United Against Poverty And Disease

United Against Poverty And Disease Mission: Every woman should have the right to a safe pregnancy. Every baby should have a chance at life. Every child should have the right to grow up in a safe, educational environment. UAPAD is here to empower women and children around the world so we can all overcome poverty, prevent disease, and create sustainable solutions. UAPAD strongly believes that educated, empowered women and healthy children will lead to a better world for all of us. We hope to achieve these goals through education and healthcare initiatives that will spread awareness, examine the impacts and root causes of poverty and disease, improve communities, and save lives. All articles written by Jinny Jung, UAPAD blogger. Contact her at [email protected] if you wish to use her articles or have any further media inquiries. Visit our website for updates on what we're doing!

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Confidentiality, treatment, & their impact on maternal mortality

In South Africa, hundreds of pregnant young women are dying in order to protect a dark secret, one they fear will be exposed should they visit the health center for antenatal services. What secret could possibly be grave enough that it would warrant death?  

Undue fears over their personal HIV status being revealed by lack of patient confidentiality in hospitals drive pregnant women to stay away from health centers in hordes. HIV-positive individuals in South Africa society are viewed as diseased and unfit to socialize, as the presence of the disease is supposed to signify improper sexual excess and moral decay on one’s character, rather than being viewed as a common viral disease that can be contracted by anyone irrespective of gender, religion, or age.  

Within South Africa’s public health care system, antenatal services are provided without charge but many South Afrikaners are made to believe that HIV testing is mandatory, and choose to forgo treatment altogether so they can avoid potential future stigmatization and shame from a HIV-positive diagnosis. However, skipping antenatal care could heighten a pregnant woman’s risk of dying from pregnancy or delivery complications.  

According to the Office of the United Nations High Commissioner for Human Rights, “Delays in the decision to seek care or opting out of the health system entirely are treated not as idiosyncratic, personal choices or immutable cultural preferences but as human rights failures.” (2010). Simply put, it is no fault of men and women alike to forgo medical care in fear of having their HIV-positive status revealed – this is a human rights failure that needs to be remedied so all individuals can access the care they deserve.  

To remedy the damaging effects of false sociocultural beliefs on healthcare, the South Africa government should implement practical and educational interventions aimed toward dismantling HIV/AIDS discrimination and promoting compassion and security. Also, more privacy should be secured in hospital clinics and waiting rooms so patients can receive their diagnoses in private and feel more comfortable about inquiring after any personal health concerns or needs.  

The centrality of culture is being recognized as an important obstacle in the fight against maternal mortality. The intangible constricts of cultural beliefs drive many young women to skip life-saving treatments and perpetuate harmful expectations on women, such as that they have no right to seek out sexual health services and protection because of their gender. All females have the right to seek out care, and when they feel that their care is denied because of factors out of their control, that is no fault of their own – it is the fault of the society for failing to take care of its females. 

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Why awareness on maternal mortality matters

Just as birth is a part of life, so is dying.

As women, we are the chosen torchbearers for the next generation. Our bodies are expected to house and nourish a living soul (if not more than one!) for nine months, before releasing it (or them) out into the world. Our special role begins with conception and endures for the rest of our lives. This role, however, is fraught with complications and sometimes demands that mothers pay the price with their lives, if not their health. Every year, at least 139 million babies are born and every year, more than 287,000 women die in pregnancy and childbirth (UNICEF 2013). Another 7 to 10 million women suffer long-lasting injuries and poor postpartum health (WHO 2012). Maternal mortality is an all-encompassing issue that, although exacerbated in low-income developing regions such as sub-Saharan Africa, should not be ignored by industrialized nations. Although the advent of medical technologies has meant that developed nations such as the United States have low mortality rates (below 16 deaths per 100,000 live births, as compared to a sky-high 230 deaths per 100,000 for developing nations), most women are still woefully unaware of how to protect themselves and their infants from the causes of maternal mortality. Right here at home in the United States, maternal mortality rates have slowly been creeping up, rather than declining. The official statistical increase in mortality can be attributed to better record-taking, but there are underlying sociocultural factors that cannot be brushed off. Primarily, poor access to affordable and quality health services to all women of the United States is sabotaging progress on maternal health. One in five women in the United States lack healthcare insurance, meaning they enter pregnancy with potential underlying health risks that could cause complications down the line. As UAPAD's founder Toyin Idehen knows all too well, pregnancy complications can be overwhelming and frightening especially when one has no idea what is happening or why. In her story posted on the UAPAD website, Toyin describes how she and her husband struggled to comprehend their pregnancy and childbirth experience: “My husband and I had no choice but to use our time during the 3 month daily, all-day visits to Neriya in the NICU to mourn, research, and try to understand what had happened. We were so confused, but while grieving and at the same time staying strong for Neriya, we were shocked that with all the advances in medical care, having a team of great medical doctors, great healthcare, all the education available to us, this could still happen here in the United States. How could this be? How did we miss all the signs? I was definitely not the only one this has happened to, but if this happened to me, then can you imagine what women in developing countries go through?” This week, let’s remind ourselves that maternal mortality is an important, universal battle. The best way we can fight it is through creating awareness of the fact that mortality is heavily dependent on many factors, the most important of which are health awareness, access to quality healthcare, and providing ample education on pregnancy complications. The latter is most important, as mothers need to be prepared for the worst – when it comes to delivering babies, every bit of information counts and could potentially save a life (or two).

