Thankfully considerable effort continues to be invested in improving birthing techniques and training. The work done around the world by midwives, doulas, nurses and doctors is extraordinary. They have all contributed to declining maternal mortality rates around the world. This is great news. And studies like these that help further improve their work are wonderful.

Now, the real story is not actually from the headline, but in the oxytocin injection. The way a placenta is removed is clearly important, but the risk of death from a mistake here is pretty rare. However the use of oxytocin is new to the more remote locations on the planet. By confirming that this technique alone, improves the odds of survival considerably this study provides added urgency to get the proper medicine and training to the women and men who participate in the baby delivery process.

Organizations like PATH have a mission to increase the number of “Safe Birth Kits” available in world and have recently started to add single use oxytocin syringes to their packages. Millions of births have now been assisted by their simply technology packages. Unfortunately there are many many millions more that would greatly benefit from these kits and training about how to use them.

They are also ranked as one of the best health non-profit organizations in the business. So if you wish to donate or volunteer this is an excellent program to work with.

Let’s hope that studies continue to find and confirm the best techniques available, the women who want to help in the delivery, especially in this remote areas, will get the training they need to be effective, and the organizations like PATH will be able to continue their good work.

http://www.nytimes.com/2012/03/13/health/study-says-umbilical-cord-shouldnt-be-pulled-during-labor.html?_r=3&src=recg

http://www.path.org/our-work/safe-birth.php

http://www.charitynavigator.org/index.cfm?bay=search.summary&orgid=4305

The Millennium Development Goal on reducing maternal mortality rates by 75% globally is in jeopardy. This fact has prompted a significant focus on emergency measures to rapidly increase improvements addressing maternal mortality.

Currently only 5% of Indonesia’s poorest 5,000,000 pregnant women receive professional care services ¹. Indonesia’s current rate of maternal mortality is 230 per 100,000 live births². In order for the UN Millennial Goals to be achieve Indonesia needs to reduce their maternal mortality rates to under 102 maternal deaths. In order to facilitate this progress by 2015, Indonesia recently announced emergency spending measures to pay for three million births for poor women to take place in hospitals with trained professionals. While their commitment is admirable there are at least three concerns for the current plan.

First is geography. Only 52% of Indonesia population lives in an urban area³ close to hospitals and medical services. Travel from the rural to urban areas can be quite precarious in much of Indonesia. Because the national plan calls for paying for health care services at hospitals by trained professionals there will necessarily be a limit to how effective this plan will be. Rural women will already be limited in their access to cities because of distance, traveling conditions, and the cost of transportation. Because of the distance concerns a mother cannot wait until the day of her birth to leave for a hospital. She would likely need to leave at least several days earlier. This additional time requirement adds an additional cost to those already severely disadvantaged by poverty.

Second, a significant factor in maternal mortality is the care received during pregnancy. Anemia, preeclampsia, teen pregnancy, multiple births, gestational diabetes etc all increase the likelihood of a maternal death, and have nothing to do with a skilled attendant at birth.

Third, what happen’s after 2015. The current plan appears to be a limited investment, not a continuous commitment to the future. After 2015 no guarantees are in place to ensure that every year thereafter mother’s will continue to receive the care the urgently need.

While there are certainly concerns with the plan Indonesia’s actions are admirable. Hopefully the Indonesian government will include in this and future plans actions that will bring the health care to the mothers throughout their pregnancy and for all future generations of mothers to come.

Nearly half of all maternal deaths occur in sub-Saharan Africa ¹, and life for mothers in Angola is particularly tragic with a life time risk of death due to child birth ranging from 1 in 7 ² to 1 in 12 [1.UNIFEC - ibid]. Most women will have between 6 and 7 children in their life time ³ increasing the risk dramatically per woman. No other country in Africa has a higher maternal mortality rate than Angola and only one (Somalia) ties it for the dubious position of highest maternal death rates in Africa.

Since 1986 the Ministry of Health has attempted to address the high rate of maternal deaths, but very little progress has been made ⁴. Depending on the accuracy of the sources of information it is possible that things have even gotten worse.

The primary problem that faces the governments ability to address the maternal mortality rate is funding and infrastructure. This is not something that is likely to be fixed any time soon. However there are a significant number of actions that can be implemented with relative ease and in a very short period of time.

Sanitation is a major source of infection that leaders to child and maternal death. Projects building safe water wells near rural populations would be extremely helpful. Education, both of the mother and midwives is also critical. Experience is important, but even a newly trained midwife will be able to do more to protect the mother than nothing at all. Training programs would require some investment, but most of the equipment that is required by a midwife can be carried in 1 or 2 bag, and can be easily deployed in rural areas.

It has been noted that in developing regions of the world the single greatest factor impacting the future development and success of a child and then the community is the overall health and education of the mother. She will do more to protect the children and ensure they have the resources they need than anything the government will do directly.

This does not minimize the impact that the government can have (positive or negative), or the realities of the AIDS epidemic that has devastated so many families and places additional stresses on mothers, the high fertility rate etc. These structural concerns and cultural legacies are extremely important to address over the long term. But is is also important to remember that Angola does not need to solve its debt crisis, or corruption, or infrastructure problems in order to have an enormous impact on maternal mortality rates in just a few years. More than anything they only need to employ one of their greatest resources which are the mothers and women in their communities.

The maternal mortality in Azerbaijan is unacceptably high and very likely is rising. In 1994 the rate of maternal mortality was 44.6 death for 100,000 births. This was already 5 times worse than the average in Europe¹. Between 2000 and 2006 in rate of maternal mortality had risen to 94/100,000²³⁴

What has given rise to the increase in maternal mortality? Several factors appear to be to blame. As of 2004 there had not been a comprehensive sexual and reproductive health program⁵. By 2009 it appears that one had been adopted, but the UN committee who reviewed the document felt that while it was commendable that they had now developed a plan, its implementation was severely hampered by limited access to health care programs in general. These programs are not particularly expensive and represent a matter of governmental priority.

