Category Archives: Women and Girls

Inside Sierra Leone’s Maternal and Newborn Mortality Rates

With an overall population of 5.9 million people in Sierra Leone, 200 women will die today from complications during childbirth. Every year, 2400 women lose their lives due to pregnancy related causes in Sierra Leone. And, close to 10,000 babies die every year during their first month of life. There has been notable progress in Sierra Leone to end maternal and newborn deaths in the small, coastal country, but the mortality rates are not decreasing fast enough.

Based on this year’s data from Save the Children’s State of the World’s Mothers Report , Sierra Leone was ranked as one of the worst places to be a mother for the past eight years. Ranked at #172, only Central African Republic, Guinea Bissau, Mali, Niger, DRC and Somalia are worse. And, according to this year’s State of the World’s Midwifery Report only 24% of all pregnancy needs are met by midwives in Sierra Leone.

Mamaye Sierra Leone is calling on its government to commit more resources to save the lives of women and their newborns. The Free Health Care Initiative has allowed countless women to deliver their babies in clinics, but unfortunately, these clinics are often void of the basic necessities for a safe delivery. In fact, over half of the clinics in Sierra Leone are not equipped to provide proper, quality maternal and newborn health care. One in six facilities in Sierra Leone are able to perform signal functions such as administering life-saving drugs, performing caesarean sections, newborn resuscitation, or blood transfusion, according to Mamaye.

What Does Sierra Leone Need to Save More Mothers and Babies?

  • Mamaye Sierra Leone says that the government needs to allocate more funds to emergency obstetrics and newborn care nationwide.
  • Mamaye Sierra Leone also says there needs to be a rapid scale-up of health workers who can provide safe delivery services to women across Sierra Leone.
  • And, thirdly, Mamaye Sierra Leone says there needs to be quality care across all health services.


Every Newborn Action Plan Launches in Johannesburg

Johannesburg – After over a year of work, the Every Newborn Action Plan (ENAP) was officially launched on Monday, June 30 in Johannesburg during the third Partners’ Forum. In May, the Plan was adopted by the World Health Assembly in Geneva by all 194 member countries during succesful, albeit precarious deliberations.

The Every Newborn Action Plan aims to save three million lives per year. Currently 2.9 million newborns die annually. And tragically, another 2.6 million are stillbirths. Most of these deaths are never counted. Counting newborns across the globe is a strategic priority in the Every Newborn Action Plan.

Graca Machel, PMNCH Board Chair, launches the Every Newborn Action Plan in Johannesburg on Monday, June 30. Photo: Jennifer James

The Every Newborn Action Plan lays out the ways in which more newborns can survive through robust continuum of care and provides a framework for countries to reduce their individual newborn mortality rates. The plan has an ambitious goal to reduce newborn deaths t0 10 per 1000 people the world over by 2035. In order to reach these goals five strategic objectives have been outlined. The five objectives are  (1) strengthen and invest in care during labour, birth and the first day and week of life, (2) improve the quality of maternal and newborn care (3) reach every woman and newborn to reduce inequities (4) harness the power of parents, families and communities and (5) count every newborn – measurement, programme-tracking and  accountability.

Now that the Every Newborn Action Plan has been adopted by the World Health Assembly and officially launched at the Partners’ Forum, it is now time for individual countries to implement the plan and save more newborn lives. It’s now time for the implementation and accountability phase. We’ll be watching closely.

#SouthAfricaCares Side Event In Photos #PMNCHLive

During a packed event at Michelangelo hotel in Johannesburg, key partners including Save the Children, World Vision, PATH, Mothers 2 Mothers, and the Society of Midwives of South Africa came together to rally support for newborns and celebrate the progress thus far to save millions of vulnerable newborns around the world.

South Africa Cares

The Every Newborn Action Plan was endorsed by 194 countries in May 2014 and will be officially launched at the PMNCH Partners’ Forum today. At this early pre-event called “A Common Thread: Reaching Every Woman and Every Newborn” leaders in the global call to save newborns and their mothers spoke including Margaret Chan, Director General of the World Health Organization, Joy Lawn, professor at the London School of Hygiene and Tropical Medicine, and Dr. Tedros Ghebreyesus, former Ethiopian Minister of Health as well as the Minister of Health of South Africa.