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Mothers are a part of a rising African continent, and their health and welfare cannot be separated from the rest of society. For stronger and healthier communities, we need to secure basic rights for African mothers. Maternal mortality remains an enormous challenge, but can be overcome with female empowerment.

Jinny Jung

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After A Mother is Gone:

Time and time again, we have focused on the socioeconomic and environmental conditions that ultimately result in the avoidable deaths of many pregnant women in developing countries. However, we have not really considered the implications of a mother’s death –without understanding how the absence of a mother affects her family and community both immediately and in the long run, we cannot fully combat maternal mortality. In regions like sub-Saharan Africa where approximately 179,000 women die each year, maternal mortality is a public health issue that cannot be separated from the overall wellbeing of the population.  

Mothers are the heart of the family. They act as the bearers of the next generation, giving birth to and raising future workers, leaders, and functioning society members. Education and social statuses of mothers have a great impact on her children’s wellbeing – children of educated mothers are 50 percent more likely to have longer lifespans and make smarter decisions about their health and family planning (The State of the World’s Children 2009 Report, World Health Organization). When the mother is taken out of the picture abruptly and unexpectedly, the family loses a central figure and important household contributor (culturally, emotionally, and financially). Her death also indirectly affects her daughters’ chances of dying when it is their turn to bear children, turning maternal mortality into a familial cycle.

Without a mother, children suffer. Family structure is greatly disrupted, and poverty becomes a great threat to the family. In many already-impoverished households, the strain of maternal medical bills, the death of the mother, and the funeral costs associated with the mother’s death compel many fathers to take their children out of school and put them to work. For school-aged girls, this robs them of the chance to educate and empower themselves on personal health and independence. Girls also feel more pressured to start families earlier, placing them at higher risk of maternal mortality. Infants whose mothers die during the first six weeks of their lives are far more likely to die in the first two years of life than babies whose mothers survive (WHO). The mother is a key figure in ensuring that her household remain as stable and healthy as possible.

Acknowledging the importance of women -- especially in developing African countries -- is an crucial step in gaining rights for women. In the WHO 2009 State of the World’s Children Report, Aslihan Kes, an economist and gender specialist at International Center for Research on Women (ICRW), stated that “women’s contribution to their families’ wellbeing is immeasurable. They contribute as producers, as income earners, farmers, and entrepreneurs, and at the same time take on most, if not all, of the household care work.” If we have improved policies and increased investment in maternal health care, we could lessen the severity of the impact of maternal deaths on families and communities.

Creating a supportive environment for females, mothers, and newborns is essential in the maternal mortality battle. Maternal mortality is very much a product of the oppressive environment in which women of developing countries live in. Women remain disadvantaged and disempowered at home and in their communities, but if given the tools to empower themselves, they could create a more supportive and healthy environment for themselves and their families. Education is “pivotal to improving maternal and neonatal health, reducing the incidence of child marriage” (WHO 2009 State of the World’s Children Report). Societal female disempowerment propagates the unfortunate maternal mortality trend, but if we educate girls and protect them from discrimination, we could see a further decline in mortality.

