Category Archives: Women’s Issues

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She would never tell her family. They could never know.

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I was amazed that the young woman was brave enough to tell her story at all.

With a teary smile she explained that she was telling us because she was just so happy that her life was not over as feared.  She was just so relieved to have found someone to help her.  The week before she had called her friend to say goodbye. Read the rest of this entry

Health Post At Mosebo Village, Ethiopia

Health Post At Mosebo Village, Ethiopia

Elizabeth Atalay

We had just spent the night at the source of the Blue Nile River. Lake Tana sits in Bahir Dar, Ethiopia, and as our caravan of Land Cruisers wove through the countryside from Bahir Dar to Mosebo I took in deep gulping breaths of sweet fresh Ethiopian air. The lush colors of our surroundings looked to me like they had been enhanced in Photoshop in the way that everything seemed to pop.  How could I feel this emotional connection to place that was never mine? A place I had never been?

Though this is my first time in Ethiopia, the verdant landscape brought me back to other rural parts of Africa I’d traveled through in my youth, similar topographies that had stayed with me ever since.  This time I’d returned to the continent as a new media fellow with the International Reporting Project to report on newborn health.  We were heading to one of the villages housing a Health Post which serves the local and surrounding population of approximately 3,500 people.

Photo by Elizabeth Atalay

Mosebo Village is part of Save The Children’s Saving Newborn Lives program, and as such is looked to as a model village in the Ethiopian Government’s plan to reduce maternal and newborn mortality.  Mosebo is a rural agrarian community that produces wheat, teff and corn.  There I met seven-year-old Zina whose mother, Mebrate was about to give birth.  Through our translator Mebrate estimated her age to be around 26, and told us that Zina was her first child.  As we learned from interviewing many mothers along the way, her age estimate was really more of a suggestion, and at times might be a full decade older than the expecting mother’s true age. I suspect this is somewhat the case with Mebrate as well.   She said that for economic reasons she and her husband had waited to have a second child, but again, as we also learned, this might not be the full story. Losing a newborn in the act of childbirth is so common, and almost expected in rural Ethiopia, that it is not spoken of openly.   Almost in the way a western mother might not offer up a miscarriage amongst her healthy born children if asked how many children she has.

When she had Zina, Mebrate had gone to her parent’s home to give birth, as women in Ethiopia often do. It is estimated that 80% of Ethiopian mothers will give birth in their home, often without a trained health care attendant. Towards the end of Mebrate’s first pregnancy she went to live with her parents as her family instructed, until after the baby was born.  In that way her mother could help her deliver, could care for her and the baby, and feed her the traditional porridge after birth. Although there were no complications during her delivery, sadly, many young mothers giving birth at home are not as fortunate. The time period during and around birth are the most vulnerable for the lives of both the mothers and babies. The Saving Newborn Lives Program aims to reduce maternal and newborn mortality beginning with awareness programs and pre-natal care on the local level at Health Posts like the one we visited in Mosebo.

Mosebo Health Post

The Mosebo Health Post and Health Extension Workers

We had met Tirgno and Fasika, the two Health Extension Workers at the Mosebo Health Post earlier that day as they showed us the two room interior, and explained their role in improving maternal and newborn health.  They work to raise awareness in the community about the importance of pre-natal care, and the potential dangers of giving birth at home for both mother and child. Newborn health is interdependent with maternal health, and the most prevalent causes of newborn mortality, infection, Asphyxiation, pre-maturity or low birth weight, and diarrhea can often be avoided with proper care.   These days in Mosebo after receiving pre-natal care at the Health Post women are then referred to the regional Health Center for deliveries.

Zina shyly smiled when we ask her how she felt about having a new sibling, she stood straight and tall listening intently as we asked her mother about the babies’ arrival.  When Mebrate goes into labor this time, with her second child, she will embark on the walk along rural dirt roads for around an hour to the nearest Health Center to give birth.

This story was reported by Elizabeth Atalay from Ethiopia where she traveled as a fellow with the International Reporting Project (IRP). This post is a modified version of one first written for World Moms Blog.

Health Extension Workers Impact On #EthiopiaNewborns Via ONE.org

Health Extension Workers Impact On #EthiopiaNewborns Via ONE.org
Photo Credit: Elizabeth Atalay

Photo Credit: Elizabeth Atalay

“My turning point, was I lost a mom of six from bleeding,” said Dr. Abeba Bekele when speaking about her commitment to maternal and newborn health in Ethiopia. She distinctly remembered that moment as her turning point.