South Africa Cares 6

During the event Save the Children unveiled its Blanket of Hope with squares from across the globe.


South Africa Cares 5

South Africa Cares 3

And global stories of mothers and their newborns and their survival were placed throughout.

South Africa Cares 1 South Africa Cares 2

The Partners’ Forum begins today in Johannesburg. Follow along at #PMNCHLive.

How Ethiopia is Scaling Midwifery to Save More Mothers, Newborns

Addis Ababa- In Ethiopia there are 4.9 million pregnancies each year of which 84% take place in rural areas. Here in Ethiopia, where the vast majority of women deliver at home, only 32% of maternal, newborn and child health needs are being met by midwives according to the newly released State of Midwifery Report. That is troubling for a country that is making noticeable strides to save its women and children, including reaching Millennium Development Goal 4 last year. There is still scalable work to be done to save more Ethiopian mothers and their newborns.

What is important to note is those aforementioned numbers don’t tell the full story. Ethiopia’s Federal Ministry of Health has committed itself to providing more quality care and support for institutional births as well as prenatal and postnatal care by scaling the number of midwives in Ethiopia. Today there are nearly 7000 midwives in Ethiopia (2520 graduated in 2012), up from 1139 midwives in 2011; notable progress to be sure. Despite scaling up the number of midwives here, the increased rate of institutional deliveries is slow-going. Cultural customs prevent many women from delivering at a health center or hospital. These women opt to deliver at home and whether or not she is attended by a trained birth attendant is a toss-up, especially in the deepest rural parts of the country.

Hawassa Health Science College
Skills Lab Class at Hawassa Health Sciences College. Jhpiego is working with Ethiopia’s Federal Ministry of Health and the college to provide tools, materials, equipment, and quality education for midwives in training.

Increasingly, however, pregnant Ethiopian women (especially those in urban centers) are opting to deliver with trained health workers. In fact, health extension workers can deliver babies at mothers’ homes and in health posts. The Ethiopian Federal Ministry of Health has proven its commitment to saving the lives of more mothers and children by hiring and training 34,000 health extension workers in Ethiopia and paying their salaries each month. This committed cadre of women is the backbone of health care on the community level in Ethiopia. Midwives provide quality institutional deliveries in both health centers and hospitals.

Journalists in Ethiopia

As I  mentioned in my previous post, I am here in Ethiopia co-leading a group of journalists who are reporting on newborn health and its surrounding issues with the International Reporting Project. This week the journalists visited the Hawassa Health Sciences College in the Southern Nations, Nationalities, and People’s (SNNP) region where midwives are being trained to go out into mostly rural communities to assist with maternal, newborn and child health with a special focus on safe, clean deliveries. Jhpiego, an international health NGO, is working in tandem with the Federal Ministry of Health and the Hawassa Health Sciences College to provide materials, equipment, and quality training for the college’s midwifery students. Just announced this week,  Jhpiego was awarded the largest government funded project to save mothers and children throughout the world, of which Ethiopia is one of 24 priority countries.

Journalists Nicole Melancon, Heather Horn and Corine Milano interview midwives in training at the Hawassa Health Sciences College

Jhpiego is not only working in Hawassa, but throughout Ethiopia by replicating and scaling its programs to train more health workers with quality education as well as providing the tools and assistance that midwives in training need in order to save the lives of those who are most vulnerable.

Journalist, Elizabeth Atalay interviews a midwife in training
Journalist, Elizabeth Atalay, interviews a midwife in training

Project Mercy

In the highlands of the southern part of the country, a faith-based Ethiopian NGO, Project Mercy, is also working to train midwives with the help of Jhpiego. Armed with a $2 million grant from USAID’s Human Resources for Health program, Project Mercy is slated to train 480 midwives and 120 anesthesia nurses starting with its first class  in September 2014. Once graduated, the newly trained midwives will receive automatic job placement in southern Ethiopia by the regional SNNP government. The aim is to scale up the midwives in the region to actively prevent maternal and newborn deaths.