A human-rights based approach toward improving quality of and access to maternal care would include addressing gender discrimination and inequities in society through social and cultural changes.  Granting wider access to family planning and adequate diets are cost-effective measures that women of reproductive age have a right to expect. Currently, the rights of many African mothers are being blatantly neglected, leaving them out to die and condemning their daughters to similar fates. They are marginalized, ignored, and used by a society and healthcare system that does not care about them enough. We can change their fates by focusing on creating a female-friendly environment where young girls and women feel safe coming forward for sexual information, medical care, and personal empowerment.

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Facts about maternal mortality in Ethiopia: check out our blog article from last week for more information! (Read more here)

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Ethiopia: Preventing Mother-To-Child HIV Transmission

In Ethiopia, young mothers undergo regular antiretroviral therapy (ART) in order to increase the chances of delivering HIV-free babies. Antiretroviral therapy is nothing new; however, the increased provision of ART is strengthening Ethiopia’s maternal healthcare services and enabling more mothers to live healthier lives with their babies.

In Ethiopia, 90,000 pregnant women live with HIV and 14,000 HIV-positive births occur annually (World Health Organization). Despite these numbers, only 24% of eligible pregnant women receive ART and other medical services. Without medical intervention, the mother is not the only one at risk – a baby being born in a developing nation is at a 25% to 35% risk of getting HIV from an infected mother (PubMed). HIV is a public health issue that endangers countless lives, including those who haven’t been born yet.

Ethiopian mothers are being given the chance to break the cycle. According to 33-year-old Sisay Dinku, who offers counseling to HIV-positive women, “There have been a lot of improvements. When I first knew I was HIV positive, we used to go to the hospitals far away because the services weren’t given at the community centers like they are now.”

For instance, people no longer have to wait as long to receive their CD4 count results. The results gauge how well one’s immune system can fight infections such as HIV, and also determine when a person should begin treatment. Previously, women would have to wait up to two weeks to receive their results, if at all – more often than not, the results would become mixed up, rendering them useless.

The Pima machine was a revolutionary change. Now, patients can have their blood samples analyzed in twenty minutes, allowing all eligible patients to begin treatment right away, rather than having to wait weeks. When it comes to pregnant women, a difference of mere days can make all the difference in life and death. Sisay was one of nine other women who discovered they were HIV-positive on the same day, but she is the only survivor. The rest, unfortunately, were not able to begin treatment or sustain treatments once they begin due to causes such as lack of transportation to the health center.

The Pima machines were initially funded and provided by UNITAID, a global health organization, but the Ethiopian government has since chosen to expand and extend the program, due to its success and efficiency. The United States Agency for International Development (USAID) also ran a three-year HIV prevention program for pregnant, HIV-positive mothers. It collaborated with the Ethiopian Ministry of Health to strengthen existing maternal and newborn health services. Community-based measures were also taken. Pathfinder International, another organization focused on sexual and reproductive health, worked closely with health workers, religious leaders, and government structures in order to ease the accessibility and costs of maternal, newborn, and PMTCT services.

Providing antenatal care has proven to lower HIV prevalence among pregnant women. A study conducted from January 2006 to June 2010 examined 7,887 pregnant women in the Antenatal Care Unit of Bishoftu Hospital. In 2006, the overall prevalence rate was 8.3% but declined to 4.3% in 2010. Due to the remarkable decline in HIV prevalence in the observed five-year period, researchers concluded that the involvement of male partners in HIV counseling, HIV testing, and early interventions targeted at HIV-negative individuals are vital.*

Prevention of mother-to-child transmission (PMTCT) includes: • Antenatal care and testing for HIV • For HIV-positive women, antiretroviral treatment • For infants, antiretroviral treatment within 72 hours of delivery

In order to prevent mother-to-child HIV transmission, the mother must stick to a regular regimen of medications while pregnant and breastfeeding.

Says Ababa**, an HIV-positive mother, “Now I know my daughter doesn’t have it while I have it, I’m very happy. It changes everything for me.”

*”Trend of HIV prevalence among pregnant women attending Antenatal Care Unit of Bishoftu Hospital, Ethiopia”, PubMed July 2013. **Name changed for anonymity.

