF responded to an annual average of 276 emergencies in 92 countries. Over 50 per cent were caused by disasters, 30 per cent were a result of conflict, and health-related emergencies, like epidemics, accounted for 19 per cent of UNICEF’s emergency response.
The report also notes that higher food prices and climate change have negatively affected most of the countries for which emergency aid is sought. UNICEF has initiatives in place to address nutrition insecurity, but more resources are required to ensure the response meets urgent 2009 needs.
The UNICEF report cites recent studies which find the risk of hunger could increase for some 50 million people worldwide by 2010 as a result of climate change.
Some experts have estimated that in the next decade children and women will represent 65 per cent of all those affected by climate-related disasters. If these predictions prove correct, some 175 million victims of climate change will be children.
UNICEF is present in more than 150 countries and is often among the first responders to crises.
“These funds will help UNICEF respond effectively and efficiently to the needs of children affected by emergencies,” said Veneman. “As a result the lives of many will be saved.”
UNICEF is on the ground in over 150 countries and territories to help children survive and thrive, from early childhood through adolescence. The world’s largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments.
Malta and Ireland have the highest percentage of newborn deaths due to congenital anomalies, a pan-European report has found, pointing out that this could be due to abortion being illegal in both countries.
Figures released last month as part of the comprehensive European Perinatal Health Report (EPHR), which compares data on maternal and infant health across Europe, shows that 41.7 per cent of babies born with congenital anomalies in 2004 died.
Figures for Ireland – where terminations are also illegal – are close to Malta’s, with 40.1 per cent.
The report itself points out that abortion is illegal in the two countries, implying that in other countries foetuses with congenital anomalies would be candidates for abortion. Such anomalies are a leading cause of foetal and neonatal deaths and there are wide international variations in prenatal screening policies, regulations on termination of pregnancies and the timing and attitude of the medical profession to children born with severe malformation, the report says.
Statistics collected by the Malta Congenital Anomalies Registry show that 3.4 per cent of babies born between 2001 and 2003 suffered from a congenital anomaly.
The EPHR report also shows that in 2004 Malta had the highest rate of labour inductions, with 37.9 per cent of all births born following an induction. The island also has the third highest rate of elective caesarean deliveries carried out before labour starts.
The statistic suggests a light attitude on the part of the medical profession to this sort of surgery, an argument which midwives have made for years.
But Malta is not alone. In fact, between 70 and 90 per cent of multiple births in Malta, Germany, Spain, Italy, Luxembourg and Austria were by caesarean section during this period, compared to 36 per cent of those in The Netherlands, between 40 and 50 per cent in Slovenia, Lithuania, Finland and Norway and just over half in Flanders, Brussels, Estonia, France and Sweden.
The report also ranks Malta as the highest scorer of triplets or higher multiple births but with the seventh-lowest number of twin births among 25 European countries in 2004.
However, figures collected by the National Obstetric Information System show that 2004 had an abnormally high rate of triplet and quadruplet births.
In fact, while 2004 saw four sets of triplets and two sets of quadruplets born, this was more than double the number in other years from 2000 to last year. The next highest number of triplets – three sets – were born in 2003, 2005 and 2006, while only one other set of quadruplets was born in 2007.
Donald Felice, president of the Malta College of Obstetricians and Gynaecologists, said that given the small size of Malta, and its small number of births, it is extremely difficult to compare the rate of multiple births with other countries.
Access to HIV testing and antiretrovirals for prevention of mother to child HIV transmission has grown substantially over the past four years in the countries most severely affected by HIV, UN agencies reported today – but around 40% of women in the high prevalence countries of southern Africa are still not being offered an HIV test during pregnancy.
HIV testing is essential during pregnancy if women and their infants are to benefit from antiretroviral prophylaxis to prevent mother to child HIV transmission.
Sixty per cent of women in the high prevalence countries of southern Africa underwent HIV testing during pregnancy in 2007, compared to 33% in 2004, but across the wider Eastern and Southern Africa region only 43% of women with HIV are estimated to receive antiretroviral drugs for prevention of mother to child transmission, compared to 11% in 2003.
Antiretroviral coverage was 57% in South Africa (compared to 15% in 2004) and 46% in Mozambique (compared to 3% in 2004). However coverage is still very low in Ethiopia; just 10% of women with HIV were able to receive antiretroviral prophylaxis in 2007, perhaps due to the country’s very low level of access to antenatal care (28% of women have access to it).
Access to antiretroviral prophylaxis is very poor in West and Central Africa, where only 11% of women with HIV received the drugs in 2007.
Across 60 low and middle-income countries, only 26% of women who receive antiretroviral prophylaxis are able to obtain two-drug prophylaxis despite a World Health Organization (WHO) recommendation that wherever possible women should receive a short course of one or two drugs in addition to single dose nevirapine, due to evidence showing a much greater reduction in mother to child transmission when multiple drugs are used. (Only 8% receive a three-drug combination).
