Improving Quality of Care is the Most Powerful Means to End Preventable Maternal Deaths

Many would assume that the 45,000 mothers dying in India every year during childbirth is a result of complications that are difficult to manage. It should be rather surprising that these deaths are mostly preventable. In fact, one of the main reasons for losing lives is often due to sub-standard and inconsistent quality of care.

Our entire maternal health care community is aware of this. And yet, improving the quality of maternal health services has been a tough challenge in India, largely due to insufficient tools and incentives for providers to change.

In recent years, considerable efforts to improve the quality of institutional care during the antenatal, delivery and postpartum periods have favored public health care facilities, largely excluding private ones. This has been the case despite the fact that private providers in India account for up to 30% of institutional deliveries in rural areas and up to 52.5% of institutional deliveries in urban areas, and despite evidence suggesting that quality of care is an issue in both sectors. Many such facilities, even those that have been in business for 5 to 10 years and even longer, have been found not to be following recognized, evidence-based quality standards of care in their labor and delivery wards. They do not have the necessary emergency protocols in place to prevent complications.

These challenges persist due to a widespread lack of technical resources, insufficient training and other opportunities for nurses and paramedics to update their skills and knowledge (leading to continued use of outdated, ineffective and sometimes harmful practices); weak incentives for private maternity facilities to invest in quality improvement because efforts typically do not immediately translate into an increased client base; and limited capacity (if not total absence) of systems to measure and monitor the quality of their services.

Greater efforts must be made to bridge the gap between research-supported knowledge and clinical practice. What we need is a large scale streamlined quality improvement initiative, offering a practical and compelling way for private health care facilities to improve their capacities for managing care during labor, delivery and the immediate postpartum period, when risks for life threatening complications are the highestAn intervention which offers all of the above is an important step forward for maternal health in India. Read more here

Investing in the health of mothers in Africa: Social hurdles

Even when maternal health facilities are available, expectant mothers in Africa do not always get timely care. A study by the Africa regional office of the World Health Organization (WHO), Reducing Mortality Rates, reports that sometimes women or birth attendants “fail to recognize danger signals and are not prepared to deal with them.” One answer, argues Dr. Yves Bergevin, senior adviser on reproductive health for the UN Population Fund (UNFPA), is to improve the skills of birth attendants and the knowledge and capacity of women, their families and their communities.

Involving men is important, says Lucy Idoko, UNFPA’s former assistant representative in Nigeria. Most men, she says, do not know the risks of going through labour. “Maternal health is not only a woman’s issue but also a man’s issue, and important to society as a whole.”

Cultural practices can also affect women’s health risks. WHO cites genital mutilation, early marriage and multiple pregnancies. Women who have undergone infibulation, a form of genital mutilation where the external genitalia are stitched, are more likely to suffer from obstructed labour. UNFPA data show that girls who give birth between the ages of 15 and 20 are twice as likely to die in childbirth as those in their twenties, while girls under 15 are more than five times as likely to die.

“Adolescent girls face the highest risk of premature delivery,” says Dr. Grace Kodindo, former chief of maternity at the Ndjamena general hospital in Chad. “Because their bodies are not yet fully mature, they risk obstructed labour. This is why we encourage young women to postpone their first pregnancy.”

Dr. Kodindo argues that both young age and the low status of women in society often leave them with little power to determine if, when and with whom to become pregnant. They also have little choice in the number and timing of their children.

Read more here

Nigeria enhances maternal, child survival through family planning

The Challenge Initiative, TCI, is doing business in an unusual way. It’s really nothing new but a practical way of ensuring that the owners of the land take it back for themselves with us just providing the light technical assistance. In reality, what this means is that the State and Local Government Areas are taking ownership in scaling up a home grown model that has worked for Nigeria in increasing modern use of contraceptives for family planning in our bid to reduce maternal mortality.

Evidence has shown that if we embrace and scale up family planning, we would reduce deaths of mothers by 30 percent and promote child survival by 25 percent. So really, it is a quick win if we really must ensure that maternal and child survival which we have all signed to as a community of practice in the State and National levels but actually put in action rather than lip service. We have found it is cost effective rather than tackling emergencies and other secondary issues that emanate from lack of spacing your family, or limiting it when you are satisfied with the number that you want.

This initiative called TCI is led by the government, which means for the first time, government will show expression of interest that they are interested in scaling up this model that we have rolled out in some other parts of the country. Evidence has shown that TCI is working and so, they want to use it, integrate it into their existing plans and make that action a reality in the community especially among the poor who really need it and are the voiceless, who really do not have funds when it comes to out-of pocket expenses.

Ogun State is doing so much in that area in reaching out through many of the medical outreaches. The State is at the forefront of taking this challenge initiative and integrate and make things more effective in the machinery that has already been set up. The journey actually started last year when this idea came on board and different states were showing interest. But then taking the whole hog need the buy-in of everyone led by the Chief Executive of the State and the Commissioners and those who make things work for the policy to be on board...

Read more from Dr Mojisola Odeku  here

$20m safe birth initiative for Nigeria and Ivory Coast

Coca-Cola Company is set to launch a new programme tagged: “The Safe Birth Initiative” to support the Ministries of Health in Nigeria and Ivory Coast to tackle the high incidence of maternal and newborn mortalities.

Disclosing this during a courtesy visit to the President of the Republic of Ivory Coast, Alassane Ouattara, the Coca-Cola Europe, Middle East & Africa (EMEA) Group President, Brian Smith, said the programme will focus on strengthening the capacity of maternity and neonatal units in selected public hospitals in the two countries.

“With US$20 million grant from Coca-Cola to Medshare International Inc., the US-based not-for-profit NGO will source essential equipment, kits and supplies worth about US$20 million to enable safe deliveries and post-delivery emergency care for both mothers and their newborns,” Smith said. “The program will also include the training of biomedical technicians and other appropriate hospital personnel by Medshare International on the operation, repair and maintenance of the donated equipment as well as the reactivation of a huge stock of faulty or abandoned equipment in public hospitals which is a major challenge for the country’s healthcare delivery system.

According to UNICEF’s 2016 State of the World’s Children report, 38 out of every 1,000 babies die within the first 28 days of birth while 645 out of 100,000 women die during or shortly after child birth due to avoidable conditions. In Nigeria on the other hand, about 40,000 women and 260,000 newborns (excluding 300,000 stillborn) die during or shortly after childbirth annually. For this reason, neonatal mortality is considered as one of the worst public health crises in Nigeria and a major priority for the Government in its resolve to meet the Sustainable Development Goals, SDGs. Read more here

Online Newspaper 'FreshNEWS' launches initiative to promote maternal health

“Our efforts will therefore attempt to increase advocacy and drive action from government and private organisations with the aim of raising the proportion of births attended by skilled health personnel, while under-five and neonatal mortality rates are also cut down.”

An online media group, FreshNEWS has kicked-off an initiative to raise awareness for the reduction of maternal and neonatal deaths and promote access to proper medical care for pregnant women and children in Nigeria.

Speaking at the launch of the initiative tagged: No Woman Should Die Giving Birth in Abuja at the weekend, the Managing Director of FreshNEWS, Desmond Utomwen said: “The initiative will be directed at promoting well-being for all and at all ages with the aim of improving reproductive, maternal and child health among others; and ensuring access to safe, affordable and effective medicines and vaccines for all. The target is to improve reproductive, maternal and child health.

“Today, we commit to take up campaigns that will attempt to foster awareness on issues that limit the poor and vulnerable in our midst. These range from Social, Economic and Environmental factors, which constitute the three dimensions of development.

Read more here ...