- See more at: http://uapad.com/blog-2/#sthash.8PY5votL.dpuf

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Algeria: What it's doing right for its mothers, and what it still needs to do

Every day, 396 African women die due to pregnancy-related complications and causes (WHO). Maternal mortality is an ongoing struggle and it can become easy to be disheartened by the apparent lack of progress being made in maternal health. Regardless, there is still hope. Algeria, a country in North Africa, has reported a 50 percent decrease in maternal mortality in the past few decades. According to the United Populations Fund (UNFPA), maternal deaths have decreased from 523,000 in 1990 to 289,000 in recent years. What did Algeria do differently for its mothers, and why did it work?

The Algerian government started investing much more money in the health sector and in human resources, greatly easing the strain that overburdened and understaffed health centers and hospitals were experiencing. It spends more than $100 per capita on health – a generous amount compared to Tanzania and Uganda’s $15 per capita (WHO). Investing human resources for the health sector allowed for the establishment of disease detection programs, the improvement of existing healthcare services, and a reform of the healthcare system. How did these help mothers survive? The creation of multiple health services decreased disease incidence rates and put fewer mothers at risk of contracting diseases during pregnancy. As a result, mothers were healthier when giving birth, which greatly improved their survival chances.

At the 68th General Assembly of the World Health Organization (WHO), the Minister of Health of Geneva, Population and Hospital Reform Abdelmalek Boudiaf praised Algeria’s efforts: “Algeria’s investments in the health sector have allowed meeting many challenges and achieving promising results in terms of health indicators.”

Algeria might have slashed its maternal mortality rate in half, but the battle isn’t over just yet. Progress in maternal mortality is tracked by the fifth millennium development goal (MDG) established by the United Nations: “To reduce by three quarters, between 1990 and 2015, the maternal mortality ratio” and “[to] achieve, by 2015, universal access to reproductive health” (UN.org). If Algeria is to achieve the fifth MDG, it needs to grant wider access to sexual and reproductive health services for young women, instead of stigmatizing the need for antenatal and postnatal care and education.

Antenatal and postnatal care are so important in increasing a mother’s chance of survival. A 2009 study found that 95.3% of births are attended in Algeria, yet mortality is still high because of poorly trained healthcare staff and a lack of antenatal care being provided to the mother. Without proper antenatal care, early identification of health risks to the mother can be missed and become life-threatening later on. Eclampsia, one such pregnancy condition, manifests itself as regular pregnancy pains but if not caught in time, can cause uncontrollable bleeding and seizures in the mother. 79% of mothers receive postnatal care in Algeria, but we need to question how often they visit the hospital after delivery, how long they wait to visit the hospital after delivery, and whether they were examined by qualified nurses and doctors.

The most important thing to consider when it comes to fighting maternal mortality and analyzing what works and what doesn’t, is whether there is a bridge between policy and on-the-ground implementation. There is no doubt that the Algerian government is taking steps to reduce mortality, but the sustained high mortality levels hint that more needs to be done than just throwing money at the problem. Pregnant mothers are dying unnecessarily, and Algeria needs to figure out what it’s still not doing right.

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Men can't get pregnant, but they should care.

Making a baby takes two, and raising a family also takes a strong partnership. However, most African mothers are left trying to handle everything on their own, from the very moment they become pregnant. Africa’s dominant patriarchal society has significant implications for maternal health and family rearing, and if we are to help mothers in Africa, we must also recruit fathers.

Pregnancy and family rearing are viewed as exclusively women’s affairs. Men are often excluded from the pregnancy process – expecting fathers often are not allowed to remain in the room when antenatal examinations are conducted, and there is a general disconnect between reproductive health knowledge and men. Although men are not actively engaged during pregnancy, they hold an enormous amount of sway over their partner’s reproductive decisions. 87.7 percent of women have husbands who are solely responsible for family planning. Every pregnancy in Africa is affected by men, whether men choose to take responsibility or not.

The exclusion of men from the maternal process ultimately negatively affects the pregnancy outcome and weakens family bonds. As head of the family, men have a disproportionate amount of sway over when a woman becomes pregnant and what happens afterwards; he can keep her from leaving the house to visit the doctor or subject her to dangerous traditional birth practices. Men can also propagate harmful cultural beliefs about pregnancy and birth which can ultimately endanger the mother’s health and safety.

