Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide
Authored by Prof Suellen Miller et al.
Published On: 15th September, 2016
Source : The Lancet, http://dx.doi.org/10.1016/S0140-6736(16)31472-6
On the continuum of maternal health care, two extreme situations exist: too little, too late (TLTL) and too much, too soon (TMTS). TLTL describes care with inadequate resources, below evidence-based standards, or care withheld or unavailable until too late to help. TLTL is an underlying problem associated with high maternal mortality and morbidity. TMTS describes the routine over-medicalisation of normal pregnancy and birth. TMTS includes unnecessary use of non-evidence-based interventions, as well as use of interventions that can be life saving when used appropriately, but harmful when applied routinely or overused. As facility births increase, so does the recognition that TMTS causes harm and increases health costs, and often concentrates disrespect and abuse. Although TMTS is typically ascribed to high-income countries and TLTL to low-income and middle-income ones, social and health inequities mean these extremes coexist in many countries. A global approach to quality and equitable maternal health, supporting the implementation of respectful, evidence-based care for all, is urgently needed. We present a systematic review of evidence-based clinical practice guidelines for routine antenatal, intrapartum, and postnatal care, categorising them as recommended, recommended only for clinical indications, and not recommended. We also present prevalence data from middle-income countries for specific clinical practices, which demonstrate TLTL and increasing TMTS. Health-care providers and health systems need to ensure that all women receive high-quality, evidence-based, equitable and respectful care. The right amount of care needs to be offered at the right time, and delivered in a manner that respects, protects, and promotes human rights.
A common monitoring framework for ending preventable maternal mortality, 2015–2030: phase I of a multi-step process
Authored by Allisyn C. Moran, R. Rima Jolivet et al.
Published On: 26th August, 2016
Source : BMC Pregnancy and Childbirth, DOI 10.1186/s12884-016-1035-4
Background : While global maternal mortality declined 44% between 1990 and 2015, the majority of countries fell short of attaining Millennium Development Goal targets. The Sustainable Development Goals (SDGs), adopted in late 2015, include a target to reduce national maternal mortality ratios (MMR) to achieve a global average of 70 per 100,000 live births by 2030. A comprehensive paper outlining Strategies toward Ending Preventable Maternal Mortality (EPMM) was launched in February 2015 to support achievement of the SDG global targets. To date, there has not been consensus on a set of core metrics to track progress toward the overall global maternal mortality target, which has made it difficult to systematically monitor maternal health status and programs over time.
Findings : The World Health Organization (WHO), Maternal Health Taskforce (MHTF), and the US Agency for International Development (USAID) along with its flagship Maternal and Child Survival Program (MCSP), facilitated a consultative process to seek consensus on maternal health indicators for global monitoring and reporting by all countries. Consensus was reached on 12 indicators and four priority areas for further indicator development and testing. These indicators are being harmonized with the Every Newborn Action Plan core metrics for a joint global maternal newborn monitoring framework. Next steps include a similar process to agree upon indicators to monitor social, political and economic determinants of maternal health and survival highlighted in the EPMM strategies.
Conclusion : This process provides a foundation for the maternal health community to work collaboratively to track progress on core global indicators. It is important that actors continue to work together through transparent and participatory processes to track progress to end preventable maternal mortality and achieve the SDG maternal mortality targets.
‘YOU TRY TO PLAY A ROLE IN HER PREGNANCY’ - A QUALITATIVE STUDY ON RECENT FATHERS’ PERSPECTIVES ABOUT CHILDBEARING AND ENCOUNTER WITH THE MATERNAL HEALTH SYSTEM IN KIGALI, RWANDA
Authored by Jessica Pafs et al.
Published On: 25th August, 2016
Source : Glob Health Action 2016, 9: 31482 - http://dx.doi.org/10.3402/gha.v9.31482
Background : Rwanda has raised gender equality on the political agenda and is, among other things, striving for involving men in reproductive health matters. With these structural changes taking place, traditional gender norms in this setting are challenged. Deeper understanding is needed of men’s perceptions about their gendered roles in the maternal health system.
Objective : To explore recent fathers’ perspectives about their roles during childbearing and maternal care - seeking within the context of Rwanda’s political agenda for gender equality.
Design : Semi-structured interviews were conducted with 32 men in Kigali, Rwanda, between March 2013 and April 2014. A framework of naturalistic inquiry guided the overall study design and analysis. In order to conceptualize male involvement and understand any gendered social mechanisms, the analysis is inspired by the central principles from relational gender theory.
Results : The participants in this study appeared to disrupt traditional masculinities and presented ideals of an engaged and caring partner during pregnancy and maternal care-seeking. They wished to carry responsibilities beyond the traditional aspects of being the financial provider. They also demonstrated willingness to negotiate their involvement according to their partners’ wishes, external expectations, and perceived cultural norms. While the men perceived themselves as obliged to accompany their partner at first antenatal care (ANC) visit, they experienced several points of resistance from the maternal health system for becoming further engaged.
Conclusions : These men perceived both maternal health system policy and care providers as resistant toward their increased engagement in childbearing. Importantly, perceiving themselves as estranged may consequently limit their engagement with the expectant partner. Our findings therefore recommend maternity care to be more.
responsive to male partners. Given the number of men already taking part in ANC, this is an opportunity to embrace men’s presence and promote behavior in favor of women’s health during pregnancy and childbirth- and may also function as a cornerstone in promoting gender-equitable attitudes.
Coverage and timing of antenatal care among poor women in 6 Mesoamerican countries
Authored by Emily Dansereau et al.
Published On: 19th August, 2016
Source : BMC Pregnancy and Childbirth, 16: 234
Background : Poor women in the developing world have a heightened need for antenatal care (ANC) but are often the least likely to attend it. This study examines factors associated with the number and timing of ANC visits for poor women in Guatemala, Honduras, Mexico, Nicaragua, Panama, and El Salvador.
Methods : We surveyed 8366 women regarding the ANC they attended for their most recent birth in the past two years. We conducted logistic regressions to examine demographic, household, and health characteristics associated with attending at least one skilled ANC visit, four skilled visits, and a skilled visit in the first trimester.
Results : Across countries, 78 % of women attended at least one skilled ANC visit, 62 % attended at least four skilled visits, and 56 % attended a skilled visit in the first trimester. The proportion of women attending four skilled visits was highest in Nicaragua (81 %) and lowest in Guatemala (18 %) and Panama (38 %). In multiple countries, women who were unmarried, less-educated, adolescent, indigenous, had not wanted to conceive, and lacked media exposure were less likely to meet international ANC guidelines. In countries with health insurance programs, coverage was associated with attending skilled ANC, but not the timeliness.
Conclusion : Despite significant policy reforms and initiatives targeting the poor, many women living in the poorest regions of Mesoamérica are not meeting ANC guidelines. Both supply and demand interventions are needed to prioritize vulnerable groups, reduce unplanned pregnancies, and reach populations not exposed to common forms of media. Top performing municipalities can inform effective practices across the region.
Who Delivers without Water? A Multi Country Analysis of Water and Sanitation in the Childbirth Environment
Authored by Giorgia Gon et al.
Published On: 17th August, 2016
Source : PLoS ONE 11(8): e0160572. doi: 10.1371/journal.pone.0160572
Background and Objective : Hygiene during childbirth is essential to the health of mothers and newborns, irrespective of where birth takes place. This paper investigates the status of water and sanitation in both the home and facility childbirth environments, and for whom and where this is a more significant problem.
Methods : We used three datasets: a global dataset, with information on the home environment from 58 countries, and two datasets for each of four countries in Eastern Africa: a healthcare facility dataset, and a dataset that incorporated information on facilities and the home environment to create a comprehensive description of birth environments in those countries. We constructed indices of improved water, and improved water and sanitation combined (WATSAN), for the home and healthcare facilities. The Joint Monitoring Program was used to construct indices for household; we tailored them to the facility context–household and facility indices include different components. We described what proportion of women delivered in an environment with improved WATSAN. For those women who delivered at home, we calculated what proportion had improved WATSAN by socio-economic status, education and rural-urban status.
Results : Among women delivering at home (58 countries), coverage of improved WATSAN by region varied from 9% to 53%. Fewer than 15% of women who delivered at home in Sub-Saharan Africa, had access to water and sanitation infrastructure (range 0.1% to 37%). This was worse among the poorest, the less educated and those living in rural areas. In Eastern Africa, where we looked at both the home and facility childbirth environment, a third of women delivered in an environment with improved water in Uganda and Rwanda; whereas, 18% of women in Kenya and 7% in Tanzania delivered with improved water and sanitation. Across the four countries, less than half of the facility deliveries had improved water, or improved water and sanitation in the childbirth environment.
Conclusions : Access to water and sanitation during childbirth is poor across low and middle-income countries. Even when women travel to health facilities for childbirth, they are not guaranteed access to basic WATSAN infrastructure. These indicators should be measured routinely in order to inform improvements.