After having practicing medicine for five years in deep rural areas of the country, “I saw the issues, the problems, the challenges,” she said. “What made me decide actually to go into public health…..was I lost a mom of six from bleeding. Just bleeding on a couch because there was nothing, no supplies in the facility, we didn’t have IV fluids. The family was not willing to give blood for various reasons. But there was nothing in the hospital. So we tried to do everything, I had two midwives with me, and myself, and we lost her. I said, OK this is it. I don’t want to continue my life seeing these types of challenges. I have to go into prevention.”Now the Thematic Sector lead at Save the Children Ethiopia’s Saving Newborn Lives Program, Dr. Bekele has stayed true to that vow. Maternal deaths have been reduced by two-thirds since the year 2000, from 1 in 24 to 1 in 67.Ethiopia has been praised as a success story in Child Health, having reached Millennium Development Goal #4, to reduce child mortality, ahead of the 2015 schedule. Yet while the mortality rate of children age 1 month to just under 5 years has annually declined by 6.1%, the neonatal mortality rate in Ethiopia is only declining at a rate of 2.4 %. Newborn deaths account for 43% of all deaths under the age of 5 years old.Save The ChildrenThe major issue in Ethiopia is that approximately 80% of women give birth at home, often without the presence of a trained health care worker. The majority of the population lives in rural areas with poor access to health care.Dr. Abebe’s own story also illustrates that even in the presence of the most skilled physician, without resources, or transportation to a hospital from a remote area, lives can still be lost. The fact that less than half of newborns are protected against tetanus is another major contributing factor, especially for home births in unsterile conditions.The country’s success on MDG 4 illustrates that with dedicated financial and intellectual commitment, Ethiopia’s goal to reduce the number of newborn deaths by 2015 can be achieved. The Health Extension Plan implemented by the government to target the issue is deploying trained Health Extension Workers, and the Health Development Army, both key delivery platforms at the primary level.The ultimate goal is one health care post for every 5,000 regional inhabitants attended by two Health Extension Workers. Then one larger health care center serving every five health care posts and one major hospital for each of the 800 districts of Ethiopia. Health Extension Workers train for one year after graduating high school in the communities in which they will serve. The Health Development Army volunteers have been key to the success of the program on a local level by educating their own communities.

In such a large, diverse country, there are cultural challenges to getting mothers and communities to adopt new health practices. In the southern region of Ethiopia when women were not coming in to the new Health Care Center to give birth, they figured out that the women did not feel comfortable with the birthing position on the table. When they changed it to a more culturally suitable option, women began to come in to give birth. Working with formal and informal community leaders has also proved important.

Dr. Abeba Bekele has kept her pledge from that moment when she lost that mother years ago as she continues to implement change in her country through her work with Save the Children. The government of one of the poorest countries in the world seems committed to preventative health care measures, and with education the thinking in rural communities is beginning to change. The great hope is that the newborn mortality rate will soon significantly change as well.

This is a slightly altered version of an article that appeared on ONE.org.  ONE Mom Elizabeth Atalay was in Ethiopia as an International Reporting Project Fellow on a New Media Fellowship to report on newborn health. Follow her journey on Twitter with hashtag #EthiopiaNewborns.

 

 

 

#EthiopiaNewborns & Maternova Innovations

#EthiopiaNewborns & Maternova Innovations
7 week old #EthiopianNewborns

7 week old #EthiopianNewborns Photo by Elizabeth Atalay

The first thing I pulled out of the bag was the strip of condoms. As a happily married mother of four I can’t remember the last time I handled a strip of condoms, and I confess that they made me giggle. I was checking out the contents of the Maternova backpack I was bringing to Ethiopia, and was quickly informed that they were not included for that reason.

Upon learning that I would be traveling to Ethiopia as a New Media Fellow with The International Reporting Project to report on newborn health I had immediately reached out to my friends at Maternova. Maternal and Newborn health is what they do, particularly in low-resource settings, and I knew they would have some great insights as to what topics I might see on the trip. Part of our reporting will be from rural villages in Ethiopia where most births take place in the home, without a trained healthcare attendant. Maternova is headquartered in the state of Rhode Island where I live, but provides the leading global on-line resource for Governments, non-profits, and health care providers to access affordable healthcare solutions to save the lives of mothers, and newborns.  I asked founder Meg Wirth to tell me about a few of the Maternova products that I was bringing on the trip, and how they are used to save lives.

Lake Tana source of the Blue Nile, Bahir Dar, Ethiopia

Lake Tana source of the Blue Nile, Bahir Dar, Ethiopia

Elizabeth Atalay: The condoms in the bag actually come with instructions on how to save a woman’s life from postpartum hemorrhage with the Condom Balloon Tamponade method.  Can you talk a bit about the evolution of the CBT method?

