Tag Archives: newborn health 2014

Can a Village Revolution for Mothers and Newborns Go Global?

Kenya: Carolyn MilesBy Carolyn Miles, President & CEO, Save the ChildrenFollow Carolyn Miles at @carolynsave.

Fifteen years have passed since a husband and wife team in western India challenged the notion that the deaths of thousands of mothers and millions of babies during pregnancy and childbirth are inevitable in poor and remote communities.

Drs. Abhay and Rani Bang trained a battalion of local women to deliver lifesaving care to mothers and newborns who had little access to doctors or hospitals. Their paper published in 1999 in the prestigious medical journal, The Lancet, recorded that the interventions delivered by these community-based health workers led to a 62 percent reduction in newborn mortality in only three years. Since then, more evidence has been generated suggesting that up to 75 percent of maternal and newborn deaths are preventable — most without intensive care.

Today babies in some of the world’s poorest, most remote communities are being saved through the use of low-tech interventions, such as a low-cost, hand-held device that can resuscitate babies who are not breathing at birth or an antiseptic gel that can prevent deadly infections when applied to the umbilical cord immediately after birth.

These interventions — and a number of others — have the potential of saving 1.9 million newborns and 158,000 mothers a year, while also averting 800,000 stillbirths, according to the latest estimates published in The Lancet last month. But the problem is this: So far no country in Africa or South Asia — where 80 percent of maternal and newborn deaths take place — has succeeded in delivering these high-impact, cost-effective interventions nationwide. Yet, based on the work of the Bangs and others, we know that these lives CAN be saved.

Without these interventions reaching every woman and every newborn, many deaths happen needlessly each year. But that may be about to change.

Last month, when the World Health Assembly met in Geneva, health ministers from around the world took the historic step of making maternal and newborn health and stillbirths a top global health priority. The health ministers approved the Every Newborn Action Plan (ENAP), a roadmap to help countries sharpen their plans to reduce stillbirths and maternal and newborn deaths.

Even more importantly, many countries, including India, Bangladesh, Nepal, Ethiopia, Uganda and Malawi have already taken steps to change health policies that will help ensure that proven newborn interventions are made more widely available. In Ethiopia and India, for example, trained personnel at community health posts are now allowed to use injectable antibiotics to treat severe newborn infections when a hospital referral is not possible. In both countries severe infections are among the leading killers of newborns.

Increasing access and use of such interventions, especially for those that have not been reached, will help ensure that the reductions in newborn mortality start to catch up with great global declines we’ve already seen in deaths to children after the first month of life. Currently, babies who die within the first month of life account for almost half (44 percent) of all deaths of children under age 5.

On Monday, ENAP will be launched with great fanfare in Johannesburg, with many notables and agencies including Save the Children joining in a global call to action.

Hopefully, this will mark the beginning of one of the world’s greatest health crusades in history — ending preventable deaths of mothers and newborns and stillbirths within our own lifetime.

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.

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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.

Why Newborns are on the World Health Assembly’s Agenda

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

 

Why Parent Advocates Are Important to the Survival of Newborns

Photo: New mothers at a health clinic in Awassa, Ethiopia

By virtue of raising families, mothers and fathers know intimately and first-hand how fragile the lives of newborns are. In low- and middle-income countries where resources and trained health workers can be scarce, the chances of survival for newborns are drastically lowered. In fact, the mortality ratios in poorer nations stand in stark contrast to those in industrialized countries. More newborn lives, however, can be saved in through proven interventions that work effectively when performed by trained healthworkers.

This year saving the lives of newborns is front and center on the global political and development agenda and parents around the world are poised to lend their collective voice to this effort. The UNICEF-and WHO-led Every Newborn Action Plan draft is currently online to be read, shared, and commented upon by a vast coalition of constituents including parents, families, and communities. The plan seeks to provide a joint action platform in which to reduce preventable newborn mortality by scaling up quality care.