The influence of distance and quality of care on place of delivery in rural Ghana
Facility delivery is an important aspect of the strategy to reduce maternal and newborn mortality. Geographic access to care is a strong determinant of facility delivery, but few studies have simultaneously considered the influence of facility quality, with inconsistent findings. In rural Brong Ahafo region in Ghana, we combined surveillance data on 11,274 deliveries with quality of care data from all 64 delivery facilities in the study area. We used multivariable multilevel logistic regression to assess the influence of distance and several quality dimensions on place of delivery. Women lived a median of 3.3 km from the closest delivery facility, and 58% delivered in a facility. The probability of facility delivery ranged from 68% among women living 1 km from their closest facility to 22% among those living 25 km away, adjusted for confounders. Measured quality of care at the closest facility was not associated with use, except that facility delivery was lower when the closest facility provided substandard care on the EmOC dimension. These results do not imply, however, that we should increase geographic accessibility of care without improving facility quality. While this may be successful in increasing facility deliveries, such care cannot be expected to reduce maternal and neonatal mortality.
Preconception blood pressure and risk of preterm birth: a large cohort study in China
Authored by Li Nan et al.
Published On: 10th August, 2016
Source : Journal of Hypertension, doi: 10.1097/HJH.0000000000001069
Background : To examine whether blood pressure (BP) in the preconceptional period was associated with preterm birth in Chinese women.
Methods : The data are from a large population-based cohort study established to evaluate the effectiveness of the campaign to prevent neural tube defects in 21 Chinese counties. We included 44 494 singleton live births delivered at gestational ages of 20-42 weeks to women who were registered before pregnancy in seven counties in southern China. Blood pressure was measured during registration by trained healthcare workers. We used logistic regression to evaluate the associations between prepregnancy blood pressure and increased risk of preterm birth, adjusting for potential confounders.
Results : The study size had 93% power ([alpha]=0.05) to detect an increase of 38% over the unexposed rate of 5.32% for preterm birth. The prevalence of hypertension of study population in prepregnancy was 4.55% (2023/44 494). The incidence of preterm birth was 5.73% for hypertension group and 5.32% for nonhypertension group. Compared with nonhypertension group, hypertension group did not show significant increased risk for preterm birth overall [adjusted risk ratio (RR)=1.10, 95% confidence interval (CI) 0.91-1.34], iatrogenic subtype [adjusted RR=1.21, 95% CI 0.78-1.88], or noniatrogenic subtype [adjusted RR=1.08, 95% CI 0.88-1.34]. When the participants with normal blood pressure were used as the reference, the adjusted RRs of noniatrogenic preterm birth were 0.79 (0.70-0.89) for prehypertensive women.
Conclusion : Our results do not support the association between hypertension or higher blood pressure prior to pregnancy and the increased risk of preterm birth.
The burden of maternal morbidity and mortality attributable to hypertensive disorders in pregnancy: a prospective cohort study from Uganda
Authored by Annettee Nakimulli et al.
Published On: 4th August, 2016
Source : BioMed Central Pregnancy and Childbirth, Vol. 16 (1), pages 1-8
Background : Hypertensive disorders of pregnancy are a major cause of morbidity and mortality. The objective was to estimate the disease burden attributable to hypertensive disorders of pregnancy in two referral hospitals in Uganda.
Methods : Through a prospective cohort study conducted in Jinja and Mulago hospitals in Uganda from March 1, 2013 and February 28, 2014, hypertension-related cases were analyzed. Maternal near miss cases were defined according to the WHO criteria. Maternal deaths were also analyzed. The maternal near miss incidence ratio, the case-specific severe maternal outcome ratio, the case-specific maternal mortality ratio and the case-fatality ratio were computed.
Results : Of 403 women with hypertensive disorders of pregnancy, 218 (54.1 %) had severe preeclampsia, 172 (42.7 %) had eclampsia, and 13 had chronic hypertension or Hemolysis, elevated liver enzymes or low platelets (HELLP) syndrome. The case-specific maternal near miss incidence ratios was 8.60 per 1,000 live births for all hypertensive disorders, 3.06 per 1,000 live births for severe preeclampsia and 5.11 per 1,000 live births for eclampsia. The case-specific severe maternal outcome ratio was 9.37 per 1,000 live births for all hypertensive disorders, and was 3.25 per 1,000 live births for severe preeclampsia and 5.61 per 1,000 live births for eclampsia. The case-specific maternal mortality ratio was 780 per 100,000 live births for all hypertensive disorders, and was 1940 per 100,000 live births for severe preeclampsia and 501 per 100,000 live births for eclampsia. The case-fatality ratio was 5.1 % overall (for all hypertensive disorders), but was 8 times higher for eclampsia compared to severe preeclampsia. Cyanosis, abnormal respiration, oliguria, circulatory collapse, coagulopathy, thrombocytopenia, and elevated serum lactate were significantly associated with severe maternal outcomes.
Conclusions : There is high morbidity attributable to hypertensive disorders in pregnancy. Since some of the complications associated with morbidity can be recognized early, it is possible to prevent severe morbidity through early intervention with delivery, antihypertensive therapy and prophylactic magnesium sulphate treatment. The findings highlight the feasibility of implementing a facility-based surveillance system for severe maternal morbidity due to hypertensive disorders.
Health System Competency for Maternal Health Services in Balasore District and Jaleswar Block, Balasore, Odisha, India: An Assessment
Authored by Ranjit Kumar Dehury and Janmejaya Samal
Published On: August, 2016
Source : Journal of Clinical and Diagnostic Research. 2016 Aug, Vol-10(8): IC01-IC056
Introduction : A competent health system is of paramount importance in delivering the desired health services in a particular community.
Aim : The broad objective of this study was to assess the health system competency for the maternal health services in Balasore District and Jaleswar block of Balasore district, Odisha, India.
Materials and Methods : A mixed method approach was adopted in order to understand the health system competency for maternal health services in the study area.
Results : There was poor accessibility through road, poor electricity connection and piped water for the health care centers in the district. Even, existing Primary Health Centres (PHCs) lack ECG and X-Ray machines for proper diagnostic services which jeopardize the catering of health services. Community Health Centres (CHC) lack basic diagnostic and ambulance services making the tribal pockets inaccessible. The tribal dominated Jaleswar block shows poor performance in terms of total registered Antenatal Checkups (ANC) (only 77%). A gradual decrease in the rate of ANC, from first to fourthcheckup, was observed in the district.
Conclusion : Lack of public health infrastructure in general and non-compliance to Indian Public Health Standards (IPHS) in particular, affect the health of tribal women resulting in lack of interest in availing the institutional delivery services and other pertinent maternal health services.
Mitigating disrespect and abuse during childbirth in Tanzania: an exploratory study of the effects of two facility-based interventions in a large public hospital
Authored by H.L. Ratcliffe
Published On: 18th July, 2016
Source : Reproductive Health, Vol. 13:79
Background : There is emerging evidence that disrespect and abuse (D&A) during facility-based childbirth is prevalent in countries throughout the world and a barrier to achieving good maternal health outcomes. However, much work remains in the identification of effective interventions to prevent and eliminate D&A during facility-based childbirth. This paper describes an exploratory study conducted in a large referral hospital in Dar es Salaam, Tanzania that sought to measure D&A, introduce a package of interventions to reduce its incidence, and evaluate their effectiveness.
Methods : After extensive consultation with critical constituencies, two discrete interventions were implemented: (1) Open Birth Days (OBD), a birth preparedness and antenatal care education program, and (2) a workshop for healthcare providers based on the Health Workers for Change curriculum. Each intervention was designed to increase knowledge of patient rights and birth preparedness; increase and improve patient-provider and provider-administrator communication; and improve women’s experience and provider attitudes. The effects of the interventions were assessed using a pre-post design and a range of tools: pre-post questionnaires for OBD participants and pre-post questionnaires for workshop participants; structured interviews with healthcare providers and administrators; structured interviews with women who gave birth at the study facility; and direct observations of patient-provider interactions during labor and delivery.
Results : Comparisons before and after the interventions showed an increase in patient and provider knowledge of user rights across multiple dimensions, as well as women’s knowledge of the labor and delivery process. Women reported feeling better prepared for delivery and provider attitudes towards them improved, with providers reporting higher levels of empathy for the women they serve and better interpersonal relationships. Patients and providers reported improved communication, which direct observations confirmed. Additionally, women reported feeling more empowered and confident during delivery. Provider job satisfaction increased substantially from baseline levels, as did user reports of satisfaction and perceptions of care quality.
Conclusions : Collectively, the outcomes of this study indicate that the tested interventions have the potential to be successful in promoting outcomes that are prerequisite to reducing disrespect and abuse. However, a more rigorous evaluation is needed to determine the full impact of these interventions.
Inter-Regional Disparities with Multi-Dimensional Aspect in India
Authored by P.Ponmuthusaravanan and G.Ravi
Published On: 7th July, 2016
Source : International Journal of scientific research and management, Vol 4(7), 4378-4380.
The study explains the disparities with multi-dimensional aspects in India. Some of its major dimensions include: The level of economic growth, level of education, level of health services, status of women, level of nutrition, etc., the disparities almost exist in all aspects which mentioned above numerous measures have undertaken to reduce the disparities but still it wide in India.
Disparities in economic and social development across the regions and intra-regional disparities among different segments of the society have been the major planks for adopting planning process in India since independence. Apart from massive investments in backwards regions, various public policies directed at encouraging private investments in such regions have been pursued during the first three decades of planned development. The efforts taken to reduce regional disparities were not lacking but the achievements were not often commensurate with these efforts. Considerable level of regional disparities remained at the end of the seventies. The accelerated economic growth since the early eighties appears to have aggravated regional disparities. The on-going economic reforms since 1991 with stabilisation and deregulation policies as their central pieces seem to have further widened the regional disparities. The seriousness of the emerging acute regional imbalance has not yet received the public attention it deserves.