Currently, Project Mercy hospital staff are already being trained in midwifery skills by volunteer doctors from the United States.

Project Mercy

Awaiting the new students is a brand-new facility located near Butajira, Ethiopia. Project Mercy is currently recruiting nurses who want to learn new medical and practical skills as midwives to keep women and their newborns safe during pregnancy and delivery.

Project Mercy

While the number of midwives is still quite low in comparison to the population and the rate of births in Ethiopia, the government has recognized that educating more midwives is critical to saving the lives of mothers and newborns. Ethiopia has already proved that it understands how to scale health workers. Just look at the Health Extension Worker program. Now, it’s time to scale up midwives and that is what Ethiopia is doing.

Journalists Travel to Ethiopia to Report on #NewbornHealth

It may seem a little quiet around, but for good reason. I am co-leading a group of journalists throughout Ethiopia who are reporting on newborn health with the International Reporting Project.  Putting together a robust itinerary for the journalists has been a capstone to all of the knowledge I have gained since learning about the importance of saving newborns.

The timing of this trip is perfect in the midst of such important achievements for newborns including the adoption of the Every Newborn Action Plan and the Partners’ Forum that will take place at the beginning of July in Johannesburg.



Thus far the journalists have seen Kangaroo Mother Care and the best NICU in the country at Black Lion Hospital, Addis Ababa’s largest hospital. They have seen how orphaned newborns are placed in homes with SOS Children’s Villages. They have also looked at obstetrics services and family planning with Marie Stopes’s largest clinic and community-based Blue Star clinics in urban areas. Yesterday, we spent a full day with Save the Children in Mosebo village (about 43 kilometers from Bahir Dar) and how they are advocating for Kangaroo Mother Care in rural areas as well as ways in which they are working with Health Extension Workers to save more newborns and their mothers.


The trip goes until June 27. Follow the journalists at #EthiopiaNewborns.

24 Compelling Mobile Photos from #ICMLive

Neonatalie Newborn Resuscitation model in a baby cot, this was one of the models donated by UNFPA to 12 midwifery training schools | UNFPA/Evelyn Kiapi

Have you been following the 30th International Confederation of Midwives Triennial Congress? Throughout my travels to low-and middle-income countries and reporting on maternal, newborn, and child health midwives prove time and time again how important they are to the health, wellness, and survival of mothers, children, and newborns.

3000 midwives have gathered in Prague to discuss best practices, share experiences, and lay the foundation for increased quality care for women and children around the world.

As I mentioned yesterday in 11 Key Tweets from #ICMLive I have been following the #ICMLive hashtag. Here are some photos that have been shared on Twitter that I found particularly compelling. Continue to follow the #ICMLive hashtag through June 5 to join the global midwifery conversation.

Continue to follow the conversation at #ICMLive

11 Key Tweets from #ICMLive

Trainee Midwives demonstrating the childbirth process using the Advanced Child birth simulator Anatomical Model donated by UNFPA at the handover ceremony at Public Health Nurses College. UNFPA/Evelyn Kiapi

3000 midwives have gathered in Prague for the 30th International Confederation of Midwives Triennial Congress. I have been reading the twitter stream closely ahead of my upcoming trip to Ethiopia next week where I will lead a delegation of journalists to report on newborn health.

Here are some tweets I’ve found interesting thus far. Follow the #ICMLive hashtag through June 5 to join the global midwifery conversation.

Why Newborns are on the World Health Assembly’s Agenda


Today the 67th World Health Assembly convened in Geneva, Switzerland. On tap this week will be discussions about health issues ranging from climate change to tuberculosis. Also on the agenda is a key discussion about newborns and the draft of the Every Newborn Action Plan (item 14.2 on the agenda). You might remember that as a network of moms we helped provide comments on the draft plan earlier this year. Our comments along with other stakeholders – over 300 comments  in all — helped UNICEF, WHO and their  partners revise the Every Newborn Action Plan draft that will be discussed and presented to the assembly.