Meg Wirth:  Well listen, if someone needs a condom you should probably give it to them—because averting a pregnancy, as you know, can save a life too.  But the condom also has another very intriguing use—a brand new condom can be used as a kind of do-it-yourself medical device to stop postpartum hemorrhage.  We sent you with instructions!  Rather than break it down step by step here, suffice it to say that the condom can be attached to a foley catheter and IV, filled with saline or water when inserted in a uterus post childbirth.. the pressure of the condom balloon can stop internal bleeding.

EA: I am also bringing the Maternova solar head lamp created for night birthing scenarios, can you remind me of the story you once told me about observing a night birth when you first introduced me to this product?

MW: Well that story wasn’t mine, but we hear stories every single week about birth occurring in the dark.  While a normal birth may be fine in the dark, a complication or a hemorrhage create a serious problem because no one can manage the complication properly.  A simple solar lamp allows task lighting to manage births but they also light the way for heroic midwives who are so often called out at night to remote places and could use light for their own safety.

EA: It is always been surprising to me that newborns in Sub-Saharan Africa can die from simply preventable causes like hypothermia. Two of the Maternova products I am bringing come in tiny packages, yet can be the difference between life and death of a newborn. Can you talk about the importance of the Sterile Foil Baby Bunting, and the Thermo Spot stickers?

ThermoSpot

MW:  The ThermoSpot is a temperature indicator that, when stuck onto a newborn (in a very specific place) can signal—just with color—whether the infant is too cold.  The face on the round sticker fades from green to black and indicates that the core temperature of the infant is far too low. Remember, the average villager in Ethiopia is not going to have a thermometer at the ready, and this amazing, re-usable, ultra low-cost device is a thermal indicator that can be ‘read’ just with color meaning the mom or father need not be numerate or literate. The mylar bunting is a very lightweight wrap to keep infants warm, particularly during transport or when separated from mothers.  Both of these items are in major trials in Pakistan and Kenya though they are already in use in many settings.

EA: I recently learned that in Ethiopia most rural healthcare clinics do not have pregnancy tests available.  Are women able to keep track of their cycles and pregnancies with the CycleBeads for family planning?

MW:  Yes the CycleBeads can be used by anyone with a regular cycle to predict ovulation times!!!  They are a very rapidly-spreading form of birth control.

Cycle Beads

EA: What are some of the issues of newborn health in Ethiopia that you and the Maternova team are interested in hearing about? What innovations should be keeping an eye out for?

MW:  We are interested in local ‘fixes’ or ideas that nurses and midwives have come up with.  Part of our mission is to spread innovation more rapidly and if we can learn from them and spread the messages quickly we’d be thrilled.  See if they have working blood pressure cuffs in the clinics.  See if they have magnesium sulfate.  What about misoprostol?  How do they stop postpartum hemorrhage?

EA: I will definitely be looking to see what innovative solutions the midwives have developed in their communities and share what I see.  Just a few days into the trip we have already been gaining real insight into the Maternal and Newborn landscape here in Ethiopia.  Despite the lack of resources, there seems to be a real commitment to preventative measures and education so I’m excited to bring the Maternova products to midwives we are meeting with later this week!

MW:  Thank you for your work Elizabeth!!

I am in Ethiopia for two weeks with The  International Reporting project on a New Media Fellowship to report on Newborn Health.

You can follow along at The International Reporting Project #EthiopiaNewborns

It Is Safer To Give Birth In Estonia Or Slovenia Than The United States #SOWM

It Is Safer To Give Birth In Estonia Or Slovenia Than The United States #SOWM

According to the 2014 Mother’s Index Rankings published in the Save The Children’s State of the World’s Mothers Report last week,  you are statistically safer giving birth in Slovenia, (ranked the 17th safest country in which to give birth), or Estonia (ranked the 23rd), than you are in the United States of America (which is way down the list at number 31).  In fact last week at the launch of the State of the World’s Mothers Report at the United Nations in New york City I was shocked to learn that the United States is one of the few countries where the risk to mothers in childbirth has gone up rather than down.

Global Team of 200 Member Harriet Shugarman Exec. Dir. of ClimateMama, and Carolyn Miles, President and CEO of Save The Children pictured here with the author at the State of the World's Mothers Report launch in NYC .

Global Team of 200 Member Harriet Shugarman, Exec. Dir. of ClimateMama, and Carolyn Miles, President and CEO of Save The Children pictured here with the author at the State of the World’s Mothers Report launch in NYC .

The Mothers’ Index is part of the overall annual State of the World’s Mothers Report that Save The Children has produced for the past 15 years. The  five indicators used in the index are the lifetime risk of maternal death, the under 5 year child mortality rate, the expected years of formal schooling, the gross national income per capita, and the participation of women in national government.

Credit:  Save The Children

Credit: Save The Children

To see how other countries rank you can view the entire Mothers’ Index HERE.