Development is a multi-dimensional phenomenon. Some of its major dimensions include: the level of economic growth, level of education, level of health services, degree of modernization status of women, level of nutrition, quality of housing, distribution of goods and services, and access to communication.
In India, the progress of socio-economic development among major states is not uniform. In India, the states are marked with wide disparity in socio-economic development. The factors, which are found out to be more important for the overall development process, relate to basic needs such as education, availability of food, minimum purchasing power and facilities like safe drinking water, health care infrastructure, etc., to attain true development. The government has to take necessary action to improve elementary education, safe drinking water facilities and health care, and to remove barriers against social minorities, especially women. The role of social development such as education especially promoting female literacy is prerequisite for overall development.
Maternal Health Services in the Tribal Community of Balasore District, Odisha: Challenges and Implications
Authored by Ranjit Kumar Dehury
Published On: 7th July, 2016
Source : BMJ Global Health
Background : Odisha is a ‘high-focus’ state, a category set up in the National Rural Health Mission, as it has high maternal mortality ratio. The state is still far away to achieve the Millennium Development Goal of reducing maternal mortality ratio to 109 by 2015. While tribal population constitutes 22.9% of Odisha’s total population, maternal mortality among tribal women is observed to be significantly high. Failure to adequately promote maternal health services including Janani Surakhya Yojna ( JSY) has accentuated poor maternal health condition in tribal pockets. Since maternal health is largely dependent on the health infrastructure, consorted effort of the service provider, creating scope to integrate indigenous practice with modern medicine and evidence-based decision-making using Health Management Information System is critical. The broad objective of this study is to appraise maternal health services of tribal areas that are remotely situated by using medical as well as non-medical parameters. Specifically, the study makes an assessment of the infrastructural capacity and competence of the frontline health worker, Accredited Social Health Activist (ASHA), for promotion of maternal health. Our study also captured the perceptions and expectations of the local tribal community during childbirth. Further, the study evaluated the Health Management Information System for integral planning and monitoring of maternal health in tribal community for transformation of JSY programme.
Methods : We studied Jaleswar block of Balasore district, which is declared as a Modified Area Development Approach block by the government of India due to its high concentration of tribal population and geographical inaccessibility because of its riverine feature. In order to assess the infrastructural capacity related to maternal health, the study used ‘Parijata tool’ developed by the United Nations Children’s Fund but with modification for regional suitability. The assessment tool covered number of parameters like manpower strength, availability of drugs and consumables and procedure for clinical practices. Additionally a checklist was developed for assessing competency of ASHA and their involvement in promoting maternal health as per national guidelines. Our study has specifically looked into how ASHAs promoted health services in congruence with the tribal culture and empower these marginalized. We analysed data from Health Management Information System from the government of India for the year 2013–2014 and compared to assess the functionality.
Findings : Our study revealed that many public healthcare facilities deviated from the recommended safe medical practices. The district hospital (Balasore) and the community health centre (Hatigarh), which provide basic and referral services in Jaleswar block, do not comply with and fall short of the minimum requirement prescribed by the WHO guidelines. It is felt that the state is attempting to implement maternal health programme uniformly across its territory without considering the cultural specificity of the tribal pockets. This is well visible in the capacity-building curriculum where specific strategies to work in hard-to-reach areas are not addressed. Subsequently, ASHAs fail to reach the pregnant women effectively, disseminate good practices and motivate them for adequate health care. Another illustration of the tailor-made strategy of the state is the way Health Management Information System is designed.
Discussion : In order to comply with national standards, the state has failed to incorporate traditional practices that largely fall outside the recommended scientific procedure. Despite their cultural confirmation and deep indigenous value, they are dismissed as trivial practices. Resultantly, health plans that are based on information generated through Health Management Information System do not incorporate cultural variations. Strategies that follow from health plans are mainly target-driven rather than reinforcing indigenous practices.
Determinants of place of delivery: A comparison between an urban and a rural community in Nigeria
Authored by Shehu C.E. et al.
Published On: June, 2016
Source : Journal of Public Health and Epidemiology, Vol. 8(6), pp. 91-101.
Child-birth is a risk producing event that requires timely and adequate medical intervention for women who experience obstetric complications. The provision of a health worker with midwifery skills at every birth, plus access to emergency hospital obstetric care, is the option to mitigate this risk. However, in sub Saharan Africa, most births take place outside health facilities and without skilled attendants. This study aimed to determine and compare the factors which influence the choice of place of delivery among women in an urban and a rural community in Sokoto. It was a cross-sectional comparative study of 600 randomly selected women of reproductive age, in Sokoto South and Gwadabawa Local Government Areas of Sokoto State, Nigeria using semi-structured interviewer administered questionnaires. The proportion of women who delivered in health facilities was 65.0 and 4.7% in the urban and rural groups, respectively; whereas the proportion that had skilled attendants at delivery was 70 and 4.3% in the urban and rural groups, respectively. Lack of consent from husband, no privacy in health facilities, distance to the health facility and non-availability of delivery wards were the reasons for home deliveries in the rural study group, while the emergency nature of labour was the reason in the urban group. Women residing in rural areas need health promotion interventions in order to meet the International Conference on Population and Development + target of achieving 90% births attended by skilled attendants by 2015.
Barriers and facilitators to health care seeking behaviours in pregnancy in rural communities of southern Mozambique
Background : In countries, such as Mozambique, where maternal mortality remains high, the greatest contribution of mortality comes from the poor and vulnerable communities, who frequently reside in remote and rural areas with limited access to health care services. This study aimed to understand women’s health care seeking practices during pregnancy, taking into account the underlying social, cultural and structural barriers to accessing timely appropriate care in Maputo and Gaza Provinces, southern Mozambique.
Methods : This ethnographic study collected data through in-depth interviews and focus group discussions with women of reproductive age, including pregnant women, as well as household-level decision makers (partners, mothers and mothers-in-law), traditional healers, matrons, and primary health care providers. Data was analysed thematically using NVivo 10.
Results : Antenatal care was sought at the heath facility for the purpose of opening the antenatal record. Women without antenatal cards feared mistreatment during labour. Antenatal care was also sought to resolve discomforts, such as headaches, flu-like symptoms, body pain and backache. However, partners and husbands considered lower abdominal pain as the only symptom requiring care and discouraged women from revealing their pregnancy early in gestation. Health care providers for pregnant women often included those at the health facility, matrons, elders, traditional birth attendants, and community health workers. Although seeking care from traditional healers was discouraged during the antenatal period, they did provide services during pregnancy and after delivery. Besides household-level decision-makers, matrons, community health workers, and neighbours were key actors in the referral of pregnant women. The decision-making process may be delayed and particularly complex if an emergency occurs in their absence. Limited access to transport and money makes the decision-making process to seek care at the health facility even more complex.
Conclusions : Women do seek antenatal care at health facilities, despite the presence of other health care providers in the community. There are important factors that prevent timely care-seeking for obstetric emergencies and delivery. Unfamiliarity with warning signs, especially among partners, discouragement from revealing pregnancy early in gestation, complex and untimely decision-making processes, fear of mistreatment by health-care providers, lack of transport and financial constraints were the most commonly cited barriers. Women of reproductive age would benefit from community saving schemes for transport and medication, which in turn would improve their birth preparedness and emergency readiness; in addition, pregnancy follow-up should include key family members, and community-based health care providers should encourage prompt referrals to health facilities, when appropriate.
Community perceptions of pre-eclampsia in rural Karnataka State, India: a qualitative study
Background : Maternal deaths have been attributed in large part to delays in recognition of illness, timely transport to facility, and timely treatment once there. As community perceptions of pregnancy and their complications are critical to averting maternal morbidity and mortality, this study sought to contribute to the literature and explore community-based understandings of pre-eclampsia and eclampsia.
Methods : The study was conducted in rural Karnataka State, India, in 2012–2013. Fourteen focus groups were held with the following community stakeholders: three with community leaders (n = 27), two with male decision-makers (n = 19), three with female decision-makers (n = 41), and six with reproductive age women (n = 132). Focus groups were facilitated by local researchers with clinical and research expertise. Discussions were audio-recorded, transcribed verbatim and translated to English for thematic analysis using NVivo 10.
Results : Terminology exists in the local language (Kannada) to describe convulsions and hypertension, but there were no terms that are specific to pregnancy. Community participants perceived stress, tension and poor diet to be precipitants of hypertension in pregnancy. Seizures in pregnancy were thought to be brought on by anaemia, poor medical adherence, lack of tetanus toxoid immunization, and exposure in pregnancy to fire or water. Sweating, fatigue, dizziness-unsteadiness, swelling, and irritability were perceived to be signs of hypertension, which was recognized to have the potential to lead to eclampsia or death. Home remedies, such as providing the smell of onion, placing an iron object in the hands, or squeezing the fingers and toes, were all used regularly to treat seizures prior to accessing facility-based care although transport is not delayed.
Conclusions : It is evident that ‘pre-eclampsia’ and ‘eclampsia’ are not well-known; instead hypertension and seizures are perceived as conditions that may occur during or outside pregnancy. Improving community knowledge about, and modifying attitudes towards, hypertension in pregnancy and its complications (including eclampsia) has the potential to address community-based delays in disease recognition and delays in treatment that contribute to maternal and perinatal morbidity and mortality. Advocacy and educational initiatives should be designed to target knowledge gaps and potentially harmful practices, and respond to cultural understandings of disease.