  • Three quarters of all newborn deaths occur in the first week of life. – World Health Organization

Why is there a need for an action plan to save more newborns? While the mortality rate for children under five has been effectively reduced by 50% between 1990 and 2012, the neonatal mortality rate deceased  far too slowly even though there are interventions that can save more newborns’ lives. Over the same time period neonatal mortality only fell 37%.  The vast majority of newborn deaths occur in low- and middle-income countries due to a lack of investments and quality maternal and newborn health care with 12 countries contributing to most newborn deaths. Most newborns die from one of three causes: prematurity, intrapartum-related neonatal deaths (including birth asphyxia) and neonatal infections.

  • Up to two thirds of newborn deaths can be prevented if known, effective health measures are provided at birth and during the first week of life. – World Health Organization

Causes for Child Mortality

The Every Newborn Action Plan lays out the ways in which more newborns can survive through robust continuum of care and provides a framework for countries to reduce their individual newborn mortality rates. The plan has an abitious goal to reduce newborn deaths t0 10 per 1000 people the world over by 2035. In order to reach these goals five strategic objectives have been outlined. The five objectives are  (1) strengthen and invest in care during labour, birth and the first day and week of life, (2) improve the quality of maternal and newborn care (3) reach every woman and newborn to reduce inequities (4) harness the power of parents, families and communities and (5) count every newborn – measurement, programme-tracking and  accountability.

The health assembly is invited to adopt the plan. Doing so will ensure that more newborn lives will be saved through interventions that work.

Follow for up-to-date information on the draft plan and follow #EveryNewborn on Twitter.


Save the Children Releases New Report on Motherhood in Conflict

This article was originally published on the Bill and Melinda Gates Foundation’s Impatient Optimists.

Every year Save the Children releases its annual State of the World’s Mothers report and each year a magnifying glass is held up to motherhood around the world and how mothers fare based solely on where they live. Now in its fifteenth year, Save the Children’s State of the World’s Mothers report puts into clear perspective the countries where motherhood is best and worst. This year Save the Children focuses its attention on motherhood in crisis.

Devastating crises have popped up across the globe, some of them ongoing and others that are fairly new, relatively speaking. No conflict, of course, is beneficial for the health and welfare of mothers and their children. In fact, women and children are precisely the ones who tend to suffer most during times of civil unrest, natural disasters, and all-out wars. Internal conflicts break families apart, cause families to flee to neighboring countries to then become refugees, or they become trapped inside of their home country and internally displaced. Basic services such as food assistance and health care then become scarce causing undue damage to the lives of children and the mothers who take care of them. The same is true for natural disasters that can irreparably ruin families’ lives and livelihoods.

This year over 60 million women and children are in need of humanitarian assistance according to the report and Save the Children has responded to nearly 120 humanitarian crises in 48 countries. Mothers and children, therefore, who are trapped in fragile countries are more susceptible to death and disease. We already know that 800 women die in childbirth and 18,000 children under the age of five die as a direct result of preventable disease every day. Did you know that half of these deaths for both women and children occur in countries that are fragile meaning there is a lack of good governance and political stability that leaves a country’s citizens open and vulnerable to a range of disasters whether man-made or natural.

During any crisis situation expectant mothers are in particular perilous situations. Obstetric services are often halted save for rudimentary services that many not be equipped to save a mother’s life in critical situations, that is if a pregnant woman is lucky. She may have to give birth alone in the bush or in the back of truck fleeing across the border to save her life and the life of her newborn.

The lives of newborns, of course, are also at increased risk when a mother gives birth in high-intensity, crises situations where mothers worry not only about giving birth to a healthy baby, but also simply staying alive.

As aforementioned, when countries experience crisis situations ordinary citizens suffer most. Health systems suffer. Frontline health workers – even the most dedicated of them – may have to flee along with citizens to save their own lives. And furthermore, hospitals and health centers can become targets of destruction in civil unrest in order to hurt those who need the services most.

Consider the conflict in the Central African Republic (CAR) where sectarian violence has left nearly 3000 dead and hundreds of thousands of people homeless and without access to the most basic needs such as food, clean water, and sanitation. And now that the rainy season is nearing the hardships in people’s lives will be greatly intensified. It is no wonder that the CAR ranks 173rd in the report rankings.

