Earlier this month, global health experts (and students aspiring to be experts) from around the world gathered for a series of presentations, panels and posters at the 2017 Consortium of Universities for Global Health (CUGH) Conference in Washington, D.C. The panel titled “Perspectives on Monitoring Progress Toward Ending Preventable Maternal Mortality: What Measures Matter?” provided an opportunity to discuss the monitoring framework developed to accompany the Strategies toward ending preventable maternal mortality (EPMM) report released in 2015. The panel was moderated by Mary Ellen Stanton, Senior Maternal Health Advisor at USAID, and included Rima Jolivet, Maternal Health Technical Director of the Maternal Health Task Force, Elahi Chowdhury of icddr,b (Bangaldesh) and Chibugo Okoli of the Maternal Child Survival Program (MCSP, Nigeria). Representing maternal health monitoring at the global, national and facility-levels respectively, the panelists provided insights from their unique perspectives and highlighted the importance of the EPMM monitoring framework. Continue reading “Perspectives on Monitoring Progress Toward Ending Preventable Maternal Mortality: Highlights from CUGH 2017”
There has been some confusion recently about the Sustainable Development Goals (SDG) target for reducing global maternal mortality. The SDG global target is to reduce the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births by 2030. In addition to this global target, there are separate country-level targets: The primary national target is that by 2030, every country should reduce its MMR by at least two-thirds from its 2010 baseline. The secondary target, which applies to countries with the highest maternal mortality burdens, is that no country should have an MMR greater than 140 deaths per 100,000 live births by 2030.
This month, the FCI Program of MSH is featuring stories about fearless champions, powerful evidence, and advocacy wins from the Rights & Realities archive. Here is a recap of the fearless stories we shared on Twitter and Facebook February 1 -10.
By Catharine Taylor
Catharine Taylor is Vice President for health programs at Management Sciences for Health. This post originally appeared on STAT News.
President Trump’s reinstatement of the Mexico City Policy, better known as the global gag rule, came as no surprise to anyone working in the field of global health. We have been through this before — in 1984, when the policy was first put into effect by President Reagan, and then in 1993, 2001, and 2009, when it was repealed, reinstated, and repealed again.
The Mexico City Policy is called a gag rule because it limits not just what organizations and health providers do but what they are permitted to say. It prevents foreign organizations that receive US government funding from performing abortions — even if they are using funds from non-US government sources and even if abortion is completely legal in their countries.
The global gag rule also steps right between a woman and her doctor, nurse, or midwife, preventing these frontline health providers from telling their patients about the full, legal range of health options available to them. It forbids trusted advisers from giving honest, comprehensive health advice and information. I started my career as a nurse-midwife, and then worked in maternal and newborn health programs in Africa and Asia, so I know what this will mean for the lives and health of women and their families. Continue reading “Trump’s global gag rule silences doctors and midwives and harms their patients”
By Aishling Thurow
Aishling Thurow is a Project Support Associate at Management Sciences for Health.
Every maternal death must be documented to prevent the next one. In the Caribbean, where 175 women die for every 100,000 live births (WHO, 2015), understanding the reasons they died is essential to preventing more unnecessary maternal deaths in the future.
In 2013, the World Health Organization developed guidelines for maternal death surveillance and response (MDSR) to capture the number and systemic causes of maternal deaths and to strengthen policies and programs that will better respond to maternal health needs.
In December 2016, the Latin America and Caribbean Regional Task Force for the Reduction of Maternal Mortality (GTR for its Spanish acronym), of which MSH is an Executive Committee member, hosted a technical consultation on guidelines for maternal death surveillance and response systems in the Caribbean. Held in Montego Bay, Jamaica, the workshop welcomed 20 delegates−Ministry of Health officials, as well as prominent maternal mortality surveillance experts−from Jamaica, Belize, Suriname, Guyana, and Trinidad and Tobago. The workshop aimed to strengthen maternal mortality surveillance and response systems in the sub-region, to improve maternal mortality data quality, and to strengthen policy development and implementation capacities at the national level.
By Alexia Escóbar
Alexia Escóbar is the National Coordinator for FCI-Bolivia.