The state of access to PMTCT (prevention of mother to child transmission) and paediatric HIV treatment is summarised in the Children and AIDS: Third stocktaking report published by UNICEF, UNAIDS, the World Health Organization and UNFPA.
The report also covers progress on access to antiretroviral treatment for children. WHO and UNAIDS estimate that around 2 million children were living with HIV in 2007, and 370,000 infants were infected with HIV that year.
While the report shows progress in providing treatment for children – up from 75,000 children on treatment in 2005 to 198,000 in 2007 – coverage still falls far short of the estimated need, due chiefly to lack of early diagnosis.
HIV diagnosis in infants is challenging in developing countries because it requires the use of a test to detect HIV DNA up until the age of 18 months, when HIV antibodies can be reliably detected in small children. Testing for HIV DNA requires a laboratory test called DNA PCR that can only be carried out by highly trained laboratory staff using special equipment.
Countries are attempting to improve the rate of infant HIV diagnosis by collecting blood spots on filter papers and sending them to a central laboratory, where the blood can be tested using DNA PCR. The number of countries using this method has grown from 17 to 30 since 2005, and testing of infants is now becoming possible even in remote areas.
However the report notes that in many countries routine testing of infants born to mothers with HIV is still not taking place, due to poor linkage between PMTCT services and child health services. Instead children are diagnosed only when they present at hospitals with serious illness.
But much childhood illness caused by HIV could be prevented by two proven interventions, prophylaxis with the cheap antibiotic cotrimoxazole, or where it is available, antiretroviral therapy started within three months of birth.
But the report notes that worldwide only 4% of infants born to mothers with HIV infection are estimated to be getting cotrimoxazole, although some countries have been more successful in making the drug available (83% coverage in Botswana, 63% coverage in Ukraine).
Antiretrovirals are reaching a small proportion of children in most countries (around 5% in Ethiopia, 10% in South Africa and 8% in Tanzania).
Scale up of early diagnosis is needed, the report recommends.
The report also highlights the needs of adolescents, including those already infected with HIV, with a call for a stronger focus on the vulnerability of girls to HIV infection, a greater role for the education sector in high-prevalence countries and more attention to how circumcision can be delivered to male adolescents when it forms part of a national HIV prevention programme.
Children and AIDS: Third Stocktaking Report can be downloaded here http://www.unicef.org/aids/files/StocktakingReport08_Full_FINAL_18_Nov_08.pdf
More than half a million women still die each year in pregnancy and childbirth, often bleeding to death because no emergency obstetrical care is available, the United Nations Children’s Fund (UNICEF) said on Friday.
Despite modest progress, particularly in Asia, the global maternal mortality toll remains stubbornly stable due to a lack of financial resources and political will, it said.
More than 99 percent of the estimated 536,000 maternal deaths worldwide in 2005 occurred in developing countries, half of them in sub-Saharan Africa, it said in a report entitled “Progress for Children: A Report Card on Maternal Maternity”.
“One of the critical bottlenecks has always been access to highly skilled health workers required to deliver emergency obstetrical care, particularly caesarian sections,” Peter Salama UNICEF’s chief of health, told a news briefing.
Around 50 million births in the developing world, or about 4 in 10 of all births worldwide, are not attended by trained personnel, according to the report.
Haemorrhaging is the leading cause of maternal death in Africa and Asia, causing one in three deaths, it said. Infections, hypertensive disorders, complications of abortion, obstructed labour or HIV/AIDS are other causes.
Such complications can be easily treated in a health system whose facilities are staffed with skilled personnel to handle emergencies around the clock, but disparities persist, it said.
“The lifetime risk of maternal death in the developing world as a whole is 1 in 76, compared with 1 in 8,000 in the industrialised world,” UNICEF said.
The riskiest place to give birth is Niger, where the risk of dying in pregnancy or childbirth over the course of a woman’s lifetime is one in seven, it said. In Sierra Leone it is 1 in 8.
But developing countries including Sri Lanka and Mozambique have succeeded in reducing maternal mortality rates, it said.
A combination of family planning, training skilled birth attendants, emergency obstetrical care and post-natal care is the key to reducing maternal mortality, according to the agency.
At the current average reduction rate of less than one per cent a year, the world will miss the goal of reducing maternal mortality rates by 75 percent between 1990 and 2015, to less than 150,000, one of the Millennium Development Goals, it said.
“The time is right. We now know exactly what to do for maternal mortality reduction to make this one of the next big issues in global health,” Salama said.
Programmes to combat three major epidemics — HIV/AIDS, tuberculosis and malaria — now receive the required international attention and billions in funding, he said.
“But maternal mortaility and child mortality do not yet receive the attention that the scale of the problem deserves,” he said. An additional $10 billion would be needed each year to combat both child and maternal mortality, according to Salama.
UNICEF said last week that more than 9 million children died before their fifth birthday in 2007, down slightly from a year before, but a huge gap remains between rich and poor countries.