“Nothing will stop a mother from trying to keep her children safe and protected,” said Carolyn Miles, president and CEO of Save the Children, “But when disaster strikes, whether it’s a war in Syria, a tornado in Oklahoma or a typhoon in the Philippines, women and children are often at the greatest risk – up to 14 times more likely to die than men.  Fortunately, our evidence also shows we can save and dramatically improve the lives of mothers and children, even in the most challenging places to live, if we invest in the services they need.”

In Syria where the civil war has been raging on for four years 1.4 million children and nearly 700,000 women have fled the country, according to the report. There are now over 200,000 women and girls of reproductive age inside and outside of Syria according to the UNFPA meaning there will be an increased necessity for obstetric and newborn health care and family planning services. And, in the case of civil unrest, rape and torture of women and girls are often used as weapons of war exacerbating gender-based violence.

Even in the United States when a natural disaster such as Hurricane Sandy devastated the east coast, mothers and children with the least resources fared the worst amid the devastation and months of rebuilding. No matter the country or crises, women and children remain the most vulnerable communities to death, disease, abuse, and violence.

Through its report Save the Children is putting forth a reminder that in fragile countries the health of women and children remains a top priority and systems must be in placed to ensure they are not let down when they need help the most.

Read the full report at

Photo by Allessio Romenzi for Save the Children.

WHO Releases New Maternal Health and Mortality Data

Trends in Maternal Mortality: 1990 – 2013Maternal health  is one of the world’s biggest global health priorities especially as the deadline for the Millineum Development Goals near. As a global priority MDG 5 (improve maternal health) cannot be effectively measured without full and complete data resources. According to the new report, Trends in Maternal Mortality: 1990 – 2013, only 40% of countries accurately record the cause of death for expecting mothers. Without this vital data measuring maternal mortality will continue to be an ongoing challenge with missing pieces to the overall maternal health puzzle.

In order to reach MDG 5, vital records must be accurately attained and recorded globally. It was the recommendation of the Commission on Information and Accountability for Women’s and Children’s Health that countries make marked improvements in vital events and statistics to better measure maternal mortality rates and ratios, and yet that progress continues to be slow-going according to the report.

With the current, available data released by the World Health Organization we know that most maternal deaths occur in sub-Saharan Africa and that the two countries with the highest maternal mortality deaths are India and Nigeria, but Sierra Leone has the highest ratio of maternal deaths at 1100 per every 100,00 people.

The Maternal Mortality Estimation Inter-Agency Group (MMEIG) has worked to determine comparable MMR rates along with a technical advisory group. Due to the progress made by the MMEIG in conjunction with the advisory group new MMR estimates have been established and released in this latest data report.

In 2013 there were 210 maternal deaths worldwide per every 100,000 people. In 1990, that number was significantly higher at 380 showing a steep decline of 45%. Over the course of nearly 25 years, the maternal mortality rate has decreased significantly as the numbers show, but there is yet more work to do particularly in sub-Saharan Africa where the need to keep more mothers alive is greatest. Women die in childbirth for causes that are completely preventable such as excess bleeding and infection.

Data from 183 countries were included in the new report. According to Trends in Maternal Mortality national-level data from civil registration, surveys, surveillance systems, censuses, and sample registration systems among others were used to determine the new data rates. Despite the still-high numbers all WHO regions experienced a reduction in maternal deaths since 1990. In sub-Saharan Africa, however, women have a 1 in 38 chance of dying in childbirth as opposed to women in developed countries who have a 1 in 3700 chance of dying from pregnancy-related causes. The worldwide MMR (number of maternal deaths) is 210. In 2013, 289,000 women died in childbirth. In 1990, that number was 523,000.

Concerted Improvements

There is no doubt clear improvements in maternal health have been realized over the course of two decades. However, the global health community can save more women’s lives. 800 women die every day from birth complications that are largely preventable. The World Health Organization recommends that women have access to more antenatal care, delivery with trained midwives and frontline health workers, blood supplies and medications and education about having a healthy pregnancy and delivery.

UN Photo/David Ohana