In April, I journeyed by boat along Bolivia’s Ichilo River to a remote community of the Yuracaré people. I hoped to better understand how pregnant women from these poor indigenous villages travel to the nearest health facility–located an hour and a half away—for the skilled care they need. During our trip to Tres Islas, colleagues from UNICEF Bolivia and I discovered that these women face not only transportation difficulties but also many other barriers in accessing culturally respectful, high-quality health care. Continue reading “My journey to Tres Islas”
Amy Boldosser-Boesch is Interim President and CEO of Family Care International. This post originally appeared on the Maternal Health Task Force blog.
Next week at the 68th World Health Assembly, the Ending Preventable Maternal Mortality (EPMM)Working Group — led by WHO in partnership with Family Care International (FCI), the Maternal Health Task Force, UNICEF, UNFPA, USAID, the Maternal Child Survival Program, and the White Ribbon Alliance — will launch its much-anticipated report, Strategies Toward Ending Preventable Maternal Mortality (EPMM). For FCI and our partners, this report presents an important opportunity to highlight the critical linkages between the health of a woman and that of her newborn baby. Continue reading “Calling for an integrated approach to maternal and newborn health: Strategies toward Ending Preventable Maternal Mortality”
What happens when a mother dies? In the West, the most ready and obvious answer is grief – the harrowing emotional and psychological toll of losing a loved one. A mother’s death is largely viewed as a private tragedy that will grow more manageable in time.
But in many developing countries, a mother’s death is much more than an emotional crisis, often leading to long-term social and economic breakdown, both for her immediate family and the wider community. This topic is explored in new depth, in a special issue launched today in Reproductive Health (an open-access journal).
“The True Cost of Maternal Death: Individual Tragedy Impacts Family, Community and Nations” focuses exclusively on the immediate and longer-term effects of maternal death on surviving children, households, and communities. It features seven studies, with data drawn from four African countries – Ethiopia, Kenya, Malawi, and South Africa.
The research was conducted by two research groups, one led by Harvard’s FXB Center for Health and Human Rights, and the other a consortium made up of Family Care International, the International Center for Research on Women, and the Kenya Medical Research Institute (KEMRI)-CDC Research and Public Health Collaboration. The results provide hard evidence that a mother’s loss can devastate the livelihoods, quality of life, and survival chances of those she leaves behind.
By Emily Maistrellis
Emily Maistrellis is a policy coordinator at Harvard University’s FXB Center for Health and Human Rights and a research study coordinator at Boston Children’s Hospital. This article originally appeared on Boston NPR station WBUR’s CommonHealth blog.
Walif was only 16 and his younger sister, Nassim, just 11 when their mother died in childbirth in Butajira, Ethiopia.
Both Walif and Nassim had been promising students, especially Walif, who had hoped to score high on the national civil service exam after completing secondary school. But following the death of their mother, their father left them to go live with a second wife in the countryside. Walif dropped out of school to care for his younger siblings, as did Nassim and two other sisters, who had taken jobs as house girls in Addis Ababa and Saudi Arabia.
Nassim was married at 15, to a man for whom she bore no affection, so that she would no longer be an economic burden to the family. By the age of 17, she already had her first child. Seven years after his mother died, Walif was still caring for his younger siblings, piecing together odd jobs to pay for their food, although he could not afford the school fees.
In all, with one maternal death, four children’s lives were derailed, not just emotionally but economically.
More than 1,000 miles away, in the rural Nyanza province of Kenya, a woman in the prime of her life died while giving birth to her seventh child, leaving a void that her surviving husband struggled to fill. He juggled tending the family farm, maintaining his household, raising his children and keeping his languishing newborn son alive.
But he didn’t know how to feed his son, so he gave him cow’s milk mixed with water. At three months old, the baby was severely malnourished. A local health worker visited the father and showed him how to feed and care for the baby. That visit saved the baby’s life.
As these stories illustrate, the impact of a woman’s death in pregnancy or childbirth goes far beyond the loss of a woman in her prime, and can cause lasting damage to her children — consequences now documented in new research findings from two groups: Harvard’s FXB Center for Health and Human Rights, and a collaboration among Family Care International, the International Center for Research on Women and the KEMRI-CDC Research Collaboration.