Although African men do not realize how helpful their presence can be during their partners’ pregnancies, male involvement can have enormous positive impacts on maternal mortality and family stability. Men can reach out to community elders, leaders, and religious leaders in order to advocate for pregnant women. For this Father’s Day, we should all think about how to include more of Africa’s fathers to create healthier and happier families. Men and women should be viewed as equal partners in pregnancy and childrearing, rather than be separated on the basis of traditional gender roles.

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A Shortage of Blood

It is undeniable that far too many pregnant women die unnecessarily, especially in areas of extreme poverty. Nigeria is no exception – in fact, it has one of the highest maternal mortality rates in the world. Every ten minutes, a Nigerian woman dies from pregnancy or childbirth, and many more are left disabled from delivery complications. There is also a hidden culprit driving up maternal mortality – lack of proper blood. 

A severe blood bank shortage is currently hitting hospitals in Nigeria hard, leaving many unable to provide life-saving blood transfusions for their patients. Blood is one of the most basic and essential resources a hospital needs, but in Nigeria, hospitals are struggling to find enough blood donors who do not have HIV/AIDS. 

There is widespread misapprehension about donating one’s blood, so most blood supplies come from commercial blood donation. Approximately 60 percent of all blood donations are from commercial sources. Commercial blood is rarely screened properly for viral diseases and the supply usually is not good. In Nigeria, where severe postpartum bleeding can kill even a healthy woman within 48 hours of delivery, the blood bank shortage leaves many women to die.  

One of the leading causes of maternal mortality in Nigeria is postpartum hemorrhage, which accounts for more than 19% of deaths. As such, having a strong blood bank system would certainly help more pregnant women access the care they need. Says Dr. Oluwarotimi Ireti Akinola, a professor of Obstetrics and Gynecology, “If facilities and blood products are more available, medical professionals will try everything to reduce blood loss in women, take measures to prevent bleeding, and when bleeding happens, they must be skillful enough to know what to do to stop it.”

Establishing an adequate blood bank is necessary for reducing maternal deaths by hemorrhaging. In 2003, Malawi established the National Blood Transfusion Service and analyzed the efficacy of the program at the Queen Elizabeth Hospital in Blantyre. Results yielded a 50 percent decrease in mortality among pregnant women with severe blood loss. Not only that, the results were directly attributed to the availability of sterile blood, proving the initiative a success.

Inadequate blood transfusion services is a major factor fueling maternal deaths. Pregnant women are bleeding to death because hospitals do not have clean blood, and this is absolutely unacceptable and unethical. Hospitals have a responsibility to their patients to have adequate clean blood on supply for emergency cases, and when babies and women start dying because there is no blood left, we have to seriously question the healthcare system of the nation. Hospitals need to be able to collect safe blood donations and maintain blood banks at a high level, because otherwise, more women and babies will continue to suffer.

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May: Preeclampsia Awareness Month

Many pregnant mothers are used to regularly tracking the progress of their pregnancies to make sure everything is going smoothly. However, pregnancy is an unpredictable experience and any mother is vulnerable to unexpected complications. Preeclampsia is the most common and one of the most dangerous, complications that can occur. 

Preeclampsia causes high blood pressure, swelling, sudden weight gain, headaches, and in severe cases, seizures and death. Although it can be easily mistaken for normal pregnancy pains, preeclampsia is a condition that needs to be diagnosed and treated as soon as possible. It affects one in 20 pregnancies and generally arises during the third trimester or later. Most women will deliver successfully but for others, a mild case can quickly become life-threatening, and the only way to resolve it is delivery of the baby. 

If preeclampsia sets in before 37 weeks, the infant is at higher risk of suffering premature birth complications. Both mother and baby are closely monitored to ensure the baby has enough time to develop without putting the mother’s life at risk. Her kidneys and liver can become impaired and blood clotting problems can also arise.

Preeclampsia is easily monitored and resolved in developed countries, but this is not the same in developing countries. In some countries in Africa, this is a major problem because hospitals and local health centers suffer from a severe lack of water, electricity, and staff. Dr. Laura Stachel, an obstetrician-gynecologist, said, “I really want a world where women can deliver safely and with dignity, and women don’t have to fear an event that we consider a joy in this country. To see birth associated with death and fear is an outrage.” She spoke with KQED about how she was troubled to see so many pregnant women die in poor countries such as Nigeria because of a lack of basic resources.