Improved measurement for mothers, newborns and children in the era of the Sustainable Development Goals
Authored by Tanya Marchant
Published On: June 2016
Source : Journal of Global Health, Vol. 6(1)
Background : An urgent priority in maternal, newborn and child health is to accelerate the scale–up of cost–effective essential interventions, especially during labor, the immediate postnatal period and for the treatment of serious infectious diseases and acute malnutrition. Tracking intervention coverage is a key activity to support scale– up and in this paper we examine priorities in coverage measurement, distinguishing between essential interventions that can be measured now and those that require methodological development.
Methods : We conceptualized a typology of indicators related to intervention coverage that distinguishes access to care from receipt of an intervention by the population in need. We then built on documented evidence on coverage measurement to determine the status of indicators for essential interventions and to identify areas for development.
Results : Contact indicators from pregnancy to childhood were identified as current indicators for immediate use, but indicators reflecting the quality of care provided during these contacts need development. At each contact point, some essential interventions can be measured now, but the need for development of indicators predominates around interventions at the time of birth and interventions to treat infections. Addressing this need requires improvements in routine facility based data capture, methods for linking provider and community–based data, and improved guidance for effective coverage measurement that reflects the provision of high–quality care.
Conclusions : Coverage indicators for some essential interventions can be measured accurately through household surveys and be used to track progress in maternal, newborn and child health. Other essential interventions currently rely on contact indicators as proxies for coverage but urgent attention is needed to identify new measurement approaches that directly and reliably measure their effective coverage.
Early Initiation of Breastfeeding: A systematic literature review of factors and barriers in South Asia
Authored by Indu K. Sharma * and Abbey Byrne
Published On: 18th June, 2016
Source : International Breastfeeding Journal
Background : Early or timely initiation of breastfeeding is crucial in preventing newborn deaths and influences childhood nutrition however remains low in South Asia and the factors and barriers warrant greater consideration for improved action. This review synthesises the evidence on factors and barriers to initiation of breastfeeding within 1 h of birth in South Asia encompassing Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka.
Methods : Studies published between 1990 and 2013 were systematically reviewed through identification in Academic Search Complete, CINAHL, Global Health, MEDLINE and Scopus databases. Twenty-five studies meeting inclusion criteria were included for review. Structured thematic analysis based on leading frameworks was undertaken to understand factors and barriers.
Results : Factors at geographical, socioeconomic, individual, and health-specific levels, such as residence, education, occupation, income, mother’s age and newborn’s gender, and ill health of mother and newborn at delivery, affect early or timely breastfeeding initiation in South Asia. Reported barriers impact through influence on acceptability by traditional feeding practices, priests’ advice, prelacteal feeding and discarding colostrum, mother-in-law’s opinion; availability and accessibility through lack of information, low access to media and health services, and misperception, support and milk insufficiency, involvement of mothers in decision making.
Conclusions : Whilst some barriers manifest similarly across the region some factors are context-specific thus tailored interventions are imperative. Initiatives halting factors and directed towards contextual barriers are required for greater impact on newborn survival and improved nutrition in the South Asia region.
Reaching Nepal’s mothers in time
Published On: 5th May, 2016
Source : Bulletin of World Health Organisation, Vol. 94, pp. 318-319
Women’s chances of survival during pregnancy and childbirth have greatly improved in Nepal. Sophie Cousins reports.
Standing at a community health post and looking around the valley, Laxmi Tamang, a nurse and public health expert from the Midwifery Society of Nepal, points to the other side of the mountain. “See that, all the way over there? That’s all the same district. If a woman is in labour, how on earth will she get here?” The Midwifery Society of Nepal is running an outreach health camp in Nuwakot, 75 km from Nepal’s capital of Kathmandu, after much of the district’s infrastructure was damaged by the April 25 earthquake last year. But for expectant mothers living in remote parts of the district – where there are few if any roads – accessing this midwifery care, especially in emergencies, is difficult – if not impossible.
Timing of initiation, patterns of breastfeeding, and infant survival: prospective analysis of pooled data from three randomised trials
Authored by NEOVITA Study Group
Published On: 4th April, 2016
Source : Lancet Global Health, 4(4):e266-75. doi: 10.1016/S2214-109X(16)00040-1
Background : Although the benefi ts of exclusive breastfeeding for child health and survival, particularly in the post-neonatal period, are established, the independent benefi cial eff ect of early breastfeeding initiation remains unclear. We studied the association between timing of breastfeeding initiation and post-enrolment neonatal and post- neonatal mortality up to 6 months of age, as well as the associations between breastfeeding pattern and mortality.
Methods : We examined associations between timing of breastfeeding initiation, post-enrolment neonatal mortality (enrolment 28 days), and post-neonatal mortality up to 6 months of age (29–180 days) in a large cohort from three neonatal vitamin A trials in Ghana, India, and Tanzania. Newborn babies were eligible for these trials if their mother reported that they were likely to stay in the study area for the next 6 months, they could feed orally, were aged less than 3 days, and the primary caregiver gave informed consent. We excluded infants who initiated breastfeeding after 96 h, did not initiate, or had missing initiation status. We pooled the data from both randomised groups of the three trials and then categorised time of breastfeeding initiation as: at ≤1 h, 2–23 h, and 24–96 h. We defi ned breastfeeding patterns as exclusive, predominant, or partial breastfeeding at 4 days, 1 month, and 3 months of age. We estimated relative risks using log binomial regression and Poisson regression with robust variances. Multivariate models controlled for site and potential confounders.
Findings : Of 99 938 enrolled infants, 99 632 babies initiated breastfeeding by 96 h of age and were included in our prospective cohort. 56 981 (57•2%) initiated breastfeeding at ≤1 h, 38 043 (38•2%) at 2–23 h, and 4608 (4•6%) at 24–96 h. Compared with infants initiating breastfeeding within the fi rst hour of life, neonatal mortality between enrolment and 28 days was higher in infants initiating at 2–23 h (adjusted relative risk 1•41 [95% CI 1•24–1•62], p<0•0001), and in those initiating at 24–96 h (1•79 [1•39–2•30], p<0•0001). These associations were similar when deaths in the fi rst 4 days of life were excluded (1•32 [1•10–1•58], p=0•003, for breastfeeding initiation at 2–23 h, and 1•90 [1•38–2•62], p=0•0001, for initiation at 24–96 h). When data were stratifi ed by exclusive breastfeeding status at 4 days of age (p value for interaction=0•690), these associations were also similar in magnitude but with wider confidence intervals for initiation at 2–23 h (1•41 [1•12–1•77], p=0•003) and for initiation at 24–96 h (1•51 [0•63–3•65], p=0•357). Exclusive breastfeeding was also associated with the lower mortality during the first 6 months of life (1–3 months mortality: exclusive vs partial breastfeeding at 1 month 1•83 [1•45–2•32], p<0•0001, and exclusive breastfeeding vs no breastfeeding at 1 month 10•88 [8•27–14•31], p<0•0001).
Interpretation : Our findings suggest that early initiation of breastfeeding reduces neonatal and early infant mortality both through increasing rates of exclusive breastfeeding and by additional mechanisms. Both practices should be promoted by public health programmes and should be used in models to estimate lives saved.
Effectiveness of virtual classroom training in improving the knowledge and key maternal neonatal health skills of general nurse midwifery students in Bihar, India: A pre- and post-intervention study
Background : In 2008–09, the National Health Systems Resource Center of India reported overall quality of nursemidwifery education in Bihar as grossly sub-optimal. To address this, we implemented a competency-based training using virtual classrooms in two general nurse midwives (GNM) schools of Bihar. The students from remotely located nursing institutions were now able to see live demonstrations of maternal and newborn health (MNH) practices performed by a trained faculty on simulation models at instructor location.
Objective : To evaluate the effectiveness of virtual classroom training in improving the MNH-related skills of the nursing-midwifery students in Bihar, India. Design: This study used a pre- and post-intervention design without a control group. Settings: Students from two public GNM schools of Bihar.
Participants : Final-year students from both the GNM schools who have completed their coursework in MNH. Method: A total of 83 students from selected GNM schools were assessed for their competencies in six key MNH practices using objective structured clinical examination method prior to intervention. A 72 hour standardized training package was then implemented in these schools through virtual classroom approach. Post-intervention, 92 students from the next batch who attended virtual training were assessed for the same competencies.
Results : The mean student score assessed before the intervention was 21.3 (95% CI, 19.9–22.6), which increased to 62.0 (95% CI, 60.3–63.7) post-intervention. This difference was statistically significant. When adjusted for clustering using linear regression analysis, the students in post-intervention scored 52.3 (95% CI, 49.4%–55.3%) percentage points higher than pre-intervention, and this was statistically significant. Conclusion: Virtual classroom training was found to be effective in improving knowledge and key MNH skills of GNM students in Bihar, India.
Human Resources for Health in India: An Overview
Author: K.S. Nair
Published On: May, 2015
Source : International Journal of Health Sciences and Research, Vol. 5(5)
This research article further explains the dearth of human resource in health sector in India.
