GlobalHealthAfrica

Archive for the ‘Maternal and Child Health’ Category

Supporting Senegalese Midwives and Birth Attendants – a lesson from the African Midwives Collective

In Healthcare, Maternal and Child Health, Midwives on June 7, 2014 at 6:48 pm

Julia Nakad, Hesperian blog coordinator, for the African Birth Collective, describes how the African Birth Collective collaborates with communities to support healthy mothers and newborns in Senegal.

“Midwives provide amazing services to our communities. Aside from assisting with births, they’re a great resource for reproductive health, family planning, and STD information. They are well connected with communities, and distribute critical health information.” – Kaya Skye, African Birth Collective

A Senegalese midwife performing a prenatal checkup

A Senegalese midwife performing a prenatal checkup

When Kaya Skye moved to the northern Mboro region of Senegal in 1996 to research topics in medical anthropology, she found herself fascinated by the state of maternal health. She observed that healthcare workers were being pushed to adopt western birthing practices, but the government- sponsored training was not explaining the rationale for certain actions. For example, health workers were taught how to take blood pressure, but not why it’s important or how high blood pressure could affect a pregnant woman. “But these women are incredibly intelligent and capable of understanding and doing so much more,” says Kaya. She also noticed that along with the westernization of birth care, the more natural approach that had underpinned the work of local midwives for centuries was being lost. Now, instead of natural births, midwives have “rushed births by overusing drugs such as Pitocin,” said Kaya, “which has been a major source of infant mortalities.”

Over the past 18 years, Kaya and a diverse group of health workers and midwives from the United States and Senegal have pioneered midwifery trainings that fuse modern medical advances with traditional Senegalese practices. The African Birth Collective has designed an exchange program between Senegalese and North American midwives to observe and learn from each other’s work. This approach has led to “more sustainable change – midwives will ask each other why they adopt certain practices, and then we’ll have long meetings where we debate these processes and come to a better understanding about these issues. It allows for a longer lasting change in knowledge and practice.”

Traditional Midwives in Kabar with their medicinal herbs

Traditional Midwives in Kabar with their medicinal herbs

The African Birth Collective has also helped to coordinate the construction of Kassoumay Traditional Birth House, and works with different clinicians all over the country to improve the quality of birthing care, encouraging conversations between traditional birth attendants and clinicians. Their work has resulted in improved in birth outcomes, and increased participants’ overall understanding of the birth process. Instead of overusing medications, which Kaya says “focuses on pushing the baby out,” midwives have reclaimed the more traditional roles as “supporters who wait for the process to happen if all the vital signs are fine.”

The African Birth Collective has also undertaking a translation of Hesperian’s A Book for Midwives into French. A long list of midwives from the Congo, Burkina Faso, Haiti, Guinea, and other francophone locations eagerly await its publication. The Collective anticipates it will have “a massive impact on midwifery practices,” since there are very few French language training materials available that are suited for rural birth attendants. Unlike other resources, A Book for Midwives is simply written, easy to use, and contains many helpful illustrations that reinforce difficult concepts and valuable skills.

In addition to the comprehensive pregnancy and birth information in A Book for Midwives, the general health content (on topics such as nutrition, HIV, STDs, and how to perform pelvic exams) will help strengthen larger public health campaigns. Kaya stresses the importance of midwives in Senegal, saying that “often, outside public health projects will publish brochures and make billboards, but this doesn’t usually change people’s behaviors. They want to hear medical advice from someone they know and trust in the community, like their local midwives. The more effective these people are, the better these public health campaigns can be.”

Find out more about the work of the African Birth Collective and their partner, Mother Health International.

Midwives: A Key Partner in Reducing Maternal Death

In Healthcare, Maternal and Child Health, MDGs on May 3, 2014 at 3:48 pm

Midwives are key partners in reducing maternal and newborn deaths in Africa. GHA contributor, Leigh Bernstein Reardon, makes a case for increased support for midwife training programs.

A quick Google search revealed that there are dozens of trained OB-GYNs in the 0.5 square-mile zip code where I work in New York City. Comparatively, Malawi, for example, has less than 20 trained OB-GYNs in the entire county. Another quick Google search led me to this statistic: a woman’s lifetime risk of dying as a result of pregnancy or childbirth is 1 in 39 in Sub-Saharan Africa, as compared to 1 in 4,700 in industrialized countries. Leaving behind (for now) all of the obvious disparities that these facts represent, what comes to my mind first is that these figures—the number of trained health care providers and maternal deaths—are inextricably linked. Recognizing the dangerous combination of limited physician training programs and the high prevalence of brain drain the African continent faces, global health experts are calling for increased support for midwife training programs.