All pregnant women are at risk of developing preeclampsia, but some are more vulnerable than others. Women carrying their first pregnancies have a higher risk of developing the condition, as well as diabetic mothers and mothers carrying twins. All women who develop preeclampsia are at elevated risk of developing end-stage renal disease, heart disease, and chronic hypertension. The more aware people are of preeclampsia and its symptoms, the better – more women and babies can be saved. Especially in poor countries where women do not have the luxury of having nurses and trained midwives monitor their pregnancies and deliveries, women need to be educated on potential complications, such as preeclampsia.

Our Executive Director, Toyin Idehen, is a severe preeclampsia survivor who lost one of her twin daugthers as a result. This quote is from her experience in the Neonatal Intensive Care Unit (NICU) while she pondered on the survival of her then called 'Baby Girl Idehen #2': "Know that I will always be there for you. Know that I have your back. Know that we are in this storm together. Know that tomorrow is a new day and new day's bring hope and light. - Toyin Idehen.

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Fighting maternal mortality in the Gambia

In a tiny barren village somewhere in Gambia, a woman is in labor but there are complications. Although health workers are present, none of them are qualified to provide emergency obstetrics care, meaning the woman will have to be transported to a larger hospital farther away from her location. Although maternal mortality is statistically on the decline, the Gambia remains one of the top ten countries in the world where it is most dangerous to become a mother.

Women in the Gambia are highly fertile however, many of them live under the national poverty line. Most women give birth to more than five children in their lifetime and lack of sexual education and birth planning makes each subsequent pregnancy more dangerous than the last. Last year alone, maternal mortality rates stood at 433 deaths per 100,000 live births (World Health Organization). CEO of Save the Children Carolyn Miles stresses that “conditions for mothers and their children in the bottom countries are grim, as nations struggle to provide the basic infrastructure for the health and wellness of their citizens”. Women living in remote and rural areas often lack the most basic tools for a medically sound delivery, such as clean water and cotton gauze.

What then are the main factors behind maternal mortality? Quality of care and availability of health services top the list. The primary cause of maternal deaths are delays in transporting women to health care facilities. In Gambia, a three-tier healthcare system separates rural clinics from basic clinics and major hospitals. The primary level consists of village health services, community health workers, and traditional birth attendants. The secondary level is made up of basic health clinics and facilities, and the tertiary level includes all major health centers and hospitals, as well as special privately-owned institutes or NGO-run institutes. In Gambia, only hospitals are qualified to provide emergency obstetrics care, meaning that women experiencing complications must be transported to a major hospital immediately.

A decline in health workers has resulted in longer wait times at clinics, further increasing the delay in treatment. Currently, the average wait time at a clinic is 68 minutes, but this wait time only occurs when the clinic is adequately staffed. The ratio of doctors to patients is 1:1964, and the ratio of nurses to patients is 1:5614, which shows the apparent need for medical professionals. Expectant women are denied necessary antenatal and postnatal care, and many women avoid clinics altogether, choosing to give birth at home instead, where they won’t have to wait in line for a doctor.

There are needless and life-threatening delays in Gambia's healthcare system that transform the process of birth into a fatal, feared one. Considering the great shortage in trained medical professionals at the smaller regional healthcare centers, increased spending on training healthcare workers would yield long-term benefits for women. Establishing a healthcare system that functions adequately in rural areas as well as urban areas, would decrease treatment delays and grant more women access to lifesaving prenatal and postnatal care.

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What African Mothers Really Want for Mother’s Day

All mothers dream of witnessing and celebrating milestones of their children’s lives, of living long and healthy lives with family. These simple, pleasant ideas of family life are robbed from far too many women in Africa due to the harsh reality. Poor healthcare, unpaid labor, inadequate women’s rights and equality, poor education, and sexual violence are all factors that affect African girls and women every day. When we discuss maternal health, we cannot have the dialogue without including women’s empowerment. So, in honor of this year’s Mother’s Day, let us talk about girls and women.

The African Union (AU) called 2015 the “Year of Women’s Empowerment,” but what does that truly mean? African women have made considerable progress in political, social, and economic positions, but a vast majority is still marginalized by their government. If we want true empowerment for females, that means making a political effort to secure basic rights and privileges. Currently, too many policies and cultural beliefs put females at an enormous disadvantage.