Among the 7,000 families living in camps for the displaced since the Koshi River – the country’s largest – burst its banks on 18 August, women and girls are most vulnerable, say agencies, as facilities in Sunsari and Saptari districts lack adequate healthcare and protection.
A principal concern is lack of privacy for women treated in health centres, and the dearth of specialised health services for children and female medical workers, according to the UN’s Office for the Coordination of Humanitarian Affairs (OCHA) in Nepal. “There is a lack of separate maternal healthcare and this could risk the health of pregnant women, new mothers and their newborn,” said Hemlalta Chaudhary, a village facilitator from Sabal, a local NGO supported by the UN Children’s Agency (UNICEF).
According to the government’s District Public Health Offices (DPHO) in both Saptari and Sunsari districts, there are almost 1,000 pregnant women, with more than half of them in Saptari camps.
More than 15 are said to be about to give birth, the DPHO reports, and officials maintain that provisions for safe deliveries were being made. However, women on the ground remain sceptical. “I hope the government will come to help on time,” Sabitri Mukhia, who is seven months pregnant, said. “This is my first child and I don’t want her to be born in this camp,” she added, concerned by the lack of maternal care facilities almost a month after the camps were established. Her worries were shared by health workers.
To date, no separate site for delivery has been erected, ambulance service remains erratic, and most serious of all, there is a shortage of female healthcare workers, they say. Once the baby is born, it will be forced to live in the tiny and cramped shelters with low ceilings, making it difficult to ward off the scorching heat or get fresh air.
The UN Population Fund (UNFPA) is planning to offer transport to health services away from shelters to ensure pregnancy-related complications are responded to quickly.
Several aid agencies and NGOs working with women and children have requested that the government boost security in the area due to possible risks and reported cases of violence and abuse of women, they told IRIN in Saptari District.
According to UNFPA, women and adolescent girls are highly vulnerable to gender-based violence due to inadequate lighting and security at night. The agency has therefore been advocating for the deployment of female police officers to the shelters for both day and night duty. There have been unverified reports of between five and 11 rape cases in Saptari over the past few days, OCHA said. “Young women and girls are living under vulnerable conditions and the weak security is putting many of them at sexual risk,” said Avha Setu Singh, a rights activist from a local NGO, Setu Community Development and Human Rights Forum.
Although government authorities maintain they have taken this issue on board, women on the ground more than one week later said no serious action had yet been taken.
More than 800,000 people are in dire need of humanitarian assistance in Haiti in the wake of hurricanes Fay and Gustav and tropical storm Hanna. Houses, medical facilities, main roads and bridges have been destroyed, and an estimated 100,000 people have sought refuge in temporary shelters.
The crisis-affected population includes some 24,000 pregnant women. Eight thousand are due to deliver in the next three months and many need basic antenatal care and support for any complications. In any population, even in the best of times, about one in seven women will have complications that require emergency obstetric care or surgical delivery. Of the pregnant Haitian women in the disaster affected areas, over a thousand will need such care. Limited access to emergency obstetric care puts the lives of these women — and their babies — at risk.
In a Flash Appeal launched in New York, UNFPA, the United Nations Population Fund, is requesting $1.5 million to ensure pregnant women have access to emergency obstetric care, medical supplies, and skilled medical professionals, such as obstetricians and midwives, to ensure safe child delivery.
The funds will also help UNFPA protect women and girls affected by the crisis from exploitation and all forms of violence, and to facilitate access to both food and non-food items for marginalized groups, especially individuals living with HIV and disabilities, while monitoring human rights violations.
Tens of thousands of homes have been severely and partially damaged, leaving families without shelter and access to basic supplies, such as clothes, soap and toothbrushes. UNFPA will use the requested funds to distribute essential non-food items and provide women with access to sanitation stations. A rapid assessment, which will be conducted to establish the economic and housing needs of those affected, will serve to better inform the government and the international community responses.
UNFPA will work in close cooperation with the Haitian Government and civil society, with other United Nations agencies, such as the World Health Organization, the World Food Programme, UNICEF, and the United Nations Development Fund for Women, as well as with international and local non-governmental organizations, such as the International Organization for Migration and the Haitian Red Cross. UNFPA will also support these agencies in protecting vulnerable women and their families from all forms of violence, preventing separation of families, and providing individuals with psychosocial care, when needed.
These interventions will complement UNFPA activities in response to the impact of tropical storm Hanna on the island of Hispaniola. For the crisis-affected region of Gonaives, as well as the South-East and Central Plateau, UNFPA has already been working to identify and fund additional medical staff and provide medical teams with supplies for safe child delivery, and to ensure qualified care providers are available in shelters and health centres.
UNFPA, the United Nations Population Fund, is an international development agency that promotes the right of every woman, man and child to enjoy a life of health and equal opportunity. UNFPA supports countries in using population data for policies and programmes to reduce poverty and to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect.
SOURCE United Nations Population Fund