India faces an acute shortage of human resources for health (HRH). The shortage is so severe in rural areas and major challenges remain in bringing qualified human resources to rural, remote and underserved areas. Despite the implementation of National Rural Health Mission (NRHM), the absence of inadequate trained HRH in both public and private sectors remain a major concern. Apart from taking efforts to increase numerical availability of human resources in rural areas, it is imminent to strengthen competencies of these workers at all levels through specialized courses and setting up of specialized training institutions at state levels to continuously improve the capacity of HRH engaged in provision of basic health services. In order to encourage qualified human resources to work in rural, remote and underserved areas, appropriate packages of monetary and non-monetary incentives, reservation for PG seats, career progression, scheduled transfers, avenues for promotion should be instituted. Most importantly, emphasis should be given on recruiting candidates from the rural, remote and underserved areas and training them on necessary skills adjacent to their places enabling them to work in these areas. Reserving medical seats for candidates from these areas to enabling them to work in these areas would also be beneficial.
Sexual rights as human rights: a guide to authoritative sources and principles for applying human rights to sexuality and sexual health
Authored by Alice M. Miller, Eszter Kismödi, Jane Cottingham, Sofia Gruskin.
source:Reproductive Health Matters 2015;23(46):16–30.Doi: 10.1016/j.rhm.2015.11.007
Abstract : This Guide seeks to provide insight and resources to actors interested in the development of rights claims around sexuality and sexual health. After engaging with the vexed question of the scope of sexual rights, it explores the rules and principles governing the way in which human rights claims are developed and applied to sexuality and sexual health, and how that development is linked to law and made a matter of state obligation. This understanding is critical to policy and programming in sexual health and rights, as it supports calling on the relevant range of human rights, such as privacy, non-discrimination, health or other universally accepted human rights, as well as demanding the action of states under their international and national law obligations to support sexual health.
Janani Suraksha Yojana pays dividends: Study
Published On : 10th October, 2016
Source : The Hindu
A new study brings in first conclusive evidence of the role played by Janani Suraksha Yojana (JSY) in reducing ‘socioeconomic disparities’ existing in maternal care.
The JSY was launched in 2005 as part of the National Rural Health Mission (NRHM) to improve maternal and neonatal health by promotion of institutional deliveries (childbirth in hospitals).
According to a working paper by Ruchi Jain (NCAER), Sonalde Desai (NCAER, University of Maryland) and Reeve Vanneman (University of Maryland), “JSY has led to an enhancement in the utilisation of health services among all groups especially among the poorer and underserved sections in the rural areas, thereby reducing the prevalent disparities in maternal care.”
While previous studies had shown the impact of JSY in reducing maternal mortality, it was not known if it had reduced socioeconomic inequalities — differences in access to maternal care between individual people of higher or lower socioeconomic status.
The study was conducted using data from two rounds of the India Human Development Survey (IHDS) — conducted in 2004-05 and 2011-12. The IHDS data serves two advantages in this case. First, round 1 of IHDS was conducted in 2004-05 when the JSY was not in place and round two was conducted six years after the launch, providing a before-after scenario for comparison. Secondly, the IHDS is a longitudinal data set — same households were interviewed in both rounds, which allows to examine changes in maternal care patterns.
How Good Are Our Current Measures for Maternal Health Care Quality?
Published On : 5th October, 2016
Source : Maternal Health task Force Blog
The public health community has emphasized the importance of quality of maternal health care, noting that increasing access to care alone is not sufficient for improving maternal health outcomes. Many of the maternal health quality of care indicators currently used around the world have not yet been validated, which means that we may not be measuring what really matters. Researchers have demonstrated a lack of correlation between quality measures and maternal mortality. The challenge is how to capture the quality of maternal health care in diverse settings across the globe: What factors are important, and how can those factors be measured accurately? In an effort to answer that question, the Maternal Health Task Force (MHTF) partnered with colleagues at the Population Council to evaluate current measures of maternal health care quality.
A research team led by Ann Blanc examined the validity of common quality measures—particularly the skilled birth attendant (SBA) indicator—in Kenya and Mexico. The researchers compared women’s self-reports with those of trained, third party observers for numerous indicators including the health care provider’s skill level and actions, finding that the women’s and observers’ reports were incongruent for many of these indicators. For example, in Kenya, 78.9% of the women surveyed reported that the baby was placed immediately skin-to-skin after delivery, but only 16.3% of the third party observers reported that skin-to-skin contact was performed. Similarly, while 59.1% of the women surveyed reported receiving a uterotonic after delivering the placenta, only 2.4% of the observers reported that a uterotonic was administered. Reports were inconsistent in Mexico as well: 94.1% of the women surveyed reported receiving a uterotonic immediately after delivering the placenta, but only 20% of third party observers reported that a uterotonic was administered.
Effective Antenatal Interventions to Prevent Maternal and Newborn Mortality
Author : Sarah Hodin
Published On : 6th September, 2016
Source : Maternal health Task Force Blog
Compared to intrapartum care, antenatal care (ANC) has been largely neglected as an opportunity for intervention despite its potential to greatly impact the health of mothers and newborns. For many women around the world, particularly in low- and middle-income countries, ANC is their first adult contact with the formal health care system. ANC coverage has expanded over the last fifteen years: the proportion of women in developing countries receiving at least one ANC visit increased from 64% in 1990 to 83% in 2014. While this increase in utilization is a step in the right direction, content and quality of ANC are equally important factors.
A recent study published in PLOS One reviews the current state of evidence on a number of antenatal interventions designed to reduce adverse maternal and newborn health outcomes. The authors analyze 21 types of interventions that fall into three categories: nutrition, infection and obstetrical/other. Key findings from the review and areas needing further research are summarized below.
India Short Of 5 Lakh Doctors, 1674 People Dependent On 1 Doctor, Worse Than Algeria, Vietnam And Pakistan
Published On : 5th September, 2016
Source : The Logical Indian
Reports from Orissa and Kanpur of a woman and a boy being carried by their relatives on their shoulders after they were denied medical care shook the entire nation. As we hang our heads in shame, we must also look at why such tragic situations occurred in the first place. It is not hidden that public healthcare in India is in a really bad shape. But a report tabled in Rajya Sabha early this year provides statistical evidence for this. As per its analysis by the website IndiaSpend, the country is short of as much as 5,00,000 doctors. This means that it needs 67% more doctors than what it has in order to provide sufficient healthcare to everyone.
India is 35 tanker-trucks short of the blood it requires for medical procedures, yet some areas of the country wasted blood because there was too much of it, according to an IndiaSpend analysis of government data. The shortage was estimated at 1.1 million units — as blood is measured, with a unit being either 350 ml or 450 ml — in 2015-16, Minister for Health and Family Welfare J.P. Nadda told the Lok Sabha in July 2016. We converted these data into tankers, assuming a standard tanker-truck of 11,000 lt and a 350 ml unit.
In percentage terms, India is 9 per cent short of its needs — the shortage reducing from 17 per cent in 2013-2014.
The 9 per cent national shortfall hides local shortages and oversupply.
Bihar is 84 per cent short of its blood requirements, more than any other state, followed by Chhattisgarh (66 per cent) and Arunachal Pradesh (64 per cent). Chandigarh had almost nine times the blood it needed, Delhi three times, Dadra and Nagar Haveli, Mizoram, and Pondicherry twice, according to government data.
Another Odisha man forced to carry daughters body for 6 km after ambulance dropped them midway
Published On : 2nd September, 2016
Source : India TV
A man had to walk six km with daughter's body after the ambulance allegedly dropped them midway after getting to know that the girl had died while going to the hospital.
In a near rerun of the Dana Majhi incident in Kalahandi in Odisha , a man again was forced to walk 6 km carrying his seven-year-old daughters body today as the ambulance transporting them allegedly left them midway.
The ambulance driver had allegedly asked the girls parents to get down after coming to know that the girl has died on the way to Malkangiri district hospital.
Mother Delivers Baby In Auto-Rickshaw As Janani Express Fails To Arrive, Baby Slips From Auto, Dies
Published On : 29th August, 2016
Source : Ommcom News
Nabrangpur : Witnessing the rotting and crumbling health infrastructure of Odisha, an expectant mother delivered her baby in an auto- rickshaw few kilometers away from the hospital, and the baby died after taking birth falling from the auto-rickshaw.
The mother, Jamuna Bhatra of Chalanguda village, Umerkote block in Nabrangpur district was experiencing labour pain from early in the morning. Her husband, Madhu Bhatra had called the ‘Janani Express’, a novel transport system for carrying expectant mothers to the nearby health institutions.
Dead bodies hauled over shoulders, corpses desecrated: India is no country to die in
Published On : 26th August, 2016
Source : India Today
Three incidents in two days from the states of Odisha and Madhya Pradesh show how despite India emerging as a superpower, a basic dignity of death is being denied to the common man
India is a nuclear power, an IT superpower and an economic giant in global trade. However, 69 years after Independence, a basic dignity of death seems to still be eluding many people.
Three incidents in two days show how the system has failed the common man even in death.
The first report came from Kalahandi in Odisha, where a tribal man, Dana Manjhi had to carry the body of his wife, Amangadei for 12 kilometres after not being able to get any government help.
District hospital authorities allegedly refused to arrange a vehicle for him and he did not have money to hire a hearse. Manjhi wrapped his wife's body in old bed sheets and started walking towards his home, some 60 kilometres away. His teenage daughter was seen sobbing along the way.
He had walked with his wife's body for 12 kilometres, before some youths alerted local officials, who arranged an ambulance.
More and more women are now dying in childbirth, but only in America
Author : Sarah Frostenson
Published On : 8th August, 2016
Source : Vox: Science and Health
More women are dying in childbirth in the US than in any other developed country. And experts say the problem is likely to keep getting worse.