Females are one of Africa’s greatest untapped resources, but their government does not see them as such, and instead makes it harder for them to survive in society. Nyaradzayi Gumbonzvanda said, the AU Goodwill Ambassador for Ending Child Marriage, “The leaders need to know that the young women and girls are here and they are not a statistic... This is part of Africa rising. Africa will not rise as long as its daughters are bleeding and Africa will never be prosperous or at peace with itself if the whole generation is losing opportunities.” Females of all ages make up nearly half the agricultural workforce, but sexist laws restrict their access to property, land, money, credit, and decision-making powers. In addition to this, they are expected to manage their families and care for the children, all forms of unpaid labor. Gender violence, coupled with sexual and reproductive health issues, only worsen the plight of the African female.

When it comes to healthcare and gender equality, African females suffer some of the worst statistics on the planet. Childbirth is the second leading cause of death for adolescent girls. Every day, more than 400 African females die by pregnancy and childbirth-related complications. Far too many girls and women die in the prime of their lives, and their deaths have lasting consequences for the communities they leave. Those who do not die often suffer from life-lasting aftereffects of childbirth that take a toll on their health.

Women’s health and education in Africa is so important and we can never stop talking about it for as long as healthcare and accessibility issues remain present, because the existence of these issues affects all other aspects of society. Economic development is slowed, and government funds are wasted on health issues that could be otherwise eradicated entirely if women were given more access to stronger healthcare and sexual education.

For this Mother’s Day, we need to continue pressuring African leaders to view girls and women as important members of society. If females are enabled to participate in their community politically, socially, and economically, we can expect lasting strides in women’s health and equality. Working toward a vision where women live in a world that offers them social justice, equality, and respect can result in healthy, lively communities.

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Gestational Diabetes and Pregnancy

We’ve been talking about maternal mortality for so long and employing so many strategies in the fight against mortality, so why is Africa still plagued by high mortality rates? Medicine and technology have evolved to the point where we can provide relatively inexpensive supplies and treatment for pregnant women across Africa, but still pregnant women suffer from an enormous lack of education on health risks during pregnancy.

Gestational diabetes mellitus (GDM) is one such health risk that is widespread yet not very well known. Diabetes is a chronic disease where the affected patient cannot produce or use insulin, resulting in symptoms such as thirst, hunger, weight loss, changes in vision, and fatigue. It reduces blood flow, damages nerves in the feet, and increases the risk of heart disease and stroke. In people with diabetes, heart disease is responsible for 50-80% of deaths (World Health Organization).

Worldwide, GDM affects up to 15% of pregnant women (International Diabetes Foundation). In pregnant women, GDM increases the risk of eclampsia, miscarriage, labor complications, hemorrhage, and stillbirths. These same women are also at higher risk of developing Type 2 diabetes within the next ten years. Their infants are also born with a higher prevalence of obesity and Type 2 diabetes later on. Despite the short-term and long-term health impacts of GDM, it remains an overlooked maternal health issue.

In many low-income African countries such as Ethiopia, diabetes is not a part of the regular screening offered during prenatal care. As a result, many cases of gestational diabetes go unnoticed. Management Sciences for Health (MSH) estimates that as few as two in ten cases are diagnosed. In a study of 1,242 pregnant Ethiopian women, 11% of all screened were positive for GDM. Hidden but high rates of gestational diabetes are credited as the reason maternal mortality rates remain elevated in the face of improving basic health services. In the past 25 years, maternal mortality rates have dropped 45% globally, but few African countries have experienced a similar drop in mortality rates – likely due to hidden diseases and risks such as GDM.

The high prevalence of missed GDM during pregnancy is worrying, but treatment is surprisingly both inexpensive and effective. In the same study mentioned before, 79% of the pregnant women with GDM responded positively to simple interventions such as changes in diet and increased exercise. Pregnant women were recommended to maintain a healthy body weight, eat a healthy diet with decreased sugar, salt, and saturated fat intake, avoid smoking, and receive regular blood sugar tests.

There is no reason why we should not increase screening for GDM when treatment is so basic and inexpensive. Katie Dain, executive director of NCD Alliance, emphasizes interventions on GDM: “Concerted action on gestational diabetes has the potential to accelerate progress toward the MDGs, and simultaneously curb the growing burden of noncommunicable diseases (NCDs). It is a win-win situation.” Thus, screening for and managing GDM is a crucial factor in lowering maternal mortality rates.