Midwives can provide critical care in places where no other health infrastructure exists. According to the United Nations Population Fund (UNFPA), “Midwives can help avert two thirds of all maternal deaths and half of newborn deaths, provided they are well-trained, well-equipped, well-supported and authorized.” They not only deliver care during pregnancy, labor, and postpartum, but can provide front-line access to family planning and HIV/AIDS services. Midwives can also help reduce the need for emergency care by managing complications before they become critical. Importantly, midwives can be trained in 2-3 years, as compared to the 8-9 years it can take to train doctors, meaning they can provide more immediate care to women in need.

UNFPA’s State of the World’s Midwifery Report 2011 is the first comprehensive analysis of midwifery services and issues in countries where midwives are needed the most. Based on data and information from over 50 countries, the report highlights current issues facing the midwifery profession and urges governments, the international community, regulatory bodies, and training facilities to invest in the health of its mothers. Among the report’s key findings is that the global community lacks as many as 350,000 skilled midwives in order to meet the needs of women globally. The report also notes the importance of including midwives in costed maternal and child health plans, and health care policies. State of the World’s Midwifery Report 2014 will be published in June.

One movement working to increase the number of trained midwives is Amref’s Stand Up for African Mothers Campaign. Launched in 2011, the campaign seeks to help African nations meet Millennium Development Goals 4 and 5 by training 15,000 midwives in 13 countries by 2015. According to their website, Amref has trained over 5,000 midwives using a mix of conventional and distance learning techniques. In an effort to bring to the forefront the estimated 250,000 women who die from complications of pregnancy and childbirth each year, the Stand up for African Mothers Campaign has created a petition to nominate Esther Madudu, a midwife from Uganda, for the Nobel Peace Prize. The goal of the campaign is to have the global community recognize these needless deaths and the important role that midwives play in saving the lives of mothers and children worldwide.

This week, the world will celebrate International Day of the Midwife. In honor of this day, check out a video of Edna Adam Ismail, a former midwife and UN diplomat, giving a TedX talk on the value of midwives and the notion that progress can be made in even the most seemingly desperate situations.

The Role of Fathers in Maternal and Child Health

In Maternal and Child Health on May 20, 2013 at 2:50 pm

Family

The emerging issue of father involvement in maternal and child health (MCH) programs is important. Fathers have always played a significant role and the time for organizations to stop overlooking the father role and include them in their programmatic work is now. According to UNICEF, Nigeria loses about 2,300 under-five year olds and 145 women of childbearing age every single day. This makes the country the second largest contributor to the under-five and maternal mortality rate in the world. Although recent research provides essential interventions that can avert most of these deaths, father involvement is rarely addressed.

Research on father involvement in Africa is not prevalent, but evidence has shown that father involvement has positive effects on MCH outcomes. Father involvement increases the likelihood that a woman will receive prenatal care in her first trimester by 40 percent and reduces a pregnant woman’s cigarette consumption by 36 percent (Martin, McNamara, Milot, Halle, Hair, 2007). Expectant fathers can be influential advocates for breastfeeding by playing a critical role in encouraging a mother to breastfeed the newborn infant (Wolfberg et al. 2004). Fathers who also accompanied the mother on a prenatal visit were more likely to engage in father-child activities later in the child’s life (Vogel, Boller, Faerber, Shannon, Tamis-LeMonda, 2003).

In order to engage fathers in MCH programs and services, public health organizations need to focus on the family as a whole. Families are the building blocks of society hence excluding fathers from initiatives can negatively impact children. In addition to further research on father involvement in Africa, social inequalities that prevent fathers from being present in the home have to be challenged. Public health professionals can help promote father engagement within family systems to support an atmosphere of paternal inclusion. Fathers are an important part of the family system and their contributions (or omissions) have a lasting impact on the overall welfare of the mother and child.

References

1. Martin, L., McNamara., M., Milot, A., Halle, T., Hair, E. (2007). The Effects of Father Involvement during Pregnancy on Receipt of Prenatal Care and Maternal Smoking. Maternal Child Health Journal, 11, 595–602.

2. Wolfberg, A., Michels, K., Shields, W., O’Campo,P., Bronner,Y.,Bienstock,J. (2004) Dads as Breastfeeding Advocates: Results from a Randomized Controlled Trial of Educational Intervention. American Journal of Obstetrics and Gynecology. 191(3), 708-12.

3. Vogel, C., Boller, K., Faerber, J., Shannon, J., Tamis-LeMonda, C. (2003). Understanding Fathering: The Early Head Start Study of Fathers of Newborns. Mathematica Policy Research, Inc. Available at: http://www.mathematica-mpr.com/earlycare/fatheroverview.asp.

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