You can see how alarming the issue is in this chart. In other countries, maternal death rates have fallen sharply since 1990. In South Korea, the rate of women dying in childbirth fell from 20.7 deaths per 100,000 live births in 1990 to 12 today. In Germany, it dropped from 18 to 6.5.
But in the United States, the opposite is happening. The rate of women dying in childbirth is going up.
The Current State of Pre-eclampsia/Eclampsia Prevention and Treatment
Author : Sharif Mohammed Ismail Hossain
Published On : 5th August, 2016
Source : Maternal Health Task Force Blog
The global impact of pre-eclampsia/eclampsia
In Kenya and Nigeria, hypertensive disorders such as pre-eclampsia/eclampsia are the leading cause of pregnancy-related deaths. In Bangladesh, Pakistan and Ethiopia, hypertensive disorders are among the top three causes. But despite the high fatality rate, deaths from pre-eclampsia/eclampsia are entirely preventable. Early detection, diagnosis and treatment are crucial for preventing mortality due to pre-eclampsia/eclampsia.
Pre-eclampsia is characterized by elevated blood pressure and increased protein in the urine after 20 weeks of pregnancy. A woman with pre-eclampsia can suffer from blurred vision, severe headaches and edema, and if her pre-eclampsia goes untreated, she has an increased risk of developing eclampsia, which can cause life-threatening seizures. Pre-eclampsia/eclampsia is also a risk factor for preterm and stillborn births, maternal kidney and liver problems and pre-eclampsia/eclampsia in future pregnancies.
Celebrating World Breastfeeding Week: The Role of Breastfeeding in Achieving the SDGs
Author : Sarah Hodin and Harvard T.H.
Published On : 2nd August, 2016
Source : Maternal Health Task Force
During this year’s World Breastfeeding Week, we reflect on the crucial role of breastfeeding in pursuing the Sustainable Development Goals (SDGs). The World Health Organization (WHO)recommends that infants be exclusively breastfed for at least the first six months and continue breastfeeding for two years. The WHO aims to increase global exclusive breastfeeding rates to at least 50% by the year 2025. Currently, only 38% of infants around the world are breastfed exclusively, which contributes to approximately 800,000 infant deaths annually. Breastfed infants are at least six times more likely to survive in the first few months of life compared to non-breastfed infants. Breast milk helps prevent respiratory infections, diarrhoeal disease, urinary tract infections, obesity, asthma, diabetes and other life-threatening conditions in children. Furthermore, research suggests that breastfeeding protects mothers against breast and ovarian cancer, reduced bone density and possibly postpartum hemorrhage. Promoting exclusive breastfeeding is particularly important in low-resource settings where maternal and infant mortality and morbidity rates are high.
More than half of newborns not breastfed in first hour raising health risks – UNICEF
Author : Ellen Wulfhorst
Published On : 29th July, 2016
Source : Thompson Reuters Foundation News
"Breast milk is a baby's first vaccine, the first and best protection they have against illness and disease" - U.N. children's agency
More than half of newborn babies are not breastfed within the first hour of life, putting them at heightened risk of disease and death, the United Nations' children's agency said on Friday, highlighting sub-Saharan Africa as an area of concern. Feeding babies within an hour of birth passes on critical nutrients, antibodies and skin contact with their mothers that can protect them, UNICEF said.
Delaying breastfeeding by two to 23 hours after birth increases the risk of a baby dying in its first month by 40 percent and delaying by 24 hours or more increases the risk of death to 80 percent, UNICEF said.
Woman Delivers Child On Hospital Porch In Madhya Pradesh; Probe Ordered
Published On : 17th July, 2016
Source : NDTV
KATNI, MADHYA PRADESH: A 23-year-old tribal woman gave birth to a child on the porch of the district hospital in Madhya Pradesh's Katni as she was allegedly not given medical attention on time, prompting the authorities to order a probe into the incident.
Rama Singh, wife of Ravendra, a resident of Kalwara Fathak area in Katni, gave birth to the child on the porch at around 1 pm on July 15, according to eyewitnesses. A hospital official also confirmed the incident.
The doctors at the government-run medical facility were in a meeting at that time.
From barely regulated marketing to a lack of healthcare services, there are many factors that make it difficult for mothers in developing countries to breastfeed their babies. The solution, say experts, requires more than just saying “breast is best.”
Around the world, medical professionals recommend breastfeeding babies exclusively for their first six months. But despite the overwhelming evidence of its benefits, breastfeeding is not the norm. Globally, nearly two out of three infants are not exclusively breastfed for the recommended six months – a rate that has remained steady for the past two decades.
According to UNICEF, breastfeeding has “profound impact on a child’s survival, health, nutrition and development.” Research shows that breast milk provides all of the nutrients, vitamins and minerals an infant needs in its first six months. The act of breastfeeding has been shown to stimulate the proper growth of a baby’s mouth and jaw and, later in life, can have a positive effect on behavior and speech, as well as lower the risk of chronic conditions such as obesity, high blood pressure and childhood leukemia. A series in the Lancet suggested that the deaths of 823,000 children and 20,000 mothers each year could be averted through universal breastfeeding.
In a Landmark Judgement, SC Allows Abortion for 24-Week Abnormal Pregnancy
Author : Gayatri Manu
Published On : 26th July, 2016
Source : The Better India
The Supreme Court granted a 24-week pregnant woman and rape survivor the permission to go for an abortion in a landmark judgment on Thursday. The judgment questioned the constitutional validity of the Medical Termination of Pregnancy (MTP) Act 1971, which currently allows abortion only up to the 20th week.
A bench headed by Justice J.S. Khehar said: “In view of the clear findings of the medical board whose examination showed that contained pregnancy could endanger the petitioner’s life, we are satisfied that it may be permissible to terminate pregnancy.”
Putting more money into family planning programs in the developing world makes populations healthier and boosts national stability, writes John Bongaarts, vice president of the Population Council.
Let’s consider the difference between deciding you want two children and deciding you want two TV sets. Both involve figuring costs and benefits relative to income. Both require supplies and expense. Both invoke comments from friends and relatives, and both may preclude something else – nights out, perhaps, or a bicycle or a car.
Many economists would say these are choices people make. But that assumes the couple that chooses to have two children can access, purchase and effectively use modern contraceptives. With this line of argument, we would not need programs to promote family planning. Because unwanted pregnancies would be as rare as unwanted TV sets.
Menstrual Regulation in Bangladesh: is the law effective enough?
Author : Anika
Published On : 14th July, 2016
Source : Asia Safe Abortion Partnership Blog
Meena, a 17-year-old girl went to a traditional birth attendant to terminate her unwanted pregnancy. The attendant inserted a tree branch into her uterus. This caused severe pain and heavy bleeding. Although the pregnancy was terminated, when in later years she tried to get pregnant, she was told that the unsafe abortion method had damaged her uterus. Like her, every year, around 572,000 women suffer from unsafe abortion in Bangladesh (research data from the Guttmacher Institute).
Deficiencies in quality of care result from knowledge gaps or the inability to change.
‘Bengal doctor beaten up’, ‘Hospital ransacked by angry relatives’, ‘AIIMS doctor assaulted by patient’s relative, FIR filed’… over the last many years such events continue to make frequent headlines. The quality of care in health remains among the promises yet to be achieved.
The overwhelming focus on quantity of health care in India has long ignored a massive problem with the quality of health care that is delivered both through public as well as private institutions. However, it is in the last three years that there has been a lot of interest in the quality of health services in the country. This is an interesting development and long due, however the reasons behind this have not been well understood. Why has quality suddenly started occupying centre stage in the delivery of health-care services today? One reason is that private health care has suddenly exploded in the country in many forms, including the entry of corporate entities. The other reasons could be heightened expectations from new governments and easy access to health information.
Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) – Free Health Checkup for Pregnant Women
Published On : 26th June, 2016
Source : Sarkari Yojana
Pradhan Mantri Surakshit Matritva Abhiyan or Yojana is a new initiative of the Narendra Modi Government launched on June 9, 2016. The scheme has been launched with the objective of boosting the health care facilities for the pregnant women, especially the poor.
Under the Pradhan Mantri Surakshit Matritva Abhiyan, the pregnant ladies will be given free health check-up and required treatment for free on 9th of every month. The scheme will be applicable for pregnant women to avail in all Government hospitals across the country.
Accountability for RMNCAH in India: The Critical Role of Civil Society
Authors: Poonam Muttreja and Nejla Liias
Published On: 21st June, 2016
Source: Maternal Health Task Force Blog
With the 2015 launch of the Sustainable Development Goals (SDGs), the Global Strategy for Women’s, Children’s, and Adolescents’ Health, and the Global Financing Facility (GFF), the world is poised to improve the survival, health, and wellbeing of women, children, and adolescents. In particular, making progress in India is crucial because it bears so much of the world’s burden of mortality and morbidity. In 2015, India accounted for an estimated 15% (45,000) of all maternal deaths (303,000) worldwide. Indeed, India’s own reproductive, maternal, newborn, child, and adolescent health (RMNCH+A) strategic approach, launched in 2013, directs states to address the major causes of mortality and issues of access to care across the full continuum of care, with a special focus on reaching the most vulnerable.
Natural Births: Bringing Back the Midwife
Birthing centres like BirthVillage in Kochi are part of a growing trend
Authors: Preeti Zachariah
Published On: 12th June, 2016
Source: Mint on Sunday, Big Story.