So why does the United States perform so poorly on the Mothers’ Index? According to the State of the World’s Mothers report :

Although the U.S. performs quite well on economic and educational status it lags behind all other top ranked countries on maternal health and children’s well-being, and performs quite poorly on political status ( the #of women in government).- Save The Children p. 74 State of the World’s Women Report

 

The lag in the United States is alarming, but this year the report specifically addresses the preventable maternal and child deaths in crisis-affected places.  The 2014 report focuses primarily on saving mothers and children, who tend to be the most vulnerable, in humanitarian crisis.  The launch event last week was co-hosted by the Permanent Mission of the Philippines to the United Nations. Save The Children responded immediately with aid to the crisis in the Philippines caused by Typhoon Haiyan in 2013, as it has done in crisis areas around the world for over 90 years.   Save The Children provides health care, food, and protection to those most vulnerable in humanitarian crisis, most often the women and children. It is not surprising that all of bottom 10 countries on the Mothers’ Index are areas that have recently been in, or are currently in conflict situations, or experienced natural disaster.  Statistics in the report show that more than half of maternal and child deaths take place in these types of fragile settings.

Cover photo of the Save The Children's State of the World's Mothers Report Photo by Phil Moore

Cover photo of the Save The Children’s State of the World’s Mothers Report Photo by Phil Moore

Looking at trends so far in this century, we see how armed conflict, political instability and natural disasters have played a major role in undermining the well-being of mothers and children in the world’s poorest countries. We also see that progress is possible, even in countries suffering from devastating humanitarian crisis.- SOWM

One of the countries I was surprised to hear had made such progress was war-torn Afghanistan, which has moved up the Mothers’ Index list by 32 places. At the UN event Yasmin Haque, Deputy Director of the Office of Emergency Programmes for UNICEF noted that the key components for improvement in Afghanistan were the training of mid-wives, putting medical interventions in place for safe birth, educating girls, and immunization campaigns against vaccine preventable diseases.  Proving, as she said, that “the investment of minds and funding works”. She also noted that the recommendations coming from the State of the World’s Mothers Report are pressing.

HRH Princess Sarah Zeid of Jordan and Carolyn Miles, President and CEO of Save The Children

HRH Princess Sarah Zeid of Jordan and Carolyn Miles, President and CEO of Save The Children

Princess Sarah Zeid of Jordan is a global champion for maternal and child health and she backed this up with the urgency of the Syrian crisis. She described things becoming so dire in the refugee camps bursting at the seams, that food rations from the World Food Program have recently been reduced by 20% per family to accommodate the influx.  Some of the Syrian mothers in these camps who were not breastfeeding their infants but using formula to feed their babies, have turned to sugar-water as a substitute as formula has become more and more scarce, and costly.

So what are the recommendations that this report says need to happen? You can read the detailed recommendations in the full SOWM report, but to give you an idea here are a few bullet points of the overall suggestions:

1. Ensure that even mothers and newborns in crisis areas have access to high quality health care. This includes ensuring at least the basic high-impact public health interventions of clean water, sanitation and vaccines. Increased number of female health care workers, and safe birth during the highest risk times of birth and the first week of life as recommended by the Every Newborn Action Plan.

2. Invest in women and girls and ensure their protection.  One component is that by educating girls and putting an end to child marriage entire communities are positively impacted. Educated girls grow up to better contribute to the economy, tend to have fewer children, and her children have better survival rates than children of uneducated mothers.

3. Build longer term resilience to minimize the damaging effects of crisis on health. Early warning systems need to be put in place. There is a need for community based disaster preparedness, response and contingency planning.  These plans should prioritize infants and children who often suffer the most in the face of disaster.

4. Design emergency interventions with a longer term view and the specific needs of mothers and newborns in mind. Prioritize maternal and newborn survival in crisis settings by ensuring access to safe birthing, medical care, and setting up specific safe spaces for them. Continue vaccines programs even during crisis.

5.Ensure adequate financing, coordination, and research to guarantee the above can be accomplished. This includes donor countries  committing to increased  long-term and reliable aid to fragile areas. Reconciling short-term disaster aid with long-term development financing, addressing gender issues, and proper data reporting.

We have the solutions to many of the issues impacting women and children around the world, stories of progress like Ethiopia and Afghanistan prove that it can be done.  The State of the World’s Mothers Report aims to highlight unmet needs, effective solutions, and recommended policy changes to that end.

global teamI was invited by Save The Children to the State of The World’s Mothers Report at the UN last week in NYC as a member of The Global Team of 200, a highly specialized group of members of Mom Bloggers for Social Good that concentrates on issues involving women and girls, children, world hunger and maternal health. Our Motto: Individually we are all powerful. Together we can change the world. We believe in the power of collective action to help others and believe in ourselves to make this world a better place for our children and the world’s children.