If you have followed my travels or have read my blog over the years you know that Ethiopia is my favorite country in the world. There is something about the people, the culture, its beauty and the sheer size of the country I love. Even though I love Ethiopia I have never been under a grand illusion that it is a unified country. There have been mass arrests and killings in Oromia, journalist and freedom fighter imprisonments, and now a civil war with mass atrocities and forced starvation against the people of the Tigray region. In fact, just this week reports of an airstrike on a market near Tigray’s capital Mekele killed at least 64 people and wounded over 100.
Even as war is still happening in Ethiopia’s northernmost region, its national election officially wrapped on Monday without voting in Tigray, of course. Now, ballots are being tallied across the country with the likelihood that the current prime minister Abiy Ahmend will be reelected.
By Caroline Kinsella, Advocacy and Communications Intern, White Ribbon Alliance
One of the more hidden human rights abuses around the world is the fact that one billion people have no legal proof of identity. Alarmingly, UNICEF estimates that about one in four children under age 5, or 166 million, are unregistered and without any trace that they exist. Conversations about reducing global poverty and protecting the health and human rights of mothers and newborns must include the challenges of birth registration.
A single piece of paper has the power to transform a person’s future. Birth certificates are necessary to access government services, life-saving medical treatment, a nationality and age related legal protections. Legal proof of birth is often required to attend school and apply to higher education, as well as open a bank account and vote. Many of the individuals without a birth certificate today are children who were never registered at birth. In some cases, nobody knows for decades that a child does not have a birth certificate.
In Uganda, Senfuka Samuel, who goes by Sam, applied for a master’s degree program that required a birth certificate. As he did not have one, Sam had to venture to the hospital where he was born. There, he discovered that hospital records before the year 2000, including any proof of his birth, were destroyed in the civil war. Traveling hundreds of miles over two weeks, Sam spent his own money to first get issued a necessary ‘birth notification’ – a slip of paper with birth details handwritten by a midwife – to later gain a new legal birth certificate.
The United Nations has designated Sierra Leone as the most dangerous place to have a baby. In fact, it has the highest maternal mortality rate in the world at 1,360 deaths per 100,000 live births. On average, most women have at least six babies in Sierra Leone.
In a previous post I mentioned the Aminata Maternal Foundation that helps pregnant women in Sierra Leone. An Australian organization, it was started by a woman, Aminata Conteh-Biger, who became a sex slave during the Liberian Civil War. Now, she is giving back to expectant mothers after so many years away from her home country.
This video shows the work of the Aminata Maternal Foundation and how it oftentimes becomes difficult for young pregnant girls to receive permission from family and elders to deliver in a hospital or health center. It also shows the frustration of healthcare workers who try to teach entire villages about the importance of proper maternal healthcare.
When I was in Zambia I saw ways in which nurses treat cervical cancer in low resource settings. Women who do not benefit from the HPV vaccine and still develop cervical cancer are often subject to visual inspection of the cancer typically with a digital camera followed by cryotherapy to freeze the diseased part of the cervix. Some researchers question whether this approach to cervical cancer treatment is effective in low-and-middle income countries. Globally, the cervical cancer burden falls disproportionately upon women in low and middle-income countries. In fact, approximately 90% of deaths from cervical cancer occur in these countries like Bolivia, Guinea, and Swaziland. Rates are highest in Central America, sub-Saharan Africa, and Melanesia.
As I have written many times before postpartum hemorrhage (PPH) or excessive uterine bleeding after childbirth is the leading cause of maternal mortality in low-and-middle income countries. The recommended drug to prevent PPH according to the World Health Organization (WHO) is oxytocin. When administered in its recommended dose it causes little to no side effects. Oxytocin, the WHO’s current gold standard therapy, however, must be refrigerated and administered by skilled health workers posing two obstacles to its wider use in low resource, tropical settings.
Some countries have approved misoprostol, an oral drug, to prevent PPH, but there are several concerns that its use can be misappropriated for abortions instead of used solely for PPH. The World Health Organization has listed misoprostol as an alternative to oxytocin if it is not available.
Now, another PPH preventative drug, carbetocin, has been added to the latest updated 2019 WHO Essential Medicines List. The announcement was made last week. Unlike oxytocin, even at high temperatures carbetocin remains effective. The recommendation is that carbetocin can be used when oxytocin is not available or if its quality is uncertain. Additionally, the cost must be comparable to oxytocin.