Dusk-tinted light filters in through the reed curtains covering the large windows of the birthing room. It casts long shadows on a large king-sized bed covered with a bright cotton bedspread. Multicoloured cushions are scattered across it and a small, ornate lamp on the adjacent table lends a warm glow to the wood-panelled walls of the room, giving it a homely, comforting aura.
At the foot of the bed is a sturdy birthing stool. The crescent shaped seat with its hollow centre lets you give birth while upright. A rope of knotted batik fabric slithers down from a hook affixed on the ceiling and performs a similar function.
“Lying down on a bed with your legs in stirrups is the most commonly perceived position while giving birth,” says Priyanka Idicula, co-founder and director at the BirthVillage in Vytilla, Kochi, and a certified professional midwife. “BirthVillage utilizes gravity (squatting/standing) to help babies get into an optimal position to descend and come out.”
A Fresh Look at the Adequacy of Antenatal Health Care
Authors: Jacquelyn Caglia
Published On: 10th June, 2016
Source: Maternal Health Task Force Blog
High quality care during pregnancy is a critical part of the continuum of reproductive, maternal, newborn and child health care. Antenatal care (ANC) provides an opportunity to promote healthy behaviors during pregnancy, identify and treat health problems, and raise awareness of danger signs that may arise throughout pregnancy. Most efforts to measure the effectiveness of ANC, however, are limited by only tracking the number of visits a woman has during pregnancy, without incorporating key measures of the quality of that care or the content of the visits.
Heredia-Pi and colleagues published a study in this month’s Bulletin of the World Health Organization in which they propose a new way to look at antenatal care. The authors note that historically, studies have analyzed antenatal care indicators – such as timeliness, sufficiency, and adequacy – independently, which may result in high average levels that do not convey an accurate depiction of care. To better measure the adequacy and continuity of antenatal care, the authors propose a comprehensive approach that incorporates several dimensions of the health care process.
Babies born late-term may get a brain boost, a new study finds.
"Our hope is that this research will enrich conversations between ob-gyns and expectant parents about the ideal time to have the baby," said study lead author David Figlio. He's an economist and director of Northwestern University's Institute for Policy Research, in Evanston, Ill.
For the study, researchers analyzed birth and education records for 1.4 million elementary and middle school children in Florida.
Study: Restrictive laws do not curb number of abortions
Published On: May, 2016
Source: DW Made for Minds
Researchers have found that abortion rates in rich countries are at an all-time low, but remained steady for developing countries. The study highlighted the urgent need for wider access to modern contraceptive methods.
The rate of abortions has dropped since 1990 in developed nations, scientists announced on Thursday in the first analysis of global abortion trends since 2008. Researchers found that per 1,000 women of childbearing age in developed countries, the rate of abortions dropped from 46 to 27 between 1990 and 2014.
Tracking Perioperative Mortality: Lessons Learned From the Maternal Mortality Ratio
Authors: Kayla McGowan and Harvard T.H. Chan
Published On: 31st May, 2016
Source: Maternal Health Task Force Blog
As the global health community works towards the Sustainable Development Goals target of achieving universal health coverage by 2030, we must consider disparities in access to essential health care, including sexual and reproductive health, maternal health, and surgical care. The Lancet Commission on Global Surgery currently estimates that 5 billion people lack safe and affordable surgical and anesthesia care when needed.
To assess this inequity, the Commission seeks to refine the perioperative mortality ratio (POMR), an indicator that measures the number of all-cause deaths before discharge in patients who have undergone a surgical procedure. A recent commentary published in The Lancet Global Health, co-authored by Ana Langer, Director of the Women and Health Initiative at Harvard T.H. Chan School of Public Health and the Maternal Health Task Force, explores what policymakers who are working on improving the POMR can learn from the established maternal mortality ratio (MMR). The authors note that historical problems with the MMR — such as underreported and misclassified maternal deaths, inconsistent data sources, and varying definitions — provide insight into developing a valid tool for measuring perioperative mortality.
Women Delivering Babies at Home With No One Present Is Unacceptable
Authors: Bolaji Fapohunda, Nosa Orobaton, and Anne Austin
Published On: 26th May, 2016
Source: Maternal Health Task Force
Experts at the international public health organization, John Snow, Inc., have recently published a series of research articles exploring why and where women deliver with no one present (NOP). Per these studies, the phenomenon of giving birth with NOPis concentrated in regions of the world with the worst maternal and newborn indicators, such as Nigeria, Niger, India, Tanzania, Kenya, Uganda and Ethiopia. The studies demonstrate that delivering with NOP brings untold suffering to women and children, including permanent disability and maternal and newborn deaths.
Nurse-Identified Barriers To Providing Newborn Care In India: How Do They Fit With The Sustainable Development Goals?
Authors: Dr. Marsha Campbell-Yeo
Published On: 22nd May, 2016
Source: Healthy Newborn Network
Relative and absolute poverty continues to be a prevalent issue around the world that impacts all aspects of people’s lives. Receiving adequate health care, specifically in the neonatal period, is highly important due to the vulnerabilities that exists around complications during and after birth. However, there are many barriers to receiving such care, particularly for those in resource-poor countries where almost 99% of cases of neonatal mortality occur.
Abortion rates drop in more developed regions but fail to improve in developing regions
Published On: 12th May, 2016
Source: World Health Organisation
New estimates, published today in the Lancet, indicate that the induced abortion rate has declined significantly in more developed countries between 1990 and 2014, but not in developing countries.
A new study, undertaken by the Guttmacher Institute and WHO, has estimated that, worldwide, during the period 2010-2014, there were 35 abortions per 1000 women aged 15-44. This translates to over 56 million abortions per year.
Standards for Improving Maternal and Newborn Care in Health Facilities
Published in : 2016
Source : World Health Organisation
The Sustainable Development Goals have set ambitious health-related targets for mothers, newborns, children under the umbrella of Universal Health Coverage by 2030. Addressing quality of care will be fundamental in reducing maternal and newborn mortality and achieving the health-related SDG targets. For mothers and newborns, the period around childbirth is the most critical for saving the maximum number of lives and preventing stillbirths. In this context, WHO has elaborated a global vision where ‘every pregnant woman and newborn receives quality care throughout pregnancy, childbirth and the postnatal period’ under the umbrella of Universal Health Coverage and quality.’ This vision is in alignment with two complementary global action agendas conceptualised by WHO and partners, namely Strategies toward Ending Preventable Maternal Mortality (EPMM)' and the ‘Every Newborn Action Plan (ENAP)’.
To realize this vision, a “framework” for improving the quality of care for mothers and newborns around the time of childbirth encompassing both the provision and experience of care has been developed. The framework contains eight domains of quality of care that should be assessed, improved and monitored within the context of the health system building blocks. Within this framework and in line with the Organization’s mandate, six strategic areas have been identified as a basis for a systematic, evidence-based approach to providing guidance for improving the quality of maternal and newborn care. These are clinical guidelines, standards of care, effective interventions, quality measures, and the relevant research and capability building.
This publication of the Framework, standards of care and quality measures is the first in a series of normative guidance documents that will be developed to support maternal, newborn and child quality of care improvement. The development of standards of care and measures of quality were prioritized because of lack of substantive WHO guidance in this area of work. Eight standards are formulated, one for each of the eight domains of the quality of care framework. These standards explicitly define what is required in order to achieve high-quality care around the time of childbirth to set a benchmark against which improvements can be measured to drive and monitor quality of care improvement. They are broad statements underpinned by more specific 2-3 quality statements except for standard 1 with 13, and each quality statement has a number of input, output or process and outcome measures.
Breastfeeding is not a one-woman job. Women who choose to breastfeed need support from their governments, health systems, workplaces, communities and families to make it work. While the evidence on the power of breastfeeding for lifelong health and prosperity is stronger than ever, there is much work to be done in improving breastfeeding rates worldwide. Part I of this global report, From the first hour of life: Making the case for improved infant and young child feeding everywhere, paints a troubling picture about the state of breastfeeding practices around the world. This report reviews the most recent evidence on breastfeeding and provides updated global and regional estimates on early initiation of breastfeeding, exclusive breastfeeding and continued breastfeeding. The report concludes with recommendations to guide policy action on breastfeeding at the national level.
Marketing of Breast-milk Substitutes: National Implementation of the International Code: Status Report 2016
Published in : 2016
Source : World Health Organization, UNICEF, IBFAN
This report provides updated information on the status of implementing the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolutions (“the Code”) in and by countries. It presents the legal status of the Code, including - where such information is available - to what extent Code provisions have been incorporated in national legal measures. The report also provides information on the efforts made by countries to monitor and enforce the Code through the establishment of formal mechanisms. Its findings and subsequent recommendations aim to improve the understanding of how countries are implementing the Code, what challenges they face in doing so, and where the focus must be on further efforts to assist them in more effective Code implementation.
Time to respond: a report on the global implementation of maternal death surveillance and response (MDSR)
Published in : 2016
Source : World Health Organisation (WHO)
Understanding exactly why a woman died in pregnancy or around the time of childbirth is a crucial first step towards preventing other women dying in the same way. As well as identifying the medical causes of death, it is important to know the woman’s personal story and the precise circumstances of her death. Where was she when she died? Did she and her family realize she needed emergency care? Was care available to her and was it of good quality? Were there obstacles to her accessing care?
In 2004, a WHO publication, Beyond the Numbers, highlighted the importance of answering such questions and of taking action on the results. It set out the essential information required – including how many mothers are dying, where, when and why – to inform the design of targeted policies and programmes that work towards the elimination of preventable maternal deaths.