Why are the voices of mothers and fathers important to the Every Newborn Action Plan? Parents and families bring a fresh, new perspective to ensuring newborn lives are saved around the world. Shockingly, 2.9 million newborns lose their lives every year. What is particularly troubling is the vast majority of these deaths are wholly preventable.  It is a matter of providing the resources, training, care, health access, and health workers that will change the trajectory of newborn lives for the better, but it takes a plan first to ensure these interventions come through.

Read the rest on Healthy Newborn Network.

Photo copyright: Jennifer James

A Plan to Save More Newborns in 2014 and Beyond

In 2014 newborns the world over will receive the much-needed attention they need to live and survive. Drawing on all of the great work from last year starting with the Global Newborn Health Conference held in Johannesburg last April leading up until now with the draft of the Every Newborn Action Plan newborns and their survival worldwide will be top on the global agenda as the year progresses.

We are happy to be able to lend our global voices to the importance of keeping newborns alive. Did you know 2.9 million newborns die during their first month of life each year? This number makes up 44% of all child deaths. Experts, researchers, and medical practitioners all know with certainty that if the newborn mortality rate can drop drastically the overall child mortality rate would subsequently decrease as well. These reductions in mortality rates will also aid the progress of MDGs 4 and 5.

The Every Newborn Action Plan was led by the World Health Organization and UNICEF. Now in draft form the plan will be discussed during the 134th session of the World Health Organization Executive Meeting from January 20 – 24, 2014. Online consultations will begin through the end of February to hear the suggestions and ideas about the plan from stakeholders including mothers around the world.

As a part of the United Nation’s Every Woman Every Child movement the action plan details the research and expertise that will need to be followed in order to reduce newborn mortality. The five strategic objectives are as follows:

  • Strategic objective 1: Strengthen and invest in care during labor, childbirth, and the first day and week of life.
  • Strategic objective 2: Improve the quality of maternal and newborn care.
  • Strategic objective 3: Reach every woman and every newborn to reduce inequities.
  • Strategic objective 4: Harness the power of parents, families and communities.
  • Strategic objective 5: Count every newborn – measurement, program tracking and accountability.

Each strategic goal is also coupled with proposed action in order to ensure that the goals have a roadmap and framework to actually work. There is no lip service here. Overall the plan seeks to forge a reduction in newborn mortality of 66% by 2035. This certainly won’t be easy, but according to the plan it is doable. There are key strategies that need to be followed including increased funding for maternal and newborn health especially in low-income countries and low-resource areas. Countries need to be even more responsible and vigilant for the well-being of its citizens by providing access to quality care (emphasis on quality) for both mother and child. Countries also must create or increase its frontline health worker task force that will see to the care of mothers and newborns during the first month after birth and periodically thereafter. Additionally, according to the plan, there needs to be more community support for mothers and their newborns from women’s groups. And further more women and their families cannot be irreparably harmed financially for getting prenatal and postnatal care and for delivering their babies in health facilities.

Ethiopia has been cited time and again as a country that took researched and expert recommendations from the global health community and effectively reduced their child mortality rate. One of the ways Ethiopia accomplished this was through the will of the government, health extension workers, as well as through the health development army, a volunteer core of women who aid in the health and education of mothers with newborns.

Health Development Army - Photo: Jennifer James
Members of the Health Development Army – Photo: Jennifer James

Many low-income countries can learn greatly from Ethiopia’s example. Even as a low-income country themselves they have been able to achieve vastly improved nationwide health results for Ethiopian children because they wanted to. That is, the will of the country and its stakeholders are vital to all health improvements. Following the Every Newborn Action Plan can do this for countless low and middle-income countries as well.

The online consultation to share your thoughts, ideas, and recommendations for the plan starts during the last week of January through the end of February. All stakeholders are encouraged to take advantage of the online consultation phase. Follow @HealthyNewborns for the link to the online consultation form.

Photo Copyright: United Nations