Respect During Childbirth Is a Right, Not a Luxury

“I have practiced medicine for 20 years and this is the first meeting I have attended that made me want to go back to work and apologize to all the women I have yelled at.”

This thoughtful comment, from a doctor attending a national stakeholders meeting on respectful maternity care (RMC) in Rwanda, was echoed by others in attendance. “We are teaching midwives to do good vaginal exams, but not to be kind!” said another participant.

These vibrant exchanges were part of a larger discussion on common types and causes of mistreatment during maternity care. During the November 2015 meeting—convened by the Rwandan Ministry of Health, Rwanda Gender Monitoring Office, USAID’s flagship Maternal and Child Survival Program (MCSP), and USAID/Rwanda—participants agreed that more work is needed to achieve high-quality care that is both safe and respectful.

In a second break-out session, participants discussed locally appropriate solutions for combating mistreatment and promoting RMC, acknowledging that multiple stakeholders, including representatives of government, civil society, facilities and professional associations, need to work together to ensure that women receive dignified care during childbirth.

And these issues are not unique to Rwanda.

A rights based approach to RMC may seem to be an obvious standard embraced by all stakeholders. However, in many countries, mistreatment is an all-too familiar experience for women who give birth in facilities.

The effects of mistreatment may ripple far beyond the individual woman who experiences verbal or physical abuse, neglect, humiliation or discrimination. One woman’s negative experience may be enough to dissuade her family, neighbors or friends from giving birth in a facility.

RMC is sometimes framed as a ‘soft issue’ without the same urgency as emergency obstetric services, but the consequences of mistreatment can be serious and far-reaching.

In many settings, fear of mistreatment has proved to be an important deterrent to seeking childbirth care in facilities. In many parts of the world, the percentage of women who give birth in facilities remains low, with mistreatment a known, important contributing factor. This includes Tanzania, where the rate of facility childbirth has stagnated at or below 51% for more than 20 years. 

Read more here

By: Claire Baldwin, MCSP Communications
Susan Moffson, MCSP Senior Program Officer

Photo credit: Mother and newborn at the district hospital in Allahabad, Uttar Pradesh. (Indrani Kashyap/Jhpiego)

The burden of infertility in Nigeria

In low-resource settings such as Nigeria, accessing basic assisted reproductive technology treatments can be challenging or impossible for many couples who want to conceive. Many fear the negative consequences of childlessness resulting from societal pressure. Couples who cannot conceive often experience emotional and psychological trauma. Sadly, societal norms dictate that the woman is the cause of the infertility, ignoring male infertility. Infertility comes at a high price financially, emotionally and physically for many couples in Nigeria.

The prevalence of infertility is generally higher in sub-Saharan Africa compared to most other regions. Given the poverty that exists in Nigeria, where 92.4% of the population live on less than 2 USD a day, the high cost of infertility treatments is associated with a significant risk of catastrophic health expenditure. For example, tubal disease, which is the most common cause of infertility in Nigeria, is best treated with in-vitro fertilization (IVF), and one cycle of IVF in Nigeria costs an average of 3,289 USD. This out-of-pocket payment has the potential to create or exacerbate poverty.

Evidence suggests that many women discontinue treatment for financial reasons. In desperation, some have sought cheaper care from traditional healers such as “mamas that rub.” Mamas that rub are generally untrained providers who use herbal medicines and abdominal massage, a technique that is not supported by scientific evidence for infertility treatment, exploiting and deceiving their patients. Read more here

News credit : Maternal health task force

First evidence drug used to combat malaria in pregnancy also protects against sexually transmitted infections

A drug given to pregnant women in 35 countries worldwide to protect against malaria has been shown also to safeguard against the consequences of gonorrhoea, chlamydia, trichomoniasis, and bacterial vaginosis, according to a new study published in Clinical Infectious Diseases. 

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The World Health Organization recommends providing intermittent preventive treatment (IPTp) using sulphadoxine-pyrimethamine (SP) to pregnant women living in malaria-endemic areas as part of every scheduled antenatal care visit, from the second trimester until delivery, to reduce adverse birth outcomes caused by malaria infection. This study has produced the first compelling evidence that the same preventive treatment reduces adverse birth outcomes attributable to curable sexually transmitted/reproductive tract infections (STIs/RTIs).

The research, led by the London School of Hygiene & Tropical Medicine with partners the University of Zambia, involved 1,086 pregnant women in Zambia. Researchers investigated the protective effect that different doses of IPTp-SP had on pregnancy outcomes. The analyses confirmed IPTp-SP protects against adverse birth outcomes but of particular interest to the team was the effect the drug had on the infections themselves. At delivery, women who experienced an adverse birth outcome who had had two or more doses of IPTp-SP compared to 0-1 dose were 76% less likely to have a malaria infection, 94% less likely to have gonorrhoea or chlamydia, and 66% less likely to have trichomoniasis or bacterial vaginosis. 

There are 880,000 stillbirths and 1.2 million newborn deaths each year in sub-Saharan Africa, many of which are linked to maternal infection. A 2012 School study found that nearly 4 of every 10 women at health facilities have a malaria infection.  An even higher number of women, if added together, are infected with the STIs/RTIs syphilis, gonorrhoea, chlamydia, tichomononiasis and bacterial vaginosis.

Lead author of this new study, Assistant Professor Matthew Chico from the London School of Hygiene & Tropical Medicine, said: “Sexually transmitted and reproductive tract infections are linked to devastating birth consequences for pregnant women, including spontaneous abortion, stillbirth and premature and low birthweight. While sulfadoxine-pyrimethamine has been thought to offer pregnant women protection against other infections, no evidence existed - until now.  The findings show that IPTp-SP offers unrecognised potential that extends beyond its life-saving protection against malaria.” - See more here

News credit:

Matthew Chico, Enesia Banda Chaponda, Cono Ariti, Daniel Chandramohan. Sulfadoxine-Pyrimethamine Exhibits Dose-Response Protection Against Adverse Birth Outcomes Related to Sexually Transmitted and Reproductive Tract Infections. Clinical Infectious Diseases. DOI:10.1093/cid/cix026

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