Interactions between families and frontline workers – their frequency, quality, and equity – and coverage of interventions for mothers and newborns
Report from six-district surveys in Uttar Pradesh, India, 2012-2015
Author : Tanya Marchant and Joanna Schellenberg
Published in : May, 2016
Source : IDEAS and London School of Hygiene and Tropical Medicine
The 2011 census of India estimated the population of the State of Uttar Pradesh to be 200 million, 79% of whom live in rural areas and 31% live below the poverty line. Maternal and newborn mortality is very high across the State. In 2011, UNICEF estimated the maternal mortality ratio to be 440/100,000, with one in 42 women dying from maternal complications. Neonatal mortality is also very high, with an estimated 45 newborn deaths in the first 28 days of life for every 1000 live births.
Upholding Commitments to Maternal and Newborn Health
Source : Global Health Visions
Over the past decade, impressive strides have been made to improve the health of women, children, and newborns across the globe. Accessible and affordable healthcare is on the rise and communities are increasingly demanding that governments fulfill their promises to citizens.
The shift towards more equitable and available services highlights the need for additional accountability through both government systems and civil society engagement in the planning, review, and implementation of health services. Improved policies and programming on the part of government does not guarantee effective implementation, nor does it ensure that adequate resources – both human and financial – are allocated to deliver on these commitments.
Transparency and accountability initiatives play an important role in providing input and oversight to government programs, particularly when citizens and civil society participate in the monitoring and measurement of achievements. Without listening to the populace and understanding the real barriers to effective implementation, successful outcomes will remain elusive. Through citizen engagement, civil society advocacy, and strategic accountability mechanisms, the most vulnerable can have a voice and communities can be empowered to drive government action.
Unmet Need for Contraception in Developing Countries: Examining Women's Reasons for Not Using a Method
Source : Global Health Visions
Authors : Gilda Sedgh et al.
Published in : June, 2016
Source : Guttmacher Institute
Demographic and Health Surveys in 52 countries between 2005 and 2014 reveal the most
common reasons that married women cite for not using contraception despite wanting to avoid a pregnancy. Twenty-six percent of these women cite concerns about contraceptive side effects and health risks; 24% say that they have sex infrequently or not at all; 23% say that they or others close to them oppose contraception; and 20% report that they are breast- feeding and/or haven’t resumed menstruation after a birth.
In the majority of countries, married women who cite concerns about contraceptive side effects and health risks are more likely to have used a method in the past than are women who cite other reasons for nonuse.
Married women who cite infrequent sex as a reason for nonuse are less likely to have had sexual intercourse in the three months preceding the survey than peers who cite other reasons for nonuse.
Married women who cite opposition to family planning are less likely to have ever used any method than women who cite other reasons for nonuse. Thus, some, but not all, women might experience opposition that precludes trying a method at all.
Among sexually active never-married women wanting to avoid pregnancy, the most common
Reason cited for not using contraception is infrequent sex (49%), followed by not being married (29%) and concerns about contraceptive side effects (19%).
Women with unmet need for contraception rarely say that they are unaware of contraception, that they do not have access to a source of supply, or that it costs too much. The countries where more than 10% of women cite any of these reasons are in West and Middle Africa.
Compared with earlier studies on women’s reasons for not using contraception, larger proportions of women now cite side effects and infrequent sex as reasons for nonuse.
Contraceptive services should place priority on improving the information and counseling they provide and the range of methods they offer. All sexually active women, whether married or not, need information about their risk of becoming pregnant and about the choices of methods that could meet their needs.
Adding it Up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents
Source : Global Health Visions
Authors : Jacqueline E. Darroch, Vanessa Woog, Akinrinola Bankole and Lori S. Ashford
Published in : May, 2016
Source : Guttmacher Institute
Preventing unintended pregnancy is essential to improving adolescents’ sexual and reproductive health and their social and economic well-being.
About half of pregnancies among adolescent women aged 15–19 living in developing regions are unintended, and more than half of these end in abortion, often under unsafe conditions.
Of the 252 million adolescent women aged 15–19 living in developing regions in 2016, an estimated 38 million are sexually active and do not want a child in the next two years.
About 15 million of these adolescents use a modern contraceptive method, while 23 million have an unmet need for modern contraception and are thus at elevated risk of unintended pregnancy.
Improving services for current contraceptive users and expanding them to serve those with unmet need will cost an estimated $770 million annually, or $548 million more than current costs.
For an average cost of $21 per user annually, these improvements go well beyond providing contraceptive information and supplies. They include increased training and supervision of health care workers, investments in upgraded facilities and supply systems, and information and communication efforts to ensure that adolescents have access to a range of methods and support in choosing a method and using it effectively.
Meeting the unmet need for modern contraception of women aged 15–19 would reduce unintended pregnancies among this age-group by 6.0 million annually. That would mean averting 2.1 million unplanned births, 3.2 million abortions and 5,600 maternal deaths.
The dramatic reduction in unintended pregnancies would spare women and their families the adverse consequences of early childbearing, reap savings in maternal and child health care, and boost young women’s education and economic prospects.
Abortion Stigma Around the World: A synthesis of the qualitative literature
Source : Global Health Visions
Authors : K. LeTourneau
Published in : 2016
inroads- International Network for the Reduction of Abortion Discrimination and Stigma
An effective and much needed report created by International Network for the Reduction of Abortion Discrimination and Stigma that provides synthesis of qualitative literature around the world exploring the way abortion stigma manifests at various levels. The proposed ecological model in the report explains the manifestation of abortion stigma at the level of individual, community, institutional and mass media.
Country Case Study: India
In-depth landscape analysis of accountability for maternal and new-born health in India
Source : Global Health Visions
In recent years India has made considerable progress in lowering maternal and newborn mortality rates. The Government of India's National Health Mission (NHM, formerly the National Rural Health Mission, or NRHM) has made both programmatic and financial commitments to ensure safe birthing and better neonatal health. Civil society organizations have also played a key role in accountability efforts, working to make the health system more responsive and efficient, and to ensure that the government is meeting the needs of India's diverse population.
Over the past 10 years, civil society accountability and monitoring efforts have existed at the local, state, and national levels. Accountability efforts within the health sector began when civil society first became involved in monitoring health services throughout small pockets of the country. By the time the Government of India's flagship health program, the NRHM, launched in 2005, community monitoring was being implemented and included in many government social service programs.
This case study seeks to summarize these national and state-level programs and players that could be leveraged for future MNH accountability efforts.
The Global Strategy for Women's Children's and Adolescent's Health (2016-2030)
Source : Every Woman Every Child
Why we need an updated Global Strategy?
Today we have both the knowledge and the opportunity to end preventable deaths among all women, children and adolescents, to greatly improve their health and well-being and to bring about the transformative change needed to shape a more prosperous and sustainable future. That is the ambition of this Global Strategy for Women's, Children's and Adolescents' Health.
Maternal death reviews help countries identify missed opportunities and plan interventions
Published in : August, 2016
Source : World Health Organisation
Every year, an estimated 303 000 women die due to complications in pregnancy and childbirth. Most of these deaths could be prevented with high-quality care. However, accurate information on how many women died, where they died and how they died is often lacking in most countries.
Through maternal death surveillance and response (MDSR), WHO is helping countries review maternal deaths, and to implement and monitor steps to prevent similar deaths in the future. MDSR contributes to better information for action by promoting routine identification and timely notification of maternal deaths, review of maternal deaths, and implementation and monitoring of steps to prevent similar deaths in the future.
This photo story describes how countries are implementing MDSR and ensuring all deaths of women of reproductive age are notified and reviewed by experts.
Women's Rights Current Global Issues Video Presentation
By Janelle Smith, Published on May 22, 2012
Description : Throughout history, women all over the world have faced, and largely taken: oppression, abuse, violence, and gender - based discrimination. Many may believe that because women in the United States can vote, and have been granted many of the same rights as men, rights are no longer an issue. Yet within modern western civilization, there are still prevalent issues that women are faced with daily. Women of the world suffer. They have become a commodity, and a symbol of weakness. Women do not recieve equal treatment to men, even within modern western society. This needs to stop.
Women's Rights Infographic
By Linda Shirar, May 18, 2013
Labor of Love
By Join the Lights, August 27th 2013.
Description : As her second child's due date approaches, Eliza grows anxious as she is constantly reminded of the horrifying physical and emotional pain she experienced during her first childbirth. Worse, she must find a way to cover the nearly insurmountable cost of giving birth in the local hospital or take the risk of giving birth without care in her own home. Labor of Love follows Eliza's antepartum journey and the hope provided to mothers in the Philippines by Mercy in Action
FAIL : First Attempt in Learning – Learning from What doesn't Work in Maternal and Newborn Health
From Maternal Health Task Force PRO December 2, 2015
Funding for Impact : Global Financing for Maternal and Newborn Health
By Maternal Health Task Force, Thursday, December 3rd 2015
Benefiting Mothers &Newborns Through Integrated Care
By Maternal Health Task Force, December 1st 2015
Global Maternal Newborn Health Conference
Monday, October 19, 2015 • Mexico City
The Next Frontier : Approaches to Advance the Quality of Maternal Newborn Health Care
By Maternal Health Task Force, November 3rd 2015
Global Maternal Newborn Health Conference
Monday, October 19, 2015 • Mexico City