The causes and high number of maternal deaths in Ethiopia, Malawi, Tanzania, South Africa, and Kenya — the five countries explored in the research — are well documented, but this is the first time research has catalogued the consequences of those deaths to children, families, and communities.
The studies found stark differences between the wellbeing of children whose mothers did and did not survive childbirth:
- Out of 59 maternal deaths, only 15 infants survived to two months, according to a study in Kenya.
- In Tanzania, researchers found that most newborn orphans weren’t breastfed. Fathers rarely provided emotional or financial support to their children following a maternal death, affecting their nutrition, health care, and education.
- Across the settings studied, children were called upon to help fill a mother’s role within the household following her death, which often led to their dropping out of school to take on difficult farm and household tasks beyond their age and abilities.
How do we use these new research findings to advocate for greater international investment in women’s health?
At a webcast presentation earlier this month, a panel of researchers, reproductive and maternal health program implementers, advocates and development specialists discussed that question.
Central to the discussion was the belief that the death of a woman during pregnancy and childbirth is a terrible injustice in and of itself. The vast majority of these deaths are preventable, and physicians and public health practitioners have long known the tools needed to prevent them. And yet, every 90 seconds a woman dies from maternal causes, most often in a developing country.
The panelists expressed hope that these new data, which show that the true toll of these deaths is far greater than previously understood, can help translate advocacy into action.
It’s important to recognize that, beyond the personal tragedy and the enormous human suffering that these numbers reflect — some hundreds of thousands of women die needlessly every year — there are enormous costs involved as well. -Panelist Jeni Klugman, a senior adviser to the World Bank Group and a fellow at the Harvard Kennedy School of Government.
“So quantifying those effects in terms of [children’s] lower likelihood of surviving, the enormous financial and health costs involved and the repercussions down the line in terms of poverty, dropping out of school, bad nutrition and future life prospects are all tremendously powerful as additional information to take to the ministries of finance, to take to the donors, to take to stakeholders, to help mobilize action,” said Klugman.
Just what does “action” mean? Currently, the countries of the world are debating the new global development agenda to succeed the eight Millennium Development Goals, an ambitious global movement to end poverty. Advocates can use this research to make the case that reproductive, maternal, newborn, and child health should play a central role in this agenda, given that it reveals the linkages between the health of mothers, stable families, and ultimately, more able communities, according to Amy Boldosser-Boesch, Interim President and CEO of FCI.
Panelists also called for more aggressive implementation of the strategies known to prevent maternal mortality in the first place; as well as for the provision of social, educational, and financial support to children who have lost their mothers; and for continued research that outlines the direct and indirect financial costs of a woman’s contributions to her household, and what her absence does to her family’s social and economic well-being.
But action is also required outside of the realm of health care, said Alicia Ely Yamin, lecturer in Global Health and Population at the Harvard School of Public Health and policy director of the FXB Center.
In fact, the cascade of ill effects for children and families documented by this research doesn’t begin with a maternal death. The plight of the women captured in these studies begins when they experience discrimination and marginalization in their societies: “It [maternal death] is not a technical problem. It’s because women lack voice and agency at household, community, and societal levels; and because their lives are not valued,” she said.
Klugman added that this research adds to work on gender discrimination, including issues like gender-based violence, which affects one in three women worldwide.
It’s a tall order: advancing gender equality, preventing maternal, newborn, and child death, and improving the overall well-being of families. But panelists were hopeful that this research can show policy makers, and the public, that these issues are intertwined, and must be addressed as parts of a whole.
As Aslihan Kes, an economist and gender specialist at ICRW and one of the researchers on the Kenya study concluded, this research is “making visible the central role women have in sustaining their households.”
This is an opportunity to really put women front and center, making all of the arguments for addressing the discrimination and constraints they face across their lives. -Aslihan Kes
On October 7, 2014, a panel of experts in maternal health—moderated by Dr. Ana Langer, the Director of the Maternal Health Task Force—gathered at the Harvard School of Public Health to discuss the socioeconomic impact of a maternal death on her family and community. Several studies were summarized and priorities for how to use this research were discussed by the panel and audience at “Women’s Lives Matter: The Impact of Maternal Death on Families and Communities.”