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Malaria Matters

A buzzing mosquito is annoying enough on its own, but what are the effects on a pregnant woman? That mosquito could mean life or death for you and your unborn child. The WHO estimates that annually, 30 million African women living in malaria-endemic areas become pregnant. Malaria is responsible for 20% of maternal deaths, making it a more lethal killer of pregnant women than HIV/AIDS. Undoubtedly, malaria is an important culprit we must pay attention to in the battle against maternal mortality.

Malaria is a life-threatening but entirely preventable disease that spreads through mosquito bites. Caused by the parasite Plasmodium falciparum, malaria thrives in tropical and subtropical regions. A bitten victim will experience a fever, headache, and joint aches as the P. falciparum parasites attack the red blood cells. Annually, the disease kills more than one million a year, the majority of deaths being concentrated in sub-Saharan Africa in children under the age of five.

Malaria-infected pregnant women experience more pregnancy and birth complications than healthy pregnant women; their infants are also adversely affected. If bitten by an infected mosquito, a pregnant woman will be at higher risk for anemia, miscarriages, premature births, and delivering underweight babies. The babies are put at greater risk once born because they are usually premature and underdeveloped, lacking the vitality they need in order to survive.

A three-step approach has been taken toward malaria prevention among pregnant women. This approach includes treatment with antimalarial drugs, insecticide-treated bed nets to protect pregnant women from mosquito bites, and the management of malaria among pregnant women. The effectiveness of this treatment stems from the fact that many pregnant women do not know if they are infected and can be asymptomatic. By providing all pregnant women with antimalarial drugs and preventative measures, healthcare workers are able to lower the incidence of malaria.

Malaria in pregnancy often has devastating consequences to mother and child; addressing this issue would simultaneously address maternal mortality. Sam Kutesa, president of the UN General Assembly, is heartened by the progress being made in malaria prevention but cautions the world to stay aware. “To reach our goals, we must have sustained investments and political commitments for malaria control and elimination,” he said in a statement to Leadership. We, along with international leaders, need to commit ourselves to women’s health and lowering maternal mortality so every household, rich or poor, urban or rural, has access to healthcare.

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Why are pregnant women still dying?

In Africa, at least 125,000 women and 870,000 newborns die in the first week after birth every year. We know that skilled care, clean water, and sanitation before, during, and after childbirth saves lives. We have all this information available, so why are so many mothers and children still dying?

The bulk of maternal mortality cases consists of impoverished women, isolated in rural areas of developing countries. A pregnant woman in sub-Saharan Africa has a 1 in 16 chance of dying from maternal causes, compared to a 1 in 4,000 risk in a developed country (UNICEF). Evidently, the quality of maternal care is very different in poor and rich countries. For one, disadvantaged women lack the security of a functioning basic infrastructure – clean water still is one of the biggest concerns for pregnant women. Additionally, distant healthcare facilities paired with lack of transportation drives up the number of unattended births at home. In the developing world, pregnant women need to worry about every little detail.

Pregnant women living in poverty often forgo prenatal and postnatal care, as well as skilled medical assistance during delivery. Without medical care, these pregnant women are at greater risk of overlooking pregnancy and birth complications, putting themselves and their unborn babies at risk. Prenatal care provides expecting mothers with the opportunity to educate themselves on maternal health, breastfeeding, sexual planning, and the importance of postnatal care. Postnatal care is just as lifesaving, if not more, as prenatal care because the time period right after the baby is born is crucial for mother and infant. Half of all postnatal maternal deaths occur during the first week, usually in the first 24 hours of childbirth. These deaths could be avoided if more mothers were encouraged to stay in the hospital after delivery, under proper medical supervision and care.

The impact of providing prenatal and postnatal care cannot be ignored – if 90% of African mothers and infants had access to such care, there would be 310,000 fewer newborn deaths and many maternal lives would be saved. Emphasizing maternal care empowers and educates pregnant mothers, in addition to saving their lives. Currently, pregnant women of the developing world are neglected by their healthcare systems. If we know that the most important intervention in maternal health is adequate medical attention, then why are we still denying these women the care they need?