Access is particularly limited in rural and remote areas and especially for internally displaced populations of refugee women. Also contributing to the rising maternal mortality was a “steep decrease in the use of contraceptives”⁶ It would appear that this decrease in access, and use, of contraceptives like condoms is correlated with changes in United States and international policies in 2004 to suspend contraceptive supplies. When access to contraceptives was essentially eliminated, this trend collided with cultural perceptions of family size and economics in disastrous ways for maternal mortality.

The current trend in Azerbaijan is to have only 2 children. 80% of women with 2 children indicated that did not desire any more. This population trend combined with abortion as the only available contraception has led to the increase in maternal mortality. 21% of all abortions, even those performed in medical facilities, have severe complications and have resulted in the rapid rise in maternal mortality⁷. With abortion as the primary means of contraceptive means in the country this trend is likely to continue and become worse⁸

Also of grave concern is that the UN committee noted that Azerbaijan does not use the official definition of maternal mortality as recommended by the World Health Organization and therefore is very likely to be under-reporting its numbers⁹.

Austria should be commended for all of the excellent work they have done to reduce maternal mortality within their country. Austria has one of the lowest maternal mortality rates in world at just 4 per 100,000 live births¹

Because of the low maternal mortality rate, any initiatives for maternal health are concentrated either on contraception or on poorer immigrant communities: “With the amendment to the Federal Ministries Act of 2003, Federal Law Gazette I, No. 17/2003, the Federal Ministry of Health and Women’s Issues was set up, which amongst other tasks performs the function of co-ordinating matters relating to women’s policy and equality of women and men in the labour market. Please find more detailed information on the Inter-ministerial Coordinating Committee on Gender Mainstreaming in Article 4, Number 1. The Federal Ministry of Health and Women’s Issues set up a separate department with the title “Women’s Services and Integration of Female Migrants”. This department devotes itself to fundamental research and project work benefiting women in the host country Austria. Special attention is focused on the socio-economic and cultural integration of female migrants. In the meantime, top priority concerns have emerged. These are: Equal treatment with regard to access to the labour market and to education (especially language coaching as well as the recognition of diplomas acquired in the country of origin) and health. The provinces also launched initiatives, such as, for example, the setting up of integration offices, the launching of language programs, training and counselling on matters relating to the Aliens’ Act for the staff of non-governmental organizations and easy-access women-specific health care services for female migrants” ²

Australian should be commended for their effects to reduce maternal mortality rates. For the majority of the population the rates are extremely low by world standards (8/100,0000 live births)1. “The Government is providing funding to improve Indigenous peoples’ access to comprehensive primary health care services. This provides for coordinated clinical care, population health, and health [...]

The rest of this post was lost. We will restore the remaining portion as soon as possible.

The full story of maternal mortality in Algeria is hard to pin down. It is clear that over the last two decades the maternal mortality rates have clearly been on the decline. However, there is substantial evidence that the state of affairs in not quite as good as some reports might otherwise suggest.

In 1989 the maternal mortality rates was estimated at 230/100,000 live births ¹. Efforts were made to reduce the maternal mortality rate over the last two decades, however there is some dispute over how successful these programs have actually been.

For instance, the African Development Bank states that the  average maternal mortality rate for the years 1990-96 was 62 per 100000, and that for the period between 2002 – 2004 maternal mortality rates fell to 37 per 100000 [2.  African Development Bank, Gender Poverty and Economic Indicators on African Countries, Economic and Social Statistics Department: Tunis, Tunisia, 2007,  p32]

The UNFPA put the rates in 2006 at 140 maternal mortality deaths per 100,000 live births [3. RN - (RN, UNFPA, State of the World Population 2006: A Passage to Hope; Women and International Migration, 2006, p94-9]

And the country itself records in its self reporting for the CEDAW report that its maternal mortality rate is 117/100,000 live births [4. UN, CEDAW 2005 Algeria, p4]

Clearly there is a wide discrepancy in the data that needs to be reconciled.

It is unclear what motivation that African Development Bank would have in under reporting the maternal mortality rate for Algeria, but it is clear that even Algeria does not believe in the reported number. In addition to efforts by Algeria to reduce the actual maternal mortality rate significantly more resources need to be devoted to the proper recording and reconciliation of the reported maternal mortality statistics.

One of the problems that has complicated the maternal mortality outlook in Albania has been their continued struggle to fully transition to a fully functional capitalist and democratic economic and political system. “After 1991 when democracy was proclaimed in Albania, the health system deteriorated drastically. In the last five years, there has been more emphasis to improve health care. Many private clinics are open, which use modern technology. However, there is corruption in the public clinics which might affect the quality of maternal care. It is not unusual for nurses and doctors to demand money for every service, even a small one such as bringing medication to the patient” ¹.

UN organizations have urged Albania to allocate more resources toward adequate health care service for women ², but their ability to do so is hampered by both a lack of political will and resources. Technically health care if free to all citizens but the type of care that is available is severally limited in both location as well as training in preventative measures that might considerably reduce the maternal mortality rates were proper techniques and attention devoted to the well being of Albanian women.

In particular health care in the rural areas of Albania (4 in 5 Albanians live in rural areas) are particularly problematic as well as care of the Roma people in general ^{3 4}.

Albania certainly has not completely neglected their mothers bearing children, and the women in Albania having children is better than in many of the worlds countries. However, it is important for the health care system and the politicians to not become complacent or comfortable with the circumstances they now endure. There are many innovative and cost effective program like those being implemented in Afghanistan now that would vastly improve the safety of the women bearing children in Albania.