What does the research say?
In many countries around the world, the household is the main economic unit of a society. At the center of this unit is the mother and the work—both productive and reproductive—that she provides for her family. A study in Kenya, led by Aslihan Kes of the International Center for Research on Women (ICRW) and Amy Boldosser-Boesch of Family Care International (FCI), showed great indirect and direct costs of a mother losing her life. This cost is often accompanied by the additional cost and care-taking needs of a newborn. “Once this woman dies the household has to reallocate labor across all surviving members to meet the needs of the household. In many cases that meant giving up other productive work, loss of income, hiring an external laborer, girls and boys dropping out of school or missing school days to contribute [to household work],” shared Kes. In addition, the study done in Kenya determined that families whose mother died used 30% of their annual spending for pregnancy and delivery costs; a proportion categorized by the WHO as catastrophic and a shock to a household.
Similar research was conducted in South Africa, Tanzania, Ethiopia, and Malawi by Ali Yamin and colleagues. In addition to similar socioeconomic findings to those in Kenya, Yamin found that less than 50% of children survived to their fifth birth if their mother died compared to over 90% of children whose mothers lived. An even more dramatic relationship was found in Ethiopia with 81% of children dying by six months of age if their mother had died. In South Africa, mortality rates for children whose mothers had died were 15 times higher compared to children whose mothers survived.
Increasing the visibility of maternal death
While a family is grappling with grief they are also making significant changes in roles and structure to meet familial needs. Dr. Klugman emphasized this point when she said, “Quantifying [the] effects [of maternal death]… and the repercussions down the line—in terms of poverty, dropping out of school, bad nutrition, and future life prospects—I think are all tremendously powerful. [This] additional information [is] very persuasive—to take to the ministries of finance, to take to donors, to take to stakeholders—to help mobilize action for the interventions that are needed.”
Apart from the economic and social costs, is a foundation of human rights violations and gender inequalities. The high rate of preventable maternal mortality is no longer a technical issue, but a social issue. “Maternal mortality it is a global injustice. It is the indicator that shows the most disparities between the North and the developing world in the South. It’s not a technical problem, it’s because women lack voice and agency at household, community, and societal levels and because their lives are not valued. Through this research of showing what happens when those women die, it shows in a way how much they do [and how it] is discounted,” said Dr. Yamin, whose research focuses on the human rights violations in maternal health.
Leveraging this research for improved reproductive, maternal, newborn, and child health
The research findings are clear: prevention of maternal mortality is technically feasible, the right of every woman, and significantly important for the well-being of a family and a community. Boldosser-Boesch provided three reasons why making the case for preventing maternal mortality is critical at this time.
- These findings strengthen our messaging globally and in countries with the highest rates on the importance of preventing maternal mortality, by increasing access to quality care, which includes emergency obstetric and newborn care.
- This research supports integration across the reproductive, maternal, newborn, and child health (RMNCH) continuum to break down current silos in funding and programs.
- “We are at a key moment… for having new information about the centrality of RMNCH to development, because… the countries of the world are working now to define a new development agenda, beyond the MDGS, post-2015. And that agenda will focus a lot on sustainable development… and we see in these findings… , connections to the economic agenda…, questions of gender equality, particularly what this means for surviving girl children, who… may experience earlier marriage or lack of access to education,” shared Boldosser-Boesch.
In order to move the agenda forward on preventing maternal mortality and ensuring gender equality, ministries of health and development partners must be engaged. In addition, donors can fund the action of integration to address a continuum approach and media outlets should be leveraged to disseminate these findings and hold governments accountable for keeping promises and making changes. The prevention of maternal mortality is a human rights-based, personal, and in the socioeconomic interest of a family, community, and a society.
This panel included:
- Ana Langer, Director of the Maternal Health Task Force
- Alicia Yamin, Lecturer on Global Health at the Harvard School of Public Health
- Amy Boldosser-Boesch, Interim President & CEO, Family Care International
- Jeni Klugman, Senior Adviser at The World Bank Group
- Aslihan Kes, Economist and Gender Specialist, International Center for Research on Women
Watch the webcast here.